1.2relating to state government; establishing the health and human services budget;
1.3modifying provisions related to health care, continuing care, human services
1.4licensing, chemical and mental health, managed care organizations, waiver
1.5provider standards, home care, and the Department of Health; redesigning
1.6home and community-based services; establishing payment methodologies
1.7for home and community-based services; adjusting nursing and ICF/DD
1.8facility rates; setting and modifying fees; modifying autism coverage; making
1.9technical changes; requiring studies; requiring reports; appropriating money;
1.10amending Minnesota Statutes 2012, sections 16A.724, subdivisions 2, 3; 16C.10,
1.11subdivision 5; 16C.155, subdivision 1; 62A.65, subdivision 2, by adding a
1.12subdivision; 62J.692, subdivision 4; 62Q.19, subdivision 1; 103I.005, by
1.13adding a subdivision; 103I.521; 119B.13, subdivision 7; 144.051, by adding
1.14subdivisions; 144.0724, subdivisions 4, 6; 144.123, subdivision 1; 144.125,
1.15subdivision 1; 144.966, subdivisions 2, 3a; 144.98, subdivisions 3, 5, by
1.16adding subdivisions; 144.99, subdivision 4; 144A.351; 144A.43; 144A.44;
1.17144A.45; 144A.53, subdivision 2; 144D.01, subdivision 4; 145.986; 145C.01,
1.18subdivision 7; 148E.065, subdivision 4a; 149A.02, subdivisions 1a, 2, 3, 4, 5,
1.1916, 23, 27, 34, 35, 37, by adding subdivisions; 149A.03; 149A.65, by adding
1.20subdivisions; 149A.70, subdivisions 1, 2, 3, 5; 149A.71, subdivisions 2, 4;
1.21149A.72, subdivisions 3, 9, by adding a subdivision; 149A.73, subdivisions 1,
1.222, 4; 149A.74; 149A.91, subdivision 9; 149A.93, subdivisions 3, 6; 149A.94;
1.23149A.96, subdivision 9; 174.30, subdivision 1; 214.40, subdivision 1; 243.166,
1.24subdivisions 4b, 7; 245.4661, subdivisions 5, 6; 245.4682, subdivision 2;
1.25245A.02, subdivisions 1, 9, 10, 14; 245A.03, subdivisions 7, 8, 9; 245A.04,
1.26subdivision 13; 245A.042, subdivision 3; 245A.07, subdivisions 2a, 3; 245A.08,
1.27subdivision 2a; 245A.10; 245A.11, subdivisions 2a, 7, 7a, 7b, 8; 245A.1435;
1.28245A.144; 245A.1444; 245A.16, subdivision 1; 245A.40, subdivision 5;
1.29245A.50; 245C.04, by adding a subdivision; 245C.08, subdivision 1; 245D.02;
1.30245D.03; 245D.04; 245D.05; 245D.06; 245D.07; 245D.09; 245D.10; 246.18,
1.31subdivision 8, by adding a subdivision; 246.54; 254B.04, subdivision 1; 254B.13;
1.32256.01, subdivisions 2, 24, 34, by adding subdivisions; 256.9657, subdivisions 2,
1.333a; 256.9685, subdivision 2; 256.969, subdivisions 3a, 29; 256.975, subdivision
1.347, by adding subdivisions; 256.9754, subdivision 5, by adding subdivisions;
1.35256B.02, by adding subdivisions; 256B.021, by adding subdivisions; 256B.04,
1.36subdivisions 18, 21, by adding a subdivision; 256B.055, subdivisions 3a, 6,
1.3710, 14, 15, by adding a subdivision; 256B.056, subdivisions 1, 1c, 3, 4, as
1.38amended, 5c, 10, by adding a subdivision; 256B.057, subdivisions 1, 8, 10,
1.39by adding a subdivision; 256B.06, subdivision 4; 256B.0623, subdivision 2;
2.1256B.0625, subdivisions 9, 13e, 19c, 31, 39, 48, 58, by adding subdivisions;
2.2256B.0631, subdivision 1; 256B.064, subdivisions 1a, 1b, 2; 256B.0659,
2.3subdivision 21; 256B.0755, subdivision 3; 256B.0756; 256B.0911, subdivisions
2.41, 1a, 3a, 4d, 6, 7, by adding a subdivision; 256B.0913, subdivision 4, by
2.5adding a subdivision; 256B.0915, subdivisions 3a, 5, by adding a subdivision;
2.6256B.0916, by adding a subdivision; 256B.0917, subdivisions 6, 13, by
2.7adding subdivisions; 256B.092, subdivisions 11, 12, by adding subdivisions;
2.8256B.0946; 256B.095; 256B.0951, subdivisions 1, 4; 256B.0952, subdivisions 1,
2.95; 256B.097, subdivisions 1, 3; 256B.431, subdivision 44; 256B.434, subdivision
2.104, by adding a subdivision; 256B.437, subdivision 6; 256B.439, subdivisions
2.111, 2, 3, 4, by adding a subdivision; 256B.441, subdivisions 13, 53; 256B.49,
2.12subdivisions 11a, 12, 14, 15, by adding subdivisions; 256B.4912, subdivisions
2.131, 2, 3, 7, by adding subdivisions; 256B.4913, subdivisions 5, 6, by adding a
2.14subdivision; 256B.492; 256B.493, subdivision 2; 256B.5011, subdivision 2;
2.15256B.5012, by adding subdivisions; 256B.69, subdivisions 5c, 31, by adding a
2.16subdivision; 256B.694; 256B.76, subdivisions 2, 4, by adding a subdivision;
2.17256B.761; 256B.764; 256B.766; 256I.04, subdivision 3; 256I.05, subdivision
2.181e, by adding a subdivision; 256J.35; 256K.45; 256L.01, subdivisions 3a, 5, by
2.19adding subdivisions; 256L.02, subdivision 2, by adding subdivisions; 256L.03,
2.20subdivisions 1, 1a, 3, 5, 6, by adding a subdivision; 256L.04, subdivisions 1, 7, 8,
2.2110, by adding subdivisions; 256L.05, subdivisions 1, 2, 3; 256L.06, subdivision
2.223; 256L.07, subdivisions 1, 2, 3; 256L.09, subdivision 2; 256L.11, subdivision 6;
2.23256L.15, subdivisions 1, 2; 257.0755, subdivision 1; 260B.007, subdivisions 6,
2.2416; 260C.007, subdivisions 6, 31; 471.59, subdivision 1; 626.556, subdivisions 2,
2.253, 10d; 626.557, subdivisions 4, 9, 9a, 9e; 626.5572, subdivision 13; Laws 1998,
2.26chapter 407, article 6, section 116; Laws 2011, First Special Session chapter
2.279, article 1, section 3; article 2, section 27; article 10, section 3, subdivision
2.283, as amended; proposing coding for new law in Minnesota Statutes, chapters
2.2962A; 62D; 144; 144A; 145; 149A; 214; 245; 245A; 245D; 254B; 256; 256B;
2.30256L; repealing Minnesota Statutes 2012, sections 103I.005, subdivision 20;
2.31144.123, subdivision 2; 144A.46; 144A.461; 149A.025; 149A.20, subdivision
2.328; 149A.30, subdivision 2; 149A.40, subdivision 8; 149A.45, subdivision 6;
2.33149A.50, subdivision 6; 149A.51, subdivision 7; 149A.52, subdivision 5a;
2.34149A.53, subdivision 9; 245A.655; 245B.01; 245B.02; 245B.03; 245B.031;
2.35245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, 7; 245B.055; 245B.06; 245B.07;
2.36245B.08; 245D.08; 256B.055, subdivisions 3, 5, 10b; 256B.056, subdivision 5b;
2.37256B.057, subdivisions 1c, 2; 256B.0911, subdivisions 4a, 4b, 4c; 256B.0917,
2.38subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14; 256B.096, subdivisions 1, 2, 3, 4;
2.39256B.14, subdivision 3a; 256B.49, subdivision 16a; 256B.4913, subdivisions 1,
2.402, 3, 4; 256B.5012, subdivision 13; 256J.24, subdivision 6; 256K.45, subdivision
2.412; 256L.01, subdivision 4a; 256L.031; 256L.04, subdivisions 1b, 9, 10a;
2.42256L.05, subdivision 3b; 256L.07, subdivisions 5, 8, 9; 256L.11, subdivision 5;
2.43256L.12; 256L.17, subdivisions 1, 2, 3, 4, 5; 485.14; 609.093; Laws 2011, First
2.44Special Session chapter 9, article 7, section 54, as amended; Minnesota Rules,
2.45parts 4668.0002; 4668.0003; 4668.0005; 4668.0008; 4668.0012; 4668.0016;
2.464668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040; 4668.0050;
2.474668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100;
2.484668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160;
2.494668.0170; 4668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220;
2.504668.0230; 4668.0240; 4668.0800; 4668.0805; 4668.0810; 4668.0815;
2.514668.0820; 4668.0825; 4668.0830; 4668.0835; 4668.0840; 4668.0845;
2.524668.0855; 4668.0860; 4668.0865; 4668.0870; 4669.0001; 4669.0010;
2.534669.0020; 4669.0030; 4669.0040; 4669.0050.
2.54BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:


3.4    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 3, is amended to read:
3.5    Subd. 3. MinnesotaCare federal receipts. Receipts received as a result of federal
3.6participation pertaining to administrative costs of the Minnesota health care reform waiver
3.7shall be deposited as nondedicated revenue in the health care access fund. Receipts
3.8received as a result of federal participation pertaining to grants shall be deposited in the
3.9federal fund and shall offset health care access funds for payments to providers. All federal
3.10funding received by Minnesota for implementation and administration of MinnesotaCare
3.11as a basic health program, as authorized in section 1331 of the Affordable Care Act,
3.12Public Law 111-148, as amended by Public Law 111-152, is dedicated to that program and
3.13shall be deposited into the health care access fund. Federal funding that is received for
3.14implementing and administering MinnesotaCare as a basic health program and deposited in
3.15the fund shall be used only for that program to purchase health care coverage for enrollees
3.16and reduce enrollee premiums and cost-sharing or provide additional enrollee benefits.
3.17EFFECTIVE DATE.This section is effective January 1, 2015.

3.18    Sec. 2. Minnesota Statutes 2012, section 254B.04, subdivision 1, is amended to read:
3.19    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal
3.20Regulations, title 25, part 20, persons eligible for medical assistance benefits under
3.21sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, or who meet
3.22the income standards of section 256B.056, subdivision 4, and persons eligible for general
3.23assistance medical care under section 256D.03, subdivision 3, are entitled to chemical
3.24dependency fund services. State money appropriated for this paragraph must be placed in
3.25a separate account established for this purpose.
3.26Persons with dependent children who are determined to be in need of chemical
3.27dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
3.28a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
3.29local agency to access needed treatment services. Treatment services must be appropriate
3.30for the individual or family, which may include long-term care treatment or treatment in a
3.31facility that allows the dependent children to stay in the treatment facility. The county
3.32shall pay for out-of-home placement costs, if applicable.
3.33(b) A person not entitled to services under paragraph (a), but with family income
3.34that is less than 215 percent of the federal poverty guidelines for the applicable family
4.1size, shall be eligible to receive chemical dependency fund services within the limit
4.2of funds appropriated for this group for the fiscal year. If notified by the state agency
4.3of limited funds, a county must give preferential treatment to persons with dependent
4.4children who are in need of chemical dependency treatment pursuant to an assessment
4.5under section 626.556, subdivision 10, or a case plan under section 260C.201, subdivision
4.66 , or 260C.212. A county may spend money from its own sources to serve persons under
4.7this paragraph. State money appropriated for this paragraph must be placed in a separate
4.8account established for this purpose.
4.9(c) Persons whose income is between 215 percent and 412 percent of the federal
4.10poverty guidelines for the applicable family size shall be eligible for chemical dependency
4.11services on a sliding fee basis, within the limit of funds appropriated for this group for the
4.12fiscal year. Persons eligible under this paragraph must contribute to the cost of services
4.13according to the sliding fee scale established under subdivision 3. A county may spend
4.14money from its own sources to provide services to persons under this paragraph. State
4.15money appropriated for this paragraph must be placed in a separate account established
4.16for this purpose.

4.17    Sec. 3. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
4.18to read:
4.19    Subd. 35. Federal approval. (a) The commissioner shall seek federal authority
4.20from the U.S. Department of Health and Human Services necessary to operate a health
4.21coverage program for Minnesotans with incomes up to 275 percent of the federal poverty
4.22guidelines (FPG). The proposal shall seek to secure all federal funding available from at
4.23least the following sources:
4.24(1) all premium tax credits and cost-sharing subsidies available under United States
4.25Code, title 26, section 36B, and United States Code, title 42, section 18071, for individuals
4.26with incomes above 133 percent and at or below 275 percent of the federal poverty
4.27guidelines who would otherwise be enrolled in the Minnesota Insurance Marketplace as
4.28defined in Minnesota Statutes, section 62V.02;
4.29(2) Medicaid funding; and
4.30(3) other funding sources identified by the commissioner that support coverage or
4.31care redesign in Minnesota.
4.32(b) Funding received shall be used to design and implement a health coverage
4.33program that creates a single streamlined program and meets the needs of Minnesotans with
4.34incomes up to 275 percent of the federal poverty guidelines. The program must incorporate:
5.1(1) payment reform characteristics included in the health care delivery system and
5.2accountable care organization payment models;
5.3(2) flexibility in benefit set design such that benefits can be targeted to meet enrollee
5.4needs in different income and health status situations and can provide a more seamless
5.5transition from public to private health care coverage;
5.6(3) flexibility in co-payment or premium structures to incent patients to seek
5.7high-quality, low-cost care settings; and
5.8(4) flexibility in premium structures to ease the transition from public to private
5.9health care coverage.
5.10(c) The commissioner shall develop and submit a proposal consistent with the above
5.11criteria and shall seek all federal authority necessary to implement the health coverage
5.12program. In developing the request, the commissioner shall consult with appropriate
5.13stakeholder groups and consumers.
5.14(d) The commissioner is authorized to seek any available waivers or federal
5.15approvals to accomplish the goals under paragraph (b) prior to 2017.
5.16(e) The commissioner shall report progress on implementing this subdivision to the
5.17chairs and ranking minority members of the legislative committees with jurisdiction over
5.18health and human services policy and finance by December 1, 2014.
5.19(f) The commissioner is authorized to accept and expend federal funds that support
5.20the purposes of this subdivision.

5.21    Sec. 4. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
5.22to read:
5.23    Subd. 18. Caretaker relative. "Caretaker relative" means a relative, by blood,
5.24adoption, or marriage, of a child under age 19 with whom the child is living and who
5.25assumes primary responsibility for the child's care.
5.26EFFECTIVE DATE.This section is effective January 1, 2014.

5.27    Sec. 5. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
5.28to read:
5.29    Subd. 19. Insurance affordability program. "Insurance affordability program"
5.30means one of the following programs:
5.31(1) medical assistance under this chapter;
5.32(2) a program that provides advance payments of the premium tax credits established
5.33under section 36B of the Internal Revenue Code or cost-sharing reductions established
5.34under section 1402 of the Affordable Care Act;
6.1(3) MinnesotaCare as defined in chapter 256L; and
6.2(4) a Basic Health Plan as defined in section 1331 of the Affordable Care Act.
6.3EFFECTIVE DATE.This section is effective the day following final enactment.

6.4    Sec. 6. Minnesota Statutes 2012, section 256B.04, subdivision 18, is amended to read:
6.5    Subd. 18. Applications for medical assistance. (a) The state agency may take
6.6 shall accept applications for medical assistance and conduct eligibility determinations for
6.7MinnesotaCare enrollees by telephone, via mail, in-person, online via an Internet Web
6.8site, and through other commonly available electronic means.
6.9    (b) The commissioner of human services shall modify the Minnesota health care
6.10programs application form to add a question asking applicants whether they have ever
6.11served in the United States military.
6.12    (c) For each individual who submits an application or whose eligibility is subject to
6.13renewal or whose eligibility is being redetermined pursuant to a change in circumstances,
6.14if the agency determines the individual is not eligible for medical assistance, the agency
6.15shall determine potential eligibility for other insurance affordability programs.
6.16EFFECTIVE DATE.This section is effective January 1, 2014.

6.17    Sec. 7. Minnesota Statutes 2012, section 256B.055, subdivision 3a, is amended to read:
6.18    Subd. 3a. Families with children. Beginning July 1, 2002, Medical assistance may
6.19be paid for a person who is a child under the age of 18, or age 18 if a full-time student
6.20in a secondary school, or in the equivalent level of vocational or technical training, and
6.21reasonably expected to complete the program before reaching age 19; the parent or
6.22stepparent of a dependent child under the age of 19, including a pregnant woman; or a
6.23caretaker relative of a dependent child under the age of 19.
6.24EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
6.25approval, whichever is later. The commissioner of human services shall notify the revisor
6.26of statutes when federal approval is obtained.

6.27    Sec. 8. Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:
6.28    Subd. 6. Pregnant women; needy unborn child. Medical assistance may be paid
6.29for a pregnant woman who has written verification of a positive pregnancy test from a
6.30physician or licensed registered nurse, who meets the other eligibility criteria of this
6.31section and whose unborn child would be eligible as a needy child under subdivision 10 if
6.32born and living with the woman. In accordance with Code of Federal Regulations, title
7.142, section 435.956, the commissioner must accept self-attestation of pregnancy unless
7.2the agency has information that is not reasonably compatible with such attestation. For
7.3purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.
7.4EFFECTIVE DATE.This section is effective January 1, 2014.

7.5    Sec. 9. Minnesota Statutes 2012, section 256B.055, subdivision 10, is amended to read:
7.6    Subd. 10. Infants. Medical assistance may be paid for an infant less than one year
7.7of age, whose mother was eligible for and receiving medical assistance at the time of birth
7.8or who is less than two years of age and is in a family with countable income that is equal
7.9to or less than the income standard established under section 256B.057, subdivision 1.
7.10EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
7.11approval, whichever is later. The commissioner of human services shall notify the revisor
7.12of statutes when federal approval is obtained.

7.13    Sec. 10. Minnesota Statutes 2012, section 256B.055, subdivision 15, is amended to read:
7.14    Subd. 15. Adults without children. Medical assistance may be paid for a person
7.15who is:
7.16(1) at least age 21 and under age 65;
7.17(2) not pregnant;
7.18(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII
7.19of the Social Security Act;
7.20(4) not an adult in a family with children as defined in section 256L.01, subdivision
7.213a ; and not otherwise eligible under subdivision 7 as a person who meets the categorical
7.22eligibility requirements of the supplemental security income program;
7.23(5) not enrolled under subdivision 7 as a person who would meet the categorical
7.24eligibility requirements of the supplemental security income program except for excess
7.25income or assets; and
7.26(5) (6) not described in another subdivision of this section.
7.27EFFECTIVE DATE.This section is effective January 1, 2014.

7.28    Sec. 11. Minnesota Statutes 2012, section 256B.055, is amended by adding a
7.29subdivision to read:
7.30    Subd. 17. Adults who were in foster care at the age of 18. Medical assistance may
7.31be paid for a person under 26 years of age who was in foster care under the commissioner's
7.32responsibility on the date of attaining 18 years of age, and who was enrolled in medical
8.1assistance under the state plan or a waiver of the plan while in foster care, in accordance
8.2with section 2004 of the Affordable Care Act.
8.3EFFECTIVE DATE.This section is effective January 1, 2014.

8.4    Sec. 12. Minnesota Statutes 2012, section 256B.056, subdivision 1, is amended to read:
8.5    Subdivision 1. Residency. To be eligible for medical assistance, a person must
8.6reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota,
8.7 in accordance with the rules of the state agency Code of Federal Regulations, title 42,
8.8section 435.403.
8.9EFFECTIVE DATE.This section is effective January 1, 2014.

8.10    Sec. 13. Minnesota Statutes 2012, section 256B.056, subdivision 1c, is amended to read:
8.11    Subd. 1c. Families with children income methodology. (a)(1) [Expired, 1Sp2003
8.12c 14 art 12 s 17]
8.13(2) For applications processed within one calendar month prior to July 1, 2003,
8.14eligibility shall be determined by applying the income standards and methodologies in
8.15effect prior to July 1, 2003, for any months in the six-month budget period before July
8.161, 2003, and the income standards and methodologies in effect on July 1, 2003, for any
8.17months in the six-month budget period on or after that date. The income standards for
8.18each month shall be added together and compared to the applicant's total countable income
8.19for the six-month budget period to determine eligibility.
8.20(3) For children ages one through 18 whose eligibility is determined under section
8.21256B.057, subdivision 2, the following deductions shall be applied to income counted
8.22toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
8.2316, 1996: $90 work expense, dependent care, and child support paid under court order.
8.24This clause is effective October 1, 2003.
8.25(b) For families with children whose eligibility is determined using the standard
8.26specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
8.27earned income shall be disregarded for up to four months and the following deductions
8.28shall be applied to each individual's income counted toward eligibility as allowed under
8.29the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
8.30under court order.
8.31(c) If the four-month disregard in paragraph (b) has been applied to the wage
8.32earner's income for four months, the disregard shall not be applied again until the wage
9.1earner's income has not been considered in determining medical assistance eligibility for
9.212 consecutive months.
9.3(d) The commissioner shall adjust the income standards under this section each July
9.41 by the annual update of the federal poverty guidelines following publication by the
9.5United States Department of Health and Human Services except that the income standards
9.6shall not go below those in effect on July 1, 2009.
9.7(e) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
9.8organization to or for the benefit of the child with a life-threatening illness must be
9.9disregarded from income.

9.10    Sec. 14. Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:
9.11    Subd. 3. Asset limitations for certain individuals and families. (a) To be
9.12eligible for medical assistance, a person must not individually own more than $3,000 in
9.13assets, or if a member of a household with two family members, husband and wife, or
9.14parent and child, the household must not own more than $6,000 in assets, plus $200 for
9.15each additional legal dependent. In addition to these maximum amounts, an eligible
9.16individual or family may accrue interest on these amounts, but they must be reduced to the
9.17maximum at the time of an eligibility redetermination. The accumulation of the clothing
9.18and personal needs allowance according to section 256B.35 must also be reduced to the
9.19maximum at the time of the eligibility redetermination. The value of assets that are not
9.20considered in determining eligibility for medical assistance is the value of those assets
9.21excluded under the supplemental security income program for aged, blind, and disabled
9.22persons, with the following exceptions:
9.23(1) household goods and personal effects are not considered;
9.24(2) capital and operating assets of a trade or business that the local agency determines
9.25are necessary to the person's ability to earn an income are not considered;
9.26(3) motor vehicles are excluded to the same extent excluded by the supplemental
9.27security income program;
9.28(4) assets designated as burial expenses are excluded to the same extent excluded by
9.29the supplemental security income program. Burial expenses funded by annuity contracts
9.30or life insurance policies must irrevocably designate the individual's estate as contingent
9.31beneficiary to the extent proceeds are not used for payment of selected burial expenses;
9.32(5) for a person who no longer qualifies as an employed person with a disability due
9.33to loss of earnings, assets allowed while eligible for medical assistance under section
9.34256B.057, subdivision 9 , are not considered for 12 months, beginning with the first month
10.1of ineligibility as an employed person with a disability, to the extent that the person's total
10.2assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
10.3    (6) when a person enrolled in medical assistance under section 256B.057, subdivision
10.49 , is age 65 or older and has been enrolled during each of the 24 consecutive months
10.5before the person's 65th birthday, the assets owned by the person and the person's spouse
10.6must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d),
10.7when determining eligibility for medical assistance under section 256B.055, subdivision
10.87 . The income of a spouse of a person enrolled in medical assistance under section
10.9256B.057, subdivision 9 , during each of the 24 consecutive months before the person's
10.1065th birthday must be disregarded when determining eligibility for medical assistance
10.11under section 256B.055, subdivision 7. Persons eligible under this clause are not subject to
10.12the provisions in section 256B.059. A person whose 65th birthday occurs in 2012 or 2013
10.13is required to have qualified for medical assistance under section 256B.057, subdivision 9,
10.14prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and
10.15(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
10.16required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
10.17Law 111-5. For purposes of this clause, an American Indian is any person who meets the
10.18definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
10.19(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
10.2015.
10.21EFFECTIVE DATE.This section is effective January 1, 2014.

10.22    Sec. 15. Minnesota Statutes 2012, section 256B.056, subdivision 4, as amended by
10.23Laws 2013, chapter 1, section 5, is amended to read:
10.24    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under
10.25section 256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of
10.26the federal poverty guidelines. Effective January 1, 2000, and each successive January,
10.27recipients of supplemental security income may have an income up to the supplemental
10.28security income standard in effect on that date.
10.29    (b) To be eligible for medical assistance, families and children may have an income
10.30up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996,
10.31AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16,
10.321996, shall be increased by three percent.
10.33    (c) Effective January 1, 2014, to be eligible for medical assistance, under section
10.34256B.055, subdivision 3a , a parent or caretaker relative may have an income up to 133
10.35percent of the federal poverty guidelines for the household size.
11.1    (d) To be eligible for medical assistance under section 256B.055, subdivision 15,
11.2a person may have an income up to 133 percent of federal poverty guidelines for the
11.3household size.
11.4    (e) To be eligible for medical assistance under section 256B.055, subdivision 16, a
11.5child age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines
11.6for the household size.
11.7    (f) To be eligible for medical assistance under section 256B.055, subdivision 3a, a
11.8child under age 19 may have income up to 275 percent of the federal poverty guidelines
11.9for the household size or an equivalent standard when converted using modified adjusted
11.10gross income methodology as required under the Affordable Care Act. Children who are
11.11enrolled in medical assistance as of December 31, 2013, and are determined ineligible
11.12for medical assistance because of the elimination of income disregards under modified
11.13adjusted gross income methodology as defined in subdivision 1a remain eligible for
11.14medical assistance under the Children's Health Insurance Program Reauthorization Act
11.15of 2009, Public Law 111-3, until the date of their next regularly scheduled eligibility
11.16redetermination as required in section 256B.056, subdivision 7a.
11.17    (f) (g) In computing income to determine eligibility of persons under paragraphs (a)
11.18to (e) (f) who are not residents of long-term care facilities, the commissioner shall disregard
11.19increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
11.20For persons eligible under paragraph (a), veteran aid and attendance benefits and Veterans
11.21Administration unusual medical expense payments are considered income to the recipient.
11.22EFFECTIVE DATE.This section is effective January 1, 2014.

11.23    Sec. 16. Minnesota Statutes 2012, section 256B.056, subdivision 5c, is amended to read:
11.24    Subd. 5c. Excess income standard. (a) The excess income standard for families
11.25with children parents and caretaker relatives, pregnant women, infants, and children ages
11.26two through 20 is the standard specified in subdivision 4, paragraph (c).
11.27(b) The excess income standard for a person whose eligibility is based on blindness,
11.28disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
11.29family size. Effective July 1, 2002, the excess income standard for this paragraph shall
11.30equal 75 percent of the federal poverty guidelines.
11.31EFFECTIVE DATE.This section is effective January 1, 2014.

11.32    Sec. 17. Minnesota Statutes 2012, section 256B.056, is amended by adding a
11.33subdivision to read:
12.1    Subd. 7a. Periodic renewal of eligibility. (a) The commissioner shall make an
12.2annual redetermination of eligibility based on information contained in the enrollee's case
12.3file and other information available to the agency, including but not limited to information
12.4accessed through an electronic database, without requiring the enrollee to submit any
12.5information when sufficient data is available for the agency to renew eligibility.
12.6(b) If the commissioner cannot renew eligibility in accordance with paragraph (a),
12.7the commissioner must provide the enrollee with a prepopulated renewal form containing
12.8eligibility information available to the agency and permit the enrollee to submit the form
12.9with any corrections or additional information to the agency and sign the renewal form via
12.10any of the modes of submission specified in section 256B.04, subdivision 18.
12.11(c) An enrollee who is terminated for failure to complete the renewal process may
12.12subsequently submit the renewal form and required information within four months after
12.13the date of termination and have coverage reinstated without a lapse, if otherwise eligible
12.14under this chapter.
12.15(d) Notwithstanding paragraph (a), individuals eligible under subdivision 5 shall be
12.16required to renew eligibility every six months.
12.17EFFECTIVE DATE.This section is effective January 1, 2014.

12.18    Sec. 18. Minnesota Statutes 2012, section 256B.056, subdivision 10, is amended to read:
12.19    Subd. 10. Eligibility verification. (a) The commissioner shall require women who
12.20are applying for the continuation of medical assistance coverage following the end of the
12.2160-day postpartum period to update their income and asset information and to submit
12.22any required income or asset verification.
12.23    (b) The commissioner shall determine the eligibility of private-sector health care
12.24coverage for infants less than one year of age eligible under section 256B.055, subdivision
12.2510 , or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
12.26if this is determined to be cost-effective.
12.27    (c) The commissioner shall verify assets and income for all applicants, and for all
12.28recipients upon renewal.
12.29    (d) The commissioner shall utilize information obtained through the electronic
12.30service established by the secretary of the United States Department of Health and Human
12.31Services and other available electronic data sources in Code of Federal Regulations, title
12.3242, sections 435.940 to 435.956, to verify eligibility requirements. The commissioner
12.33shall establish standards to define when information obtained electronically is reasonably
12.34compatible with information provided by applicants and enrollees, including use of
13.1self-attestation, to accomplish real-time eligibility determinations and maintain program
13.2integrity.
13.3EFFECTIVE DATE.This section is effective January 1, 2014.

13.4    Sec. 19. Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:
13.5    Subdivision 1. Infants and pregnant women. (a)(1) An infant less than one year
13.6 two years of age or a pregnant woman who has written verification of a positive pregnancy
13.7test from a physician or licensed registered nurse is eligible for medical assistance if the
13.8individual's countable family household income is equal to or less than 275 percent of the
13.9federal poverty guideline for the same family household size or an equivalent standard
13.10when converted using modified adjusted gross income methodology as required under
13.11the Affordable Care Act. For purposes of this subdivision, "countable family income"
13.12means the amount of income considered available using the methodology of the AFDC
13.13program under the state's AFDC plan as of July 16, 1996, as required by the Personal
13.14Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public
13.15Law 104-193, except for the earned income disregard and employment deductions.
13.16    (2) For applications processed within one calendar month prior to the effective date,
13.17eligibility shall be determined by applying the income standards and methodologies in
13.18effect prior to the effective date for any months in the six-month budget period before
13.19that date and the income standards and methodologies in effect on the effective date for
13.20any months in the six-month budget period on or after that date. The income standards
13.21for each month shall be added together and compared to the applicant's total countable
13.22income for the six-month budget period to determine eligibility.
13.23    (b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]
13.24    (2) For applications processed within one calendar month prior to July 1, 2003,
13.25eligibility shall be determined by applying the income standards and methodologies in
13.26effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
13.272003, and the income standards and methodologies in effect on the expiration date for any
13.28months in the six-month budget period on or after July 1, 2003. The income standards
13.29for each month shall be added together and compared to the applicant's total countable
13.30income for the six-month budget period to determine eligibility.
13.31    (3) An amount equal to the amount of earned income exceeding 275 percent of
13.32the federal poverty guideline, up to a maximum of the amount by which the combined
13.33total of 185 percent of the federal poverty guideline plus the earned income disregards
13.34and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
13.35by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
14.1Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
14.2pregnant women and infants less than one year of age.
14.3    (c) Dependent care and child support paid under court order shall be deducted from
14.4the countable income of pregnant women.
14.5    (d) (b) An infant born to a woman who was eligible for and receiving medical
14.6assistance on the date of the child's birth shall continue to be eligible for medical assistance
14.7without redetermination until the child's first birthday.
14.8EFFECTIVE DATE.This section is effective January 1, 2014.

14.9    Sec. 20. Minnesota Statutes 2012, section 256B.057, subdivision 8, is amended to read:
14.10    Subd. 8. Children under age two. Medical assistance may be paid for a child under
14.11two years of age whose countable family income is above 275 percent of the federal poverty
14.12guidelines for the same size family but less than or equal to 280 percent of the federal
14.13poverty guidelines for the same size family or an equivalent standard when converted using
14.14modified adjusted gross income methodology as required under the Affordable Care Act.
14.15EFFECTIVE DATE.This section is effective January 1, 2014.

14.16    Sec. 21. Minnesota Statutes 2012, section 256B.057, subdivision 10, is amended to read:
14.17    Subd. 10. Certain persons needing treatment for breast or cervical cancer. (a)
14.18Medical assistance may be paid for a person who:
14.19(1) has been screened for breast or cervical cancer by the Minnesota breast and
14.20cervical cancer control program, and program funds have been used to pay for the person's
14.21screening;
14.22(2) according to the person's treating health professional, needs treatment, including
14.23diagnostic services necessary to determine the extent and proper course of treatment, for
14.24breast or cervical cancer, including precancerous conditions and early stage cancer;
14.25(3) meets the income eligibility guidelines for the Minnesota breast and cervical
14.26cancer control program;
14.27(4) is under age 65;
14.28(5) is not otherwise eligible for medical assistance under United States Code, title
14.2942, section 1396a(a)(10)(A)(i); and
14.30(6) is not otherwise covered under creditable coverage, as defined under United
14.31States Code, title 42, section 1396a(aa).
15.1(b) Medical assistance provided for an eligible person under this subdivision shall
15.2be limited to services provided during the period that the person receives treatment for
15.3breast or cervical cancer.
15.4(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance
15.5without meeting the eligibility criteria relating to income and assets in section 256B.056,
15.6subdivisions 1a to 5b 5a.

15.7    Sec. 22. Minnesota Statutes 2012, section 256B.057, is amended by adding a
15.8subdivision to read:
15.9    Subd. 12. Presumptive eligibility determinations made by qualified hospitals.
15.10The commissioner shall establish a process to qualify hospitals that are participating
15.11providers under the medical assistance program to determine presumptive eligibility for
15.12medical assistance for applicants who may have a basis of eligibility using the modified
15.13adjusted gross income methodology as defined in section 256B.056, subdivision 1a,
15.14paragraph (b), clause (1).
15.15EFFECTIVE DATE.This section is effective January 1, 2014.

15.16    Sec. 23. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
15.17    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
15.18to citizens of the United States, qualified noncitizens as defined in this subdivision, and
15.19other persons residing lawfully in the United States. Citizens or nationals of the United
15.20States must cooperate in obtaining satisfactory documentary evidence of citizenship or
15.21nationality according to the requirements of the federal Deficit Reduction Act of 2005,
15.22Public Law 109-171.
15.23(b) "Qualified noncitizen" means a person who meets one of the following
15.24immigration criteria:
15.25(1) admitted for lawful permanent residence according to United States Code, title 8;
15.26(2) admitted to the United States as a refugee according to United States Code,
15.27title 8, section 1157;
15.28(3) granted asylum according to United States Code, title 8, section 1158;
15.29(4) granted withholding of deportation according to United States Code, title 8,
15.30section 1253(h);
15.31(5) paroled for a period of at least one year according to United States Code, title 8,
15.32section 1182(d)(5);
15.33(6) granted conditional entrant status according to United States Code, title 8,
15.34section 1153(a)(7);
16.1(7) determined to be a battered noncitizen by the United States Attorney General
16.2according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
16.3title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
16.4(8) is a child of a noncitizen determined to be a battered noncitizen by the United
16.5States Attorney General according to the Illegal Immigration Reform and Immigrant
16.6Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
16.7Public Law 104-200; or
16.8(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
16.9Law 96-422, the Refugee Education Assistance Act of 1980.
16.10(c) All qualified noncitizens who were residing in the United States before August
16.1122, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
16.12medical assistance with federal financial participation.
16.13(d) Beginning December 1, 1996, qualified noncitizens who entered the United
16.14States on or after August 22, 1996, and who otherwise meet the eligibility requirements
16.15of this chapter are eligible for medical assistance with federal participation for five years
16.16if they meet one of the following criteria:
16.17(1) refugees admitted to the United States according to United States Code, title 8,
16.18section 1157;
16.19(2) persons granted asylum according to United States Code, title 8, section 1158;
16.20(3) persons granted withholding of deportation according to United States Code,
16.21title 8, section 1253(h);
16.22(4) veterans of the United States armed forces with an honorable discharge for
16.23a reason other than noncitizen status, their spouses and unmarried minor dependent
16.24children; or
16.25(5) persons on active duty in the United States armed forces, other than for training,
16.26their spouses and unmarried minor dependent children.
16.27 Beginning July 1, 2010, children and pregnant women who are noncitizens
16.28described in paragraph (b) or who are lawfully present in the United States as defined
16.29in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
16.30eligibility requirements of this chapter, are eligible for medical assistance with federal
16.31financial participation as provided by the federal Children's Health Insurance Program
16.32Reauthorization Act of 2009, Public Law 111-3.
16.33(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
16.34are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
16.35subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
16.36Code, title 8, section 1101(a)(15).
17.1(f) Payment shall also be made for care and services that are furnished to noncitizens,
17.2regardless of immigration status, who otherwise meet the eligibility requirements of
17.3this chapter, if such care and services are necessary for the treatment of an emergency
17.4medical condition.
17.5(g) For purposes of this subdivision, the term "emergency medical condition" means
17.6a medical condition that meets the requirements of United States Code, title 42, section
17.71396b(v).
17.8(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
17.9of an emergency medical condition are limited to the following:
17.10(i) services delivered in an emergency room or by an ambulance service licensed
17.11under chapter 144E that are directly related to the treatment of an emergency medical
17.12condition;
17.13(ii) services delivered in an inpatient hospital setting following admission from an
17.14emergency room or clinic for an acute emergency condition; and
17.15(iii) follow-up services that are directly related to the original service provided
17.16to treat the emergency medical condition and are covered by the global payment made
17.17to the provider.
17.18    (2) Services for the treatment of emergency medical conditions do not include:
17.19(i) services delivered in an emergency room or inpatient setting to treat a
17.20nonemergency condition;
17.21(ii) organ transplants, stem cell transplants, and related care;
17.22(iii) services for routine prenatal care;
17.23(iv) continuing care, including long-term care, nursing facility services, home health
17.24care, adult day care, day training, or supportive living services;
17.25(v) elective surgery;
17.26(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
17.27part of an emergency room visit;
17.28(vii) preventative health care and family planning services;
17.29(viii) dialysis;
17.30(ix) chemotherapy or therapeutic radiation services;
17.31(x) rehabilitation services;
17.32(xi) physical, occupational, or speech therapy;
17.33(xii) transportation services;
17.34(xiii) case management;
17.35(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;
17.36(xv) dental services;
18.1(xvi) hospice care;
18.2(xvii) audiology services and hearing aids;
18.3(xviii) podiatry services;
18.4(xix) chiropractic services;
18.5(xx) immunizations;
18.6(xxi) vision services and eyeglasses;
18.7(xxii) waiver services;
18.8(xxiii) individualized education programs; or
18.9(xxiv) chemical dependency treatment.
18.10(i) Beginning July 1, 2009, Pregnant noncitizens who are undocumented,
18.11nonimmigrants, or lawfully present in the United States as defined in Code of Federal
18.12Regulations, title 8, section 103.12, ineligible for federally funded medical assistance
18.13 are not covered by a group health plan or health insurance coverage according to Code
18.14of Federal Regulations, title 42, section 457.310, and who otherwise meet the eligibility
18.15requirements of this chapter, are eligible for medical assistance through the period of
18.16pregnancy, including labor and delivery, and 60 days postpartum, to the extent federal
18.17funds are available under title XXI of the Social Security Act, and the state children's
18.18health insurance program.
18.19(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
18.20services from a nonprofit center established to serve victims of torture and are otherwise
18.21ineligible for medical assistance under this chapter are eligible for medical assistance
18.22without federal financial participation. These individuals are eligible only for the period
18.23during which they are receiving services from the center. Individuals eligible under this
18.24paragraph shall not be required to participate in prepaid medical assistance.
18.25(k) Noncitizens who are lawfully present in the United States as defined in Code
18.26of Federal Regulations, title 8, section 103.12, who are not children or pregnant women
18.27as defined in paragraph (d), and who otherwise meet the eligibility requirements of this
18.28chapter, are eligible for medical assistance without federal financial participation. These
18.29individuals must cooperate with the United States Citizenship and Immigration Services to
18.30pursue any applicable immigration status, including citizenship, that would qualify them
18.31for medical assistance with federal financial participation.
18.32EFFECTIVE DATE.This section is effective January 1, 2014.

18.33    Sec. 24. Minnesota Statutes 2012, section 256B.0755, subdivision 3, is amended to read:
18.34    Subd. 3. Accountability. (a) Health care delivery systems must accept responsibility
18.35for the quality of care based on standards established under subdivision 1, paragraph (b),
19.1clause (10), and the cost of care or utilization of services provided to its enrollees under
19.2subdivision 1, paragraph (b), clause (1).
19.3(b) A health care delivery system may contract and coordinate with providers and
19.4clinics for the delivery of services and shall contract with community health clinics,
19.5federally qualified health centers, community mental health centers or programs, county
19.6agencies, and rural clinics to the extent practicable.
19.7(c) A health care delivery system must demonstrate how its services will be
19.8coordinated with other services affecting its attributed patients' health, quality of care,
19.9and cost of care that are provided by other providers and county agencies in the local
19.10service area. The health care delivery system must: (1) document how other providers
19.11and counties, including county-based purchasing plans, will provide services to persons
19.12attributed to the health care delivery system; (2) document how other providers and
19.13counties, including county-based purchasing plans, participated in developing the
19.14application; (3) provide verification that other providers and counties, including
19.15county-based purchasing plans, support the project and are willing to participate; and (4)
19.16document how it will address applicable local needs, priorities, and public health goals.
19.17EFFECTIVE DATE.This section applies to health care delivery system contracts
19.18entered into or renewed on or after July 1, 2013.

19.19    Sec. 25. Minnesota Statutes 2012, section 256B.694, is amended to read:
19.20256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
19.21CONTRACT.
19.22    (a) MS 2010 [Expired, 2008 c 364 s 10]
19.23    (b) The commissioner shall consider, and may approve, contracting on a
19.24single-health plan basis with other county-based purchasing plans, or with other qualified
19.25health plans that have coordination arrangements with counties, to serve persons with
19.26a disability who voluntarily enroll enrolled in state health care programs, in order to
19.27promote better coordination or integration of health care services, social services and
19.28other community-based services, provided that all requirements applicable to health plan
19.29purchasing, including those in section 256B.69, subdivision 23, are satisfied. Nothing in
19.30this paragraph supersedes or modifies the requirements in paragraph (a).

19.31    Sec. 26. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
19.32to read:
20.1    Subd. 1b. Affordable Care Act. "Affordable Care Act" means the federal Patient
20.2Protection and Affordable Care Act, Public Law 111-148, as amended, including the
20.3federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and
20.4any amendments to, and any federal guidance or regulations issued under, these acts.

20.5    Sec. 27. Minnesota Statutes 2012, section 256L.01, subdivision 3a, is amended to read:
20.6    Subd. 3a. Family with children. (a) "Family with children" means:
20.7(1) parents and their children residing in the same household; or
20.8(2) grandparents, foster parents, relative caretakers as defined in the medical
20.9assistance program, or legal guardians; and their wards who are children residing in the
20.10same household. "Family" has the meaning given for family and family size as defined
20.11in Code of Federal Regulations, title 26, section 1.36B-1.
20.12(b) The term includes children who are temporarily absent from the household in
20.13settings such as schools, camps, or parenting time with noncustodial parents.
20.14EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
20.15approval, whichever is later. The commissioner of human services shall notify the revisor
20.16of statutes when federal approval is obtained.

20.17    Sec. 28. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
20.18to read:
20.19    Subd. 4b. Minnesota Insurance Marketplace. "Minnesota Insurance Marketplace"
20.20means the Minnesota Insurance Marketplace as defined in Minnesota Statutes, section
20.2162V.02.

20.22    Sec. 29. Minnesota Statutes 2012, section 256L.01, subdivision 5, is amended to read:
20.23    Subd. 5. Income. (a) "Income" has the meaning given for earned and unearned
20.24income for families and children in the medical assistance program, according to the
20.25state's aid to families with dependent children plan in effect as of July 16, 1996. The
20.26definition does not include medical assistance income methodologies and deeming
20.27requirements. The earned income of full-time and part-time students under age 19 is
20.28not counted as income. Public assistance payments and supplemental security income
20.29are not excluded income modified adjusted gross income, as defined in Code of Federal
20.30Regulations, title 26, section 1.36B-1.
20.31(b) For purposes of this subdivision, and unless otherwise specified in this section,
20.32the commissioner shall use reasonable methods to calculate gross earned and unearned
21.1income including, but not limited to, projecting income based on income received within
21.2the past 30 days, the last 90 days, or the last 12 months.
21.3EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
21.4approval, whichever is later. The commissioner of human services shall notify the revisor
21.5of statutes when federal approval is obtained.

21.6    Sec. 30. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
21.7to read:
21.8    Subd. 8. Participating entity. "Participating entity" means a health carrier as
21.9defined in section 62A.011, subdivision 2; a county-based purchasing plan established
21.10under section 256B.692; an accountable care organization or other entity operating a
21.11health care delivery systems demonstration project authorized under section 256B.0755;
21.12an entity operating a county integrated health care delivery network pilot project
21.13authorized under section 256B.0756; or a network of health care providers established to
21.14offer services under MinnesotaCare.
21.15EFFECTIVE DATE.This section is effective January 1, 2015.

21.16    Sec. 31. Minnesota Statutes 2012, section 256L.02, subdivision 2, is amended to read:
21.17    Subd. 2. Commissioner's duties. The commissioner shall establish an office for the
21.18state administration of this plan. The plan shall be used to provide covered health services
21.19for eligible persons. Payment for these services shall be made to all eligible providers
21.20 participating entities under contract with the commissioner. The commissioner shall
21.21adopt rules to administer the MinnesotaCare program. Nothing in this chapter is intended
21.22to violate the requirements of the Affordable Care Act. The commissioner shall not
21.23implement any provision of this chapter if the provision is found to violate the Affordable
21.24Care Act. The commissioner shall establish marketing efforts to encourage potentially
21.25eligible persons to receive information about the program and about other medical care
21.26programs administered or supervised by the Department of Human Services. A toll-free
21.27telephone number and Web site must be used to provide information about medical
21.28programs and to promote access to the covered services.
21.29EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
21.30approval, whichever is later, except that the amendment related to "participating entities"
21.31is effective January 1, 2015. The commissioner of human services shall notify the revisor
21.32when federal approval is obtained.

22.1    Sec. 32. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
22.2to read:
22.3    Subd. 6. Federal approval. (a) The commissioner of human services shall seek
22.4federal approval to implement the MinnesotaCare program under this chapter as a basic
22.5health program. In any agreement with the Centers for Medicare and Medicaid Services
22.6to operate MinnesotaCare as a basic health program, the commissioner shall seek to
22.7include procedures to ensure that federal funding is predictable, stable, and sufficient
22.8to sustain ongoing operation of MinnesotaCare. These procedures must address issues
22.9related to the timing of federal payments, payment reconciliation, enrollee risk adjustment,
22.10and minimization of state financial risk. The commissioner shall consult with the
22.11commissioner of management and budget when developing the proposal for establishing
22.12MinnesotaCare as a basic health program to be submitted to the Centers for Medicare
22.13and Medicaid Services.
22.14(b) The commissioner of human services, in consultation with the commissioner of
22.15management and budget, shall work with the Centers for Medicare and Medicaid Services
22.16to establish a process for reconciliation and adjustment of federal payments that balances
22.17state and federal liability over time. The commissioner of human services shall request that
22.18the secretary of health and human services hold the state, and enrollees, harmless in the
22.19reconciliation process for the first three years, to allow the state to develop a statistically
22.20valid methodology for predicting enrollment trends and their net effect on federal payments.
22.21(c) The commissioner of human services, through December 31, 2015, may modify
22.22the MinnesotaCare program as specified in this chapter, if it is necessary to enhance
22.23health benefits, expand provider access, or reduce cost-sharing and premiums in order
22.24to comply with the terms and conditions of federal approval as a basic health program.
22.25The commissioner may not reduce benefits, impose greater limits on access to providers,
22.26or increase cost-sharing and premiums by enrollees under the authority granted by this
22.27paragraph. If the commissioner modifies the terms and requirements for MinnesotaCare
22.28under this paragraph, the commissioner shall provide the legislature with notice of
22.29implementation of the modifications at least ten working days before notifying enrollees
22.30and participating entities. The costs of any changes to the program necessary to comply
22.31with federal approval shall become part of the program's base funding for purposes of
22.32future budget forecasts.
22.33EFFECTIVE DATE.This section is effective the day following final enactment.

22.34    Sec. 33. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
22.35to read:
23.1    Subd. 7. Coordination with Minnesota Insurance Marketplace. MinnesotaCare
23.2shall be considered a public health care program for purposes of Minnesota Statutes,
23.3chapter 62V.
23.4EFFECTIVE DATE.This section is effective January 1, 2014.

23.5    Sec. 34. Minnesota Statutes 2012, section 256L.03, subdivision 1, is amended to read:
23.6    Subdivision 1. Covered health services. (a) "Covered health services" means the
23.7health services reimbursed under chapter 256B, and all essential health benefits required
23.8under section 1302 of the Affordable Care Act, with the exception of inpatient hospital
23.9services, special education services, private duty nursing services, adult dental care
23.10services other than services covered under section 256B.0625, subdivision 9, orthodontic
23.11services, nonemergency medical transportation services, personal care assistance and case
23.12management services, and nursing home or intermediate care facilities services, inpatient
23.13mental health services, and chemical dependency services.
23.14    (b) No public funds shall be used for coverage of abortion under MinnesotaCare
23.15except where the life of the female would be endangered or substantial and irreversible
23.16impairment of a major bodily function would result if the fetus were carried to term; or
23.17where the pregnancy is the result of rape or incest.
23.18    (c) Covered health services shall be expanded as provided in this section.
23.19EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
23.20approval, whichever is later. The commissioner of human services shall notify the revisor
23.21of statutes when federal approval is obtained.

23.22    Sec. 35. Minnesota Statutes 2012, section 256L.03, subdivision 1a, is amended to read:
23.23    Subd. 1a. Pregnant women and Children; MinnesotaCare health care reform
23.24waiver. Beginning January 1, 1999, Children and pregnant women are eligible for coverage
23.25of all services that are eligible for reimbursement under the medical assistance program
23.26according to chapter 256B, except that abortion services under MinnesotaCare shall be
23.27limited as provided under subdivision 1. Pregnant women and Children are exempt from
23.28the provisions of subdivision 5, regarding co-payments. Pregnant women and Children
23.29who are lawfully residing in the United States but who are not "qualified noncitizens" under
23.30title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
23.31Public Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage
23.32of all services provided under the medical assistance program according to chapter 256B.
24.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
24.2approval, whichever is later. The commissioner of human services shall notify the revisor
24.3of statutes when federal approval is obtained.

24.4    Sec. 36. Minnesota Statutes 2012, section 256L.03, subdivision 3, is amended to read:
24.5    Subd. 3. Inpatient hospital services. (a) Covered health services shall include
24.6inpatient hospital services, including inpatient hospital mental health services and inpatient
24.7hospital and residential chemical dependency treatment, subject to those limitations
24.8necessary to coordinate the provision of these services with eligibility under the medical
24.9assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
24.10section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
24.112 , with family gross income that exceeds 200 percent of the federal poverty guidelines or
24.12215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
24.13pregnant, is subject to an annual limit of $10,000.
24.14    (b) Admissions for inpatient hospital services paid for under section 256L.11,
24.15subdivision 3 , must be certified as medically necessary in accordance with Minnesota
24.16Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
24.17    (1) all admissions must be certified, except those authorized under rules established
24.18under section 254A.03, subdivision 3, or approved under Medicare; and
24.19    (2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
24.20for admissions for which certification is requested more than 30 days after the day of
24.21admission. The hospital may not seek payment from the enrollee for the amount of the
24.22payment reduction under this clause.
24.23EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
24.24approval, whichever is later. The commissioner of human services shall notify the revisor
24.25of statutes when federal approval is obtained.

24.26    Sec. 37. Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision
24.27to read:
24.28    Subd. 4b. Loss ratio. Health coverage provided through the MinnesotaCare
24.29program must have a medical loss ratio of at least 85 percent, as defined using the loss
24.30ratio methodology described in section 1001 of the Affordable Care Act.
24.31EFFECTIVE DATE.This section is effective January 1, 2015.

24.32    Sec. 38. Minnesota Statutes 2012, section 256L.03, subdivision 5, is amended to read:
25.1    Subd. 5. Cost-sharing. (a) Except as otherwise provided in paragraphs (b) and (c)
25.2 this subdivision, the MinnesotaCare benefit plan shall include the following cost-sharing
25.3requirements for all enrollees:
25.4    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
25.5subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;
25.6    (2) $3 per prescription for adult enrollees;
25.7    (3) $25 for eyeglasses for adult enrollees;
25.8    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
25.9episode of service which is required because of a recipient's symptoms, diagnosis, or
25.10established illness, and which is delivered in an ambulatory setting by a physician or
25.11physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
25.12audiologist, optician, or optometrist;
25.13    (5) $6 for nonemergency visits to a hospital-based emergency room for services
25.14provided through December 31, 2010, and $3.50 effective January 1, 2011; and
25.15(6) a family deductible equal to the maximum amount allowed under Code of
25.16Federal Regulations, title 42, part 447.54.
25.17    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
25.18 families with children under the age of 21.
25.19    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
25.20    (d) Paragraph (a), clause (4), does not apply to mental health services.
25.21    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
25.22poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
25.23and who are not pregnant shall be financially responsible for the coinsurance amount, if
25.24applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.
25.25    (f) (e) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
25.26or changes from one prepaid health plan to another during a calendar year, any charges
25.27submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
25.28expenses incurred by the enrollee for inpatient services, that were submitted or incurred
25.29prior to enrollment, or prior to the change in health plans, shall be disregarded.
25.30(g) (f) MinnesotaCare reimbursements to fee-for-service providers and payments to
25.31managed care plans or county-based purchasing plans shall not be increased as a result of
25.32the reduction of the co-payments in paragraph (a), clause (5), effective January 1, 2011.
25.33(h) (g) The commissioner, through the contracting process under section 256L.12,
25.34may allow managed care plans and county-based purchasing plans to waive the family
25.35deductible under paragraph (a), clause (6). The value of the family deductible shall not be
25.36included in the capitation payment to managed care plans and county-based purchasing
26.1plans. Managed care plans and county-based purchasing plans shall certify annually to the
26.2commissioner the dollar value of the family deductible.
26.3EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
26.4approval, whichever is later. The commissioner of human services shall notify the revisor
26.5of statutes when federal approval is obtained.

26.6    Sec. 39. Minnesota Statutes 2012, section 256L.03, subdivision 6, is amended to read:
26.7    Subd. 6. Lien. When the state agency provides, pays for, or becomes liable for
26.8covered health services, the agency shall have a lien for the cost of the covered health
26.9services upon any and all causes of action accruing to the enrollee, or to the enrollee's
26.10legal representatives, as a result of the occurrence that necessitated the payment for the
26.11covered health services. All liens under this section shall be subject to the provisions
26.12of section 256.015. For purposes of this subdivision, "state agency" includes prepaid
26.13health plans participating entities, under contract with the commissioner according to
26.14sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based
26.15purchasing entities under section 256B.692 section 256L.121.
26.16EFFECTIVE DATE.This section is effective January 1, 2015.

26.17    Sec. 40. Minnesota Statutes 2012, section 256L.04, subdivision 1, is amended to read:
26.18    Subdivision 1. Families with children. (a) Families with children with family
26.19income above 133 percent of the federal poverty guidelines and equal to or less than
26.20275 200 percent of the federal poverty guidelines for the applicable family size shall be
26.21eligible for MinnesotaCare according to this section. All other provisions of sections
26.22256L.01 to 256L.18, including the insurance-related barriers to enrollment under section
26.23256L.07, shall apply unless otherwise specified.
26.24    (b) Parents who enroll in the MinnesotaCare program must also enroll their children,
26.25if the children are eligible. Children may be enrolled separately without enrollment by
26.26parents. However, if one parent in the household enrolls, both parents must enroll, unless
26.27other insurance is available. If one child from a family is enrolled, all children must
26.28be enrolled, unless other insurance is available. If one spouse in a household enrolls,
26.29the other spouse in the household must also enroll, unless other insurance is available.
26.30Families cannot choose to enroll only certain uninsured members.
26.31    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies
26.32to the MinnesotaCare program. These persons are no longer counted in the parental
26.33household and may apply as a separate household.
27.1    (d) Parents are not eligible for MinnesotaCare if their gross income exceeds $57,500.
27.2(e) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
27.38 , are exempt from the eligibility requirements of this subdivision.
27.4EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
27.5approval, whichever is later. The commissioner of human services shall notify the revisor
27.6of statutes when federal approval is obtained.

27.7    Sec. 41. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
27.8to read:
27.9    Subd. 1c. General requirements. To be eligible for coverage under MinnesotaCare,
27.10a person must meet the eligibility requirements of this section. A person eligible for
27.11MinnesotaCare shall not be treated as a qualified individual under section 1312 of the
27.12Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered
27.13through the health benefit exchange under section 1331 of the Affordable Care Act.
27.14EFFECTIVE DATE.This section is effective January 1, 2015.

27.15    Sec. 42. Minnesota Statutes 2012, section 256L.04, subdivision 7, is amended to read:
27.16    Subd. 7. Single adults and households with no children. (a) The definition of
27.17eligible persons includes all individuals and households families with no children who
27.18have gross family incomes that are above 133 percent and equal to or less than 200 percent
27.19of the federal poverty guidelines for the applicable family size.
27.20    (b) Effective July 1, 2009, the definition of eligible persons includes all individuals
27.21and households with no children who have gross family incomes that are equal to or less
27.22than 250 percent of the federal poverty guidelines.
27.23EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
27.24approval, whichever is later. The commissioner of human services shall notify the revisor
27.25of statutes when federal approval is obtained.

27.26    Sec. 43. Minnesota Statutes 2012, section 256L.04, subdivision 8, is amended to read:
27.27    Subd. 8. Applicants potentially eligible for medical assistance. (a) Individuals
27.28who receive supplemental security income or retirement, survivors, or disability benefits
27.29due to a disability, or other disability-based pension, who qualify under subdivision 7, but
27.30who are potentially eligible for medical assistance without a spenddown shall be allowed
27.31to enroll in MinnesotaCare for a period of 60 days, so long as the applicant meets all other
27.32conditions of eligibility. The commissioner shall identify and refer the applications of
28.1such individuals to their county social service agency. The county and the commissioner
28.2shall cooperate to ensure that the individuals obtain medical assistance coverage for any
28.3months for which they are eligible.
28.4(b) The enrollee must cooperate with the county social service agency in determining
28.5medical assistance eligibility within the 60-day enrollment period. Enrollees who do not
28.6cooperate with medical assistance within the 60-day enrollment period shall be disenrolled
28.7from the plan within one calendar month. Persons disenrolled for nonapplication for
28.8medical assistance may not reenroll until they have obtained a medical assistance
28.9eligibility determination. Persons disenrolled for noncooperation with medical assistance
28.10may not reenroll until they have cooperated with the county agency and have obtained a
28.11medical assistance eligibility determination.
28.12(c) Beginning January 1, 2000, counties that choose to become MinnesotaCare
28.13enrollment sites shall consider MinnesotaCare applications to also be applications for
28.14medical assistance. Applicants who are potentially eligible for medical assistance, except
28.15for those described in paragraph (a), may choose to enroll in either MinnesotaCare or
28.16medical assistance.
28.17(d) The commissioner shall redetermine provider payments made under
28.18MinnesotaCare to the appropriate medical assistance payments for those enrollees who
28.19subsequently become eligible for medical assistance.
28.20EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
28.21approval, whichever is later. The commissioner of human services shall notify the revisor
28.22of statutes when federal approval is obtained.

28.23    Sec. 44. Minnesota Statutes 2012, section 256L.04, subdivision 10, is amended to read:
28.24    Subd. 10. Citizenship requirements. (a) Eligibility for MinnesotaCare is limited to
28.25citizens or nationals of the United States, qualified noncitizens, and other persons residing
28.26 and lawfully in the United States present noncitizens as defined in Code of Federal
28.27Regulations, title 8, section 103.12. Undocumented noncitizens and nonimmigrants
28.28 are ineligible for MinnesotaCare. For purposes of this subdivision, a nonimmigrant
28.29is an individual in one or more of the classes listed in United States Code, title 8,
28.30section 1101(a)(15), and an undocumented noncitizen is an individual who resides in the
28.31United States without the approval or acquiescence of the United States Citizenship and
28.32Immigration Services. Families with children who are citizens or nationals of the United
28.33States must cooperate in obtaining satisfactory documentary evidence of citizenship or
28.34nationality according to the requirements of the federal Deficit Reduction Act of 2005,
28.35Public Law 109-171.
29.1(b) Eligible persons include individuals who are lawfully present and ineligible for
29.2medical assistance by reason of immigration status, who have family income equal to or
29.3less than 200 percent of the federal poverty guidelines for the applicable family size.
29.4EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
29.5approval, whichever is later. The commissioner of human services shall notify the revisor
29.6of statutes when federal approval is obtained.

29.7    Sec. 45. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
29.8to read:
29.9    Subd. 14. Coordination with medical assistance. (a) Individuals eligible for
29.10medical assistance under chapter 256B are not eligible for MinnesotaCare under this
29.11section.
29.12(b) The commissioner shall coordinate eligibility and coverage to ensure that
29.13individuals transitioning between medical assistance and MinnesotaCare have seamless
29.14eligibility and access to health care services.
29.15EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
29.16approval, whichever is later. The commissioner of human services shall notify the revisor
29.17of statutes when federal approval is obtained.

29.18    Sec. 46. Minnesota Statutes 2012, section 256L.05, subdivision 1, is amended to read:
29.19    Subdivision 1. Application assistance and information availability. (a) Applicants
29.20may submit applications online, in person, by mail, or by phone in accordance with the
29.21Affordable Care Act, and by any other means by which medical assistance applications
29.22may be submitted. Applicants may submit applications through the Minnesota Insurance
29.23Marketplace or through the MinnesotaCare program. Applications and application
29.24assistance must be made available at provider offices, local human services agencies,
29.25school districts, public and private elementary schools in which 25 percent or more of
29.26the students receive free or reduced price lunches, community health offices, Women,
29.27Infants and Children (WIC) program sites, Head Start program sites, public housing
29.28councils, crisis nurseries, child care centers, early childhood education and preschool
29.29program sites, legal aid offices, and libraries, and at any other locations at which medical
29.30assistance applications must be made available. These sites may accept applications and
29.31forward the forms to the commissioner or local county human services agencies that
29.32choose to participate as an enrollment site. Otherwise, applicants may apply directly to the
29.33commissioner or to participating local county human services agencies.
30.1(b) Application assistance must be available for applicants choosing to file an online
30.2application through the Minnesota Insurance Marketplace.
30.3EFFECTIVE DATE.This section is effective January 1, 2014.

30.4    Sec. 47. Minnesota Statutes 2012, section 256L.05, subdivision 2, is amended to read:
30.5    Subd. 2. Commissioner's duties. The commissioner or county agency shall use
30.6electronic verification through the Minnesota Insurance Marketplace as the primary
30.7method of income verification. If there is a discrepancy between reported income
30.8and electronically verified income, an individual may be required to submit additional
30.9verification to the extent permitted under the Affordable Care Act. In addition, the
30.10commissioner shall perform random audits to verify reported income and eligibility. The
30.11commissioner may execute data sharing arrangements with the Department of Revenue
30.12and any other governmental agency in order to perform income verification related to
30.13eligibility and premium payment under the MinnesotaCare program.
30.14EFFECTIVE DATE.This section is effective January 1, 2014.

30.15    Sec. 48. Minnesota Statutes 2012, section 256L.05, subdivision 3, is amended to read:
30.16    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
30.17first day of the month following the month in which eligibility is approved and the first
30.18premium payment has been received. As provided in section 256B.057, coverage for
30.19newborns is automatic from the date of birth and must be coordinated with other health
30.20coverage. The effective date of coverage for eligible newly adoptive children added to a
30.21family receiving covered health services is the month of placement. The effective date
30.22of coverage for other new members added to the family is the first day of the month
30.23following the month in which the change is reported. All eligibility criteria must be met
30.24by the family at the time the new family member is added. The income of the new family
30.25member is included with the family's modified adjusted gross income and the adjusted
30.26premium begins in the month the new family member is added.
30.27(b) The initial premium must be received by the last working day of the month for
30.28coverage to begin the first day of the following month.
30.29(c) Benefits are not available until the day following discharge if an enrollee is
30.30hospitalized on the first day of coverage.
30.31(d) (c) Notwithstanding any other law to the contrary, benefits under sections
30.32256L.01 to 256L.18 are secondary to a plan of insurance or benefit program under which
30.33an eligible person may have coverage and the commissioner shall use cost avoidance
31.1techniques to ensure coordination of any other health coverage for eligible persons. The
31.2commissioner shall identify eligible persons who may have coverage or benefits under
31.3other plans of insurance or who become eligible for medical assistance.
31.4(e) (d) The effective date of coverage for individuals or families who are exempt
31.5from paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first
31.6day of the month following the month in which verification of American Indian status
31.7is received or eligibility is approved, whichever is later.
31.8(f) (e) The effective date of coverage for children eligible under section 256L.07,
31.9subdivision 8, is the first day of the month following the date of termination from foster
31.10care or release from a juvenile residential correctional facility.
31.11EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
31.12approval, whichever is later. The commissioner of human services shall notify the revisor
31.13of statutes when federal approval is obtained.

31.14    Sec. 49. Minnesota Statutes 2012, section 256L.06, subdivision 3, is amended to read:
31.15    Subd. 3. Commissioner's duties and payment. (a) Premiums are dedicated to the
31.16commissioner for MinnesotaCare.
31.17    (b) The commissioner shall develop and implement procedures to: (1) require
31.18enrollees to report changes in income; (2) adjust sliding scale premium payments, based
31.19upon both increases and decreases in enrollee income, at the time the change in income
31.20is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
31.21premiums. Failure to pay includes payment with a dishonored check, a returned automatic
31.22bank withdrawal, or a refused credit card or debit card payment. The commissioner may
31.23demand a guaranteed form of payment, including a cashier's check or a money order, as
31.24the only means to replace a dishonored, returned, or refused payment.
31.25    (c) Premiums are calculated on a calendar month basis and may be paid on a
31.26monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
31.27commissioner of the premium amount required. The commissioner shall inform applicants
31.28and enrollees of these premium payment options. Premium payment is required before
31.29enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
31.30received before noon are credited the same day. Premium payments received after noon
31.31are credited on the next working day.
31.32    (d) Nonpayment of the premium will result in disenrollment from the plan effective
31.33for the calendar month for which the premium was due. Persons disenrolled for
31.34nonpayment or who voluntarily terminate coverage from the program may not reenroll
31.35until four calendar months have elapsed. Persons disenrolled for nonpayment who pay
32.1all past due premiums as well as current premiums due, including premiums due for the
32.2period of disenrollment, within 20 days of disenrollment, shall be reenrolled retroactively
32.3to the first day of disenrollment. Persons disenrolled for nonpayment or who voluntarily
32.4terminate coverage from the program may not reenroll for four calendar months unless
32.5the person demonstrates good cause for nonpayment. Good cause does not exist if a
32.6person chooses to pay other family expenses instead of the premium. The commissioner
32.7shall define good cause in rule.
32.8EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
32.9approval, whichever is later. The commissioner of human services shall notify the revisor
32.10of statutes when federal approval is obtained.

32.11    Sec. 50. Minnesota Statutes 2012, section 256L.07, subdivision 1, is amended to read:
32.12    Subdivision 1. General requirements. (a) Children enrolled in the original
32.13children's health plan as of September 30, 1992, children who enrolled in the
32.14MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
32.15article 4, section 17, and children who have family gross incomes that are equal to or
32.16less than 200 percent of the federal poverty guidelines are eligible without meeting the
32.17requirements of subdivision 2 and the four-month requirement in subdivision 3, as long as
32.18they maintain continuous coverage in the MinnesotaCare program or medical assistance.
32.19    Parents Individuals enrolled in MinnesotaCare under section 256L.04, subdivision 1,
32.20and individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7, whose
32.21income increases above 275 200 percent of the federal poverty guidelines, are no longer
32.22eligible for the program and shall be disenrolled by the commissioner. Beginning January
32.231, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
32.247 , whose income increases above 200 percent of the federal poverty guidelines or 250
32.25percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
32.26the program and shall be disenrolled by the commissioner. For persons disenrolled under
32.27this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
32.28following the month in which the commissioner determines that the income of a family or
32.29individual exceeds program income limits.
32.30    (b) Children may remain enrolled in MinnesotaCare if their gross family income as
32.31defined in section 256L.01, subdivision 4, is greater than 275 percent of federal poverty
32.32guidelines. The premium for children remaining eligible under this paragraph shall be the
32.33maximum premium determined under section 256L.15, subdivision 2, paragraph (b).
32.34    (c) Notwithstanding paragraph (a), parents are not eligible for MinnesotaCare if
32.35gross household income exceeds $57,500 for the 12-month period of eligibility.
33.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
33.2approval, whichever is later. The commissioner of human services shall notify the revisor
33.3of statutes when federal approval is obtained.

33.4    Sec. 51. Minnesota Statutes 2012, section 256L.07, subdivision 2, is amended to read:
33.5    Subd. 2. Must not have access to employer-subsidized minimum essential
33.6 coverage. (a) To be eligible, a family or individual must not have access to subsidized
33.7health coverage through an employer and must not have had access to employer-subsidized
33.8coverage through a current employer for 18 months prior to application or reapplication.
33.9A family or individual whose employer-subsidized coverage is lost due to an employer
33.10terminating health care coverage as an employee benefit during the previous 18 months is
33.11not eligible that is affordable and provides minimum value as defined in Code of Federal
33.12Regulations, title 26, section 1.36B-2.
33.13(b) This subdivision does not apply to a family or individual who was enrolled
33.14in MinnesotaCare within six months or less of reapplication and who no longer has
33.15employer-subsidized coverage due to the employer terminating health care coverage as an
33.16employee benefit. This subdivision does not apply to children with family gross incomes
33.17that are equal to or less than 200 percent of federal poverty guidelines.
33.18(c) For purposes of this requirement, subsidized health coverage means health
33.19coverage for which the employer pays at least 50 percent of the cost of coverage for
33.20the employee or dependent, or a higher percentage as specified by the commissioner.
33.21Children are eligible for employer-subsidized coverage through either parent, including
33.22the noncustodial parent. The commissioner must treat employer contributions to Internal
33.23Revenue Code Section 125 plans and any other employer benefits intended to pay
33.24health care costs as qualified employer subsidies toward the cost of health coverage for
33.25employees for purposes of this subdivision.
33.26EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
33.27approval, whichever is later. The commissioner of human services shall notify the revisor
33.28of statutes when federal approval is obtained.

33.29    Sec. 52. Minnesota Statutes 2012, section 256L.07, subdivision 3, is amended to read:
33.30    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the
33.31MinnesotaCare program must have no To be eligible, a family must not have minimum
33.32essential health coverage while enrolled, as defined by section 5000A of the Internal
33.33Revenue Code. Children with family gross incomes equal to or greater than 200 percent
33.34of federal poverty guidelines, and adults, must have had no health coverage for at least
34.1four months prior to application and renewal. Children enrolled in the original children's
34.2health plan and children in families with income equal to or less than 200 percent of the
34.3federal poverty guidelines, who have other health insurance, are eligible if the coverage:
34.4(1) lacks two or more of the following:
34.5(i) basic hospital insurance;
34.6(ii) medical-surgical insurance;
34.7(iii) prescription drug coverage;
34.8(iv) dental coverage; or
34.9(v) vision coverage;
34.10(2) requires a deductible of $100 or more per person per year; or
34.11(3) lacks coverage because the child has exceeded the maximum coverage for a
34.12particular diagnosis or the policy excludes a particular diagnosis.
34.13The commissioner may change this eligibility criterion for sliding scale premiums
34.14in order to remain within the limits of available appropriations. The requirement of no
34.15health coverage does not apply to newborns.
34.16(b) Coverage purchased as provided under section 256L.031, subdivision 2, medical
34.17assistance, and the Civilian Health and Medical Program of the Uniformed Service,
34.18CHAMPUS, or other coverage provided under United States Code, title 10, subtitle A,
34.19part II, chapter 55, are not considered insurance or health coverage for purposes of the
34.20four-month requirement described in this subdivision.
34.21(c) (b) For purposes of this subdivision, an applicant or enrollee who is entitled to
34.22Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
34.23Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered
34.24to have minimum essential health coverage. An applicant or enrollee who is entitled to
34.25premium-free Medicare Part A may not refuse to apply for or enroll in Medicare coverage
34.26to establish eligibility for MinnesotaCare.
34.27(d) Applicants who were recipients of medical assistance within one month of
34.28application must meet the provisions of this subdivision and subdivision 2.
34.29(e) Cost-effective health insurance that was paid for by medical assistance is not
34.30considered health coverage for purposes of the four-month requirement under this
34.31section, except if the insurance continued after medical assistance no longer considered it
34.32cost-effective or after medical assistance closed.
34.33EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
34.34approval, whichever is later. The commissioner of human services shall notify the revisor
34.35of statutes when federal approval is obtained.

35.1    Sec. 53. Minnesota Statutes 2012, section 256L.09, subdivision 2, is amended to read:
35.2    Subd. 2. Residency requirement. To be eligible for health coverage under the
35.3MinnesotaCare program, pregnant women, individuals, and families with children must
35.4meet the residency requirements as provided by Code of Federal Regulations, title 42,
35.5section 435.403, except that the provisions of section 256B.056, subdivision 1, shall apply
35.6upon receipt of federal approval.
35.7EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
35.8approval, whichever is later. The commissioner of human services shall notify the revisor
35.9of statutes when federal approval is obtained.

35.10    Sec. 54. Minnesota Statutes 2012, section 256L.11, subdivision 6, is amended to read:
35.11    Subd. 6. Enrollees 18 or older Reimbursement of inpatient hospital services.
35.12Payment by the MinnesotaCare program for inpatient hospital services provided to
35.13MinnesotaCare enrollees eligible under section 256L.04, subdivision 7, or who qualify
35.14under section 256L.04, subdivisions subdivision 1 and 2, with family gross income that
35.15exceeds 175 percent of the federal poverty guidelines and who are not pregnant, who
35.16are 18 years old or older on the date of admission to the inpatient hospital must be in
35.17accordance with paragraphs (a) and (b). Payment for adults who are not pregnant and are
35.18eligible under section 256L.04, subdivisions 1 and 2, and whose incomes are equal to or
35.19less than 175 percent of the federal poverty guidelines, shall be as provided for under
35.20paragraph (c)., shall be at the medical assistance rate minus any co-payment required
35.21under section 256L.03, subdivision 5. The hospital must not seek payment from the
35.22enrollee in addition to the co-payment. The MinnesotaCare payment plus the co-payment
35.23must be treated as payment in full.
35.24(a) If the medical assistance rate minus any co-payment required under section
35.25256L.03, subdivision 4, is less than or equal to the amount remaining in the enrollee's
35.26benefit limit under section 256L.03, subdivision 3, payment must be the medical
35.27assistance rate minus any co-payment required under section 256L.03, subdivision 4. The
35.28hospital must not seek payment from the enrollee in addition to the co-payment. The
35.29MinnesotaCare payment plus the co-payment must be treated as payment in full.
35.30(b) If the medical assistance rate minus any co-payment required under section
35.31256L.03, subdivision 4, is greater than the amount remaining in the enrollee's benefit limit
35.32under section 256L.03, subdivision 3, payment must be the lesser of:
35.33(1) the amount remaining in the enrollee's benefit limit; or
35.34(2) charges submitted for the inpatient hospital services less any co-payment
35.35established under section 256L.03, subdivision 4.
36.1The hospital may seek payment from the enrollee for the amount by which usual and
36.2customary charges exceed the payment under this paragraph. If payment is reduced under
36.3section 256L.03, subdivision 3, paragraph (b), the hospital may not seek payment from the
36.4enrollee for the amount of the reduction.
36.5(c) For admissions occurring on or after July 1, 2011, for single adults and
36.6households without children who are eligible under section 256L.04, subdivision 7, the
36.7commissioner shall pay hospitals directly, up to the medical assistance payment rate,
36.8for inpatient hospital benefits up to the $10,000 annual inpatient benefit limit, minus
36.9any co-payment required under section 256L.03, subdivision 5. Inpatient services paid
36.10directly by the commissioner under this paragraph do not include chemical dependency
36.11hospital-based and residential treatment.
36.12EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
36.13approval, whichever is later. The commissioner of human services shall notify the revisor
36.14of statutes when federal approval is obtained.

36.15    Sec. 55. [256L.121] SERVICE DELIVERY.
36.16    Subdivision 1. Competitive process. The commissioner of human services shall
36.17establish a competitive process for entering into contracts with participating entities for
36.18the offering of standard health plans through MinnesotaCare. Coverage through standard
36.19health plans must be available to enrollees beginning January 1, 2015. Each standard
36.20health plan must cover the health services listed in and meet the requirements of section
36.21256L.03. The competitive process must meet the requirements of section 1331 of the
36.22Affordable Care Act and be designed to ensure enrollee access to high-quality health care
36.23coverage options. The commissioner, to the extent feasible, shall seek to ensure that
36.24enrollees have a choice of coverage from more than one participating entity within a
36.25geographic area. In rural areas other than metropolitan statistical areas, the commissioner
36.26shall use the medical assistance competitive procurement process under section 256B.69,
36.27subdivisions 1 to 32, under which selection of entities is based on criteria related to
36.28provider network access, coordination of health care with other local services, alignment
36.29with local public health goals, and other factors.
36.30    Subd. 2. Other requirements for participating entities. The commissioner shall
36.31require participating entities, as a condition of contract, to document to the commissioner:
36.32(1) the provision of culturally and linguistically appropriate services, including
36.33marketing materials, to MinnesotaCare enrollees; and
36.34(2) the inclusion in provider networks of providers designated as essential
36.35community providers under section 62Q.19.
37.1    Subd. 3. Coordination with state-administered health programs. The
37.2commissioner shall coordinate the administration of the MinnesotaCare program with
37.3medical assistance to maximize efficiency and improve the continuity of care. This
37.4includes, but is not limited to:
37.5(1) establishing geographic areas for MinnesotaCare that are consistent with the
37.6geographic areas of the medical assistance program, within which participating entities
37.7may offer health plans;
37.8(2) requiring, as a condition of participation in MinnesotaCare, participating entities
37.9to also participate in the medical assistance program;
37.10(3) complying with sections 256B.69, subdivision 3a; 256B.692, subdivision 1; and
37.11256B.694, when contracting with MinnesotaCare participating entities;
37.12(4) providing MinnesotaCare enrollees, to the extent possible, with the option to
37.13remain in the same health plan and provider network, if they later become eligible for
37.14medical assistance or coverage through the Minnesota health benefit exchange and if, in
37.15the case of becoming eligible for medical assistance, the enrollee's MinnesotaCare health
37.16plan is also a medical assistance health plan in the enrollee's county of residence; and
37.17(5) establishing requirements and criteria for selection that ensure that covered
37.18health care services will be coordinated with local public health services, social services,
37.19long-term care services, mental health services, and other local services affecting
37.20enrollees' health, access, and quality of care.
37.21EFFECTIVE DATE.This section is effective the day following final enactment.

37.22    Sec. 56. Minnesota Statutes 2012, section 256L.15, subdivision 1, is amended to read:
37.23    Subdivision 1. Premium determination. (a) Families with children and individuals
37.24shall pay a premium determined according to subdivision 2.
37.25    (b) Pregnant women and children under age two are exempt from the provisions
37.26of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
37.27for failure to pay premiums. For pregnant women, this exemption continues until the
37.28first day of the month following the 60th day postpartum. Women who remain enrolled
37.29during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
37.30disenrolled on the first of the month following the 60th day postpartum for the penalty
37.31period that otherwise applies under section 256L.06, unless they begin paying premiums.
37.32    (c) (b) Members of the military and their families who meet the eligibility criteria
37.33for MinnesotaCare upon eligibility approval made within 24 months following the end
37.34of the member's tour of active duty shall have their premiums paid by the commissioner.
37.35The effective date of coverage for an individual or family who meets the criteria of this
38.1paragraph shall be the first day of the month following the month in which eligibility is
38.2approved. This exemption applies for 12 months.
38.3(d) (c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and
38.4their families shall have their premiums waived by the commissioner in accordance with
38.5section 5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5.
38.6An individual must document status as an American Indian, as defined under Code of
38.7Federal Regulations, title 42, section 447.50, to qualify for the waiver of premiums.
38.8EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
38.9approval, whichever is later. The commissioner of human services shall notify the revisor
38.10of statutes when federal approval is obtained.

38.11    Sec. 57. Minnesota Statutes 2012, section 256L.15, subdivision 2, is amended to read:
38.12    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The
38.13commissioner shall establish a sliding fee scale to determine the percentage of monthly
38.14gross individual or family income that households at different income levels must pay to
38.15obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
38.16on the enrollee's monthly gross individual or family income. The sliding fee scale must
38.17contain separate tables based on enrollment of one, two, or three or more persons. Until
38.18June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
38.19individual or family income for individuals or families with incomes below the limits for
38.20the medical assistance program for families and children in effect on January 1, 1999, and
38.21proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
38.228.8 percent. These percentages are matched to evenly spaced income steps ranging from
38.23the medical assistance income limit for families and children in effect on January 1, 1999,
38.24to 275 percent of the federal poverty guidelines for the applicable family size, up to a
38.25family size of five. The sliding fee scale for a family of five must be used for families of
38.26more than five. The sliding fee scale and percentages are not subject to the provisions of
38.27chapter 14. If a family or individual reports increased income after enrollment, premiums
38.28shall be adjusted at the time the change in income is reported.
38.29    (b) Children in families whose gross income is above 275 percent of the federal
38.30poverty guidelines shall pay the maximum premium. The maximum premium is defined
38.31as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
38.32cases paid the maximum premium, the total revenue would equal the total cost of
38.33MinnesotaCare medical coverage and administration. In this calculation, administrative
38.34costs shall be assumed to equal ten percent of the total. The costs of medical coverage
38.35for pregnant women and children under age two and the enrollees in these groups shall
39.1be excluded from the total. The maximum premium for two enrollees shall be twice the
39.2maximum premium for one, and the maximum premium for three or more enrollees shall
39.3be three times the maximum premium for one.
39.4    (c) (b) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums
39.5according to the premium scale specified in paragraph (d) (c) with the exception that
39.6children in families with income at or below 200 percent of the federal poverty guidelines
39.7shall pay no premiums. For purposes of paragraph (d) (c), "minimum" means a monthly
39.8premium of $4.
39.9    (d) (c) The following premium scale is established for individuals and families with
39.10gross family incomes of 275 200 percent of the federal poverty guidelines or less:

39.11	Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
39.12	0-45%	minimum
39.13 39.14	46-54%	$4 or 1.1% of family income, whichever is greater
39.15	55-81%	1.6%
39.16	82-109%	2.2%
39.17	110-136%	2.9%
39.18	137-164%	3.6%
39.19 39.20	165-191 165-200%	4.6%
39.21	192-219%	5.6%
39.22	220-248%	6.5%
39.23	249-275%	7.2%

39.24EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
39.25approval, whichever is later. The commissioner of human services shall notify the revisor
39.26of statutes when federal approval is obtained.

39.27    Sec. 58. DETERMINATION OF FUNDING ADEQUACY.
39.28The commissioners of revenue and management and budget, in consultation with
39.29the commissioner of human services, shall conduct an assessment of health care taxes,
39.30including the gross premiums tax, the provider tax, and Medicaid surcharges, and their
39.31relationship to the long-term solvency of the health care access fund, as part of the state
39.32revenue and expenditure forecast in November 2013. The commissioners shall determine
39.33the amount of state funding that will be required after December 31, 2019, in addition to
39.34the federal payments made available under section 1331 of the Affordable Care Act, for
39.35the MinnesotaCare program. The commissioners shall evaluate the stability and likelihood
39.36of long-term federal funding for the MinnesotaCare program under section 1331. The
39.37commissioners shall report the results of this assessment to the legislature by January 15,
40.12014, along with recommendations for changes to state revenue for the health care access
40.2fund, if state funding will continue to be required beyond December 31, 2019.

40.3    Sec. 59. STATE-BASED RISK ADJUSTMENT SYSTEM ASSESSMENT.
40.4(a) The commissioners of health, human services, and commerce, and the board of
40.5MNsure, shall study whether Minnesota-based risk adjustment of the individual and small
40.6group insurance market, using either the federal risk adjustment model or a state-based
40.7alternative, can be more cost-effective and perform better than risk adjustment conducted
40.8by federal agencies. The study shall assess the policies, infrastructure, and resources
40.9necessary to satisfy the requirements of Code of Federal Regulations, title 45, section
40.10153, subpart D. The study shall also evaluate the extent to which Minnesota-based risk
40.11adjustment could meet requirements established in Code of Federal Regulations, title
40.1245, section 153.330, including:
40.13(1) explaining the variation in health care costs of a given population;
40.14(2) linking risk factors to daily clinical practices and that which is clinically
40.15meaningful to providers;
40.16(3) encouraging favorable behavior among health care market participants and
40.17discouraging unfavorable behavior;
40.18(4) whether risk adjustment factors are relatively easy for stakeholders to understand
40.19and participate in;
40.20(5) providing stable risk scores over time and across health plan products;
40.21(6) minimizing administrative costs;
40.22(7) accounting for risk selection across metal levels;
40.23(8) aligning each of the elements of the methodology; and
40.24(9) can be conducted at a per-member cost equal to or lower than the projected
40.25cost of the federal risk adjustment model.
40.26(b) In conducting the study, and notwithstanding Minnesota Rules, chapter 4653,
40.27and as part of responsibilities under Minnesota Statutes, section 62U.04, subdivision
40.284, paragraph (b), the commissioner of health shall collect from health carriers in the
40.29individual and small group health insurance market, beginning on January 1, 2014, and for
40.30service dates in calendar year 2014, all data required for conducting risk adjustment with
40.31standard risk adjusters such as the Adjusted Clinical Groups or the Hierarchical Condition
40.32Category System, including but not limited to:
40.33(1) an indicator identifying the health plan product under which an enrollee is covered;
40.34(2) an indicator identifying whether an enrollee's policy is an individual or small
40.35group market policy;
41.1(3) an indicator identifying, if applicable, the metal level of an enrollee's health plan
41.2product, and whether the policy is a catastrophic policy; and
41.3(4) additional identified demographic data necessary to link individuals' data across
41.4carriers and insurance affordability programs with 95 percent accuracy. The commissioner
41.5shall not collect more than the last four digits of an individual's social security number.
41.6(c) The commissioner of health shall also asses the extent to which data collected
41.7under paragraph (b) and under Minnesota Statutes, section 62U.04, subdivision 4,
41.8paragraph (a), are sufficient for developing and operating a state alternative risk adjustment
41.9methodology consistent with applicable federal rules by evaluating:
41.10(1) if the data submitted are adequately complete, accurate, and timely;
41.11(2) if the data should be further enriched by nontraditional risk adjusters that help
41.12in better explaining variation in health care costs of a given population and account for
41.13risk selection across metal levels;
41.14(3) whether additional data or identifiers have the potential to strengthen a
41.15Minnesota-based risk adjustment approach; and
41.16(4) what if any changes to the technical infrastructure will be necessary to effectively
41.17perform state-based risk adjustment.
41.18For purposes of this paragraph, the commissioner of health shall have the authority to
41.19use identified data to validate and audit a statistically valid sample of data for each
41.20health carrier in the individual and small group market. In conducting the study, the
41.21commissioners shall contract with entities that do not have an economic interest in the
41.22outcome of Minnesota-based risk adjustment but do have demonstrated expertise in
41.23actuarial science or health economics and demonstrated experience with designing and
41.24implementing risk adjustment models.
41.25(d) The commissioner of human services shall evaluate opportunities to maximize
41.26federal funding under section 1331 of the federal Patient and Protection and Affordable
41.27Care Act, Public Law 111-148, and further defined through amendments to the act and
41.28regulations issued under the act. The commissioner of human services shall make
41.29recommendations on risk adjustment strategies to maximize federal funding to the state
41.30of Minnesota.
41.31(e) The commissioners and board of MNsure shall submit to the legislature by March
41.3215, 2014, an interim report with preliminary findings from the assessment conducted in
41.33paragraphs (c) and (d). The interim report shall include legislative recommendations
41.34for any necessary changes to Minnesota Statutes, section 62Q.03. A final report shall
41.35be submitted by the commissioners and board of MNsure to the legislature by October
42.11, 2015. The final report must include findings from the overall assessment and a
42.2recommendation whether to conduct state-based risk adjustment.
42.3(f) For purposes of this section, the board of MNsure means the board established
42.4under Minnesota Statutes, section 62V.03.

42.5    Sec. 60. REQUEST FOR FEDERAL AUTHORITY.
42.6The commissioner of human services shall seek authority from the federal Centers
42.7for Medicare and Medicaid Services to allow persons under age 65, participating in
42.8a home and community-based services waiver under section 1915(c) of the Social
42.9Security Act, to continue to disregard spousal income and assets, in place of the spousal
42.10impoverishment provisions under the federal Patient Protection and Affordable Care Act,
42.11Public Law 111-148, section 2404, as amended by the federal Health Care and Education
42.12Reconciliation Act of 2010, Public Law 111-152, and any amendments to, or regulations
42.13and guidance issued under, those acts.

42.14    Sec. 61. REVISOR'S INSTRUCTION.
42.15The revisor shall remove cross-references to the sections repealed in this article
42.16wherever they appear in Minnesota Statutes and Minnesota Rules and make changes
42.17necessary to correct the punctuation, grammar, or structure of the remaining text and
42.18preserve its meaning.

42.19    Sec. 62. REPEALER.
42.20(a) Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.031; 256L.04,
42.21subdivisions 1b, 9, and 10a; 256L.05, subdivision 3b; 256L.07, subdivisions 5, 8, and 9;
42.22256L.11, subdivision 5; and 256L.17, subdivisions 1, 2, 3, 4, and 5, are repealed effective
42.23January 1, 2014.
42.24(b) Minnesota Statutes 2012, section 256L.12, is repealed effective January 1, 2015.
42.25(c) Minnesota Statutes 2012, sections 256B.055, subdivisions 3, 5, and 10b;
42.26256B.056, subdivision 5b; and 256B.057, subdivisions 1c and 2, are repealed effective
42.27January 1, 2014.


42.30    Section 1. Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:
42.31    Subd. 4. Resident assessment schedule. (a) A facility must conduct and
42.32electronically submit to the commissioner of health case mix assessments that conform
43.1with the assessment schedule defined by Code of Federal Regulations, title 42, section
43.2483.20, and published by the United States Department of Health and Human Services,
43.3Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
43.4Instrument User's Manual, version 3.0, and subsequent updates when issued by the
43.5Centers for Medicare and Medicaid Services. The commissioner of health may substitute
43.6successor manuals or question and answer documents published by the United States
43.7Department of Health and Human Services, Centers for Medicare and Medicaid Services,
43.8to replace or supplement the current version of the manual or document.
43.9(b) The assessments used to determine a case mix classification for reimbursement
43.10include the following:
43.11(1) a new admission assessment must be completed by day 14 following admission;
43.12(2) an annual assessment which must have an assessment reference date (ARD)
43.13within 366 days of the ARD of the last comprehensive assessment;
43.14(3) a significant change assessment must be completed within 14 days of the
43.15identification of a significant change; and
43.16(4) all quarterly assessments must have an assessment reference date (ARD) within
43.1792 days of the ARD of the previous assessment.
43.18(c) In addition to the assessments listed in paragraph (b), the assessments used to
43.19determine nursing facility level of care include the following:
43.20(1) preadmission screening completed under section 256B.0911, subdivision 4a, by a
43.21county, tribe, or managed care organization under contract with the Department of Human
43.22Services 256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line
43.23or other organization under contract with the Minnesota Board on Aging; and
43.24(2) a nursing facility level of care determination as provided for under section
43.25256B.0911, subdivision 4e, as part of a face-to-face long-term care consultation assessment
43.26completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
43.27managed care organization under contract with the Department of Human Services.

43.28    Sec. 2. Minnesota Statutes 2012, section 144A.351, is amended to read:
43.29144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS:
43.30REPORT AND STUDY REQUIRED.
43.31    Subdivision 1. Report requirements. The commissioners of health and human
43.32services, with the cooperation of counties and in consultation with stakeholders, including
43.33persons who need or are using long-term care services and supports, lead agencies,
43.34regional entities, senior, disability, and mental health organization representatives, service
43.35providers, and community members shall prepare a report to the legislature by August 15,
44.12013, and biennially thereafter, regarding the status of the full range of long-term care
44.2services and supports for the elderly and children and adults with disabilities and mental
44.3illnesses in Minnesota. The report shall address:
44.4    (1) demographics and need for long-term care services and supports in Minnesota;
44.5    (2) summary of county and regional reports on long-term care gaps, surpluses,
44.6imbalances, and corrective action plans;
44.7    (3) status of long-term care services and related mental health services, housing
44.8options, and supports by county and region including:
44.9    (i) changes in availability of the range of long-term care services and housing options;
44.10    (ii) access problems, including access to the least restrictive and most integrated
44.11services and settings, regarding long-term care services; and
44.12    (iii) comparative measures of long-term care services availability, including serving
44.13people in their home areas near family, and changes over time; and
44.14    (4) recommendations regarding goals for the future of long-term care services and
44.15supports, policy and fiscal changes, and resource development and transition needs.
44.16    Subd. 2. Critical access study. The commissioner shall conduct a onetime study to
44.17assess local capacity and availability of home and community-based services for older
44.18adults, people with disabilities, and people with mental illnesses. The study must assess
44.19critical access at the community level and identify potential strategies to build home and
44.20community-based service capacity in critical access areas. The report shall be submitted
44.21to the legislature no later than August 15, 2015.

44.22    Sec. 3. Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:
44.23    Subd. 4a. City, county, and state social workers. (a) Beginning July 1, 2016, the
44.24licensure of city, county, and state agency social workers is voluntary, except an individual
44.25who is newly employed by a city or state agency after July 1, 2016, must be licensed
44.26if the individual who provides social work services, as those services are defined in
44.27section 148E.010, subdivision 11, paragraph (b), is presented to the public by any title
44.28incorporating the words "social work" or "social worker."
44.29(b) City, county, and state agencies employing social workers and staff who are
44.30designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
44.31256.01, subdivision 24, are not required to employ licensed social workers.

44.32    Sec. 4. Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:
45.1    Subd. 2. Specific powers. Subject to the provisions of section 241.021, subdivision
45.22 , the commissioner of human services shall carry out the specific duties in paragraphs (a)
45.3through (cc) (dd):
45.4    (a) Administer and supervise all forms of public assistance provided for by state law
45.5and other welfare activities or services as are vested in the commissioner. Administration
45.6and supervision of human services activities or services includes, but is not limited to,
45.7assuring timely and accurate distribution of benefits, completeness of service, and quality
45.8program management. In addition to administering and supervising human services
45.9activities vested by law in the department, the commissioner shall have the authority to:
45.10    (1) require county agency participation in training and technical assistance programs
45.11to promote compliance with statutes, rules, federal laws, regulations, and policies
45.12governing human services;
45.13    (2) monitor, on an ongoing basis, the performance of county agencies in the
45.14operation and administration of human services, enforce compliance with statutes, rules,
45.15federal laws, regulations, and policies governing welfare services and promote excellence
45.16of administration and program operation;
45.17    (3) develop a quality control program or other monitoring program to review county
45.18performance and accuracy of benefit determinations;
45.19    (4) require county agencies to make an adjustment to the public assistance benefits
45.20issued to any individual consistent with federal law and regulation and state law and rule
45.21and to issue or recover benefits as appropriate;
45.22    (5) delay or deny payment of all or part of the state and federal share of benefits and
45.23administrative reimbursement according to the procedures set forth in section 256.017;
45.24    (6) make contracts with and grants to public and private agencies and organizations,
45.25both profit and nonprofit, and individuals, using appropriated funds; and
45.26    (7) enter into contractual agreements with federally recognized Indian tribes with
45.27a reservation in Minnesota to the extent necessary for the tribe to operate a federally
45.28approved family assistance program or any other program under the supervision of the
45.29commissioner. The commissioner shall consult with the affected county or counties in
45.30the contractual agreement negotiations, if the county or counties wish to be included,
45.31in order to avoid the duplication of county and tribal assistance program services. The
45.32commissioner may establish necessary accounts for the purposes of receiving and
45.33disbursing funds as necessary for the operation of the programs.
45.34    (b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
45.35regulation, and policy necessary to county agency administration of the programs.
46.1    (c) Administer and supervise all child welfare activities; promote the enforcement of
46.2laws protecting disabled, dependent, neglected and delinquent children, and children born
46.3to mothers who were not married to the children's fathers at the times of the conception
46.4nor at the births of the children; license and supervise child-caring and child-placing
46.5agencies and institutions; supervise the care of children in boarding and foster homes or
46.6in private institutions; and generally perform all functions relating to the field of child
46.7welfare now vested in the State Board of Control.
46.8    (d) Administer and supervise all noninstitutional service to disabled persons,
46.9including those who are visually impaired, hearing impaired, or physically impaired
46.10or otherwise disabled. The commissioner may provide and contract for the care and
46.11treatment of qualified indigent children in facilities other than those located and available
46.12at state hospitals when it is not feasible to provide the service in state hospitals.
46.13    (e) Assist and actively cooperate with other departments, agencies and institutions,
46.14local, state, and federal, by performing services in conformity with the purposes of Laws
46.151939, chapter 431.
46.16    (f) Act as the agent of and cooperate with the federal government in matters of
46.17mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
46.18431, including the administration of any federal funds granted to the state to aid in the
46.19performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
46.20and including the promulgation of rules making uniformly available medical care benefits
46.21to all recipients of public assistance, at such times as the federal government increases its
46.22participation in assistance expenditures for medical care to recipients of public assistance,
46.23the cost thereof to be borne in the same proportion as are grants of aid to said recipients.
46.24    (g) Establish and maintain any administrative units reasonably necessary for the
46.25performance of administrative functions common to all divisions of the department.
46.26    (h) Act as designated guardian of both the estate and the person of all the wards of
46.27the state of Minnesota, whether by operation of law or by an order of court, without any
46.28further act or proceeding whatever, except as to persons committed as developmentally
46.29disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
46.30recognized by the Secretary of the Interior whose interests would be best served by
46.31adoptive placement, the commissioner may contract with a licensed child-placing agency
46.32or a Minnesota tribal social services agency to provide adoption services. A contract
46.33with a licensed child-placing agency must be designed to supplement existing county
46.34efforts and may not replace existing county programs or tribal social services, unless the
46.35replacement is agreed to by the county board and the appropriate exclusive bargaining
46.36representative, tribal governing body, or the commissioner has evidence that child
47.1placements of the county continue to be substantially below that of other counties. Funds
47.2encumbered and obligated under an agreement for a specific child shall remain available
47.3until the terms of the agreement are fulfilled or the agreement is terminated.
47.4    (i) Act as coordinating referral and informational center on requests for service for
47.5newly arrived immigrants coming to Minnesota.
47.6    (j) The specific enumeration of powers and duties as hereinabove set forth shall in no
47.7way be construed to be a limitation upon the general transfer of powers herein contained.
47.8    (k) Establish county, regional, or statewide schedules of maximum fees and charges
47.9which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
47.10nursing home care and medicine and medical supplies under all programs of medical
47.11care provided by the state and for congregate living care under the income maintenance
47.12programs.
47.13    (l) Have the authority to conduct and administer experimental projects to test methods
47.14and procedures of administering assistance and services to recipients or potential recipients
47.15of public welfare. To carry out such experimental projects, it is further provided that the
47.16commissioner of human services is authorized to waive the enforcement of existing specific
47.17statutory program requirements, rules, and standards in one or more counties. The order
47.18establishing the waiver shall provide alternative methods and procedures of administration,
47.19shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and
47.20in no event shall the duration of a project exceed four years. It is further provided that no
47.21order establishing an experimental project as authorized by the provisions of this section
47.22shall become effective until the following conditions have been met:
47.23    (1) the secretary of health and human services of the United States has agreed, for
47.24the same project, to waive state plan requirements relative to statewide uniformity; and
47.25    (2) a comprehensive plan, including estimated project costs, shall be approved by
47.26the Legislative Advisory Commission and filed with the commissioner of administration.
47.27    (m) According to federal requirements, establish procedures to be followed by
47.28local welfare boards in creating citizen advisory committees, including procedures for
47.29selection of committee members.
47.30    (n) Allocate federal fiscal disallowances or sanctions which are based on quality
47.31control error rates for the aid to families with dependent children program formerly
47.32codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
47.33following manner:
47.34    (1) one-half of the total amount of the disallowance shall be borne by the county
47.35boards responsible for administering the programs. For the medical assistance and the
47.36AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
48.1shared by each county board in the same proportion as that county's expenditures for the
48.2sanctioned program are to the total of all counties' expenditures for the AFDC program
48.3formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
48.4food stamp program, sanctions shall be shared by each county board, with 50 percent of
48.5the sanction being distributed to each county in the same proportion as that county's
48.6administrative costs for food stamps are to the total of all food stamp administrative costs
48.7for all counties, and 50 percent of the sanctions being distributed to each county in the
48.8same proportion as that county's value of food stamp benefits issued are to the total of
48.9all benefits issued for all counties. Each county shall pay its share of the disallowance
48.10to the state of Minnesota. When a county fails to pay the amount due hereunder, the
48.11commissioner may deduct the amount from reimbursement otherwise due the county, or
48.12the attorney general, upon the request of the commissioner, may institute civil action
48.13to recover the amount due; and
48.14    (2) notwithstanding the provisions of clause (1), if the disallowance results from
48.15knowing noncompliance by one or more counties with a specific program instruction, and
48.16that knowing noncompliance is a matter of official county board record, the commissioner
48.17may require payment or recover from the county or counties, in the manner prescribed in
48.18clause (1), an amount equal to the portion of the total disallowance which resulted from the
48.19noncompliance, and may distribute the balance of the disallowance according to clause (1).
48.20    (o) Develop and implement special projects that maximize reimbursements and
48.21result in the recovery of money to the state. For the purpose of recovering state money,
48.22the commissioner may enter into contracts with third parties. Any recoveries that result
48.23from projects or contracts entered into under this paragraph shall be deposited in the
48.24state treasury and credited to a special account until the balance in the account reaches
48.25$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
48.26transferred and credited to the general fund. All money in the account is appropriated to
48.27the commissioner for the purposes of this paragraph.
48.28    (p) Have the authority to make direct payments to facilities providing shelter
48.29to women and their children according to section 256D.05, subdivision 3. Upon
48.30the written request of a shelter facility that has been denied payments under section
48.31256D.05, subdivision 3 , the commissioner shall review all relevant evidence and make
48.32a determination within 30 days of the request for review regarding issuance of direct
48.33payments to the shelter facility. Failure to act within 30 days shall be considered a
48.34determination not to issue direct payments.
48.35    (q) Have the authority to establish and enforce the following county reporting
48.36requirements:
49.1    (1) the commissioner shall establish fiscal and statistical reporting requirements
49.2necessary to account for the expenditure of funds allocated to counties for human
49.3services programs. When establishing financial and statistical reporting requirements, the
49.4commissioner shall evaluate all reports, in consultation with the counties, to determine if
49.5the reports can be simplified or the number of reports can be reduced;
49.6    (2) the county board shall submit monthly or quarterly reports to the department
49.7as required by the commissioner. Monthly reports are due no later than 15 working days
49.8after the end of the month. Quarterly reports are due no later than 30 calendar days after
49.9the end of the quarter, unless the commissioner determines that the deadline must be
49.10shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
49.11or risking a loss of federal funding. Only reports that are complete, legible, and in the
49.12required format shall be accepted by the commissioner;
49.13    (3) if the required reports are not received by the deadlines established in clause (2),
49.14the commissioner may delay payments and withhold funds from the county board until
49.15the next reporting period. When the report is needed to account for the use of federal
49.16funds and the late report results in a reduction in federal funding, the commissioner shall
49.17withhold from the county boards with late reports an amount equal to the reduction in
49.18federal funding until full federal funding is received;
49.19    (4) a county board that submits reports that are late, illegible, incomplete, or not
49.20in the required format for two out of three consecutive reporting periods is considered
49.21noncompliant. When a county board is found to be noncompliant, the commissioner
49.22shall notify the county board of the reason the county board is considered noncompliant
49.23and request that the county board develop a corrective action plan stating how the
49.24county board plans to correct the problem. The corrective action plan must be submitted
49.25to the commissioner within 45 days after the date the county board received notice
49.26of noncompliance;
49.27    (5) the final deadline for fiscal reports or amendments to fiscal reports is one year
49.28after the date the report was originally due. If the commissioner does not receive a report
49.29by the final deadline, the county board forfeits the funding associated with the report for
49.30that reporting period and the county board must repay any funds associated with the
49.31report received for that reporting period;
49.32    (6) the commissioner may not delay payments, withhold funds, or require repayment
49.33under clause (3) or (5) if the county demonstrates that the commissioner failed to
49.34provide appropriate forms, guidelines, and technical assistance to enable the county to
49.35comply with the requirements. If the county board disagrees with an action taken by the
50.1commissioner under clause (3) or (5), the county board may appeal the action according
50.2to sections 14.57 to 14.69; and
50.3    (7) counties subject to withholding of funds under clause (3) or forfeiture or
50.4repayment of funds under clause (5) shall not reduce or withhold benefits or services to
50.5clients to cover costs incurred due to actions taken by the commissioner under clause
50.6(3) or (5).
50.7    (r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
50.8federal fiscal disallowances or sanctions are based on a statewide random sample in direct
50.9proportion to each county's claim for that period.
50.10    (s) Be responsible for ensuring the detection, prevention, investigation, and
50.11resolution of fraudulent activities or behavior by applicants, recipients, and other
50.12participants in the human services programs administered by the department.
50.13    (t) Require county agencies to identify overpayments, establish claims, and utilize
50.14all available and cost-beneficial methodologies to collect and recover these overpayments
50.15in the human services programs administered by the department.
50.16    (u) Have the authority to administer a drug rebate program for drugs purchased
50.17pursuant to the prescription drug program established under section 256.955 after the
50.18beneficiary's satisfaction of any deductible established in the program. The commissioner
50.19shall require a rebate agreement from all manufacturers of covered drugs as defined in
50.20section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
50.21or after July 1, 2002, must include rebates for individuals covered under the prescription
50.22drug program who are under 65 years of age. For each drug, the amount of the rebate shall
50.23be equal to the rebate as defined for purposes of the federal rebate program in United
50.24States Code, title 42, section 1396r-8. The manufacturers must provide full payment
50.25within 30 days of receipt of the state invoice for the rebate within the terms and conditions
50.26used for the federal rebate program established pursuant to section 1927 of title XIX of
50.27the Social Security Act. The manufacturers must provide the commissioner with any
50.28information necessary to verify the rebate determined per drug. The rebate program shall
50.29utilize the terms and conditions used for the federal rebate program established pursuant to
50.30section 1927 of title XIX of the Social Security Act.
50.31    (v) Have the authority to administer the federal drug rebate program for drugs
50.32purchased under the medical assistance program as allowed by section 1927 of title XIX
50.33of the Social Security Act and according to the terms and conditions of section 1927.
50.34Rebates shall be collected for all drugs that have been dispensed or administered in an
50.35outpatient setting and that are from manufacturers who have signed a rebate agreement
50.36with the United States Department of Health and Human Services.
51.1    (w) Have the authority to administer a supplemental drug rebate program for drugs
51.2purchased under the medical assistance program. The commissioner may enter into
51.3supplemental rebate contracts with pharmaceutical manufacturers and may require prior
51.4authorization for drugs that are from manufacturers that have not signed a supplemental
51.5rebate contract. Prior authorization of drugs shall be subject to the provisions of section
51.6256B.0625, subdivision 13 .
51.7    (x) Operate the department's communication systems account established in Laws
51.81993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
51.9communication costs necessary for the operation of the programs the commissioner
51.10supervises. A communications account may also be established for each regional
51.11treatment center which operates communications systems. Each account must be used
51.12to manage shared communication costs necessary for the operations of the programs the
51.13commissioner supervises. The commissioner may distribute the costs of operating and
51.14maintaining communication systems to participants in a manner that reflects actual usage.
51.15Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
51.16other costs as determined by the commissioner. Nonprofit organizations and state, county,
51.17and local government agencies involved in the operation of programs the commissioner
51.18supervises may participate in the use of the department's communications technology and
51.19share in the cost of operation. The commissioner may accept on behalf of the state any
51.20gift, bequest, devise or personal property of any kind, or money tendered to the state for
51.21any lawful purpose pertaining to the communication activities of the department. Any
51.22money received for this purpose must be deposited in the department's communication
51.23systems accounts. Money collected by the commissioner for the use of communication
51.24systems must be deposited in the state communication systems account and is appropriated
51.25to the commissioner for purposes of this section.
51.26    (y) Receive any federal matching money that is made available through the medical
51.27assistance program for the consumer satisfaction survey. Any federal money received for
51.28the survey is appropriated to the commissioner for this purpose. The commissioner may
51.29expend the federal money received for the consumer satisfaction survey in either year of
51.30the biennium.
51.31    (z) Designate community information and referral call centers and incorporate
51.32cost reimbursement claims from the designated community information and referral
51.33call centers into the federal cost reimbursement claiming processes of the department
51.34according to federal law, rule, and regulations. Existing information and referral centers
51.35provided by Greater Twin Cities United Way or existing call centers for which Greater
51.36Twin Cities United Way has legal authority to represent, shall be included in these
52.1designations upon review by the commissioner and assurance that these services are
52.2accredited and in compliance with national standards. Any reimbursement is appropriated
52.3to the commissioner and all designated information and referral centers shall receive
52.4payments according to normal department schedules established by the commissioner
52.5upon final approval of allocation methodologies from the United States Department of
52.6Health and Human Services Division of Cost Allocation or other appropriate authorities.
52.7    (aa) Develop recommended standards for foster care homes that address the
52.8components of specialized therapeutic services to be provided by foster care homes with
52.9those services.
52.10    (bb) Authorize the method of payment to or from the department as part of the
52.11human services programs administered by the department. This authorization includes the
52.12receipt or disbursement of funds held by the department in a fiduciary capacity as part of
52.13the human services programs administered by the department.
52.14    (cc) Have the authority to administer a drug rebate program for drugs purchased for
52.15persons eligible for general assistance medical care under section 256D.03, subdivision 3.
52.16For manufacturers that agree to participate in the general assistance medical care rebate
52.17program, the commissioner shall enter into a rebate agreement for covered drugs as
52.18defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
52.19rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
52.20United States Code, title 42, section 1396r-8. The manufacturers must provide payment
52.21within the terms and conditions used for the federal rebate program established under
52.22section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
52.23the terms and conditions used for the federal rebate program established under section
52.241927 of title XIX of the Social Security Act.
52.25    Effective January 1, 2006, drug coverage under general assistance medical care shall
52.26be limited to those prescription drugs that:
52.27    (1) are covered under the medical assistance program as described in section
52.28256B.0625, subdivisions 13 and 13d ; and
52.29    (2) are provided by manufacturers that have fully executed general assistance
52.30medical care rebate agreements with the commissioner and comply with such agreements.
52.31Prescription drug coverage under general assistance medical care shall conform to
52.32coverage under the medical assistance program according to section 256B.0625,
52.33subdivisions 13 to 13g .
52.34    The rebate revenues collected under the drug rebate program are deposited in the
52.35general fund.
53.1(dd) Designate the agencies that operate the Senior LinkAge Line under section
53.2256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state
53.3of Minnesota Aging and the Disability Resource Centers under United States Code, title
53.442, section 3001, the Older Americans Act Amendments of 2006 and incorporate cost
53.5reimbursement claims from the designated centers into the federal cost reimbursement
53.6claiming processes of the department according to federal law, rule, and regulations. Any
53.7reimbursement must be appropriated to the commissioner and all Aging and Disability
53.8Resource Center designated agencies shall receive payments of grant funding that supports
53.9the activity and generates the federal financial participation according to Board on Aging
53.10administrative granting mechanisms.

53.11    Sec. 5. Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:
53.12    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability
53.13Linkage Line, to who shall serve people with disabilities as the designated Aging and
53.14Disability Resource Center under United States Code, title 42, section 3001, the Older
53.15Americans Act Amendments of 2006 in partnership with the Senior LinkAge Line and
53.16shall serve as Minnesota's neutral access point for statewide disability information and
53.17assistance and must be available during business hours through a statewide toll-free
53.18number and the internet. The Disability Linkage Line shall:
53.19(1) deliver information and assistance based on national and state standards;
53.20    (2) provide information about state and federal eligibility requirements, benefits,
53.21and service options;
53.22(3) provide benefits and options counseling;
53.23    (4) make referrals to appropriate support entities;
53.24    (5) educate people on their options so they can make well-informed choices and link
53.25them to quality profiles;
53.26    (6) help support the timely resolution of service access and benefit issues;
53.27(7) inform people of their long-term community services and supports;
53.28(8) provide necessary resources and supports that can lead to employment and
53.29increased economic stability of people with disabilities; and
53.30(9) serve as the technical assistance and help center for the Web-based tool,
53.31Minnesota's Disability Benefits 101.org.; and
53.32(10) provide preadmission screening for individuals under 60 years of age using
53.33the procedures as defined in section 256.975, subdivisions 7a to 7c, and 256B.0911,
53.34subdivision 4d.

54.1    Sec. 6. Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:
54.2    Subd. 7. Consumer information and assistance and long-term care options
54.3counseling; Senior LinkAge Line. (a) The Minnesota Board on Aging shall operate a
54.4statewide service to aid older Minnesotans and their families in making informed choices
54.5about long-term care options and health care benefits. Language services to persons
54.6with limited English language skills may be made available. The service, known as
54.7Senior LinkAge Line, shall serve older adults as the designated Aging and Disability
54.8Resource Center under United States Code, title 42, section 3001, the Older Americans
54.9Act Amendments of 2006 in partnership with the Disability LinkAge Line under section
54.10256.01, subdivision 24, and must be available during business hours through a statewide
54.11toll-free number and must also be available through the Internet. The Minnesota Board
54.12on Aging shall consult with, and when appropriate work through, the area agencies on
54.13aging counties, and other entities that serve aging and disabled populations of all ages,
54.14to provide and maintain the telephone infrastructure and related support for the Aging
54.15and Disability Resource Center partners which agree by memorandum to access the
54.16infrastructure, including the designated providers of the Senior LinkAge Line and the
54.17Disability Linkage Line.
54.18    (b) The service must provide long-term care options counseling by assisting older
54.19adults, caregivers, and providers in accessing information and options counseling about
54.20choices in long-term care services that are purchased through private providers or available
54.21through public options. The service must:
54.22    (1) develop and provide for regular updating of a comprehensive database that
54.23includes detailed listings in both consumer- and provider-oriented formats that can provide
54.24search results down to the neighborhood level;
54.25    (2) make the database accessible on the Internet and through other telecommunication
54.26and media-related tools;
54.27    (3) link callers to interactive long-term care screening tools and make these tools
54.28available through the Internet by integrating the tools with the database;
54.29    (4) develop community education materials with a focus on planning for long-term
54.30care and evaluating independent living, housing, and service options;
54.31    (5) conduct an outreach campaign to assist older adults and their caregivers in
54.32finding information on the Internet and through other means of communication;
54.33    (6) implement a messaging system for overflow callers and respond to these callers
54.34by the next business day;
54.35    (7) link callers with county human services and other providers to receive more
54.36in-depth assistance and consultation related to long-term care options;
55.1    (8) link callers with quality profiles for nursing facilities and other home and
55.2community-based services providers developed by the commissioner commissioners of
55.3health and human services;
55.4(9) develop an outreach plan to seniors and their caregivers with a particular focus
55.5on establishing a clear presence in places that seniors recognize and:
55.6(i) place a significant emphasis on improved outreach and service to seniors and
55.7their caregivers by establishing annual plans by neighborhood, city, and county, as
55.8necessary, to address the unique needs of geographic areas in the state where there are
55.9dense populations of seniors;
55.10(ii) establish an efficient workforce management approach and assign community
55.11living specialist staff and volunteers to geographic areas as well as aging and disability
55.12resource center sites so that seniors and their caregivers and professionals recognize the
55.13Senior LinkAge Line as the place to call for aging services and information;
55.14(iii) recognize the size and complexity of the metropolitan area service system by
55.15working with metropolitan counties to establish a clear partnership with them, including
55.16seeking county advice on the establishment of local aging and disabilities resource center
55.17sites; and
55.18(iv) maintain dashboards with metrics that demonstrate how the service is expanding
55.19and extending or enhancing its outreach efforts in dispersed or hard to reach locations in
55.20varied population centers;
55.21    (9) (10) incorporate information about the availability of housing options, as well
55.22as registered housing with services and consumer rights within the MinnesotaHelp.info
55.23network long-term care database to facilitate consumer comparison of services and costs
55.24among housing with services establishments and with other in-home services and to
55.25support financial self-sufficiency as long as possible. Housing with services establishments
55.26and their arranged home care providers shall provide information that will facilitate price
55.27comparisons, including delineation of charges for rent and for services available. The
55.28commissioners of health and human services shall align the data elements required by
55.29section 144G.06, the Uniform Consumer Information Guide, and this section to provide
55.30consumers standardized information and ease of comparison of long-term care options.
55.31The commissioner of human services shall provide the data to the Minnesota Board on
55.32Aging for inclusion in the MinnesotaHelp.info network long-term care database;
55.33(10) (11) provide long-term care options counseling. Long-term care options
55.34counselors shall:
55.35(i) for individuals not eligible for case management under a public program or public
55.36funding source, provide interactive decision support under which consumers, family
56.1members, or other helpers are supported in their deliberations to determine appropriate
56.2long-term care choices in the context of the consumer's needs, preferences, values, and
56.3individual circumstances, including implementing a community support plan;
56.4(ii) provide Web-based educational information and collateral written materials to
56.5familiarize consumers, family members, or other helpers with the long-term care basics,
56.6issues to be considered, and the range of options available in the community;
56.7(iii) provide long-term care futures planning, which means providing assistance to
56.8individuals who anticipate having long-term care needs to develop a plan for the more
56.9distant future; and
56.10(iv) provide expertise in benefits and financing options for long-term care, including
56.11Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
56.12private pay options, and ways to access low or no-cost services or benefits through
56.13volunteer-based or charitable programs;
56.14(11) (12) using risk management and support planning protocols, provide long-term
56.15care options counseling to current residents of nursing homes deemed appropriate for
56.16discharge by the commissioner and older adults who request service after consultation
56.17with the Senior LinkAge Line under clause (12). In order to meet this requirement, The
56.18Senior LinkAge Line shall also receive referrals from the residents or staff of nursing
56.19homes. The Senior LinkAge Line shall identify and contact residents deemed appropriate
56.20for discharge by developing targeting criteria in consultation with the commissioner who
56.21shall provide designated Senior LinkAge Line contact centers with a list of nursing
56.22home residents that meet the criteria as being appropriate for discharge planning via a
56.23secure Web portal. Senior LinkAge Line shall provide these residents, if they indicate a
56.24preference to receive long-term care options counseling, with initial assessment, review of
56.25risk factors, independent living support consultation, or and, if appropriate, a referral to:
56.26(i) long-term care consultation services under section 256B.0911;
56.27(ii) designated care coordinators of contracted entities under section 256B.035 for
56.28persons who are enrolled in a managed care plan; or
56.29(iii) the long-term care consultation team for those who are appropriate eligible
56.30 for relocation service coordination due to high-risk factors or psychological or physical
56.31disability; and
56.32(12) (13) develop referral protocols and processes that will assist certified health
56.33care homes and hospitals to identify at-risk older adults and determine when to refer these
56.34individuals to the Senior LinkAge Line for long-term care options counseling under this
56.35section. The commissioner is directed to work with the commissioner of health to develop
56.36protocols that would comply with the health care home designation criteria and protocols
57.1available at the time of hospital discharge. The commissioner shall keep a record of the
57.2number of people who choose long-term care options counseling as a result of this section.

57.3    Sec. 7. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
57.4to read:
57.5    Subd. 7a. Preadmission screening activities related to nursing facility
57.6admissions. (a) All individuals seeking admission to Medicaid certified nursing facilities,
57.7including certified boarding care facilities, must be screened prior to admission regardless
57.8of income, assets, or funding sources for nursing facility care, except as described in
57.9subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the
57.10need for nursing facility level of care as described in section 256B.0911, subdivision
57.114e, and to complete activities required under federal law related to mental illness and
57.12developmental disability as outlined in paragraph (b).
57.13(b) A person who has a diagnosis or possible diagnosis of mental illness or
57.14developmental disability must receive a preadmission screening before admission
57.15regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify
57.16the need for further evaluation and specialized services, unless the admission prior to
57.17screening is authorized by the local mental health authority or the local developmental
57.18disabilities case manager, or unless authorized by the county agency according to Public
57.19Law 101-508.
57.20(c) The following criteria apply to the preadmission screening:
57.21(1) requests for preadmission screenings must be submitted via an online form
57.22developed by the commissioner;
57.23(2) the Senior LinkAge Line must use forms and criteria developed by the
57.24commissioner to identify persons who require referral for further evaluation and
57.25determination of the need for specialized services; and
57.26(3) the evaluation and determination of the need for specialized services must be
57.27done by:
57.28(i) a qualified independent mental health professional, for persons with a primary or
57.29secondary diagnosis of a serious mental illness; or
57.30(ii) a qualified developmental disability professional, for persons with a primary or
57.31secondary diagnosis of developmental disability. For purposes of this requirement, a
57.32qualified developmental disability professional must meet the standards for a qualified
57.33developmental disability professional under Code of Federal Regulations, title 42, section
57.34483.430.
58.1(d) The local county mental health authority or the state developmental disability
58.2authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
58.3nursing facility if the individual does not meet the nursing facility level of care criteria or
58.4needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
58.5purposes of this section, "specialized services" for a person with developmental disability
58.6means active treatment as that term is defined under Code of Federal Regulations, title
58.742, section 483.440(a)(1).
58.8(e) In assessing a person's needs, the screener shall:
58.9(1) use an automated system designated by the commissioner;
58.10(2) consult with care transitions coordinators or physician; and
58.11(3) consider the assessment of the individual's physician.
58.12Other personnel may be included in the level of care determination as deemed
58.13necessary by the screener.
58.14EFFECTIVE DATE.This section is effective October 1, 2013.

58.15    Sec. 8. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
58.16to read:
58.17    Subd. 7b. Exemptions and emergency admissions. (a) Exemptions from the federal
58.18screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:
58.19(1) a person who, having entered an acute care facility from a certified nursing
58.20facility, is returning to a certified nursing facility; or
58.21(2) a person transferring from one certified nursing facility in Minnesota to another
58.22certified nursing facility in Minnesota.
58.23(b) Persons who are exempt from preadmission screening for purposes of level of
58.24care determination include:
58.25(1) persons described in paragraph (a);
58.26(2) an individual who has a contractual right to have nursing facility care paid for
58.27indefinitely by the Veterans' Administration;
58.28(3) an individual enrolled in a demonstration project under section 256B.69,
58.29subdivision 8, at the time of application to a nursing facility; and
58.30(4) an individual currently being served under the alternative care program or under
58.31a home and community-based services waiver authorized under section 1915(c) of the
58.32federal Social Security Act.
58.33(c) Persons admitted to a Medicaid-certified nursing facility from the community
58.34on an emergency basis as described in paragraph (d) or from an acute care facility on a
58.35nonworking day must be screened the first working day after admission.
59.1(d) Emergency admission to a nursing facility prior to screening is permitted when
59.2all of the following conditions are met:
59.3(1) a person is admitted from the community to a certified nursing or certified
59.4boarding care facility during Senior LinkAge Line nonworking hours for ages 60 and
59.5older and Disability Linkage Line nonworking hours for under age 60;
59.6(2) a physician has determined that delaying admission until preadmission screening
59.7is completed would adversely affect the person's health and safety;
59.8(3) there is a recent precipitating event that precludes the client from living safely in
59.9the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
59.10inability to continue to provide care;
59.11(4) the attending physician has authorized the emergency placement and has
59.12documented the reason that the emergency placement is recommended; and
59.13(5) the Senior LinkAge Line or Disability Linkage Line is contacted on the first
59.14working day following the emergency admission.
59.15Transfer of a patient from an acute care hospital to a nursing facility is not considered
59.16an emergency except for a person who has received hospital services in the following
59.17situations: hospital admission for observation, care in an emergency room without hospital
59.18admission, or following hospital 24-hour bed care and from whom admission is being
59.19sought on a nonworking day.
59.20(e) A nursing facility must provide written information to all persons admitted
59.21regarding the person's right to request and receive long-term care consultation services as
59.22defined in section 256B.0911, subdivision 1a. The information must be provided prior to
59.23the person's discharge from the facility and in a format specified by the commissioner.
59.24EFFECTIVE DATE.This section is effective October 1, 2013.

59.25    Sec. 9. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
59.26to read:
59.27    Subd. 7c. Screening requirements. (a) A person may be screened for nursing
59.28facility admission by telephone or in a face-to-face screening interview. The Senior
59.29LinkAge Line shall identify each individual's needs using the following categories:
59.30(1) the person needs no face-to-face long-term care consultation assessment
59.31completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
59.32managed care organization under contract with the Department of Human Services to
59.33determine the need for nursing facility level of care based on information obtained from
59.34other health care professionals;
60.1(2) the person needs an immediate face-to-face long-term care consultation
60.2assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county,
60.3tribe, or managed care organization under contract with the Department of Human
60.4Services to determine the need for nursing facility level of care and complete activities
60.5required under subdivision 7a; or
60.6(3) the person may be exempt from screening requirements as outlined in subdivision
60.77b, but will need transitional assistance after admission or in-person follow-along after
60.8a return home.
60.9(b) Individuals between the ages of 60 and 64 who are admitted to nursing facilities
60.10with only a telephone screening must receive a face-to-face assessment from the long-term
60.11care consultation team member of the county in which the facility is located or from the
60.12recipient's county case manager within 40 calendar days of admission as described in
60.13section 256B.0911, subdivision 4d, paragraph (c).
60.14(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
60.15facility must be screened prior to admission.
60.16(d) Screenings provided by the Senior LinkAge Line must include processes
60.17to identify persons who may require transition assistance described in subdivision 7,
60.18paragraph (b), clause (12), and section 256B.0911, subdivision 3b.
60.19EFFECTIVE DATE.This section is effective October 1, 2013.

60.20    Sec. 10. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
60.21to read:
60.22    Subd. 7d. Payment for preadmission screening. Funding for preadmission
60.23screening shall be provided to the Minnesota Board on Aging for the population 60
60.24years of age and older by the Department of Human Services to cover screener salaries
60.25and expenses to provide the services described in subdivisions 7a to 7c. The Minnesota
60.26Board on Aging shall employ, or contract with other agencies to employ, within the limits
60.27of available funding, sufficient personnel to provide preadmission screening and level of
60.28care determination services and shall seek to maximize federal funding for the service as
60.29provided under section 256.01, subdivision 2, paragraph (dd).
60.30EFFECTIVE DATE.This section is effective October 1, 2013.

60.31    Sec. 11. Minnesota Statutes 2012, section 256.9754, is amended by adding a
60.32subdivision to read:
61.1    Subd. 3a. Priority for other grants. The commissioner of health shall give priority
61.2to a grantee selected under subdivision 3 when awarding technology-related grants, if the
61.3grantee is using technology as part of the proposal unless that priority conflicts with
61.4existing state or federal guidance related to grant awards by the Department of Health.
61.5The commissioner of transportation shall give priority to a grantee under subdivision 3
61.6when distributing transportation-related funds to create transportation options for older
61.7adults unless that preference conflicts with existing state or federal guidance related to
61.8grant awards by the Department of Transportation.

61.9    Sec. 12. Minnesota Statutes 2012, section 256.9754, is amended by adding a
61.10subdivision to read:
61.11    Subd. 3b. State waivers. The commissioner of health may waive applicable state
61.12laws and rules on a time-limited basis if the commissioner of health determines that a
61.13participating grantee requires a waiver in order to achieve demonstration project goals.

61.14    Sec. 13. Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:
61.15    Subd. 5. Grant preference. The commissioner of human services shall give
61.16preference when awarding grants under this section to areas where nursing facility
61.17closures have occurred or are occurring or areas with service needs identified by section
61.18144A.351. The commissioner may award grants to the extent grant funds are available
61.19and to the extent applications are approved by the commissioner. Denial of approval of an
61.20application in one year does not preclude submission of an application in a subsequent
61.21year. The maximum grant amount is limited to $750,000.

61.22    Sec. 14. Minnesota Statutes 2012, section 256B.021, is amended by adding a
61.23subdivision to read:
61.24    Subd. 4a. Evaluation. The commissioner shall evaluate the projects contained in
61.25subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:
61.26(1) an impact assessment focusing on program outcomes, especially those
61.27experienced directly by the person receiving services;
61.28(2) study samples drawn from the population of interest for each project; and
61.29(3) a time series analysis to examine aggregate trends in average monthly
61.30utilization, expenditures, and other outcomes in the targeted populations before and after
61.31implementation of the initiatives.

62.1    Sec. 15. Minnesota Statutes 2012, section 256B.021, is amended by adding a
62.2subdivision to read:
62.3    Subd. 6. Work, empower, and encourage independence. As provided under
62.4subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a
62.5demonstration project to provide navigation, employment supports, and benefits planning
62.6services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014.
62.7This demonstration shall promote economic stability, increase independence, and reduce
62.8applications for disability benefits while providing a positive impact on the health and
62.9future of participants.

62.10    Sec. 16. Minnesota Statutes 2012, section 256B.021, is amended by adding a
62.11subdivision to read:
62.12    Subd. 7. Housing stabilization. As provided under subdivision 4, paragraph (e),
62.13upon federal approval, the commissioner shall establish a demonstration project to provide
62.14service coordination, outreach, in-reach, tenancy support, and community living assistance
62.15to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This
62.16demonstration shall promote housing stability, reduce costly medical interventions, and
62.17increase opportunities for independent community living.

62.18    Sec. 17. Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:
62.19    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation
62.20services is to assist persons with long-term or chronic care needs in making care
62.21decisions and selecting support and service options that meet their needs and reflect
62.22their preferences. The availability of, and access to, information and other types of
62.23assistance, including assessment and support planning, is also intended to prevent or delay
62.24institutional placements and to provide access to transition assistance after admission.
62.25Further, the goal of these services is to contain costs associated with unnecessary
62.26institutional admissions. Long-term consultation services must be available to any person
62.27regardless of public program eligibility. The commissioner of human services shall seek
62.28to maximize use of available federal and state funds and establish the broadest program
62.29possible within the funding available.
62.30(b) These services must be coordinated with long-term care options counseling
62.31provided under subdivision 4d, section 256.975, subdivision subdivisions 7 to 7c, and
62.32section 256.01, subdivision 24. The lead agency providing long-term care consultation
62.33services shall encourage the use of volunteers from families, religious organizations, social
62.34clubs, and similar civic and service organizations to provide community-based services.

63.1    Sec. 18. Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to
63.2read:
63.3    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
63.4    (a) Until additional requirements apply under paragraph (b), "long-term care
63.5consultation services" means:
63.6    (1) intake for and access to assistance in identifying services needed to maintain an
63.7individual in the most inclusive environment;
63.8    (2) providing recommendations for and referrals to cost-effective community
63.9services that are available to the individual;
63.10    (3) development of an individual's person-centered community support plan;
63.11    (4) providing information regarding eligibility for Minnesota health care programs;
63.12    (5) face-to-face long-term care consultation assessments, which may be completed
63.13in a hospital, nursing facility, intermediate care facility for persons with developmental
63.14disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
63.15residence;
63.16    (6) federally mandated preadmission screening activities described under
63.17subdivisions 4a and 4b;
63.18    (7) (6) determination of home and community-based waiver and other service
63.19eligibility as required under sections 256B.0913, 256B.0915, and 256B.49, including level
63.20of care determination for individuals who need an institutional level of care as determined
63.21under section 256B.0911, subdivision 4a, paragraph (d) 4e, based on assessment and
63.22community support plan development, appropriate referrals to obtain necessary diagnostic
63.23information, and including an eligibility determination for consumer-directed community
63.24supports;
63.25    (8) (7) providing recommendations for institutional placement when there are no
63.26cost-effective community services available;
63.27    (9) (8) providing access to assistance to transition people back to community settings
63.28after institutional admission; and
63.29(10) (9) providing information about competitive employment, with or without
63.30supports, for school-age youth and working-age adults and referrals to the Disability
63.31Linkage Line and Disability Benefits 101 to ensure that an informed choice about
63.32competitive employment can be made. For the purposes of this subdivision, "competitive
63.33employment" means work in the competitive labor market that is performed on a full-time
63.34or part-time basis in an integrated setting, and for which an individual is compensated at or
63.35above the minimum wage, but not less than the customary wage and level of benefits paid
63.36by the employer for the same or similar work performed by individuals without disabilities.
64.1(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
64.22c, and 3a, "long-term care consultation services" also means:
64.3(1) service eligibility determination for state plan home care services identified in:
64.4(i) section 256B.0625, subdivisions 7, 19a, and 19c;
64.5(ii) section 256B.0657; or
64.6(iii) consumer support grants under section 256.476;
64.7(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
64.8determination of eligibility for case management services available under sections
64.9256B.0621, subdivision 2 , paragraph (4), and 256B.0924 and Minnesota Rules, part
64.109525.0016;
64.11(3) determination of institutional level of care, home and community-based service
64.12waiver, and other service eligibility as required under section 256B.092, determination
64.13of eligibility for family support grants under section 252.32, semi-independent living
64.14services under section 252.275, and day training and habilitation services under section
64.15256B.092 ; and
64.16(4) obtaining necessary diagnostic information to determine eligibility under clauses
64.17(2) and (3).
64.18    (c) "Long-term care options counseling" means the services provided by the linkage
64.19lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and
64.20also includes telephone assistance and follow up once a long-term care consultation
64.21assessment has been completed.
64.22    (d) "Minnesota health care programs" means the medical assistance program under
64.23chapter 256B and the alternative care program under section 256B.0913.
64.24    (e) "Lead agencies" means counties administering or tribes and health plans under
64.25contract with the commissioner to administer long-term care consultation assessment and
64.26support planning services.

64.27    Sec. 19. Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
64.28read:
64.29    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
64.30services planning, or other assistance intended to support community-based living,
64.31including persons who need assessment in order to determine waiver or alternative care
64.32program eligibility, must be visited by a long-term care consultation team within 20
64.33calendar days after the date on which an assessment was requested or recommended.
64.34Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
64.35applies to an assessment of a person requesting personal care assistance services and
65.1private duty nursing. The commissioner shall provide at least a 90-day notice to lead
65.2agencies prior to the effective date of this requirement. Face-to-face assessments must be
65.3conducted according to paragraphs (b) to (i).
65.4    (b) The lead agency may utilize a team of either the social worker or public health
65.5nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
65.6use certified assessors to conduct the assessment. The consultation team members must
65.7confer regarding the most appropriate care for each individual screened or assessed. For
65.8a person with complex health care needs, a public health or registered nurse from the
65.9team must be consulted.
65.10    (c) The assessment must be comprehensive and include a person-centered assessment
65.11of the health, psychological, functional, environmental, and social needs of referred
65.12individuals and provide information necessary to develop a community support plan that
65.13meets the consumers needs, using an assessment form provided by the commissioner.
65.14    (d) The assessment must be conducted in a face-to-face interview with the person
65.15being assessed and the person's legal representative, and other individuals as requested by
65.16the person, who can provide information on the needs, strengths, and preferences of the
65.17person necessary to develop a community support plan that ensures the person's health and
65.18safety, but who is not a provider of service or has any financial interest in the provision
65.19of services. For persons who are to be assessed for elderly waiver customized living
65.20services under section 256B.0915, with the permission of the person being assessed or
65.21the person's designated or legal representative, the client's current or proposed provider
65.22of services may submit a copy of the provider's nursing assessment or written report
65.23outlining its recommendations regarding the client's care needs. The person conducting
65.24the assessment will notify the provider of the date by which this information is to be
65.25submitted. This information shall be provided to the person conducting the assessment
65.26prior to the assessment.
65.27    (e) If the person chooses to use community-based services, the person or the person's
65.28legal representative must be provided with a written community support plan within 40
65.29calendar days of the assessment visit, regardless of whether the individual is eligible for
65.30Minnesota health care programs. The written community support plan must include:
65.31(1) a summary of assessed needs as defined in paragraphs (c) and (d);
65.32(2) the individual's options and choices to meet identified needs, including all
65.33available options for case management services and providers;
65.34(3) identification of health and safety risks and how those risks will be addressed,
65.35including personal risk management strategies;
65.36(4) referral information; and
66.1(5) informal caregiver supports, if applicable.
66.2For a person determined eligible for state plan home care under subdivision 1a,
66.3paragraph (b), clause (1), the person or person's representative must also receive a copy of
66.4the home care service plan developed by the certified assessor.
66.5(f) A person may request assistance in identifying community supports without
66.6participating in a complete assessment. Upon a request for assistance identifying
66.7community support, the person must be transferred or referred to long-term care options
66.8counseling services available under sections 256.975, subdivision 7, and 256.01,
66.9subdivision 24, for telephone assistance and follow up.
66.10    (g) The person has the right to make the final decision between institutional
66.11placement and community placement after the recommendations have been provided,
66.12except as provided in section 256.975, subdivision 4a, paragraph (c) 7a, paragraph (d).
66.13    (h) The lead agency must give the person receiving assessment or support planning,
66.14or the person's legal representative, materials, and forms supplied by the commissioner
66.15containing the following information:
66.16    (1) written recommendations for community-based services and consumer-directed
66.17options;
66.18(2) documentation that the most cost-effective alternatives available were offered to
66.19the individual. For purposes of this clause, "cost-effective" means community services and
66.20living arrangements that cost the same as or less than institutional care. For an individual
66.21found to meet eligibility criteria for home and community-based service programs under
66.22section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
66.23approved waiver plan for each program;
66.24(3) the need for and purpose of preadmission screening conducted by long-term
66.25care options counselors according to section 256.975, subdivisions 7a to 7c, and section
66.26256.01, subdivision 24, if the person selects nursing facility placement. If the individual
66.27selects nursing facility placement, the lead agency shall forward information needed to
66.28complete the level of care determinations and screening for developmental disability and
66.29mental illness collected during the assessment to the long-term care options counselor
66.30using forms provided by the commissioner;
66.31    (4) the role of long-term care consultation assessment and support planning in
66.32eligibility determination for waiver and alternative care programs, and state plan home
66.33care, case management, and other services as defined in subdivision 1a, paragraphs (a),
66.34clause (7), and (b);
66.35    (5) information about Minnesota health care programs;
66.36    (6) the person's freedom to accept or reject the recommendations of the team;
67.1    (7) the person's right to confidentiality under the Minnesota Government Data
67.2Practices Act, chapter 13;
67.3    (8) the certified assessor's decision regarding the person's need for institutional level
67.4of care as determined under criteria established in section 256B.0911, subdivision 4a,
67.5paragraph (d) 4e, and the certified assessor's decision regarding eligibility for all services
67.6and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
67.7    (9) the person's right to appeal the certified assessor's decision regarding eligibility
67.8for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
67.9(b), and incorporating the decision regarding the need for institutional level of care or the
67.10lead agency's final decisions regarding public programs eligibility according to section
67.11256.045, subdivision 3 .
67.12    (i) Face-to-face assessment completed as part of eligibility determination for
67.13the alternative care, elderly waiver, community alternatives for disabled individuals,
67.14community alternative care, and brain injury waiver programs under sections 256B.0913,
67.15256B.0915 , and 256B.49 is valid to establish service eligibility for no more than 60
67.16calendar days after the date of assessment.
67.17(j) The effective eligibility start date for programs in paragraph (i) can never be
67.18prior to the date of assessment. If an assessment was completed more than 60 days
67.19before the effective waiver or alternative care program eligibility start date, assessment
67.20and support plan information must be updated in a face-to-face visit and documented in
67.21the department's Medicaid Management Information System (MMIS). Notwithstanding
67.22retroactive medical assistance coverage of state plan services, the effective date of
67.23eligibility for programs included in paragraph (i) cannot be prior to the date the most
67.24recent updated assessment is completed.

67.25    Sec. 20. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
67.26read:
67.27    Subd. 4d. Preadmission screening of individuals under 65 60 years of age. (a)
67.28It is the policy of the state of Minnesota to ensure that individuals with disabilities or
67.29chronic illness are served in the most integrated setting appropriate to their needs and have
67.30the necessary information to make informed choices about home and community-based
67.31service options.
67.32    (b) Individuals under 65 60 years of age who are admitted to a Medicaid-certified
67.33 nursing facility from a hospital must be screened prior to admission as outlined in
67.34subdivisions 4a through 4c according to the requirements outlined in section 256.975,
68.1subdivisions 7a to 7c. This shall be provided by the Disability Linkage Line as required
68.2under section 256.01, subdivision 24.
68.3    (c) Individuals under 65 years of age who are admitted to nursing facilities with
68.4only a telephone screening must receive a face-to-face assessment from the long-term
68.5care consultation team member of the county in which the facility is located or from the
68.6recipient's county case manager within 40 calendar days of admission.
68.7    (d) Individuals under 65 years of age who are admitted to a nursing facility
68.8without preadmission screening according to the exemption described in subdivision 4b,
68.9paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
68.10a face-to-face assessment within 40 days of admission.
68.11    (e) (d) At the face-to-face assessment, the long-term care consultation team member
68.12or county case manager must perform the activities required under subdivision 3b.
68.13    (f) (e) For individuals under 21 years of age, a screening interview which
68.14recommends nursing facility admission must be face-to-face and approved by the
68.15commissioner before the individual is admitted to the nursing facility.
68.16    (g) (f) In the event that an individual under 65 60 years of age is admitted to a
68.17nursing facility on an emergency basis, the county Disability Linkage Line must be
68.18notified of the admission on the next working day, and a face-to-face assessment as
68.19described in paragraph (c) must be conducted within 40 calendar days of admission.
68.20    (h) (g) At the face-to-face assessment, the long-term care consultation team member
68.21or the case manager must present information about home and community-based options,
68.22including consumer-directed options, so the individual can make informed choices. If the
68.23individual chooses home and community-based services, the long-term care consultation
68.24team member or case manager must complete a written relocation plan within 20 working
68.25days of the visit. The plan shall describe the services needed to move out of the facility
68.26and a time line for the move which is designed to ensure a smooth transition to the
68.27individual's home and community.
68.28    (i) (h) An individual under 65 years of age residing in a nursing facility shall receive
68.29a face-to-face assessment at least every 12 months to review the person's service choices
68.30and available alternatives unless the individual indicates, in writing, that annual visits are
68.31not desired. In this case, the individual must receive a face-to-face assessment at least
68.32once every 36 months for the same purposes.
68.33    (j) (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay
68.34county agencies directly for face-to-face assessments for individuals under 65 years of age
68.35who are being considered for placement or residing in a nursing facility.
69.1(j) Funding for preadmission screening shall be provided to the Disability Linkage
69.2Line for the under 60 population by the Department of Human Services to cover screener
69.3salaries and expenses to provide the services described in subdivisions 7a to 7c. The
69.4Disability Linkage Line shall employ, or contract with other agencies to employ, within
69.5the limits of available funding, sufficient personnel to provide preadmission screening and
69.6level of care determination services and shall seek to maximize federal funding for the
69.7service as provided under section 256.01, subdivision 2, paragraph (dd).
69.8EFFECTIVE DATE.This section is effective October 1, 2013.

69.9    Sec. 21. Minnesota Statutes 2012, section 256B.0911, is amended by adding a
69.10subdivision to read:
69.11    Subd. 4e. Determination of institutional level of care. The determination of the
69.12need for nursing facility, hospital, and intermediate care facility levels of care must be
69.13made according to criteria developed by the commissioner, and in section 256B.092,
69.14using forms developed by the commissioner. Effective January 1, 2014, for individuals
69.15age 21 and older, the determination of need for nursing facility level of care shall be
69.16based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the
69.17determination of the need for nursing facility level of care must be made according to
69.18criteria developed by the commissioner until criteria in section 144.0724, subdivision 11,
69.19becomes effective on or after October 1, 2019.

69.20    Sec. 22. Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:
69.21    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance
69.22reimbursement for nursing facilities shall be authorized for a medical assistance recipient
69.23only if a preadmission screening has been conducted prior to admission or the county has
69.24authorized an exemption. Medical assistance reimbursement for nursing facilities shall
69.25not be provided for any recipient who the local screener has determined does not meet the
69.26level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
69.27if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
69.28Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
69.29mental illness is approved by the local mental health authority or an admission for a
69.30recipient with developmental disability is approved by the state developmental disability
69.31authority.
69.32    (b) The nursing facility must not bill a person who is not a medical assistance
69.33recipient for resident days that preceded the date of completion of screening activities
69.34as required under section 256.975, subdivisions 4a, 4b, and 4c 7a to 7c. The nursing
70.1facility must include unreimbursed resident days in the nursing facility resident day totals
70.2reported to the commissioner.

70.3    Sec. 23. Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:
70.4    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
70.5    (a) Funding for services under the alternative care program is available to persons who
70.6meet the following criteria:
70.7    (1) the person has been determined by a community assessment under section
70.8256B.0911 to be a person who would require the level of care provided in a nursing
70.9facility, as determined under section 256B.0911, subdivision 4a, paragraph (d) 4e, but for
70.10the provision of services under the alternative care program;
70.11    (2) the person is age 65 or older;
70.12    (3) the person would be eligible for medical assistance within 135 days of admission
70.13to a nursing facility;
70.14    (4) the person is not ineligible for the payment of long-term care services by the
70.15medical assistance program due to an asset transfer penalty under section 256B.0595 or
70.16equity interest in the home exceeding $500,000 as stated in section 256B.056;
70.17    (5) the person needs long-term care services that are not funded through other
70.18state or federal funding, or other health insurance or other third-party insurance such as
70.19long-term care insurance;
70.20    (6) except for individuals described in clause (7), the monthly cost of the alternative
70.21care services funded by the program for this person does not exceed 75 percent of the
70.22monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
70.23does not prohibit the alternative care client from payment for additional services, but in no
70.24case may the cost of additional services purchased under this section exceed the difference
70.25between the client's monthly service limit defined under section 256B.0915, subdivision
70.263 , and the alternative care program monthly service limit defined in this paragraph. If
70.27care-related supplies and equipment or environmental modifications and adaptations are or
70.28will be purchased for an alternative care services recipient, the costs may be prorated on a
70.29monthly basis for up to 12 consecutive months beginning with the month of purchase.
70.30If the monthly cost of a recipient's other alternative care services exceeds the monthly
70.31limit established in this paragraph, the annual cost of the alternative care services shall be
70.32determined. In this event, the annual cost of alternative care services shall not exceed 12
70.33times the monthly limit described in this paragraph;
70.34    (7) for individuals assigned a case mix classification A as described under section
70.35256B.0915, subdivision 3a , paragraph (a), with (i) no dependencies in activities of daily
71.1living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating
71.2when the dependency score in eating is three or greater as determined by an assessment
71.3performed under section 256B.0911, the monthly cost of alternative care services funded
71.4by the program cannot exceed $593 per month for all new participants enrolled in
71.5the program on or after July 1, 2011. This monthly limit shall be applied to all other
71.6participants who meet this criteria at reassessment. This monthly limit shall be increased
71.7annually as described in section 256B.0915, subdivision 3a, paragraph (a). This monthly
71.8limit does not prohibit the alternative care client from payment for additional services, but
71.9in no case may the cost of additional services purchased exceed the difference between the
71.10client's monthly service limit defined in this clause and the limit described in clause (6)
71.11for case mix classification A; and
71.12(8) the person is making timely payments of the assessed monthly fee.
71.13A person is ineligible if payment of the fee is over 60 days past due, unless the person
71.14agrees to:
71.15    (i) the appointment of a representative payee;
71.16    (ii) automatic payment from a financial account;
71.17    (iii) the establishment of greater family involvement in the financial management of
71.18payments; or
71.19    (iv) another method acceptable to the lead agency to ensure prompt fee payments.
71.20    The lead agency may extend the client's eligibility as necessary while making
71.21arrangements to facilitate payment of past-due amounts and future premium payments.
71.22Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
71.23reinstated for a period of 30 days.
71.24    (b) Alternative care funding under this subdivision is not available for a person who
71.25is a medical assistance recipient or who would be eligible for medical assistance without a
71.26spenddown or waiver obligation. A person whose initial application for medical assistance
71.27and the elderly waiver program is being processed may be served under the alternative care
71.28program for a period up to 60 days. If the individual is found to be eligible for medical
71.29assistance, medical assistance must be billed for services payable under the federally
71.30approved elderly waiver plan and delivered from the date the individual was found eligible
71.31for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
71.32care funds may not be used to pay for any service the cost of which: (i) is payable by
71.33medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to
71.34pay a medical assistance income spenddown for a person who is eligible to participate in the
71.35federally approved elderly waiver program under the special income standard provision.
72.1    (c) Alternative care funding is not available for a person who resides in a licensed
72.2nursing home, certified boarding care home, hospital, or intermediate care facility, except
72.3for case management services which are provided in support of the discharge planning
72.4process for a nursing home resident or certified boarding care home resident to assist with
72.5a relocation process to a community-based setting.
72.6    (d) Alternative care funding is not available for a person whose income is greater
72.7than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
72.8to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
72.9year for which alternative care eligibility is determined, who would be eligible for the
72.10elderly waiver with a waiver obligation.

72.11    Sec. 24. Minnesota Statutes 2012, section 256B.0913, is amended by adding a
72.12subdivision to read:
72.13    Subd. 17. Essential community supports grants. (a) Notwithstanding subdivisions
72.141 to 14, the purpose of the essential community supports grant program is to provide
72.15targeted services to persons age 65 and older who need essential community support, but
72.16whose needs do not meet the level of care required for nursing facility placement under
72.17section 144.0724, subdivision 11.
72.18(b) Essential community supports grants are available not to exceed $400 per person
72.19per month. Essential community supports service grants may be used as authorized within
72.20an authorization period not to exceed 12 months. Grants must be available to a person who:
72.21(1) is age 65 or older;
72.22(2) is not eligible for medical assistance;
72.23(3) would otherwise be financially eligible for the alternative care program under
72.24subdivision 4;
72.25(4) has received a community assessment under section 256B.0911, subdivision 3a
72.26or 3b, and does not require the level of care provided in a nursing facility;
72.27(5) has a community support plan; and
72.28(6) has been determined by a community assessment under section 256B.0911,
72.29subdivision 3a or 3b, to be a person who would require provision of at least one of the
72.30following services, as defined in the approved elderly waiver plan, in order to maintain
72.31their community residence:
72.32(i) caregiver support;
72.33(ii) homemaker support;
72.34(iii) chores; or
72.35(iv) a personal emergency response device or system.
73.1(c) The person receiving any of the essential community supports in this subdivision
73.2must also receive service coordination, not to exceed $600 in a 12-month authorization
73.3period, as part of their community support plan.
73.4(d) A person who has been determined to be eligible for an essential community
73.5supports grant must be reassessed at least annually and continue to meet the criteria in
73.6paragraph (b) to remain eligible for an essential community supports grant.
73.7(e) The commissioner is authorized to use federal matching funds for essential
73.8community supports as necessary and to meet demand for essential community supports
73.9grants as outlined in paragraphs (f) and (g), and that amount of federal funds is
73.10appropriated to the commissioner for this purpose.
73.11(f) Upon federal approval and following a reasonable implementation period
73.12determined by the commissioner, essential community supports are available to an
73.13individual who:
73.14(1) is receiving nursing facility services or home and community-based long-term
73.15services and supports under section 256B.0915 or 256B.49 on the effective date of
73.16implementation of the revised nursing facility level of care under section 144.0724,
73.17subdivision 11;
73.18(2) meets one of the following criteria:
73.19(i) due to the implementation of the revised nursing facility level of care, loses
73.20eligibility for continuing medical assistance payment of nursing facility services at the
73.21first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or
73.22after the effective date of the revised nursing facility level of care criteria under section
73.23144.0724, subdivision 11; or
73.24(ii) due to the implementation of the revised nursing facility level of care, loses
73.25eligibility for continuing medical assistance payment of home and community-based
73.26long-term services and supports under section 256B.0915 or 256B.49 at the first
73.27reassessment required under those sections that occurs on or after the effective date of
73.28implementation of the revised nursing facility level of care under section 144.0724,
73.29subdivision 11;
73.30(3) is not eligible for personal care attendant services; and
73.31(4) has an assessed need for one or more of the supportive services offered under
73.32essential community supports.
73.33Individuals eligible under this paragraph includes individuals who continue to be
73.34eligible for medical assistance state plan benefits and those who are not or are no longer
73.35financially eligible for medical assistance.
74.1(g) Upon federal approval and following a reasonable implementation period
74.2determined by the commissioner, the services available through essential community
74.3supports include the services and grants provided in paragraphs (b) and (c), home-delivered
74.4meals, and community living assistance as defined by the commissioner. These services
74.5are available to all eligible recipients including those outlined in paragraphs (b) and (f).
74.6Recipients are eligible if they have a need for any of these services and meet all other
74.7eligibility criteria.

74.8    Sec. 25. Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to
74.9read:
74.10    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of
74.11waivered services to an individual elderly waiver client except for individuals described in
74.12paragraph paragraphs (b) and (d) shall be the weighted average monthly nursing facility
74.13rate of the case mix resident class to which the elderly waiver client would be assigned
74.14under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance
74.15needs allowance as described in subdivision 1d, paragraph (a), until the first day of the
74.16state fiscal year in which the resident assessment system as described in section 256B.438
74.17for nursing home rate determination is implemented. Effective on the first day of the state
74.18fiscal year in which the resident assessment system as described in section 256B.438 for
74.19nursing home rate determination is implemented and the first day of each subsequent state
74.20fiscal year, the monthly limit for the cost of waivered services to an individual elderly
74.21waiver client shall be the rate of the case mix resident class to which the waiver client
74.22would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on
74.23the last day of the previous state fiscal year, adjusted by any legislatively adopted home
74.24and community-based services percentage rate adjustment.
74.25    (b) The monthly limit for the cost of waivered services to an individual elderly
74.26waiver client assigned to a case mix classification A under paragraph (a) with:
74.27(1) no dependencies in activities of daily living; or
74.28(2) up to two dependencies in bathing, dressing, grooming, walking, and eating
74.29when the dependency score in eating is three or greater as determined by an assessment
74.30performed under section 256B.0911
74.31shall be $1,750 per month effective on July 1, 2011, for all new participants enrolled in
74.32the program on or after July 1, 2011. This monthly limit shall be applied to all other
74.33participants who meet this criteria at reassessment. This monthly limit shall be increased
74.34annually as described in paragraph (a).
75.1(c) If extended medical supplies and equipment or environmental modifications are
75.2or will be purchased for an elderly waiver client, the costs may be prorated for up to
75.312 consecutive months beginning with the month of purchase. If the monthly cost of a
75.4recipient's waivered services exceeds the monthly limit established in paragraph (a) or
75.5(b), the annual cost of all waivered services shall be determined. In this event, the annual
75.6cost of all waivered services shall not exceed 12 times the monthly limit of waivered
75.7services as described in paragraph (a) or (b).
75.8(d) Effective July 1, 2013, the monthly cost limit of waiver services, including
75.9any necessary home care services described in section 256B.0651, subdivision 2, for
75.10individuals who meet the criteria as ventilator-dependent given in section 256B.0651,
75.11subdivision 1, paragraph (g), shall be the average of the monthly medical assistance
75.12amount established for home care services as described in section 256B.0652, subdivision
75.137, and the annual average contracted amount established by the commissioner for nursing
75.14facility services for ventilator-dependent individuals. This monthly limit shall be increased
75.15annually as described in paragraph (a).

75.16    Sec. 26. Minnesota Statutes 2012, section 256B.0915, is amended by adding a
75.17subdivision to read:
75.18    Subd. 3j. Individual community living support. Upon federal approval, there
75.19is established a new service called individual community living support (ICLS) that is
75.20available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor
75.21have any interest in the recipient's housing. ICLS must be delivered in a single-family
75.22home or apartment where the service recipient or their family owns or rents, as
75.23demonstrated by a lease agreement, and maintains control over the individual unit. Case
75.24managers or care coordinators must develop individual ICLS plans in consultation with
75.25the client using a tool developed by the commissioner. The commissioner shall establish
75.26payment rates and mechanisms to align payments with the type and amount of service
75.27provided, assure statewide uniformity for payment rates, and assure cost-effectiveness.
75.28Licensing standards for ICLS shall be reviewed jointly by the Departments of Health and
75.29Human Services to avoid conflict with provider regulatory standards pursuant to section
75.30144A.43 and chapter 245D.

75.31    Sec. 27. Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:
75.32    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
75.33shall receive an initial assessment of strengths, informal supports, and need for services
75.34in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
76.1client served under the elderly waiver must be conducted at least every 12 months and at
76.2other times when the case manager determines that there has been significant change in
76.3the client's functioning. This may include instances where the client is discharged from
76.4the hospital. There must be a determination that the client requires nursing facility level
76.5of care as defined in section 256B.0911, subdivision 4a, paragraph (d) 4e, at initial and
76.6subsequent assessments to initiate and maintain participation in the waiver program.
76.7(b) Regardless of other assessments identified in section 144.0724, subdivision
76.84, as appropriate to determine nursing facility level of care for purposes of medical
76.9assistance payment for nursing facility services, only face-to-face assessments conducted
76.10according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
76.11level of care determination will be accepted for purposes of initial and ongoing access to
76.12waiver service payment.

76.13    Sec. 28. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
76.14subdivision to read:
76.15    Subd. 1a. Home and community-based services for older adults. (a) The purpose
76.16of projects selected by the commissioner of human services under this section is to
76.17make strategic changes in the long-term services and supports system for older adults
76.18including statewide capacity for local service development and technical assistance, and
76.19statewide availability of home and community-based services for older adult services,
76.20caregiver support and respite care services, and other supports in the state of Minnesota.
76.21These projects are intended to create incentives for new and expanded home and
76.22community-based services in Minnesota in order to:
76.23(1) reach older adults early in the progression of their need for long-term services
76.24and supports, providing them with low-cost, high-impact services that will prevent or
76.25delay the use of more costly services;
76.26(2) support older adults to live in the most integrated, least restrictive community
76.27setting;
76.28(3) support the informal caregivers of older adults;
76.29(4) develop and implement strategies to integrate long-term services and supports
76.30with health care services, in order to improve the quality of care and enhance the quality
76.31of life of older adults and their informal caregivers;
76.32(5) ensure cost-effective use of financial and human resources;
76.33(6) build community-based approaches and community commitment to delivering
76.34long-term services and supports for older adults in their own homes;
77.1(7) achieve a broad awareness and use of lower-cost in-home services as an
77.2alternative to nursing homes and other residential services;
77.3(8) strengthen and develop additional home and community-based services and
77.4alternatives to nursing homes and other residential services; and
77.5(9) strengthen programs that use volunteers.
77.6(b) The services provided by these projects are available to older adults who are
77.7eligible for medical assistance and the elderly waiver under section 256B.0915, the
77.8alternative care program under section 256B.0913, or essential community supports grant
77.9under subdivision 14, paragraph (b), and to persons who have their own funds to pay for
77.10services.

77.11    Sec. 29. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
77.12subdivision to read:
77.13    Subd. 1b. Definitions. (a) For purposes of this section, the following terms have
77.14the meanings given.
77.15(b) "Community" means a town; township; city; or targeted neighborhood within a
77.16city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.
77.17(c) "Core home and community-based services provider" means a Faith in Action,
77.18Living at Home Block Nurse, Congregational Nurse, or similar community-based
77.19program governed by a board, the majority of whose members reside within the program's
77.20service area, that organizes and uses volunteers and paid staff to deliver nonmedical
77.21services intended to assist older adults to identify and manage risks and to maintain their
77.22community living and integration in the community.
77.23(d) "Eldercare development partnership" means a team of representatives of county
77.24social service and public health agencies, the area agency on aging, local nursing home
77.25providers, local home care providers, and other appropriate home and community-based
77.26providers in the area agency's planning and service area.
77.27(e) "Long-term services and supports" means any service available under the
77.28elderly waiver program or alternative care grant programs; nursing facility services;
77.29transportation services; caregiver support and respite care services; and other home and
77.30community-based services identified as necessary either to maintain lifestyle choices for
77.31older adults or to support them to remain in their own home.
77.32(f) "Older adult" refers to an individual who is 65 years of age or older.

77.33    Sec. 30. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
77.34subdivision to read:
78.1    Subd. 1c. Eldercare development partnerships. The commissioner of human
78.2services shall select and contract with eldercare development partnerships sufficient to
78.3provide statewide availability of service development and technical assistance using a
78.4request for proposals process. Eldercare development partnerships shall:
78.5(1) develop a local long-term services and supports strategy consistent with state
78.6goals and objectives;
78.7(2) identify and use existing local skills, knowledge and relationships, and build
78.8on these assets;
78.9(3) coordinate planning for funds to provide services to older adults, including funds
78.10received under Title III of the Older Americans Act, Title XX of the Social Security Act,
78.11and the Local Public Health Act;
78.12(4) target service development and technical assistance where nursing facility
78.13closures have occurred or are occurring or in areas where service needs have been
78.14identified through activities under section 144A.351;
78.15(5) provide sufficient staff for development and technical support in its designated
78.16area; and
78.17(6) designate a single public or nonprofit member of the eldercare development
78.18partnerships to apply grant funding and manage the project.

78.19    Sec. 31. Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:
78.20    Subd. 6. Caregiver support and respite care projects. (a) The commissioner
78.21shall establish up to 36 projects to expand the respite care network in the state and to
78.22support caregivers in their responsibilities for care. The purpose of each project shall
78.23be to availability of caregiver support and respite care services for family and other
78.24caregivers. The commissioner shall use a request for proposals to select nonprofit entities
78.25to administer the projects. Projects shall:
78.26(1) establish a local coordinated network of volunteer and paid respite workers;
78.27(2) coordinate assignment of respite workers care services to clients and care
78.28receivers and assure the health and safety of the client; and caregivers of older adults;
78.29(3) provide training for caregivers and ensure that support groups are available
78.30in the community.
78.31(3) assure the health and safety of the older adults;
78.32(4) identify at-risk caregivers;
78.33(5) provide information, education, and training for caregivers in the designated
78.34community; and
79.1(6) demonstrate the need in the proposed service area particularly where nursing
79.2facility closures have occurred or are occurring or areas with service needs identified
79.3by section 144A.351. Preference must be given for projects that reach underserved
79.4populations.
79.5(b) The caregiver support and respite care funds shall be available to the four to six
79.6local long-term care strategy projects designated in subdivisions 1 to 5.
79.7(c) The commissioner shall publish a notice in the State Register to solicit proposals
79.8from public or private nonprofit agencies for the projects not included in the four to six
79.9local long-term care strategy projects defined in subdivision 2. A county agency may,
79.10alone or in combination with other county agencies, apply for caregiver support and
79.11respite care project funds. A public or nonprofit agency within a designated SAIL project
79.12area may apply for project funds if the agency has a letter of agreement with the county
79.13or counties in which services will be developed, stating the intention of the county or
79.14counties to coordinate their activities with the agency requesting a grant.
79.15(d) The commissioner shall select grantees based on the following criteria (b)
79.16Projects must clearly describe:
79.17(1) the ability of the proposal to demonstrate need in the area served, as evidenced
79.18by a community needs assessment or other demographic data;
79.19(2) the ability of the proposal to clearly describe how the project (1) how they will
79.20achieve the their purpose defined in paragraph (b);
79.21(3) the ability of the proposal to reach underserved populations;
79.22(4) the ability of the proposal to demonstrate community commitment to the project,
79.23as evidenced by letters of support and cooperation as well as formation of a community
79.24task force;
79.25(5) the ability of the proposal to clearly describe (2) the process for recruiting,
79.26training, and retraining volunteers; and
79.27(6) the inclusion in the proposal of the (3) their plan to promote the project in the
79.28designated community, including outreach to persons needing the services.
79.29(e) (c) Funds for all projects under this subdivision may be used to:
79.30(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
79.31care services and assign workers to clients;
79.32(2) recruit and train volunteer providers;
79.33(3) train provide information, training, and education to caregivers;
79.34(4) ensure the development of support groups for caregivers;
79.35(5) (4) advertise the availability of the caregiver support and respite care project; and
79.36(6) (5) purchase equipment to maintain a system of assigning workers to clients.
80.1(f) (d) Project funds may not be used to supplant existing funding sources.

80.2    Sec. 32. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
80.3subdivision to read:
80.4    Subd. 7a. Core home and community-based services. The commissioner shall
80.5select and contract with core home and community-based services providers for projects
80.6to provide services and supports to older adults both with and without family and other
80.7informal caregivers using a request for proposals process. Projects must:
80.8(1) have a credible, public, or private nonprofit sponsor providing ongoing financial
80.9support;
80.10(2) have a specific, clearly defined geographic service area;
80.11(3) use a practice framework designed to identify high-risk older adults and help them
80.12take action to better manage their chronic conditions and maintain their community living;
80.13(4) have a team approach to coordination and care, ensuring that the older adult
80.14participants, their families, and the formal and informal providers are all part of planning
80.15and providing services;
80.16(5) provide information, support services, homemaking services, counseling, and
80.17training for the older adults and family caregivers;
80.18(6) encourage service area or neighborhood residents and local organizations to
80.19collaborate in meeting the needs of older adults in their geographic service areas;
80.20(7) recruit, train, and direct the use of volunteers to provide informal services and
80.21other appropriate support to older adults and their caregivers; and
80.22(8) provide coordination and management of formal and informal services to older
80.23adults and their families using less expensive alternatives.

80.24    Sec. 33. Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to
80.25read:
80.26    Subd. 13. Community service grants. The commissioner shall award contracts
80.27for grants to public and private nonprofit agencies to establish services that strengthen
80.28a community's ability to provide a system of home and community-based services
80.29for elderly persons. The commissioner shall use a request for proposal process. The
80.30commissioner shall give preference when awarding grants under this section to areas
80.31where nursing facility closures have occurred or are occurring or to areas with service
80.32needs identified under section 144A.351. The commissioner shall consider grants for:
80.33(1) caregiver support and respite care projects under subdivision 6;
80.34(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and
81.1(3) services identified as needed for community transition.

81.2    Sec. 34. Minnesota Statutes 2012, section 256B.092, is amended by adding a
81.3subdivision to read:
81.4    Subd. 14. Reduce avoidable behavioral crisis emergency room, psychiatric
81.5inpatient hospitalizations, and commitments to institutions. (a) Persons receiving
81.6home and community-based services authorized under this section who have had two
81.7or more admissions within a calendar year to an emergency room, psychiatric unit,
81.8or institution must receive consultation from a mental health professional as defined in
81.9section 245.462, subdivision 18, or a behavioral professional as defined in the home and
81.10community-based services state plan within 30 days of discharge. The mental health
81.11professional or behavioral professional must:
81.12(1) conduct a functional assessment of the crisis incident as defined in section
81.13245D.02, subdivision 11, which led to the hospitalization with the goal of developing
81.14proactive strategies as well as necessary reactive strategies to reduce the likelihood of
81.15future avoidable hospitalizations due to a behavioral crisis;
81.16(2) use the results of the functional assessment to amend the coordinated service and
81.17support plan set forth in section 245D.02, subdivision 4b, to address the potential need
81.18for additional staff training, increased staffing, access to crisis mobility services, mental
81.19health services, use of technology, and crisis stabilization services in section 256B.0624,
81.20subdivision 7; and
81.21(3) identify the need for additional consultation, testing, and mental health crisis
81.22intervention team services as defined in section 245D.02, subdivision 20, psychotropic
81.23medication use and monitoring under section 245D.051, as well as the frequency and
81.24duration of ongoing consultation.
81.25(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
81.26the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

81.27    Sec. 35. Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:
81.28    Subdivision 1. Development and implementation of quality profiles. (a) The
81.29commissioner of human services, in cooperation with the commissioner of health,
81.30shall develop and implement a quality profile system profiles for nursing facilities and,
81.31beginning not later than July 1, 2004 2014, other providers of long-term care services,
81.32except when the quality profile system would duplicate requirements under section
81.33256B.5011 , 256B.5012, or 256B.5013. The system quality profiles must be developed
81.34and implemented to the extent possible without the collection of significant amounts of
82.1new data. To the extent possible, the system using existing data sets maintained by the
82.2commissioners of health and human services to the extent possible. The profiles must
82.3incorporate or be coordinated with information on quality maintained by area agencies on
82.4aging, long-term care trade associations, the ombudsman offices, counties, tribes, health
82.5plans, and other entities and the long-term care database maintained under section 256.975,
82.6subdivision 7. The system profiles must be designed to provide information on quality to:
82.7(1) consumers and their families to facilitate informed choices of service providers;
82.8(2) providers to enable them to measure the results of their quality improvement
82.9efforts and compare quality achievements with other service providers; and
82.10(3) public and private purchasers of long-term care services to enable them to
82.11purchase high-quality care.
82.12(b) The system profiles must be developed in consultation with the long-term care
82.13task force, area agencies on aging, and representatives of consumers, providers, and labor
82.14unions. Within the limits of available appropriations, the commissioners may employ
82.15consultants to assist with this project.

82.16    Sec. 36. Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:
82.17    Subd. 2. Quality measurement tools. The commissioners shall identify and apply
82.18existing quality measurement tools to:
82.19(1) emphasize quality of care and its relationship to quality of life; and
82.20(2) address the needs of various users of long-term care services, including, but not
82.21limited to, short-stay residents, persons with behavioral problems, persons with dementia,
82.22and persons who are members of minority groups.
82.23    The tools must be identified and applied, to the extent possible, without requiring
82.24providers to supply information beyond current state and federal requirements.

82.25    Sec. 37. Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:
82.26    Subd. 3. Consumer surveys of nursing facilities residents. Following
82.27identification of the quality measurement tool, the commissioners shall conduct surveys
82.28of long-term care service consumers of nursing facilities to develop quality profiles
82.29of providers. To the extent possible, surveys must be conducted face-to-face by state
82.30employees or contractors. At the discretion of the commissioners, surveys may be
82.31conducted by telephone or by provider staff. Surveys must be conducted periodically to
82.32update quality profiles of individual service nursing facilities providers.

83.1    Sec. 38. Minnesota Statutes 2012, section 256B.439, is amended by adding a
83.2subdivision to read:
83.3    Subd. 3a. Home and community-based services report card in cooperation with
83.4the commissioner of health. The profiles developed for home and community-based
83.5services providers under this section shall be incorporated into a report card and
83.6maintained by the Minnesota Board on Aging pursuant to section 256.975, subdivision
83.77, paragraph (b), clause (2), as data becomes available. The commissioner, in
83.8cooperation with the commissioner of health, shall use consumer choice, quality of life,
83.9care approaches, and cost or flexible purchasing categories to organize the consumer
83.10information in the profiles. The final categories used shall include consumer input and
83.11survey data to the extent that is available through the state agencies. The commissioner
83.12shall develop and disseminate the qualify profiles for a limited number of provider types
83.13initially, and develop quality profiles for additional provider types as measurement tools
83.14are developed and data becomes available. This includes providers of services to older
83.15adults and people with disabilities, regardless of payor source.

83.16    Sec. 39. Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:
83.17    Subd. 4. Dissemination of quality profiles. By July 1, 2003 2014, the
83.18commissioners shall implement a system public awareness effort to disseminate the quality
83.19profiles developed from consumer surveys using the quality measurement tool. Profiles
83.20may be disseminated to through the Senior LinkAge Line and Disability Linkage Line and
83.21to consumers, providers, and purchasers of long-term care services through all feasible
83.22printed and electronic outlets. The commissioners may conduct a public awareness
83.23campaign to inform potential users regarding profile contents and potential uses.

83.24    Sec. 40. Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:
83.25    Subd. 12. Informed choice. Persons who are determined likely to require the level
83.26of care provided in a nursing facility as determined under section 256B.0911, subdivision
83.274e, or a hospital shall be informed of the home and community-based support alternatives
83.28to the provision of inpatient hospital services or nursing facility services. Each person
83.29must be given the choice of either institutional or home and community-based services
83.30using the provisions described in section 256B.77, subdivision 2, paragraph (p).

83.31    Sec. 41. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
83.32    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
83.33shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
84.1With the permission of the recipient or the recipient's designated legal representative,
84.2the recipient's current provider of services may submit a written report outlining their
84.3recommendations regarding the recipient's care needs prepared by a direct service
84.4employee with at least 20 hours of service to that client. The person conducting the
84.5assessment or reassessment must notify the provider of the date by which this information
84.6is to be submitted. This information shall be provided to the person conducting the
84.7assessment and the person or the person's legal representative and must be considered
84.8prior to the finalization of the assessment or reassessment.
84.9(b) There must be a determination that the client requires a hospital level of care or a
84.10nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
84.11(d) 4e, at initial and subsequent assessments to initiate and maintain participation in the
84.12waiver program.
84.13(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
84.14appropriate to determine nursing facility level of care for purposes of medical assistance
84.15payment for nursing facility services, only face-to-face assessments conducted according
84.16to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
84.17determination or a nursing facility level of care determination must be accepted for
84.18purposes of initial and ongoing access to waiver services payment.
84.19(d) Recipients who are found eligible for home and community-based services under
84.20this section before their 65th birthday may remain eligible for these services after their
84.2165th birthday if they continue to meet all other eligibility factors.
84.22(e) The commissioner shall develop criteria to identify recipients whose level of
84.23functioning is reasonably expected to improve and reassess these recipients to establish
84.24a baseline assessment. Recipients who meet these criteria must have a comprehensive
84.25transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
84.26reassessed every six months until there has been no significant change in the recipient's
84.27functioning for at least 12 months. After there has been no significant change in the
84.28recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
84.29informal support systems, and need for services shall be conducted at least every 12
84.30months and at other times when there has been a significant change in the recipient's
84.31functioning. Counties, case managers, and service providers are responsible for
84.32conducting these reassessments and shall complete the reassessments out of existing funds.

84.33    Sec. 42. Minnesota Statutes 2012, section 256B.49, is amended by adding a
84.34subdivision to read:
85.1    Subd. 25. Reduce avoidable behavioral crisis emergency room, psychiatric
85.2inpatient hospitalizations, and commitments to institutions. (a) Persons receiving
85.3home and community-based services authorized under this section who have two or more
85.4admissions within a calendar year to an emergency room, psychiatric unit, or institution
85.5must receive consultation from a mental health professional as defined in section 245.462,
85.6subdivision 18, or a behavioral professional as defined in the home and community-based
85.7services state plan within 30 days of discharge. The mental health professional or
85.8behavioral professional must:
85.9(1) conduct a functional assessment of the crisis incident as defined in section
85.10245D.02, subdivision 11, which led to the hospitalization with the goal of developing
85.11proactive strategies as well as necessary reactive strategies to reduce the likelihood of
85.12future avoidable hospitalizations due to a behavioral crisis;
85.13(2) use the results of the functional assessment to amend the coordinated service and
85.14support plan in section 245D.02, subdivision 4b, to address the potential need for additional
85.15staff training, increased staffing, access to crisis mobility services, mental health services,
85.16use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and
85.17(3) identify the need for additional consultation, testing, mental health crisis
85.18intervention team services as defined in section 245D.02, subdivision 20, psychotropic
85.19medication use and monitoring under section 245D.051, as well as the frequency and
85.20duration of ongoing consultation.
85.21(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
85.22the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

85.23    Sec. 43. [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
85.24    Subdivision 1. Basis and scope. (a) Upon federal approval, the commissioner
85.25shall establish a medical assistance state plan option for the provision of home and
85.26community-based personal assistance service and supports called "community first
85.27services and supports (CFSS)."
85.28(b) CFSS is a participant-controlled method of selecting and providing services
85.29and supports that allows the participant maximum control of the services and supports.
85.30Participants may choose the degree to which they direct and manage their supports by
85.31choosing to have a significant and meaningful role in the management of services and
85.32supports including by directly employing support workers with the necessary supports
85.33to perform that function.
85.34(c) CFSS is available statewide to eligible individuals to assist with accomplishing
85.35activities of daily living (ADLs), instrumental activities of daily living (IADLs), and
86.1health-related procedures and tasks through hands-on assistance to complete the task or
86.2supervision and cueing to complete the task; and to assist with acquiring, maintaining, and
86.3enhancing the skills necessary to accomplish ADLs, IADLs, and health-related procedures
86.4and tasks. CFSS allows payment for certain supports and goods such as environmental
86.5modifications and technology that are intended to replace or decrease the need for human
86.6assistance.
86.7(d) Upon federal approval, CFSS will replace the personal care assistance program
86.8under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
86.9    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
86.10this subdivision have the meanings given.
86.11(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
86.12dressing, bathing, mobility, positioning, and transferring.
86.13(c) "Agency-provider model" means a method of CFSS under which a qualified
86.14agency provides services and supports through the agency's own employees and policies.
86.15The agency must allow the participant to have a significant role in the selection and
86.16dismissal of support workers of their choice for the delivery of their specific services
86.17and supports.
86.18(d) "Behavior" means a category to determine the home care rating and is based on the
86.19criteria in section 256B.0659. "Level I behavior" means physical aggression towards self,
86.20others, or destruction of property that requires the immediate response of another person.
86.21(e) "Complex health-related needs" means a category to determine the home care
86.22rating and is based on the criteria in section 256B.0659.
86.23(f) "Community first services and supports" or "CFSS" means the assistance and
86.24supports program under this section needed for accomplishing activities of daily living,
86.25instrumental activities of daily living, and health-related tasks through hands-on assistance
86.26to complete the task or supervision and cueing to complete the task, or the purchase of
86.27goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for
86.28human assistance.
86.29(g) "Community first services and supports service delivery plan" or "service delivery
86.30plan" means a written summary of the services and supports, that is based on the community
86.31support plan identified in section 256B.0911 and coordinated services and support plan
86.32and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
86.33by the participant to meet the assessed needs, using a person-centered planning process.
86.34(h) "Critical activities of daily living" means transferring, mobility, eating, and
86.35toileting.
87.1(i) "Dependency" in activities of daily living means a person requires assistance to
87.2begin and complete one or more of the activities of daily living.
87.3(j) "Financial management services contractor or vendor" means a qualified
87.4organization having a written contract with the department to provide services necessary
87.5to use the flexible spending model under subdivision 13, that include but are not limited
87.6to: participant education and technical assistance; CFSS service delivery planning and
87.7budgeting; billing, making payments, and monitoring of spending; and assisting the
87.8participant in fulfilling employer-related requirements in accordance with Section 3504 of
87.9the IRS code and the IRS Revenue Procedure 70-6.
87.10(k) "Flexible spending model" means a service delivery method of CFSS that uses
87.11an individualized CFSS service delivery plan and service budget and assistance from the
87.12financial management services contractor to facilitate participant employment of support
87.13workers and the acquisition of supports and goods.
87.14(l) "Health-related procedures and tasks" means procedures and tasks related to
87.15the specific needs of an individual that can be delegated or assigned by a state-licensed
87.16healthcare or behavioral health professional and performed by a support worker.
87.17(m) "Instrumental activities of daily living" means activities related to living
87.18independently in the community, including but not limited to: meal planning, preparation,
87.19and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning;
87.20assistance with medications; managing money; communicating needs, preferences, and
87.21activities; arranging supports; and assistance with traveling around and participating
87.22in the community.
87.23(n) "Legal representative" means parent of a minor, a court-appointed guardian, or
87.24another representative with legal authority to make decisions about services and supports
87.25for the participant. Other representatives with legal authority to make decisions include
87.26but are not limited to a health care agent or an attorney-in-fact authorized through a health
87.27care directive or power of attorney.
87.28(o) "Medication assistance" means providing verbal or visual reminders to take
87.29regularly scheduled medication and includes any of the following supports:
87.30(1) under the direction of the participant or the participant's representative, bringing
87.31medications to the participant including medications given through a nebulizer, opening a
87.32container of previously set up medications, emptying the container into the participant's
87.33hand, opening and giving the medication in the original container to the participant, or
87.34bringing to the participant liquids or food to accompany the medication;
87.35(2) organizing medications as directed by the participant or the participant's
87.36representative; and
88.1(3) providing verbal or visual reminders to perform regularly scheduled medications.
88.2(p) "Participant's representative" means a parent, family member, advocate, or
88.3other adult authorized by the participant to serve as a representative in connection with
88.4the provision of CFSS. This authorization must be in writing or by another method
88.5that clearly indicates the participant's free choice. The participant's representative must
88.6have no financial interest in the provision of any services included in the participant's
88.7service delivery plan and must be capable of providing the support necessary to assist
88.8the participant in the use of CFSS. If through the assessment process described in
88.9subdivision 5 a participant is determined to be in need of a participant's representative, one
88.10must be selected. If the participant is unable to assist in the selection of a participant's
88.11representative, the legal representative shall appoint one. Two persons may be designated
88.12as a participant's representative for reasons such as divided households and court-ordered
88.13custodies. Duties of a participant's representatives may include:
88.14(1) being available while care is provided in a method agreed upon by the participant
88.15or the participant's legal representative and documented in the participant's CFSS service
88.16delivery plan;
88.17(2) monitoring CFSS services to ensure the participant's CFSS service delivery
88.18plan is being followed; and
88.19(3) reviewing and signing CFSS time sheets after services are provided to provide
88.20verification of the CFSS services.
88.21(q) "Person-centered planning process" means a process that is driven by the
88.22participant for discovering and planning services and supports that ensures the participant
88.23makes informed choices and decisions. The person-centered planning process must:
88.24(1) include people chosen by the participant;
88.25(2) provide necessary information and support to ensure that the participant directs
88.26the process to the maximum extent possible, and is enabled to make informed choices
88.27and decisions;
88.28(3) be timely and occur at time and locations of convenience to the participant;
88.29(4) reflect cultural considerations of the participant;
88.30(5) include strategies for solving conflict or disagreement within the process,
88.31including clear conflict-of-interest guidelines for all planning;
88.32(6) offers choices to the participant regarding the services and supports they receive
88.33and from whom;
88.34(7) include a method for the participant to request updates to the plan; and
88.35(8) record the alternative home and community-based settings that were considered
88.36by the participant.
89.1(r) "Shared services" means the provision of CFSS services by the same CFSS
89.2support worker to two or three participants who voluntarily enter into an agreement to
89.3receive services at the same time and in the same setting by the same provider.
89.4(s) "Support specialist" means a professional with the skills and ability to assist the
89.5participant using either the agency provider model under subdivision 11 or the flexible
89.6spending model under subdivision 13, in services including, but not limited to assistance
89.7regarding:
89.8(1) the development, implementation, and evaluation of the CFSS service delivery
89.9plan under subdivision 6;
89.10(2) recruitment, training, or supervision, including supervision of health-related
89.11tasks or behavioral supports appropriately delegated by a health care professional, and
89.12evaluation of support workers; and
89.13(3) facilitating the use of informal and community supports, goods, or resources.
89.14(t) "Support worker" means an employee of the agency provider or of the participant
89.15who has direct contact with the participant and provides services as specified within the
89.16participant's service delivery plan.
89.17(u) "Wages and benefits" means the hourly wages and salaries, the employer's
89.18share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
89.19compensation, mileage reimbursement, health and dental insurance, life insurance,
89.20disability insurance, long-term care insurance, uniform allowance, contributions to
89.21employee retirement accounts, or other forms of employee compensation and benefits.
89.22    Subd. 3. Eligibility. (a) CFSS is available to a person who meets one of the
89.23following:
89.24(1) is a recipient of medical assistance as determined under section 256B.055,
89.25256B.056, or 256B.057, subdivisions 5 and 9;
89.26(2) is a recipient of the alternative care program under section 256B.0913;
89.27(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
89.28or 256B.49; or
89.29(4) has medical services identified in a participant's individualized education
89.30program and is eligible for services as determined in section 256B.0625, subdivision 26.
89.31(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
89.32meet all of the following:
89.33(1) require assistance and be determined dependent in one activity of daily living or
89.34Level I behavior based on assessment under section 256B.0911;
89.35(2) is not a recipient under the family support grant under section 252.32;
90.1(3) lives in the person's own apartment or home including a family foster care setting
90.2licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
90.3noncertified boarding care or boarding and lodging establishments under chapter 157;
90.4unless transitioning into the community from an institution; and
90.5(4) has not been excluded or disenrolled from the flexible spending model.
90.6(c) The commissioner shall disenroll or exclude participants from the flexible
90.7spending model and transfer them to the agency-provider model under the following
90.8circumstances that include but are not limited to:
90.9(1) when a participant has been restricted by the Minnesota restricted recipient
90.10program, the participant may be excluded for a specified time period;
90.11(2) when a participant exits the flexible spending service delivery model during the
90.12participant's service plan year. Upon transfer, the participant shall not access the flexible
90.13spending model for the remainder of that service plan year; or
90.14(3) when the department determines that the participant or participant's representative
90.15or legal representative cannot manage participant responsibilities under the service
90.16delivery model. The commissioner must develop policies for determining if a participant
90.17is unable to manage responsibilities under a service model.
90.18(d) A participant may appeal in writing to the department to contest the department's
90.19decision under paragraph (c), clause (3), to remove or exclude the participant from the
90.20flexible spending model.
90.21    Subd. 4. Eligibility for other services. Selection of CFSS by a participant must not
90.22restrict access to other medically necessary care and services furnished under the state
90.23plan medical assistance benefit or other services available through alternative care.
90.24    Subd. 5. Assessment requirements. (a) The assessment of functional need must:
90.25(1) be conducted by a certified assessor according to the criteria established in
90.26section 256B.0911;
90.27(2) be conducted face-to-face, initially and at least annually thereafter, or when there
90.28is a significant change in the participant's condition or a change in the need for services
90.29and supports; and
90.30(3) be completed using the format established by the commissioner.
90.31(b) A participant who is residing in a facility may be assessed and choose CFSS for
90.32the purpose of using CFSS to return to the community as described in subdivisions 3
90.33and 7, paragraph (a), clause (5).
90.34(c) The results of the assessment and any recommendations and authorizations for
90.35CFSS must be determined and communicated in writing by the lead agency's certified
90.36assessor as defined in section 256B.0911 to the participant and the agency-provider or
91.1financial management services provider chosen by the participant within 40 calendar days
91.2and must include the participant's right to appeal under section 256.045.
91.3    Subd. 6. Community first services and support service delivery plan. (a) The
91.4CFSS service delivery plan must be developed, implemented, and evaluated through a
91.5person-centered planning process by the participant, or the participant's representative
91.6or legal representative who may be assisted by a support specialist. The CFSS service
91.7delivery plan must reflect the services and supports that are important to the participant
91.8and for the participant to meet the needs assessed by the certified assessor and identified
91.9in the community support plan under section 256B.0911 or the coordinated services and
91.10support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS
91.11service delivery plan must be reviewed by the participant and the agency-provider or
91.12financial management services contractor at least annually upon reassessment, or when
91.13there is a significant change in the participant's condition, or a change in the need for
91.14services and supports.
91.15(b) The commissioner shall establish the format and criteria for the CFSS service
91.16delivery plan.
91.17(c) The CFSS service delivery plan must be person-centered and:
91.18(1) specify the agency-provider or financial management services contractor selected
91.19by the participant;
91.20(2) reflect the setting in which the participant resides that is chosen by the participant;
91.21(3) reflect the participant's strengths and preferences;
91.22(4) include the means to address the clinical and support needs as identified through
91.23an assessment of functional needs;
91.24(5) include individually identified goals and desired outcomes;
91.25(6) reflect the services and supports, paid and unpaid, that will assist the participant
91.26to achieve identified goals, and the providers of those services and supports, including
91.27natural supports;
91.28(7) identify the amount and frequency of face-to-face supports and amount and
91.29frequency of remote supports and technology that will be used;
91.30(8) identify risk factors and measures in place to minimize them, including
91.31individualized backup plans;
91.32(9) be understandable to the participant and the individuals providing support;
91.33(10) identify the individual or entity responsible for monitoring the plan;
91.34(11) be finalized and agreed to in writing by the participant and signed by all
91.35individuals and providers responsible for its implementation;
91.36(12) be distributed to the participant and other people involved in the plan; and
92.1(13) prevent the provision of unnecessary or inappropriate care.
92.2(d) The total units of agency-provider services or the budget allocation amount for
92.3the flexible spending model include both annual totals and a monthly average amount
92.4that cover the number of months of the service authorization. The amount used each
92.5month may vary, but additional funds must not be provided above the annual service
92.6authorization amount unless a change in condition is assessed and authorized by the
92.7certified assessor and documented in the community support plan, coordinated services
92.8and supports plan, and service delivery plan.
92.9    Subd. 7. Community first services and supports; covered services. Services
92.10and supports covered under CFSS include:
92.11(1) assistance to accomplish activities of daily living (ADLs), instrumental activities
92.12of daily living (IADLs), and health-related procedures and tasks through hands-on
92.13assistance to complete the task or supervision and cueing to complete the task;
92.14(2) assistance to acquire, maintain, or enhance the skills necessary for the participant
92.15to accomplish activities of daily living, instrumental activities of daily living, or
92.16health-related tasks;
92.17(3) expenditures for items, services, supports, environmental modifications, or
92.18goods, including assistive technology. These expenditures must:
92.19(i) relate to a need identified in a participant's CFSS service delivery plan;
92.20(ii) increase independence or substitute for human assistance to the extent that
92.21expenditures would otherwise be made for human assistance for the participant's assessed
92.22needs; and
92.23(iii) fit within the annual limit of the participant's approved service allocation
92.24or budget;
92.25(4) observation and redirection for episodes where there is a need for redirection
92.26due to participant behaviors or intervention needed due to a participant's symptoms. An
92.27assessment of behaviors must meet the criteria in this clause. A recipient qualifies as
92.28having a need for assistance due to behaviors if the recipient's behavior requires assistance
92.29at least four times per week and shows one or more of the following behaviors:
92.30(i) physical aggression towards self or others, or destruction of property that requires
92.31the immediate response of another person;
92.32(ii) increased vulnerability due to cognitive deficits or socially inappropriate
92.33behavior; or
92.34(iii) increased need for assistance for recipients who are verbally aggressive or
92.35resistive to care so that time needed to perform activities of daily living is increased;
93.1(5) back-up systems or mechanisms, such as the use of pagers or other electronic
93.2devices, to ensure continuity of the participant's services and supports;
93.3(6) transition costs, including:
93.4(i) deposits for rent and utilities;
93.5(ii) first month's rent and utilities;
93.6(iii) bedding;
93.7(iv) basic kitchen supplies;
93.8(v) other necessities, to the extent that these necessities are not otherwise covered
93.9under any other funding that the participant is eligible to receive; and
93.10(vi) other required necessities for an individual to make the transition from a nursing
93.11facility, institution for mental diseases, or intermediate care facility for persons with
93.12developmental disabilities to a community-based home setting where the participant
93.13resides; and
93.14(7) services by a support specialist defined under subdivision 2 that are chosen
93.15by the participant.
93.16    Subd. 8. Determination of CFSS service methodology. (a) All community first
93.17services and supports must be authorized by the commissioner or the commissioner's
93.18designee before services begin except for the assessments established in section
93.19256B.0911. The authorization for CFSS must be completed within 30 days after receiving
93.20a complete request.
93.21(b) The amount of CFSS authorized must be based on the recipient's home
93.22care rating. The home care rating shall be determined by the commissioner or the
93.23commissioner's designee based on information submitted to the commissioner identifying
93.24the following for a recipient:
93.25(1) the total number of dependencies of activities of daily living as defined in
93.26subdivision 2;
93.27(2) the presence of complex health-related needs as defined in subdivision 2; and
93.28(3) the presence of Level I behavior as defined in subdivision 2.
93.29(c) For purposes meeting the criteria in paragraph (b), the methodology to determine
93.30the total minutes for CFSS for each home care rating is based on the median paid units
93.31per day for each home care rating from fiscal year 2007 data for the PCA program. Each
93.32home care rating has a base number of minutes assigned. Additional minutes are added
93.33through the assessment and identification of the following:
93.34(1) 30 additional minutes per day for a dependency in each critical activity of daily
93.35living as defined in subdivision 2;
94.1(2) 30 additional minutes per day for each complex health-related function as
94.2defined in subdivision 2; and
94.3(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.
94.4    Subd. 9. Noncovered services. (a) Services or supports that are not eligible for
94.5payment under this section include those that:
94.6(1) are not authorized by the certified assessor or included in the written service
94.7delivery plan;
94.8(2) are provided prior to the authorization of services and the approval of the written
94.9CFSS service delivery plan;
94.10(3) are duplicative of other paid services in the written service delivery plan;
94.11(4) supplant natural unpaid supports that are provided voluntarily to the participant
94.12and are selected by the participant in lieu of a support worker and appropriately meeting
94.13the participant's needs;
94.14(5) are not effective means to meet the participant's needs; and
94.15(6) are available through other funding sources, including, but not limited to, funding
94.16through Title IV-E of the Social Security Act.
94.17(b) Additional services, goods, or supports that are not covered include:
94.18(1) those that are not for the direct benefit of the participant;
94.19(2) any fees incurred by the participant, such as Minnesota health care programs fees
94.20and co-pays, legal fees, or costs related to advocate agencies;
94.21(3) insurance, except for insurance costs related to employee coverage;
94.22(4) room and board costs for the participant with the exception of allowable
94.23transition costs in subdivision 7, clause (6);
94.24(5) services, supports, or goods that are not related to the assessed needs;
94.25(6) special education and related services provided under the Individuals with
94.26Disabilities Education Act and vocational rehabilitation services provided under the
94.27Rehabilitation Act of 1973;
94.28(7) assistive technology devices and assistive technology services other than those
94.29for back-up systems or mechanisms to ensure continuity of service and supports listed in
94.30subdivision 7;
94.31(8) medical supplies and equipment;
94.32(9) environmental modifications, except as specified in subdivision 7;
94.33(10) expenses for travel, lodging, or meals related to training the participant, the
94.34participant's representative, legal representative, or paid or unpaid caregivers that exceed
94.35$500 in a 12-month period;
94.36(11) experimental treatments;
95.1(12) any service or good covered by other medical assistance state plan services,
95.2including prescription and over-the-counter medications, compounds, and solutions and
95.3related fees, including premiums and co-payments;
95.4(13) membership dues or costs, except when the service is necessary and appropriate
95.5to treat a physical condition or to improve or maintain the participant's physical condition.
95.6The condition must be identified in the participant's CFSS plan and monitored by a
95.7physician enrolled in a Minnesota health care program;
95.8(14) vacation expenses other than the cost of direct services;
95.9(15) vehicle maintenance or modifications not related to the disability, health
95.10condition, or physical need; and
95.11(16) tickets and related costs to attend sporting or other recreational or entertainment
95.12events.
95.13    Subd. 10. Provider qualifications and general requirements. (a)
95.14Agency-providers delivering services under the agency-provider model under subdivision
95.1511 or financial management service (FMS) contractors under subdivision 13 shall:
95.16(1) enroll as a medical assistance Minnesota health care programs provider and meet
95.17all applicable provider standards;
95.18(2) comply with medical assistance provider enrollment requirements;
95.19(3) demonstrate compliance with law and policies of CFSS as determined by the
95.20commissioner;
95.21(4) comply with background study requirements under chapter 245C;
95.22(5) verify and maintain records of all services and expenditures by the participant,
95.23including hours worked by support workers and support specialists;
95.24(6) not engage in any agency-initiated direct contact or marketing in person, by
95.25telephone, or other electronic means to potential participants, guardians, family member
95.26or participants' representatives;
95.27(7) pay support workers and support specialists based upon actual hours of services
95.28provided;
95.29(8) withhold and pay all applicable federal and state payroll taxes;
95.30(9) make arrangements and pay unemployment insurance, taxes, workers'
95.31compensation, liability insurance, and other benefits, if any;
95.32(10) enter into a written agreement with the participant, participant's representative,
95.33or legal representative that assigns roles and responsibilities to be performed before
95.34services, supports, or goods are provided using a format established by the commissioner;
95.35(11) report suspected neglect and abuse to the common entry point according to
95.36sections 256B.0651 and 626.557; and
96.1(12) provide the participant with a copy of the service-related rights under
96.2subdivision 19 at the start of services and supports.
96.3(b) The commissioner shall develop policies and procedures designed to ensure
96.4program integrity and fiscal accountability for goods and services provided in this section.
96.5    Subd. 11. Agency-provider model. (a) The agency-provider model is limited to
96.6the services provided by support workers and support specialists who are employed by
96.7an agency-provider that is licensed according to chapter 245A or meets other criteria
96.8established by the commissioner, including required training.
96.9(b) The agency-provider shall allow the participant to retain the ability to have a
96.10significant role in the selection and dismissal of the support workers for the delivery of the
96.11services and supports specified in the service delivery plan.
96.12(c) A participant may use authorized units of CFSS services as needed within
96.13a service authorization that is not greater than 12 months. Using authorized units
96.14agency-provider services or the budget allocation amount for the flexible spending model
96.15flexibly does not increase the total amount of services and supports authorized for a
96.16participant or included in the participant's service delivery plan.
96.17(d) A participant may share CFSS services. Two or three CFSS participants may
96.18share services at the same time provided by the same support worker.
96.19(e) The agency-provider must use a minimum of 72.5 percent of the revenue
96.20generated by the medical assistance payment for CFSS for support worker wages and
96.21benefits. The agency-provider must document how this requirement is being met. The
96.22revenue generated by the support specialist and the reasonable costs associated with the
96.23support specialist must not be used in making this calculation.
96.24(f) The agency-provider model must be used by individuals who have been restricted
96.25by the Minnesota restricted recipient program.
96.26    Subd. 12. Requirements for initial enrollment of CFSS provider agencies. (a)
96.27All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider
96.28agency in a format determined by the commissioner, information and documentation that
96.29includes, but is not limited to, the following:
96.30(1) the CFSS provider agency's current contact information including address,
96.31telephone number, and e-mail address;
96.32(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
96.33provider's payments from Medicaid in the previous year, whichever is less;
96.34(3) proof of fidelity bond coverage in the amount of $20,000;
96.35(4) proof of workers' compensation insurance coverage;
96.36(5) proof of liability insurance;
97.1(6) a description of the CFSS provider agency's organization identifying the names
97.2or all owners, managing employees, staff, board of directors, and the affiliations of the
97.3directors, owners, or staff to other service providers;
97.4(7) a copy of the CFSS provider agency's written policies and procedures including:
97.5hiring of employees; training requirements; service delivery; and employee and consumer
97.6safety including process for notification and resolution of consumer grievances,
97.7identification and prevention of communicable diseases, and employee misconduct;
97.8(8) copies of all other forms the CFSS provider agency uses in the course of daily
97.9business including, but not limited to:
97.10(i) a copy of the CFSS provider agency's time sheet if the time sheet varies from
97.11the standard time sheet for CFSS services approved by the commissioner, and a letter
97.12requesting approval of the CFSS provider agency's nonstandard time sheet;
97.13(ii) the CFSS provider agency's template for the CFSS care plan; and
97.14(iii) the CFSS provider agency's template for the written agreement in subdivision
97.1521 for recipients using the CFSS choice option, if applicable;
97.16(9) a list of all training and classes that the CFSS provider agency requires of its
97.17staff providing CFSS services;
97.18(10) documentation that the CFSS provider agency and staff have successfully
97.19completed all the training required by this section;
97.20(11) documentation of the agency's marketing practices;
97.21(12) disclosure of ownership, leasing, or management of all residential properties
97.22that is used or could be used for providing home care services;
97.23(13) documentation that the agency will use the following percentages of revenue
97.24generated from the medical assistance rate paid for CFSS services for employee personal
97.25care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The
97.26revenue generated by the support specialist and the reasonable costs associated with the
97.27support specialist shall not be used in making this calculation; and
97.28(14) documentation that the agency does not burden recipients' free exercise of their
97.29right to choose service providers by requiring personal care assistants to sign an agreement
97.30not to work with any particular CFSS recipient or for another CFSS provider agency after
97.31leaving the agency and that the agency is not taking action on any such agreements or
97.32requirements regardless of the date signed.
97.33(b) CFSS provider agencies shall provide the information specified in paragraph
97.34(a) to the commissioner.
97.35(c) All CFSS provider agencies shall require all employees in management and
97.36supervisory positions and owners of the agency who are active in the day-to-day
98.1management and operations of the agency to complete mandatory training as determined
98.2by the commissioner. Employees in management and supervisory positions and owners
98.3who are active in the day-to-day operations of an agency who have completed the required
98.4training as an employee with a CFSS provider agency do not need to repeat the required
98.5training if they are hired by another agency, if they have completed the training within
98.6the past three years. CFSS provider agency billing staff shall complete training about
98.7CFSS program financial management. Any new owners or employees in management
98.8and supervisory positions involved in the day-to-day operations are required to complete
98.9mandatory training as a requisite of working for the agency. CFSS provider agencies
98.10certified for participation in Medicare as home health agencies are exempt from the
98.11training required in this subdivision.
98.12    Subd. 13. Flexible spending model. (a) Under the flexible spending model
98.13participants can exercise more responsibility and control over the services and supports
98.14described and budgeted within the CFSS service delivery plan. Under this model:
98.15(1) participants directly employ support workers;
98.16(2) participants may use a budget allocation to obtain supports and goods as defined
98.17in subdivision 7; and
98.18(3) from the financial management services (FMS) contractor the participant may
98.19choose a range of support assistance services relating to:
98.20(i) planning, budgeting, and management of services and support;
98.21(ii) the participant's employment, training, supervision, and evaluation of workers;
98.22(iii) acquisition and payment for supports and goods; and
98.23(iv) evaluation of individual service outcomes as needed for the scope of the
98.24participant's degree of control and responsibility.
98.25(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
98.26may authorize a legal representative or participant's representative to do so on their behalf.
98.27(c) The FMS contractor shall not provide CFSS services and supports under the
98.28agency-provider service model. The FMS contractor shall provide service functions as
98.29determined by the commissioner that include but are not limited to:
98.30(1) information and consultation about CFSS;
98.31(2) assistance with the development of the service delivery plan and flexible
98.32spending model as requested by the participant;
98.33(3) billing and making payments for flexible spending model expenditures;
98.34(4) assisting participants in fulfilling employer-related requirements according to
98.35Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability,
99.1regulation 137036-08, which includes assistance with filing and paying payroll taxes, and
99.2obtaining worker compensation coverage;
99.3(5) data recording and reporting of participant spending; and
99.4(6) other duties established in the contract with the department.
99.5(d) A participant who requests to purchase goods and supports along with support
99.6worker services under the agency-provider model must use flexible spending model
99.7with a service delivery plan that specifies the amount of services to be authorized to the
99.8agency-provider and the expenditures to be paid by the FMS contractor.
99.9(e) The FMS contractor shall:
99.10(1) not limit or restrict the participant's choice of service or support providers or
99.11service delivery models as authorized by the commissioner;
99.12(2) provide the participant and the targeted case manager, if applicable, with a
99.13monthly written summary of the spending for services and supports that were billed
99.14against the spending budget;
99.15(3) be knowledgeable of state and federal employment regulations under the Fair
99.16Labor Standards Act of 1938, and comply with the requirements under the Internal
99.17Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax
99.18Liability for vendor or fiscal employer agent, and any requirements necessary to process
99.19employer and employee deductions, provide appropriate and timely submission of
99.20employer tax liabilities, and maintain documentation to support medical assistance claims;
99.21(4) have current and adequate liability insurance and bonding and sufficient cash
99.22flow as determined by the commission and have on staff or under contract a certified
99.23public accountant or an individual with a baccalaureate degree in accounting;
99.24(5) assume fiscal accountability for state funds designated for the program; and
99.25(6) maintain documentation of receipts, invoices, and bills to track all services and
99.26supports expenditures for any goods purchased and maintain time records of support
99.27workers. The documentation and time records must be maintained for a minimum of
99.28five years from the claim date and be available for audit or review upon request by the
99.29commissioner. Claims submitted by the FMS contractor to the commissioner for payment
99.30must correspond with services, amounts, and time periods as authorized in the participant's
99.31spending budget and service plan.
99.32(f) The commissioner of human services shall:
99.33(1) establish rates and payment methodology for the FMS contractor;
99.34(2) identify a process to ensure quality and performance standards for the FMS
99.35contractor and ensure statewide access to FMS contractors; and
100.1(3) establish a uniform protocol for delivering and administering CFSS services
100.2to be used by eligible FMS contractors.
100.3(g) Participants who are disenrolled from the model shall be transferred to the
100.4agency-provider model.
100.5    Subd. 14. Participant's responsibilities under flexible spending model. (a) A
100.6participant using the flexible spending model must use a FMS contractor or vendor that is
100.7under contract with the department. Upon a determination of eligibility and completion of
100.8the assessment and community support plan, the participant shall choose a FMS contractor
100.9from a list of eligible vendors maintained by the department.
100.10(b) When the participant, participant's representative, or legal representative chooses
100.11to be the employer of the support worker, they are responsible for recruiting, interviewing,
100.12hiring, training, scheduling, supervising, and discharging direct support workers.
100.13(c) In addition to the employer responsibilities in paragraph (b), the participant,
100.14participant's representative, or legal representative is responsible for:
100.15(1) tracking the services provided and all expenditures for goods or other supports;
100.16(2) preparing and submitting time sheets, signed by both the participant and support
100.17worker, to the FMS contractor on a regular basis and in a timely manner according to
100.18the FMS contractor's procedures;
100.19(3) notifying the FMS contractor within ten days of any changes in circumstances
100.20affecting the CFSS service plan or in the participant's place of residence including, but
100.21not limited to, any hospitalization of the participant or change in the participant's address,
100.22telephone number, or employment;
100.23(4) notifying the FMS contractor of any changes in the employment status of each
100.24participant support worker; and
100.25(5) reporting any problems resulting from the quality of services rendered by the
100.26support worker to the FMS contractor. If the participant is unable to resolve any problems
100.27resulting from the quality of service rendered by the support worker with the assistance of
100.28the FMS contractor, the participant shall report the situation to the department.
100.29    Subd. 15. Documentation of support services provided. (a) Support services
100.30provided to a participant by a support worker employed by either an agency-provider
100.31or the participant acting as the employer must be documented daily by each support
100.32worker, on a time sheet form approved by the commissioner. All documentation may be
100.33Web-based, electronic, or paper documentation. The completed form must be submitted
100.34on a monthly basis to the provider or the participant and the FMS contractor selected by
100.35the participant to provide assistance with meeting the participant's employer obligations
100.36and kept in the recipient's health record.
101.1(b) The activity documentation must correspond to the written service delivery plan
101.2and be reviewed by the agency provider or the participant and the FMS contractor when
101.3the participant is acting as the employer of the support worker.
101.4(c) The time sheet must be on a form approved by the commissioner documenting
101.5time the support worker provides services in the home. The following criteria must be
101.6included in the time sheet:
101.7(1) full name of the support worker and individual provider number;
101.8(2) provider name and telephone numbers, if an agency-provider is responsible for
101.9delivery services under the written service plan;
101.10(3) full name of the participant;
101.11(4) consecutive dates, including month, day, and year, and arrival and departure
101.12times with a.m. or p.m. notations;
101.13(5) signatures of the participant or the participant's representative;
101.14(6) personal signature of the support worker;
101.15(7) any shared care provided, if applicable;
101.16(8) a statement that it is a federal crime to provide false information on CFSS
101.17billings for medical assistance payments; and
101.18(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
101.19    Subd. 16. Support workers requirements. (a) Support workers shall:
101.20(1) enroll with the department as a support worker after a background study under
101.21chapter 245C has been completed and the support worker has received a notice from the
101.22commissioner that:
101.23(i) the support worker is not disqualified under section 245C.14; or
101.24(ii) is disqualified, but the support worker has received a set-aside of the
101.25disqualification under section 245C.22;
101.26(2) have the ability to effectively communicate with the participant or the
101.27participant's representative;
101.28(3) have the skills and ability to provide the services and supports according to the
101.29person's CFSS service delivery plan and respond appropriately to the participant's needs;
101.30(4) not be a participant of CFSS;
101.31(5) complete the basic standardized training as determined by the commissioner
101.32before completing enrollment. The training must be available in languages other than
101.33English and to those who need accommodations due to disabilities. Support worker
101.34training must include successful completion of the following training components: basic
101.35first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
101.36and responsibilities of support workers including information about basic body mechanics,
102.1emergency preparedness, orientation to positive behavioral practices, orientation to
102.2responding to a mental health crisis, fraud issues, time cards and documentation, and an
102.3overview of person-centered planning and self-direction. Upon completion of the training
102.4components, the support worker must pass the certification test to provide assistance
102.5to participants;
102.6(6) complete training and orientation on the participant's individual needs; and
102.7(7) maintain the privacy and confidentiality of the participant, and not independently
102.8determine the medication dose or time for medications for the participant.
102.9(b) The commissioner may deny or terminate a support worker's provider enrollment
102.10and provider number if the support worker:
102.11(1) lacks the skills, knowledge, or ability to adequately or safely perform the
102.12required work;
102.13(2) fails to provide the authorized services required by the participant employer;
102.14(3) has been intoxicated by alcohol or drugs while providing authorized services to
102.15the participant or while in the participant's home;
102.16(4) has manufactured or distributed drugs while providing authorized services to the
102.17participant or while in the participant's home; or
102.18(5) has been excluded as a provider by the commissioner of human services, or the
102.19United States Department of Health and Human Services, Office of Inspector General,
102.20from participation in Medicaid, Medicare, or any other federal health care program.
102.21(c) A support worker may appeal in writing to the commissioner to contest the
102.22decision to terminate the support worker's provider enrollment and provider number.
102.23    Subd. 17. Support specialist requirements and payments. The commissioner
102.24shall develop qualifications, scope of functions, and payment rates and service limits for a
102.25support specialist that may provide additional or specialized assistance necessary to plan,
102.26implement, arrange, augment, or evaluate services and supports.
102.27    Subd. 18. Service unit and budget allocation requirements. (a) For the
102.28agency-provider model, services will be authorized in units of service. The total service
102.29unit amount must be established based upon the assessed need for CFSS services, and
102.30must not exceed the maximum number of units available as determined by section
102.31256B.0652, subdivision 6. The unit rate established by the commissioner is used with
102.32assessed units to determine the maximum available CFSS allocation.
102.33(b) For the flexible spending model, services and supports are authorized under
102.34a budget limit.
103.1(c) The maximum available CFSS participant budget allocation shall be established
103.2by multiplying the number of units authorized under subdivision 8 by the payment rate
103.3established by the commissioner.
103.4    Subd. 19. Support system. (a) The commissioner shall provide information,
103.5consultation, training, and assistance to ensure the participant is able to manage the
103.6services and supports and budgets, if applicable. This support shall include individual
103.7consultation on how to select and employ workers, manage responsibilities under CFSS,
103.8and evaluate personal outcomes.
103.9(b) The commissioner shall provide assistance with the development of risk
103.10management agreements.
103.11    Subd. 20. Service-related rights. Participants must be provided with adequate
103.12information, counseling, training, and assistance, as needed, to ensure that the participant
103.13is able to choose and manage services, models, and budgets. This support shall include
103.14information regarding: (1) person-centered planning; (2) the range and scope of individual
103.15choices; (3) the process for changing plans, services and budgets; (4) the grievance
103.16process; (5) individual rights; (6) identifying and assessing appropriate services; (7) risks
103.17and responsibilities; and (8) risk management. A participant who appeals a reduction in
103.18previously authorized CFSS services may continue previously authorized services pending
103.19an appeal under section 256.045. The commissioner must ensure that the participant
103.20has a copy of the most recent service delivery plan that contains a detailed explanation
103.21of which areas of covered CFSS are reduced, and provide notice of the amount of the
103.22budget reduction, and the reasons for the reduction in the participant's notice of denial,
103.23termination, or reduction.
103.24    Subd. 21. Development and Implementation Council. The commissioner
103.25shall establish a Development and Implementation Council of which the majority of
103.26members are individuals with disabilities, elderly individuals, and their representatives.
103.27The commissioner shall consult and collaborate with the council when developing and
103.28implementing this section.
103.29    Subd. 22. Quality assurance and risk management system. (a) The commissioner
103.30shall establish quality assurance and risk management measures for use in developing and
103.31implementing CFSS including those that (1) recognize the roles and responsibilities of those
103.32involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and budgets
103.33based upon a recipient's resources and capabilities. Risk management measures must
103.34include background studies, and backup and emergency plans, including disaster planning.
103.35(b) The commissioner shall provide ongoing technical assistance and resource and
103.36educational materials for CFSS participants.
104.1(c) Performance assessment measures, such as a participant's satisfaction with the
104.2services and supports, and ongoing monitoring of health and well-being shall be identified
104.3in consultation with the council established in subdivision 21.
104.4    Subd. 23. Commissioner's access. When the commissioner is investigating a
104.5possible overpayment of Medicaid funds, the commissioner must be given immediate
104.6access without prior notice to the agency provider or FMS contractor's office during
104.7regular business hours and to documentation and records related to services provided and
104.8submission of claims for services provided. Denying the commissioner access to records
104.9is cause for immediate suspension of payment and terminating the agency provider's
104.10enrollment according to section 256B.064 or terminating the FMS contract.
104.11    Subd. 24. CFSS agency-providers; background studies. CFSS agency-providers
104.12enrolled to provide personal care assistance services under the medical assistance program
104.13shall comply with the following:
104.14(1) owners who have a five percent interest or more and all managing employees
104.15are subject to a background study as provided in chapter 245C. This applies to currently
104.16enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
104.17agency-provider. "Managing employee" has the same meaning as Code of Federal
104.18Regulations, title 42, section 455. An organization is barred from enrollment if:
104.19(i) the organization has not initiated background studies on owners managing
104.20employees; or
104.21(ii) the organization has initiated background studies on owners and managing
104.22employees, but the commissioner has sent the organization a notice that an owner or
104.23managing employee of the organization has been disqualified under section 245C.14, and
104.24the owner or managing employee has not received a set-aside of the disqualification
104.25under section 245C.22;
104.26(2) a background study must be initiated and completed for all support specialists; and
104.27(3) a background study must be initiated and completed for all support workers.
104.28EFFECTIVE DATE.This section is effective upon federal approval. The
104.29commissioner of human services shall notify the revisor of statutes when this occurs.

104.30    Sec. 44. Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
104.31to read:
104.32    Subd. 1o. Supplementary service rate; exemptions. A county agency shall not
104.33negotiate a supplementary service rate under this section for any individual that has been
104.34determined to be eligible for Housing Stability Services as approved by the Centers
104.35for Medicare and Medicaid Services, and who resides in an establishment voluntarily
105.1registered under section 144D.025, as a supportive housing establishment or participates
105.2in the Minnesota supportive housing demonstration program under section 256I.04,
105.3subdivision 3, paragraph (a), clause (4).

105.4    Sec. 45. Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:
105.5    Subd. 4. Reporting. (a) Except as provided in paragraph (b), a mandated reporter
105.6shall immediately make an oral report to the common entry point. The common entry
105.7point may accept electronic reports submitted through a Web-based reporting system
105.8established by the commissioner. Use of a telecommunications device for the deaf or other
105.9similar device shall be considered an oral report. The common entry point may not require
105.10written reports. To the extent possible, the report must be of sufficient content to identify
105.11the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment,
105.12any evidence of previous maltreatment, the name and address of the reporter, the time,
105.13date, and location of the incident, and any other information that the reporter believes
105.14might be helpful in investigating the suspected maltreatment. A mandated reporter may
105.15disclose not public data, as defined in section 13.02, and medical records under sections
105.16144.291 to 144.298, to the extent necessary to comply with this subdivision.
105.17(b) A boarding care home that is licensed under sections 144.50 to 144.58 and
105.18certified under Title 19 of the Social Security Act, a nursing home that is licensed under
105.19section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a
105.20hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under
105.21Code of Federal Regulations, title 42, section 482.66, may submit a report electronically
105.22to the common entry point instead of submitting an oral report. The report may be a
105.23duplicate of the initial report the facility submits electronically to the commissioner of
105.24health to comply with the reporting requirements under Code of Federal Regulations, title
105.2542, section 483.13. The commissioner of health may modify these reporting requirements
105.26to include items required under paragraph (a) that are not currently included in the
105.27electronic reporting form.
105.28EFFECTIVE DATE.This section is effective July 1, 2014.

105.29    Sec. 46. Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:
105.30    Subd. 9. Common entry point designation. (a) Each county board shall designate
105.31a common entry point for reports of suspected maltreatment. Two or more county boards
105.32may jointly designate a single The commissioner of human services shall establish a
105.33 common entry point effective July 1, 2014. The common entry point is the unit responsible
105.34for receiving the report of suspected maltreatment under this section.
106.1(b) The common entry point must be available 24 hours per day to take calls from
106.2reporters of suspected maltreatment. The common entry point shall use a standard intake
106.3form that includes:
106.4(1) the time and date of the report;
106.5(2) the name, address, and telephone number of the person reporting;
106.6(3) the time, date, and location of the incident;
106.7(4) the names of the persons involved, including but not limited to, perpetrators,
106.8alleged victims, and witnesses;
106.9(5) whether there was a risk of imminent danger to the alleged victim;
106.10(6) a description of the suspected maltreatment;
106.11(7) the disability, if any, of the alleged victim;
106.12(8) the relationship of the alleged perpetrator to the alleged victim;
106.13(9) whether a facility was involved and, if so, which agency licenses the facility;
106.14(10) any action taken by the common entry point;
106.15(11) whether law enforcement has been notified;
106.16(12) whether the reporter wishes to receive notification of the initial and final
106.17reports; and
106.18(13) if the report is from a facility with an internal reporting procedure, the name,
106.19mailing address, and telephone number of the person who initiated the report internally.
106.20(c) The common entry point is not required to complete each item on the form prior
106.21to dispatching the report to the appropriate lead investigative agency.
106.22(d) The common entry point shall immediately report to a law enforcement agency
106.23any incident in which there is reason to believe a crime has been committed.
106.24(e) If a report is initially made to a law enforcement agency or a lead investigative
106.25agency, those agencies shall take the report on the appropriate common entry point intake
106.26forms and immediately forward a copy to the common entry point.
106.27(f) The common entry point staff must receive training on how to screen and
106.28dispatch reports efficiently and in accordance with this section.
106.29(g) The commissioner of human services shall maintain a centralized database
106.30for the collection of common entry point data, lead investigative agency data including
106.31maltreatment report disposition, and appeals data. The common entry point shall
106.32have access to the centralized database and must log the reports into the database and
106.33immediately identify and locate prior reports of abuse, neglect, or exploitation.
106.34(h) When appropriate, the common entry point staff must refer calls that do not
106.35allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations
106.36that might resolve the reporter's concerns.
107.1(i) a common entry point must be operated in a manner that enables the
107.2commissioner of human services to:
107.3(1) track critical steps in the reporting, evaluation, referral, response, disposition,
107.4and investigative process to ensure compliance with all requirements for all reports;
107.5(2) maintain data to facilitate the production of aggregate statistical reports for
107.6monitoring patterns of abuse, neglect, or exploitation;
107.7(3) serve as a resource for the evaluation, management, and planning of preventative
107.8and remedial services for vulnerable adults who have been subject to abuse, neglect,
107.9or exploitation;
107.10(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
107.11of the common entry point; and
107.12(5) track and manage consumer complaints related to the common entry point.
107.13(j) The commissioners of human services and health shall collaborate on the
107.14creation of a system for referring reports to the lead investigative agencies. This system
107.15shall enable the commissioner of human services to track critical steps in the reporting,
107.16evaluation, referral, response, disposition, investigation, notification, determination, and
107.17appeal processes.

107.18    Sec. 47. Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:
107.19    Subd. 9e. Education requirements. (a) The commissioners of health, human
107.20services, and public safety shall cooperate in the development of a joint program for
107.21education of lead investigative agency investigators in the appropriate techniques for
107.22investigation of complaints of maltreatment. This program must be developed by July
107.231, 1996. The program must include but need not be limited to the following areas: (1)
107.24information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
107.25conclusions based on evidence; (5) interviewing skills, including specialized training to
107.26interview people with unique needs; (6) report writing; (7) coordination and referral
107.27to other necessary agencies such as law enforcement and judicial agencies; (8) human
107.28relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
107.29systems and the appropriate methods for interviewing relatives in the course of the
107.30assessment or investigation; (10) the protective social services that are available to protect
107.31alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
107.32which lead investigative agency investigators and law enforcement workers cooperate in
107.33conducting assessments and investigations in order to avoid duplication of efforts; and
107.34(12) data practices laws and procedures, including provisions for sharing data.
108.1(b) The commissioner of human services shall conduct an outreach campaign to
108.2promote the common entry point for reporting vulnerable adult maltreatment. This
108.3campaign shall use the Internet and other means of communication.
108.4(b) (c) The commissioners of health, human services, and public safety shall offer at
108.5least annual education to others on the requirements of this section, on how this section is
108.6implemented, and investigation techniques.
108.7(c) (d) The commissioner of human services, in coordination with the commissioner
108.8of public safety shall provide training for the common entry point staff as required in this
108.9subdivision and the program courses described in this subdivision, at least four times
108.10per year. At a minimum, the training shall be held twice annually in the seven-county
108.11metropolitan area and twice annually outside the seven-county metropolitan area. The
108.12commissioners shall give priority in the program areas cited in paragraph (a) to persons
108.13currently performing assessments and investigations pursuant to this section.
108.14(d) (e) The commissioner of public safety shall notify in writing law enforcement
108.15personnel of any new requirements under this section. The commissioner of public
108.16safety shall conduct regional training for law enforcement personnel regarding their
108.17responsibility under this section.
108.18(e) (f) Each lead investigative agency investigator must complete the education
108.19program specified by this subdivision within the first 12 months of work as a lead
108.20investigative agency investigator.
108.21A lead investigative agency investigator employed when these requirements take
108.22effect must complete the program within the first year after training is available or as soon
108.23as training is available.
108.24All lead investigative agency investigators having responsibility for investigation
108.25duties under this section must receive a minimum of eight hours of continuing education
108.26or in-service training each year specific to their duties under this section.

108.27    Sec. 48. REPEALER.
108.28(a) Minnesota Statutes 2012, sections 245A.655; and 256B.0917, subdivisions 1, 2,
108.293, 4, 5, 7, 8, 9, 10, 11, 12, and 14, are repealed.
108.30(b) Minnesota Statutes 2012, section 256B.0911, subdivisions 4a, 4b, and 4c, are
108.31repealed effective October 1, 2013.

108.32    Sec. 49. EFFECTIVE DATE; CONTINGENT SYSTEMS MODERNIZATION
108.33APPROPRIATION.
109.1    Subdivision 1. Definitions. (a) For the purposes of this section, the terms in this
109.2subdivision have the meanings given.
109.3(b) Unless otherwise indicated, "commissioner" means the commissioner of human
109.4services.
109.5(c) "Contingent systems modernization appropriation" refers to the appropriation in
109.6article 15, section 2.
109.7(d) "Department" means the Department of Human Services.
109.8(e) "Plan" means the plan that outlines how the provisions in this article, and the
109.9contingent appropriation for systems modernization, are implemented once federal action
109.10on Reform 2020 has occurred.
109.11(f) Unless otherwise indicated, "Reform 2020" means the commissioner's request
109.12for any necessary federal approval of provisions in this article that modify or provide
109.13new medical assistance services, or that otherwise modify the federal role in the state's
109.14long-term care system.
109.15    Subd. 2. Intent; effective dates generally. (a) Because the changes contained in
109.16this article generate savings that are contingent on federal approval of Reform 2020,
109.17the legislature has also made an appropriation for systems modernization contingent on
109.18federal approval of Reform 2020. The purpose of this section is to outline how this article
109.19and the contingent systems modernization appropriation in article 15 are implemented if
109.20Reform 2020 is fully, partially, or incrementally approved or denied.
109.21(b) In order for sections 1 to 48 of this article to be effective, the commissioner must
109.22follow the provisions of subdivisions 3 and 4, as applicable, notwithstanding any other
109.23effective dates for those sections.
109.24    Subd. 3. Federal approval. (a) The implementation of this article is contingent
109.25on federal approval.
109.26(b) Upon full or partial approval of the waiver application, the commissioner shall
109.27develop a plan for implementing the provisions in this article that received federal
109.28approval as well as any that do not require federal approval. The plan must:
109.29(1) include fiscal estimates for the 2014-2015 and 2016-2017 biennia;
109.30(2) include the contingent systems modernization appropriation, which cannot
109.31exceed $16,992,000 for the biennium ending June 30, 2015; and
109.32(3) include spending estimates that, with federal administrative reimbursement, do
109.33not exceed the department's net general fund appropriations for the 2014-2015 biennium.
109.34(c) Upon approval by the commissioner of management and budget, the department
109.35may implement the plan.
110.1(d) The commissioner may follow this plan and implement parts of Reform 2020
110.2consistent with federal law if federal approval is denied, received incrementally, or
110.3significantly delayed.
110.4(e) The commissioner must notify the chairs and ranking minority members of the
110.5legislative committees with jurisdiction over health and human services funding of the
110.6plan. The plan must be made publicly available online.
110.7    Subd. 4. Disbursement; implementation. The commissioner of management and
110.8budget shall disburse the appropriations in article 15, section 2, to the commissioner to
110.9allow for implementation of the approved plan and make necessary adjustments in the
110.10accounting system to reflect any modified funding levels. Notwithstanding Minnesota
110.11Statutes, section 16A.11, subdivision 3, paragraph (b), these fiscal estimates must be
110.12considered in establishing the appropriation base for the biennium ending June 30, 2017.
110.13The commissioner of management and budget shall reflect the modified funding levels in
110.14the first fund balance following the approval of the plan.


110.17    Section 1. Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to
110.18read:
110.19    Subd. 2. Payment methodologies. (a) The commissioner shall establish, as defined
110.20under section 256B.4914, statewide payment methodologies that meet federal waiver
110.21requirements for home and community-based waiver services for individuals with
110.22disabilities. The payment methodologies must abide by the principles of transparency
110.23and equitability across the state. The methodologies must involve a uniform process of
110.24structuring rates for each service and must promote quality and participant choice.
110.25    (b) As of January 1, 2012, counties shall not implement changes to established
110.26processes for rate-setting methodologies for individuals using components of or data
110.27from research rates.

110.28    Sec. 2. Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:
110.29    Subd. 3. Payment requirements. The payment methodologies established under
110.30this section shall accommodate:
110.31(1) supervision costs;
110.32(2) staffing patterns staff compensation;
110.33(3) staffing and supervisory patterns;
110.34(3) (4) program-related expenses;
111.1(4) (5) general and administrative expenses; and
111.2(5) (6) consideration of recipient intensity.

111.3    Sec. 3. Minnesota Statutes 2012, section 256B.4913, is amended by adding a
111.4subdivision to read:
111.5    Subd. 4a. Rate stabilization adjustment. (a) The commissioner of human services
111.6shall adjust individual reimbursement rates by no more than 1.0 percent per year effective
111.7January 1, 2016. Rates determined under section 256B.4914 must be adjusted so that
111.8the unit rate varies no more than 1.0 percent per year from the rate effective December
111.91 of the prior calendar year. This adjustment is made annually for three calendar years
111.10from the date of implementation.
111.11(b) Rate stabilization adjustment applies to services that are authorized in a
111.12recipient's service plan prior to January 1, 2016.
111.13(c) Exemptions shall be made only when there is a significant change in the
111.14recipient's assessed needs which results in a service authorization change. Exemption
111.15adjustments shall be limited to the difference in the authorized framework rate specific to
111.16change in assessed need. Exemptions shall be managed within lead agencies' budgets per
111.17existing allocation procedures.
111.18(d) This subdivision expires January 1, 2019.

111.19    Sec. 4. Minnesota Statutes 2012, section 256B.4913, subdivision 5, is amended to read:
111.20    Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
111.21on regular intervals with the existing stakeholder group established as part of the
111.22rate-setting methodology process and others, to gather input, concerns, and data, and
111.23exchange ideas for the legislative proposals for to assist in the full implementation of
111.24 the new rate payment system and to make pertinent information available to the public
111.25through the department's Web site.

111.26    Sec. 5. Minnesota Statutes 2012, section 256B.4913, subdivision 6, is amended to read:
111.27    Subd. 6. Implementation. (a) The commissioner may shall implement changes
111.28no sooner than on January 1, 2014, to payment rates for individuals receiving home and
111.29community-based waivered services after the enactment of legislation that establishes
111.30specific payment methodology frameworks, processes for rate calculations, and specific
111.31values to populate the payment methodology frameworks disability waiver rates system.
111.32(b) On January 1, 2014, all new service authorizations must use the disability waiver
111.33rates system. Beginning January 1, 2014, all renewing individual service plans must use the
112.1disability waiver rates system as reassessment and reauthorization occurs. By December
112.231, 2014, data for all recipients must be entered into the disability waiver rates system.

112.3    Sec. 6. [256B.4914] HOME AND COMMUNITY-BASED SERVICES WAIVERS;
112.4RATE SETTING.
112.5    Subdivision 1. Application. The payment methodologies in this section apply to
112.6home and community-based services waivers under sections 256B.092 and 256B.49. This
112.7section does not change existing waiver policies and procedures.
112.8    Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
112.9meanings given them, unless the context clearly indicates otherwise.
112.10(b) "Commissioner" means the commissioner of human services.
112.11(c) "Component value" means underlying factors that are part of the cost of providing
112.12services that are built into the waiver rates methodology to calculate service rates.
112.13(d) "Customized living tool" means a methodology for setting service rates which
112.14delineates and documents the amount of each component service included in a recipient's
112.15customized living service plan.
112.16(e) "Disability Waiver Rates System" means a statewide system which establishes
112.17rates that are based on uniform processes and captures the individualized nature of waiver
112.18services and recipient needs.
112.19(f) "Lead agency" means a county, partnership of counties, or tribal agency charged
112.20with administering waivered services under sections 256B.092 and 256B.49.
112.21(g) "Median" means the amount that divides distribution into two equal groups, half
112.22above the median and half below the median.
112.23(h) "Payment or rate" means reimbursement to an eligible provider for services
112.24provided to a qualified individual based on an approved service authorization.
112.25(i) "Rates management system" means a web-based software application that uses
112.26a framework and component values, as determined by the commissioner, to establish
112.27service rates.
112.28(j) "Recipient" means a person receiving home and community-based services
112.29funded under any of the disability waivers.
112.30    Subd. 3. Applicable services. Applicable services are those authorized under the
112.31state's home and community-based services waivers under sections 256B.092 and 256B.49
112.32including, as defined in the federally approved home and community-based services plan:
112.33(1) 24-hour customized living;
112.34(2) adult day care;
112.35(3) adult day care bath;
113.1(4) behavioral programming;
113.2(5) companion services;
113.3(6) customized living;
113.4(7) day training and habilitation;
113.5(8) housing access coordination;
113.6(9) independent living skills;
113.7(10) in-home family support;
113.8(11) night supervision;
113.9(12) personal support;
113.10(13) prevocational services;
113.11(14) residential care services;
113.12(15) residential support services;
113.13(16) respite services;
113.14(17) structured day services;
113.15(18) supported employment services;
113.16(19) supported living services;
113.17(20) transportation services; and
113.18(21) other services as approved by the federal government in the state home and
113.19community-based services plan.
113.20    Subd. 4. Data collection for rate determination. (a) Rates for all applicable home
113.21and community-based waivered services, including rate exceptions under subdivision 12
113.22are set via the rates management system.
113.23(b) Only data and information in the rates management system may be used to
113.24calculate an individual's rate.
113.25(c) Service providers, with information from the community support plan, shall enter
113.26values and information needed to calculate an individual's rate into the rates management
113.27system. These values and information include:
113.28(1) shared staffing hours;
113.29(2) individual staffing hours;
113.30(3) staffing ratios;
113.31(4) information to document variable levels of service qualification for variable
113.32levels of reimbursement in each framework;
113.33(5) shared or individualized arrangements for unit-based services, including the
113.34staffing ratio; and
113.35(6) number of trips and miles for transportation services.
113.36(d) Updates to individual data shall include:
114.1(1) data for each individual that is updated annually when renewing service plans; and
114.2(2) requests by individuals or lead agencies to update a rate whenever there is a
114.3change in an individual's service needs, with accompanying documentation.
114.4(e) Lead agencies shall review and approve values to calculate the final payment rate
114.5for each individual. Lead agencies must notify the individual and the service provider
114.6of the final agreed upon values and rate. If a value used was mistakenly or erroneously
114.7entered and used to calculate a rate, a provider may petition lead agencies to correct it.
114.8Lead agencies must respond to these requests.
114.9    Subd. 5. Base wage index and standard component values. (a) The base wage
114.10index is established to determine staffing costs associated with providing services to
114.11individuals receiving home and community-based services. For purposes of developing
114.12and calculating the proposed base wage, Minnesota-specific wages taken from job
114.13descriptions and standard occupational classification (SOC) codes from the Bureau of
114.14Labor Statistics, as defined in the most recent edition of the Occupational Handbook shall
114.15be used. The base wage index shall be calculated as follows:
114.16(1) for residential direct care basic staff, 50 percent of the median wage for personal
114.17and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing
114.18aide (SOC code 31-1012); and 20 percent of the median wage for social and human
114.19services aide (SOC code 21-1093);
114.20(2) for residential direct care intensive staff, 20 percent of the median wage for home
114.21health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
114.22health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
114.2321-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
114.24and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
114.25(3) for day services, 20 percent of the median wage for nursing aide (SOC Code
114.2631-1012); 20 percent of the median wage for psychiatric technician (SOC Code 29-2053);
114.27and 60 percent of the median wage for social and human services code (SOC Code
114.2821-1093);
114.29(4) for residential asleep overnight staff, the wage will be $7.66 per hour, except
114.30in a family foster care setting the wage is $2.80 per hour;
114.31(5) for behavior program analyst staff: 100 percent of the median wage for mental
114.32health counselors (SOC code 21-1014);
114.33(6) for behavior program professional staff: 100 percent of the median wage for
114.34clinical counseling and school psychologist (SOC code 19-3031);
114.35(7) for behavior program specialist staff: 100 percent of the median wage for
114.36psychiatric technicians (SOC code 29-2053);
115.1(8) for supportive living services staff: 20 percent of the median wage for nursing
115.2aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
115.3code 29-2053); and 60 percent of the median wage for social and human services aide
115.4(SOC code 21-1093);
115.5(9) for housing access coordination staff: 50 percent of the median wage for
115.6community and social services specialist (SOC code 21-1099); and 50 percent of the
115.7median wage for social and human services aide (SOC code 21-1093);
115.8(10) for in-home family support staff: 20 percent of the median wage for nursing
115.9aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code
115.1021-1099); 40 percent of the median wage for social and human services aide (SOC code
115.1121-1093); and 10 percent of the median wage for psychiatric technician (SOC code
115.1229-2053);
115.13(11) for independent living skills staff: 40 percent of the median wage for
115.14community social service specialist (SOC code 21-1099); 50 percent of the median wage
115.15for social and human services aide (SOC code 21-1093); and 10 percent of the median
115.16wage for psychiatric technician (SOC code 29-2053);
115.17(12) for supported employment staff: 20 percent of the median wage for nursing
115.18aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
115.19code 29-2053); and 60 percent of the median wage for social and human services aide
115.20(SOC code 21-1093);
115.21(13) for adult companion staff: 50 percent of the median wage for personal and
115.22home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
115.23orderlies, and attendants (SOC code 31-1012);
115.24(14) for night supervision staff: 20 percent of the median wage for home health aide
115.25(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
115.26(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
115.2720 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
115.28percent of the median wage for social and human services aide (SOC code 21-1093);
115.29(15) for respite staff: 50 percent of the median wage for personal and home care aide
115.30(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
115.31attendants (SOC code 31-1012);
115.32(16) for personal support staff: 50 percent of the median wage for personal and
115.33home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
115.34aides, orderlies, and attendants (SOC code 31-1012); and
115.35(17) for supervisory staff: the basic wage is $17.43 per hour with exception of the
115.36supervisor of behavior analyst and behavior specialists which shall be $30.75 per hour.
116.1(b) Component values for residential support services, excluding family foster
116.2care, are:
116.3(1) supervisory span of control ratio: 11 percent;
116.4(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
116.5(3) employee-related cost ratio: 23.6 percent;
116.6(4) general administrative support ratio: 13.25 percent;
116.7(5) program-related expense ratio: 1.3 percent; and
116.8(6) absence and utilization factor ratio: 3.9 percent.
116.9(c) Component values for family foster care are:
116.10(1) supervisory span of control ratio: 11 percent;
116.11(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
116.12(3) employee-related cost ratio: 23.6 percent;
116.13(4) general administrative support ratio: 3.3 percent; and
116.14(5) program-related expense ratio: 1.3 percent.
116.15(d) Component values for day services for all services are:
116.16(1) supervisory span of control ratio: 11 percent;
116.17(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
116.18(3) employee-related cost ratio: 23.6 percent;
116.19(4) program plan support ratio: 5.6 percent;
116.20(5) client programming and support ratio: 10 percent;
116.21(6) general administrative support ratio: 13.25 percent;
116.22(7) program-related expense ratio: 1.8 percent; and
116.23(8) absence and utilization factor ratio: 3.9 percent.
116.24(e) Component values for unit-based with program services are:
116.25(1) supervisory span of control ratio: 11 percent;
116.26(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
116.27(3) employee-related cost ratio: 23.6 percent;
116.28(4) program plan supports ratio: 3.1 percent;
116.29(5) client programming and support ratio: 8.6 percent;
116.30(6) general administrative support ratio: 13.25 percent;
116.31(7) program-related expense ratio: 6.1 percent; and
116.32(8) absence and utilization factor ratio: 3.9 percent.
116.33(f) Component values for unit-based services without programming except respite
116.34are:
116.35(1) supervisory span of control ratio: 11 percent;
116.36(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
117.1(3) employee-related cost ratio: 23.6 percent;
117.2(4) program plan support ratio: 3.1 percent;
117.3(5) client programming and support ratio: 8.6 percent;
117.4(6) general administrative support ratio: 13.25 percent;
117.5(7) program-related expense ratio: 6.1 percent; and
117.6(8) absence and utilization factor ratio: 3.9 percent.
117.7(g) Component values for unit-based services without programming for respite are:
117.8(1) supervisory span of control ratio: 11 percent;
117.9(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
117.10(3) employee-related cost ratio: 23.6 percent;
117.11(4) general administrative support ratio: 13.25 percent;
117.12(5) program-related expense ratio: 6.1 percent; and
117.13(6) absence and utilization factor ratio: 3.9 percent.
117.14(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
117.15(a) based on the wage data by standard occupational code (SOC) from the Bureau of
117.16Labor Statistics available on December 31, 2016. The commissioner shall publish these
117.17updated values and load them into the rate management system. This adjustment shall
117.18occur every five years. For adjustments in 2021 and beyond, the commissioner shall use
117.19the data available on December 31 of the calendar year five years prior.
117.20(i) On July 1, 2017, the commissioner shall update the framework components in
117.21paragraph (c) for changes in the Consumer Price Index. The commissioner must adjust
117.22these values higher or lower by the percentage change in the Consumer Price Index-All
117.23Items (United States city average) (CPI-U) from January 1, 2014, to January 1, 2017. The
117.24commissioner shall publish these updated values and load them into the rate management
117.25system. This adjustment shall occur every five years. For adjustments in 2021 and
117.26beyond, the commissioner shall use the data available on January 1 of the calendar year
117.27four years prior and January 1 of the current calendar year.
117.28    Subd. 6. Payments for residential support services. (a) Payments for residential
117.29support services, as defined in sections 256B.092, subdivision 11, and 256B.49 subdivision
117.3022, must be calculated as follows:
117.31(1) determine the number of units of service to meet a recipient's needs;
117.32(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
117.33national and Minnesota-specific rates or rates derived by the commissioner as provided in
117.34subdivision 5. This is defined as the direct care rate;
118.1(3) for a recipient requiring customization for deaf or hard-of-hearing language
118.2accessibility under subdivision 12, add the customization rate provided in subdivision 12
118.3to the result of clause (2). This is defined as the customized direct care rate;
118.4(4) multiply the number of residential services direct staff hours by the appropriate
118.5staff wage in subdivision 5, paragraph (a), or the customized direct care rate;
118.6(5) multiply the number of direct staff hours by the product of the supervision span
118.7of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
118.8wage in subdivision 5, paragraph (a), clause (17);
118.9(6) combine the results of clauses (4) and (5), and multiply the result by one plus
118.10the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
118.11clause (2). This is defined as the direct staffing cost;
118.12(7) for employee-related expenses, multiply the direct staffing cost by one plus the
118.13employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
118.14(8) for client programming and supports, the commissioner shall add $2,179; and
118.15(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
118.16customized for adapted transport per year.
118.17(b) The total rate shall be calculated using the following steps:
118.18(1) subtotal paragraph (a), clauses (7) to (9);
118.19(2) sum the standard general and administrative rate, the program-related expense
118.20ratio, and the absence and utilization ratio; and
118.21(3) divide the result of clause (1) by one minus the result of clause (2). This is
118.22the total payment amount.
118.23    Subd. 7. Payments for day programs. Payments for services with day programs
118.24including adult day care, day treatment and habilitation, prevocational services, and
118.25structured day services must be calculated as follows:
118.26(1) determine the number of units of service to meet a recipient's needs;
118.27(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
118.28Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
118.29(3) for a recipient requiring customization for deaf or hard-of-hearing language
118.30accessibility under subdivision 12, add the customization rate provided in subdivision 12
118.31to the result of clause (2). This is defined as the customized direct care rate;
118.32(4) multiply the number of day program direct staff hours by the appropriate staff
118.33wage in subdivision 5, paragraph (a), or the customized direct care rate;
118.34(5) multiply the number of day program direct staff hours by the product of the
118.35supervision span of control ratio in subdivision 5, paragraph (d), clause (1), and the
118.36appropriate supervision wage in subdivision 5, paragraph (a), clause (17);
119.1(6) combine the results of clauses (4) and (5), and multiply the result by one plus
119.2the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
119.3clause (2). This is defined as the direct staffing rate;
119.4(7) for program plan support, multiply the result of clause (6) by one plus the
119.5program plan support ratio in subdivision 5, paragraph (d), clause (4);
119.6(8) for employee-related expenses, multiply the result of clause (7) by one plus the
119.7employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
119.8(9) for client programming and supports, multiply the result of clause (8) by one plus
119.9the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
119.10(10) for program facility costs, add $8.30 per week with consideration of staffing
119.11ratios to meet individual needs;
119.12(11) for adult day bath services, add $7.01 per 15 minute unit;
119.13(12) this is the subtotal rate;
119.14(13) sum the standard general and administrative rate, the program-related expense
119.15ratio, and the absence and utilization factor ratio;
119.16(14) divide the result of clause (12) by one minus the result of clause (13). This is
119.17the total payment amount;
119.18(15) for transportation provided as part of day training and habilitation for an
119.19individual who does not require a lift, add:
119.20(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle
119.21without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared
119.22ride in a vehicle with a lift;
119.23(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle
119.24without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared
119.25ride in a vehicle with a lift;
119.26(iii) $25.75 for a trip between 21and 50 miles for a nonshared ride in a vehicle
119.27without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared
119.28ride in a vehicle with a lift; or
119.29(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a
119.30lift, $16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a
119.31vehicle with a lift;
119.32(16) for transportation provide as part of day training and habilitation for an
119.33individual who does require a lift, add:
119.34(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with
119.35a lift, and $15.05 for a shared ride in a vehicle with a lift;
120.1(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
120.2lift, and $28.16 for a shared ride in a vehicle with a lift;
120.3(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with
120.4a lift, and $58.76 for a shared ride in a vehicle with a lift; or
120.5(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a
120.6lift, and $80.93 for a shared ride in a vehicle with a lift.
120.7    Subd. 8. Payments for unit-based services with programming. Payments for
120.8unit-based services with programming, including behavior programming, housing access
120.9coordination, in-home family support, independent living skills training, hourly supported
120.10living services, and supported employment provided to an individual outside of any day or
120.11residential service plan must be calculated as follows, unless the services are authorized
120.12separately under subdivision 6 or 7:
120.13(1) determine the number of units of service to meet a recipient's needs;
120.14(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
120.15Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
120.16(3) for a recipient requiring customization for deaf or hard-of-hearing language
120.17accessibility under subdivision 12, add the customization rate provided in subdivision 12
120.18to the result of clause (2). This is defined as the customized direct care rate;
120.19(4) multiply the number of direct staff hours by the appropriate staff wage in
120.20subdivision 5, paragraph (a), or the customized direct care rate;
120.21(5) multiply the number of direct staff hours by the product of the supervision span
120.22of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
120.23wage in subdivision 5, paragraph (a), clause (17);
120.24(6) combine the results of clauses (4) and (5), and multiply the result by one plus
120.25the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
120.26clause (2). This is defined as the direct staffing rate;
120.27(7) for program plan support, multiply the result of clause (6) by one plus the
120.28program plan supports ratio in subdivision 5, paragraph (e), clause (4);
120.29(8) for employee-related expenses, multiply the result of clause (7) by one plus the
120.30employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
120.31(9) for client programming and supports, multiply the result of clause (8) by one plus
120.32the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
120.33(10) this is the subtotal rate;
120.34(11) sum the standard general and administrative rate, the program-related expense
120.35ratio, and the absence and utilization factor ratio; and
121.1(12) divide the result of clause (10) by one minus the result of clause (11). This is
121.2the total payment amount.
121.3    Subd. 9. Payments for unit-based services without programming. Payments
121.4for unit-based without program services including night supervision, personal support,
121.5respite, and companion care provided to an individual outside of any day or residential
121.6service plan must be calculated as follows unless the services are authorized separately
121.7under subdivision 6 or 7:
121.8(1) for all services except respite, determine the number of units of service to meet
121.9a recipient's needs;
121.10(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
121.11Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
121.12(3) for a recipient requiring customization for deaf or hard-of-hearing language
121.13accessibility under subdivision 12, add the customization rate provided in subdivision 12
121.14to the result of clause (2). This is defined as the customized direct care rate;
121.15(4) multiply the number of direct staff hours by the appropriate staff wage in
121.16subdivision 5 or the customized direct care rate;
121.17(5) multiply the number of direct staff hours by the product of the supervision span
121.18of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
121.19wage in subdivision 5, paragraph (a), clause (17);
121.20(6) combine the results of clauses (4) and (5) and multiply the result by one plus
121.21the employee vacation, sick, and training allowance ratio in, subdivision 5, paragraph (f),
121.22clause (2). This is defined as the direct staffing rate;
121.23(7) for program plan support, multiply the result of clause (6) by one plus the
121.24program plan support ratio in subdivision 5, paragraph (f), clause (4);
121.25(8) for employee-related expenses, multiply the result of clause (7) by one plus the
121.26employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
121.27(9) For client programming and supports, multiply the result of clause (8) by one
121.28plus the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
121.29(10) this is the subtotal rate;
121.30(11) sum the standard general and administrative rate, the program-related expense
121.31ratio, and the absence and utilization factor ratio;
121.32(12) divide the result of clause (10) by one minus the result of clause (11). This is
121.33the total payment amount;
121.34(13) for respite services, determine the number of daily units of service to meet an
121.35individual's needs;
122.1(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
122.2Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
122.3(15) for a recipient requiring deaf or hard-of-hearing customization under
122.4subdivision 12, add the customization rate provided in subdivision 12 to the result of
122.5clause (14). This is defined as the customized direct care rate;
122.6(16) multiply the number of direct staff hours by the appropriate staff wage in
122.7subdivision 5, paragraph (a);
122.8(17) multiply the number of direct staff hours by the product of the supervisory span
122.9of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
122.10wage in subdivision 5, paragraph (a), clause (17);
122.11(18) combine the results of clauses (16) and (17) and multiply the result by one plus
122.12the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
122.13clause (2). This is defined as the direct staffing rate;
122.14(19) for employee-related expenses, multiply the result of clause (18) by one plus
122.15the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
122.16(20) this is the subtotal rate;
122.17(21) sum the standard general and administrative rate, the program-related expense
122.18ratio, and the absence and utilization factor ratio; and
122.19(22) divide the result of clause (20) by one minus the result of clause (21). This is
122.20the total payment amount.
122.21    Subd. 10. Updating payment values and additional information. (a) The
122.22commissioner shall develop and implement uniform procedures to refine terms and update
122.23or adjust values used to calculate payment rates in this section. For calendar year 2014,
122.24the commissioner shall use the values, terms, and procedures provided in this section.
122.25(b) The commissioner shall work with stakeholders to assess efficacy of values
122.26and payment rates. The commissioner shall report back to the legislature with proposed
122.27changes for component values and recommendations for revisions on the schedule
122.28provided in paragraphs (c) and (d).
122.29(c) The commissioner shall work with stakeholders to continue refining a
122.30subset of component values, which are to be referred to as interim values, and report
122.31recommendations to the legislature by February 15, 2014. Interim component values are:
122.32transportation rates for day training and habilitation; transportation for adult day, structured
122.33day, and prevocational services; geographic difference factor; day program facility rate;
122.34services where monitoring technology replaces staff time; shared services for independent
122.35living skills training; and supported employment and billing for indirect services.
123.1(d) The commissioner shall report and make recommendations to the legislature on:
123.2February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
123.32021, reports shall be provided on a four-year cycle.
123.4(e) The commissioner shall provide a public notice via list serve in October of each
123.5year beginning October 1, 2014. The notice shall contain information detailing legislatively
123.6approved changes in: calculation values including derived wage rates and related employee
123.7and administrative factors; services utilization; county and tribal allocation changes
123.8and; information on adjustments to be made to calculation values and timing of those
123.9adjustments. Information in this notice shall be effective January 1 of the following year.
123.10    Subd. 11. Payment implementation. Upon implementation of the payment
123.11methodologies under this section, those payment rates supersede rates established in county
123.12contracts for recipients receiving waiver services under sections 256B.092 or 256B.49.
123.13    Subd. 12. Customization of rates for individuals. (a) For persons determined to
123.14have higher needs based on being deaf or hard-of-hearing, the direct care costs must be
123.15increased by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8,
123.16and 9. The customization rate with respect to deaf or hard-of-hearing persons shall be
123.17$2.50 per hour for waiver recipients who meet the respective criteria as determined by
123.18the commissioner.
123.19(b) For the purposes of this section, "Deaf or Hard of Hearing" means:
123.20(1)(i) the person has a developmental disability and an assessment score which
123.21indicates a hearing impairment that is severe or that the person has no useful hearing;
123.22(ii) the person has a developmental disability and an expressive communications
123.23score that indicates the person uses single signs or gestures, uses an augmentative
123.24communication aid, or does not have functional communication, or the person's expressive
123.25communications are unknown; and
123.26(iii) the person has a developmental disability and a communication score which
123.27indicates the person comprehends signs, gestures, and modeling prompts or does not
123.28comprehend verbal, visual, or gestural communication or that the person's receptive
123.29communications score is unknown; or
123.30(2)(i) the person receives long-term care services and has an assessment score which
123.31indicates they hear only very loud sounds, have no useful hearing, or a determination
123.32cannot be made; and
123.33(ii) the person receives long-term care services and has an assessment which
123.34indicates the person communicates needs with sign language, symbol board, written
123.35messages, gestures or an interpreter; communicates with inappropriate content; makes
123.36garbled sounds or displays echolalia; or does not communicate needs.
124.1    Subd. 13. Transportation. The commissioner shall require that the purchase
124.2of transportation services be cost-effective and be limited to market rates where the
124.3transportation mode is generally available and accessible.
124.4    Subd. 14. Exceptions. (a) In a format prescribed by the commissioner, lead
124.5agencies must identify individuals with exceptional needs that cannot be met under the
124.6disability waiver rate system. The commissioner shall use that information to evaluate
124.7and, if necessary, approve an alternative payment rate for those individuals.
124.8(b) Lead agencies must submit exception requests to the state.
124.9(c) An application for a rate exception may be submitted for the following criteria:
124.10(1) an individual has service needs that cannot be met through additional units
124.11of service; or
124.12(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
124.13individual being discharged.
124.14(d) Exception requests must include the following information:
124.15(1) the service needs required by each individual that are not accounted for in
124.16subdivisions 6, 7, 8, and 9;
124.17(2) the service rate requested and the difference from the rate determined in
124.18subdivisions 6, 7, 8, and 9;
124.19(3) a basis for the underlying costs used for the rate exception and any accompanying
124.20documentation;
124.21(4) the duration of the rate exception; and
124.22(5) any contingencies for approval.
124.23(e) Approved rate exceptions shall be managed within lead agency allocations under
124.24sections 256B.092 and 256B.49.
124.25(f) Individual disability waiver recipients may request that a lead agency submit an
124.26exception request. A lead agency that denies such a request shall notify the individual
124.27waiver recipient of its decision and the reasons for denying the request in writing no later
124.28than 30 days after the individual's request has been made.
124.29(g) The commissioner shall determine whether to approve or deny an exception
124.30request no more than 30 days after receiving the request. If the commissioner denies the
124.31request, the commissioner shall notify the lead agency and the individual disability waiver
124.32recipient in writing of the reasons for the denial.
124.33(h) The individual disability waiver recipient may appeal any denial of an exception
124.34request by either the lead agency or the commissioner, pursuant to sections 256.045 and
124.35256.0451. When the denial of an exception request results in the proposed demission of a
124.36waiver recipient from a residential or day habilitation program, the commissioner shall
125.1issue a temporary stay of demission, when requested by the disability waiver recipient,
125.2consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c).
125.3The temporary stay shall remain in effect until the lead agency can provide an informed
125.4choice of appropriate, alternative services to the disability waiver.
125.5(i) Providers may petition lead agencies to update values that were entered
125.6incorrectly or erroneously into the rate management system, based on past service level
125.7discussions and determination in subdivision 4, without applying for a rate exception.
125.8    Subd. 15. County or tribal allocations. (a) Upon implementation of the Disability
125.9Waiver Rates Management System on January 1, 2014, the commissioner shall establish
125.10a method of tracking and reporting the fiscal impact of the Disability Waiver Rates
125.11Management System on individual lead agencies.
125.12(b) Beginning January 1, 2014, and continuing through full implementation on
125.13December 31, 2017, the commissioner shall make annual adjustments to lead agencies'
125.14home and community-based waivered service budget allocations to adjust for rate
125.15differences and the resulting impact on county allocations upon implementation of the
125.16disability waiver rates system.
125.17    Subd. 16. Budget neutrality adjustment. The commissioner shall calculate the
125.18total spending for all home and community-based waiver services under the payments as
125.19defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
125.20spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
125.21for services in one particular subdivision differs, there will be a percentage adjustment
125.22to increase or decrease individual rates for the services defined in each subdivision so
125.23aggregate spending matches projections under current law.
125.24    Subd. 17. Implementation. (a) On January 1, 2014, the commissioner shall fully
125.25implement the calculation of rates for waivered services under sections 256B.092 and
125.26256B.49, without additional legislative approval.
125.27(b) The commissioner shall phase in the application of rates determined in
125.28subdivisions 6 to 9 for two years.
125.29(c) The commissioner shall preserve rates in effect on December 31, 2013, for
125.30the two-year period.
125.31(d) The commissioner shall calculate and measure the difference in cost per
125.32individual using the historical rate and the rates under subdivisions 6 to 9, for all
125.33individuals enrolled as of December 31, 2013. This measurement shall occur statewide,
125.34and for individuals in every county.
126.1The commissioner shall provide the results of this analysis, by county for calendar
126.2year 2014, to the legislative committees with jurisdiction over health and human services
126.3finance by February 15, 2015.
126.4(e) The commissioner shall calculate the average rate per unit for each service by
126.5county. For individuals enrolled after January 1, 2014, individuals will receive the higher
126.6of the rate produced under subdivisions 6 to 9, or the by-county average rate.
126.7(f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.

126.8    Sec. 7. REPEALER.
126.9Minnesota Statutes 2012, section 256B.4913, subdivisions 1, 2, 3, and 4, are repealed.


126.12    Section 1. Minnesota Statutes 2012, section 245.4661, subdivision 5, is amended to read:
126.13    Subd. 5. Planning for pilot projects. (a) Each local plan for a pilot project, with
126.14the exception of the placement of a Minnesota specialty treatment facility as defined in
126.15paragraph (c), must be developed under the direction of the county board, or multiple
126.16county boards acting jointly, as the local mental health authority. The planning process
126.17for each pilot shall include, but not be limited to, mental health consumers, families,
126.18advocates, local mental health advisory councils, local and state providers, representatives
126.19of state and local public employee bargaining units, and the department of human services.
126.20As part of the planning process, the county board or boards shall designate a managing
126.21entity responsible for receipt of funds and management of the pilot project.
126.22(b) For Minnesota specialty treatment facilities, the commissioner shall issue a
126.23request for proposal for regions in which a need has been identified for services.
126.24(c) For purposes of this section, Minnesota specialty treatment facility is defined as
126.25an intensive rehabilitative mental health service under section 256B.0622, subdivision 2,
126.26paragraph (b).

126.27    Sec. 2. Minnesota Statutes 2012, section 245.4661, subdivision 6, is amended to read:
126.28    Subd. 6. Duties of commissioner. (a) For purposes of the pilot projects, the
126.29commissioner shall facilitate integration of funds or other resources as needed and
126.30requested by each project. These resources may include:
126.31(1) residential services funds administered under Minnesota Rules, parts 9535.2000
126.32to 9535.3000, in an amount to be determined by mutual agreement between the project's
126.33managing entity and the commissioner of human services after an examination of the
127.1county's historical utilization of facilities located both within and outside of the county
127.2and licensed under Minnesota Rules, parts 9520.0500 to 9520.0690;
127.3(2) community support services funds administered under Minnesota Rules, parts
127.49535.1700 to 9535.1760;
127.5(3) other mental health special project funds;
127.6(4) medical assistance, general assistance medical care, MinnesotaCare and group
127.7residential housing if requested by the project's managing entity, and if the commissioner
127.8determines this would be consistent with the state's overall health care reform efforts; and
127.9(5) regional treatment center resources consistent with section 246.0136, subdivision
127.101 .; and
127.11(6) funds transferred from section 246.18, subdivision 8, for grants to providers to
127.12participate in mental health specialty treatment services, awarded to providers through
127.13a request for proposal process.
127.14(b) The commissioner shall consider the following criteria in awarding start-up and
127.15implementation grants for the pilot projects:
127.16(1) the ability of the proposed projects to accomplish the objectives described in
127.17subdivision 2;
127.18(2) the size of the target population to be served; and
127.19(3) geographical distribution.
127.20(c) The commissioner shall review overall status of the projects initiatives at least
127.21every two years and recommend any legislative changes needed by January 15 of each
127.22odd-numbered year.
127.23(d) The commissioner may waive administrative rule requirements which are
127.24incompatible with the implementation of the pilot project.
127.25(e) The commissioner may exempt the participating counties from fiscal sanctions
127.26for noncompliance with requirements in laws and rules which are incompatible with the
127.27implementation of the pilot project.
127.28(f) The commissioner may award grants to an entity designated by a county board or
127.29group of county boards to pay for start-up and implementation costs of the pilot project.

127.30    Sec. 3. Minnesota Statutes 2012, section 245.4682, subdivision 2, is amended to read:
127.31    Subd. 2. General provisions. (a) In the design and implementation of reforms to
127.32the mental health system, the commissioner shall:
127.33    (1) consult with consumers, families, counties, tribes, advocates, providers, and
127.34other stakeholders;
128.1    (2) bring to the legislature, and the State Advisory Council on Mental Health, by
128.2January 15, 2008, recommendations for legislation to update the role of counties and to
128.3clarify the case management roles, functions, and decision-making authority of health
128.4plans and counties, and to clarify county retention of the responsibility for the delivery of
128.5social services as required under subdivision 3, paragraph (a);
128.6    (3) withhold implementation of any recommended changes in case management
128.7roles, functions, and decision-making authority until after the release of the report due
128.8January 15, 2008;
128.9    (4) ensure continuity of care for persons affected by these reforms including
128.10ensuring client choice of provider by requiring broad provider networks and developing
128.11mechanisms to facilitate a smooth transition of service responsibilities;
128.12    (5) provide accountability for the efficient and effective use of public and private
128.13resources in achieving positive outcomes for consumers;
128.14    (6) ensure client access to applicable protections and appeals; and
128.15    (7) make budget transfers necessary to implement the reallocation of services and
128.16client responsibilities between counties and health care programs that do not increase the
128.17state and county costs and efficiently allocate state funds.
128.18    (b) When making transfers under paragraph (a) necessary to implement movement
128.19of responsibility for clients and services between counties and health care programs,
128.20the commissioner, in consultation with counties, shall ensure that any transfer of state
128.21grants to health care programs, including the value of case management transfer grants
128.22under section 256B.0625, subdivision 20, does not exceed the value of the services being
128.23transferred for the latest 12-month period for which data is available. The commissioner
128.24may make quarterly adjustments based on the availability of additional data during the
128.25first four quarters after the transfers first occur. If case management transfer grants under
128.26section 256B.0625, subdivision 20, are repealed and the value, based on the last year prior
128.27to repeal, exceeds the value of the services being transferred, the difference becomes an
128.28ongoing part of each county's adult and children's mental health grants under sections
128.29245.4661 , 245.4889, and 256E.12.
128.30    (c) This appropriation is not authorized to be expended after December 31, 2010,
128.31unless approved by the legislature.

128.32    Sec. 4. Minnesota Statutes 2012, section 246.18, subdivision 8, is amended to read:
128.33    Subd. 8. State-operated services account. (a) The state-operated services account is
128.34established in the special revenue fund. Revenue generated by new state-operated services
129.1listed under this section established after July 1, 2010, that are not enterprise activities must
129.2be deposited into the state-operated services account, unless otherwise specified in law:
129.3(1) intensive residential treatment services;
129.4(2) foster care services; and
129.5(3) psychiatric extensive recovery treatment services.
129.6(b) Funds deposited in the state-operated services account are available to the
129.7commissioner of human services for the purposes of:
129.8(1) providing services needed to transition individuals from institutional settings
129.9within state-operated services to the community when those services have no other
129.10adequate funding source;
129.11(2) grants to providers participating in mental health specialty treatment services
129.12under section 245.4661; and
129.13(3) to fund the operation of the Intensive Residential Treatment Service program in
129.14Willmar.

129.15    Sec. 5. Minnesota Statutes 2012, section 246.18, is amended by adding a subdivision
129.16to read:
129.17    Subd. 9. Transfers. The commissioner may transfer state mental health grant funds
129.18to the account in subdivision 8 for noncovered allowable costs of a provider certified and
129.19licensed under section 256B.0622, and operating under section 246.014.

129.20    Sec. 6. Minnesota Statutes 2012, section 254B.13, is amended to read:
129.21254B.13 PILOT PROJECTS; CHEMICAL HEALTH CARE.
129.22    Subdivision 1. Authorization for navigator pilot projects. The commissioner may
129.23approve and implement navigator pilot projects developed under the planning process
129.24required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and
129.25enhance coordination of the delivery of chemical health services required under section
129.26254B.03 .
129.27    Subd. 2. Program design and implementation. (a) The commissioner and
129.28counties participating in the navigator pilot projects shall continue to work in partnership
129.29to refine and implement the navigator pilot projects initiated under Laws 2009, chapter
129.3079, article 7, section 26.
129.31    (b) The commissioner and counties participating in the navigator pilot projects shall
129.32complete the planning phase by June 30, 2010, and, if approved by the commissioner for
129.33implementation, enter into agreements governing the operation of the navigator pilot
129.34projects with implementation scheduled no earlier than July 1, 2010.
130.1    Subd. 2a. Eligibility for navigator pilot program. (a) To be considered for
130.2participation in a navigator pilot program, an individual must:
130.3    (1) be a resident of a county with an approved navigator program;
130.4    (2) be eligible for consolidated chemical dependency treatment fund services;
130.5    (3) be a voluntary participant in the navigator program;
130.6    (4) satisfy one of the following items:
130.7    (i) have at least one severity rating of three or above in dimension four, five, or six in
130.8a comprehensive assessment under Minnesota Rules, part 9530.6422; or
130.9    (ii) have at least one severity rating of two or above in dimension four, five, or six in
130.10a comprehensive assessment under Minnesota Rules, part 9530.6422, and be currently
130.11participating in a Rule 31 treatment program under Minnesota Rules, parts 9530.6405 to
130.129530.6505, or be within 60 days following discharge after participation in a Rule 31
130.13treatment program; and
130.14    (5) have had at least two treatment episodes in the past two years, not limited
130.15to episodes reimbursed by the consolidated chemical dependency treatment funds. An
130.16admission to an emergency room, a detoxification program, or a hospital may be substituted
130.17for one treatment episode if it resulted from the individual's substance use disorder.
130.18    (b) New eligibility criteria may be added as mutually agreed upon by the
130.19commissioner and participating navigator programs.
130.20    Subd. 3. Program evaluation. The commissioner shall evaluate navigator pilot
130.21projects under this section and report the results of the evaluation to the chairs and
130.22ranking minority members of the legislative committees with jurisdiction over chemical
130.23health issues by January 15, 2014. Evaluation of the navigator pilot projects must be
130.24based on outcome evaluation criteria negotiated with the navigator pilot projects prior
130.25to implementation.
130.26    Subd. 4. Notice of navigator project discontinuation. Each county's participation
130.27in the navigator pilot project may be discontinued for any reason by the county or the
130.28commissioner of human services after 30 days' written notice to the other party. Any
130.29unspent funds held for the exiting county's pro rata share in the special revenue fund under
130.30the authority in subdivision 5, paragraph (d), shall be transferred to the consolidated
130.31chemical dependency treatment fund following discontinuation of the pilot project.
130.32    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in
130.33this chapter, the commissioner may authorize navigator pilot projects to use chemical
130.34dependency treatment funds to pay for nontreatment navigator pilot services:
130.35    (1) in addition to those authorized under section 254B.03, subdivision 2, paragraph
130.36(a); and
131.1    (2) by vendors in addition to those authorized under section 254B.05 when not
131.2providing chemical dependency treatment services.
131.3    (b) For purposes of this section, "nontreatment navigator pilot services" include
131.4navigator services, peer support, family engagement and support, housing support, rent
131.5subsidies, supported employment, and independent living skills.
131.6    (c) State expenditures for chemical dependency services and nontreatment navigator
131.7pilot services provided by or through the navigator pilot projects must not be greater than
131.8the chemical dependency treatment fund expected share of forecasted expenditures in the
131.9absence of the navigator pilot projects. The commissioner may restructure the schedule of
131.10payments between the state and participating counties under the local agency share and
131.11division of cost provisions under section 254B.03, subdivisions 3 and 4, as necessary to
131.12facilitate the operation of the navigator pilot projects.
131.13    (d) To the extent that state fiscal year expenditures within a pilot project are less
131.14than the expected share of forecasted expenditures in the absence of the pilot projects,
131.15the commissioner shall deposit the unexpended funds in a separate account within the
131.16consolidated chemical dependency treatment fund, and make these funds available for
131.17expenditure by the pilot projects the following year. To the extent that treatment and
131.18nontreatment pilot services expenditures within the pilot project exceed the amount
131.19expected in the absence of the pilot projects, the pilot project county or counties are
131.20responsible for the portion of nontreatment pilot services expenditures in excess of the
131.21otherwise expected share of forecasted expenditures.
131.22    (e) (d) The commissioner may waive administrative rule requirements that are
131.23incompatible with the implementation of the navigator pilot project, except that any
131.24chemical dependency treatment funded under this section must continue to be provided
131.25by a licensed treatment provider.
131.26    (f) (e) The commissioner shall not approve or enter into any agreement related to
131.27navigator pilot projects authorized under this section that puts current or future federal
131.28funding at risk.
131.29    (f) The commissioner shall provide participating navigator pilot projects with
131.30transactional data, reports, provider data, and other data generated by county activity to
131.31assess and measure outcomes. This information must be transmitted or made available in
131.32an acceptable form to participating navigator pilot projects at least once every six months
131.33or within a reasonable time following the commissioner's receipt of information from the
131.34counties needed to comply with this paragraph.
131.35    Subd. 6. Duties of county board. The county board, or other county entity that
131.36is approved to administer a navigator pilot project, shall:
132.1    (1) administer the navigator pilot project in a manner consistent with the objectives
132.2described in subdivision 2 and the planning process in subdivision 5;
132.3    (2) ensure that no one is denied chemical dependency treatment services for which
132.4they would otherwise be eligible under section 254A.03, subdivision 3; and
132.5    (3) provide the commissioner with timely and pertinent information as negotiated in
132.6agreements governing operation of the navigator pilot projects.
132.7    Subd. 7. Managed care. An individual who is eligible for the navigator pilot
132.8program under subdivision 2a is excluded from mandatory enrollment in managed care
132.9until these services are included in the health plan's benefit set.
132.10    Subd. 8. Authorization for continuation of navigator pilots. The navigator pilot
132.11projects implemented pursuant to subdivision 1 are authorized to continue operation after
132.12July 1, 2013, under existing agreements governing operation of the pilot projects.
132.13EFFECTIVE DATE.The amendments to subdivisions 1 to 6 and 8 are effective
132.14August 1, 2013. Subdivision 7 is effective July 1, 2013.

132.15    Sec. 7. [254B.14] CONTINUUM OF CARE PILOT PROJECTS; CHEMICAL
132.16HEALTH CARE.
132.17    Subdivision 1. Authorization for continuum of care pilot projects. The
132.18commissioner shall establish chemical dependency continuum of care pilot projects to
132.19begin implementing the measures developed with stakeholder input and identified in the
132.20report completed pursuant to Laws 2012, chapter 247, article 5, section 8. The pilot
132.21projects are intended to improve the effectiveness and efficiency of the service continuum
132.22for chemically dependent individuals in Minnesota while reducing duplication of efforts
132.23and promoting scientifically supported practices.
132.24    Subd. 2. Program implementation. (a) The commissioner, in coordination with
132.25representatives of the Minnesota Association of County Social Service Administrators
132.26and the Minnesota Inter-County Association, shall develop a process for identifying and
132.27selecting interested counties and providers for participation in the continuum of care pilot
132.28projects. There will be three pilot projects; one representing the northern region, one for
132.29the metro region, and one for the southern region. The selection process of counties and
132.30providers must include consideration of population size, geographic distribution, cultural
132.31and racial demographics, and provider accessibility. The commissioner shall identify
132.32counties and providers that are selected for participation in the continuum of care pilot
132.33projects no later than September 30, 2013.
132.34(b) The commissioner and entities participating in the continuum of care pilot
132.35projects shall enter into agreements governing the operation of the continuum of care pilot
133.1projects. The agreements shall identify pilot project outcomes and include timelines for
133.2implementation and beginning operation of the pilot projects.
133.3(c) Entities that are currently participating in the navigator pilot project are
133.4eligible to participate in the continuum of care pilot project subsequent to or instead of
133.5participating in the navigator pilot project.
133.6(d) The commissioner may waive administrative rule requirements that are
133.7incompatible with implementation of the continuum of care pilot projects.
133.8(e) Notwithstanding section 254A.19, the commissioner may designate noncounty
133.9entities to complete chemical use assessments and placement authorizations required
133.10under section 254A.19 and Minnesota Rules, parts 9530.6600 to 9530.6655. Section
133.11254A.19, subdivision 3, is applicable to the continuum of care pilot projects at the
133.12discretion of the commissioner.
133.13    Subd. 3. Program design. (a) The operation of the pilot projects shall include:
133.14(1) new services that are responsive to the chronic nature of substance use disorder;
133.15(2) telehealth services, when appropriate to address barriers to services;
133.16(3) services that assure integration with the mental health delivery system when
133.17appropriate;
133.18(4) services that address the needs of diverse populations; and
133.19(5) an assessment and access process that permits clients to present directly to a
133.20service provider for a substance use disorder assessment and authorization of services.
133.21(b) Prior to implementation of the continuum of care pilot projects, a utilization
133.22review process must be developed and agreed to by the commissioner, participating
133.23counties, and providers. The utilization review process shall be described in the
133.24agreements governing operation of the continuum of care pilot projects.
133.25    Subd. 4. Notice of project discontinuation. Each entity's participation in the
133.26continuum of care pilot project may be discontinued for any reason by the county or the
133.27commissioner after 30 days' written notice to the entity.
133.28    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in this
133.29chapter, the commissioner may authorize chemical dependency treatment funds to pay for
133.30nontreatment services arranged by continuum of care pilot projects. Individuals who are
133.31currently accessing Rule 31 treatment services are eligible for concurrent participation in
133.32the continuum of care pilot projects.
133.33(b) County expenditures for continuum of care pilot project services shall not
133.34be greater than their expected share of forecasted expenditures in the absence of the
133.35continuum of care pilot projects.
133.36EFFECTIVE DATE.This section is effective August 1, 2013.

134.1    Sec. 8. [256.478] HOME AND COMMUNITY-BASED SERVICES
134.2TRANSITIONS GRANTS.
134.3(a) The commissioner shall make available home and community-based services
134.4transition grants to serve individuals who do not meet eligibility criteria for the medical
134.5assistance program under section 256B.056 or 256B.057, but who otherwise meet the
134.6criteria under section 256B.092, subdivision 13, or 256B.49, subdivision 24.
134.7(b) For the purposes of this section, the commissioner has the authority to transfer
134.8funds between the medical assistance account and the home and community-based
134.9services transitions grants account.
134.10EFFECTIVE DATE.This section is effective July 1, 2015.

134.11    Sec. 9. Minnesota Statutes 2012, section 256B.0623, subdivision 2, is amended to read:
134.12    Subd. 2. Definitions. For purposes of this section, the following terms have the
134.13meanings given them.
134.14(a) "Adult rehabilitative mental health services" means mental health services
134.15which are rehabilitative and enable the recipient to develop and enhance psychiatric
134.16stability, social competencies, personal and emotional adjustment, and independent living,
134.17parenting skills, and community skills, when these abilities are impaired by the symptoms
134.18of mental illness. Adult rehabilitative mental health services are also appropriate when
134.19provided to enable a recipient to retain stability and functioning, if the recipient would
134.20be at risk of significant functional decompensation or more restrictive service settings
134.21without these services.
134.22(1) Adult rehabilitative mental health services instruct, assist, and support the
134.23recipient in areas such as: interpersonal communication skills, community resource
134.24utilization and integration skills, crisis assistance, relapse prevention skills, health care
134.25directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking
134.26and nutrition skills, transportation skills, medication education and monitoring, mental
134.27illness symptom management skills, household management skills, employment-related
134.28skills, parenting skills, and transition to community living services.
134.29(2) These services shall be provided to the recipient on a one-to-one basis in the
134.30recipient's home or another community setting or in groups.
134.31(b) "Medication education services" means services provided individually or in
134.32groups which focus on educating the recipient about mental illness and symptoms; the role
134.33and effects of medications in treating symptoms of mental illness; and the side effects of
134.34medications. Medication education is coordinated with medication management services
135.1and does not duplicate it. Medication education services are provided by physicians,
135.2pharmacists, physician's assistants, or registered nurses.
135.3(c) "Transition to community living services" means services which maintain
135.4continuity of contact between the rehabilitation services provider and the recipient and
135.5which facilitate discharge from a hospital, residential treatment program under Minnesota
135.6Rules, chapter 9505, board and lodging facility, or nursing home. Transition to community
135.7living services are not intended to provide other areas of adult rehabilitative mental health
135.8services.

135.9    Sec. 10. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
135.10subdivision to read:
135.11    Subd. 35c. School-linked mental health services. Medical assistance covers mental
135.12health services provided in a school as part of a school-linked mental health program by
135.13an individual who is licensed by the Board of Behavioral Health and Therapy, Board of
135.14Marriage and Family Therapy, Board of Psychology, or Board of Social Work, and who also
135.15meets the definition of a mental health practitioner under section 245.462, subdivision 17,
135.16or 245.4871, subdivision 26. For purposes of this subdivision, an individual who meets the
135.17definition of mental health practitioner under section 245.462, subdivision 17, or 245.4871,
135.18subdivision 26, is not limited to having less than 4,000 hours of post-master's experience.
135.19The mental health practitioner must be supervised by a licensed mental health professional.

135.20    Sec. 11. Minnesota Statutes 2012, section 256B.0625, subdivision 48, is amended to
135.21read:
135.22    Subd. 48. Psychiatric consultation to primary care practitioners. Effective
135.23January 1, 2006, Medical assistance covers consultation provided by a psychiatrist or
135.24psychologist via telephone, e-mail, facsimile, or other means of communication to primary
135.25care practitioners, including pediatricians. The need for consultation and the receipt of the
135.26consultation must be documented in the patient record maintained by the primary care
135.27practitioner. If the patient consents, and subject to federal limitations and data privacy
135.28provisions, the consultation may be provided without the patient present.

135.29    Sec. 12. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
135.30subdivision to read:
135.31    Subd. 61. Family psychoeducation services. Effective July 1, 2013, or upon
135.32federal approval, whichever is later, medical assistance covers family psychoeducation
135.33services provided to a child up to age 21 with a diagnosed mental health condition when
136.1identified in the child's individual treatment plan and provided by a licensed mental health
136.2professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a
136.3clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who
136.4has determined it medically necessary to involve family members in the child's care. For
136.5the purposes of this subdivision, "family psychoeducation services" means information
136.6or demonstration provided to an individual or family as part of an individual, family,
136.7multifamily group, or peer group session to explain, educate, and support the child and
136.8family in understanding a child's symptoms of mental illness, the impact on the child's
136.9development, and needed components of treatment and skill development so that the
136.10individual, family, or group can help the child to prevent relapse, prevent the acquisition
136.11of comorbid disorders, and to achieve optimal mental health and long-term resilience.

136.12    Sec. 13. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
136.13subdivision to read:
136.14    Subd. 62. Mental health clinical care consultation. Effective July 1, 2013, or upon
136.15federal approval, whichever is later, medical assistance covers clinical care consultation
136.16for a person up to age 21 who is diagnosed with a complex mental health condition or a
136.17mental health condition that co-occurs with other complex and chronic conditions, when
136.18described in the person's individual treatment plan and provided by a licensed mental
136.19health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A. For
136.20the purposes of this subdivision, "clinical care consultation" means communication from a
136.21treating mental health professional to other providers not under the clinical supervision of
136.22the treating mental health professional who are working with the same client to inform,
136.23inquire, and instruct regarding the client's symptoms; strategies for effective engagement,
136.24care, and intervention needs; and treatment expectations across service settings; and to
136.25direct and coordinate clinical service components provided to the client and family.

136.26    Sec. 14. Minnesota Statutes 2012, section 256B.092, is amended by adding a
136.27subdivision to read:
136.28    Subd. 13. Waiver allocations for transition populations. (a) The commissioner
136.29shall make available additional waiver allocations and additional necessary resources
136.30to assure timely discharges from the Anoka Metro Regional Treatment Center and the
136.31Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
136.32(1) are otherwise eligible for the developmental disabilities waiver under this section;
136.33(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
136.34the Minnesota Security Hospital;
137.1(3) whose discharge would be significantly delayed without the available waiver
137.2allocation; and
137.3(4) who have met treatment objectives and no longer meet hospital level of care.
137.4(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
137.5requirements of the federal approved waiver plan.
137.6(c) Any corporate foster care home developed under this subdivision must be
137.7considered an exception under section 245A.03, subdivision 7, paragraph (a).
137.8EFFECTIVE DATE.This section is effective July 1, 2015.

137.9    Sec. 15. Minnesota Statutes 2012, section 256B.0946, is amended to read:
137.10256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.
137.11    Subdivision 1. Required covered service components. (a) Effective July 1, 2006,
137.12 upon enactment and subject to federal approval, medical assistance covers medically
137.13necessary intensive treatment services described under paragraph (b) that are provided
137.14by a provider entity eligible under subdivision 3 to a client eligible under subdivision 2
137.15who is placed in a treatment foster home licensed under Minnesota Rules, parts 2960.3000
137.16to 2960.3340.
137.17(b) Intensive treatment services to children with severe emotional disturbance mental
137.18illness residing in treatment foster care family settings must meet the relevant standards
137.19for mental health services under sections 245.487 to 245.4889. In addition, that comprise
137.20 specific required service components provided in clauses (1) to (5), are reimbursed by
137.21medical assistance must when they meet the following standards:
137.22(1) case management service component must meet the standards in Minnesota
137.23Rules, parts 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10;
137.24(1) psychotherapy provided by a mental health professional as defined in Minnesota
137.25Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota
137.26Rules, part 9505.0371, subpart 5, item C;
137.27(2) psychotherapy, crisis assistance, and skills training components must meet the
137.28 provided according to standards for children's therapeutic services and supports in section
137.29256B.0943 ; and
137.30(3) individual family, and group psychoeducation services under supervision of,
137.31defined in subdivision 1a, paragraph (q), provided by a mental health professional. or a
137.32clinical trainee;
137.33(4) clinical care consultation, as defined in subdivision 1a, and provided by a mental
137.34health professional or a clinical trainee; and
138.1(5) service delivery payment requirements as provided under subdivision 4.
138.2    Subd. 1a. Definitions. For the purposes of this section, the following terms have
138.3the meanings given them.
138.4(a) "Clinical care consultation" means communication from a treating clinician to
138.5other providers working with the same client to inform, inquire, and instruct regarding
138.6the client's symptoms, strategies for effective engagement, care and intervention needs,
138.7and treatment expectations across service settings, including but not limited to the client's
138.8school, social services, day care, probation, home, primary care, medication prescribers,
138.9disabilities services, and other mental health providers and to direct and coordinate clinical
138.10service components provided to the client and family.
138.11(b) "Clinical supervision" means the documented time a clinical supervisor and
138.12supervisee spend together to discuss the supervisee's work, to review individual client
138.13cases, and for the supervisee's professional development. It includes the documented
138.14oversight and supervision responsibility for planning, implementation, and evaluation of
138.15services for a client's mental health treatment.
138.16(c) "Clinical supervisor" means the mental health professional who is responsible
138.17for clinical supervision.
138.18(d) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371,
138.19subpart 5, item C;
138.20(e) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a,
138.21including the development of a plan that addresses prevention and intervention strategies
138.22to be used in a potential crisis, but does not include actual crisis intervention.
138.23(f) "Culturally appropriate" means providing mental health services in a manner that
138.24incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370,
138.25subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural
138.26strengths and resources to promote overall wellness.
138.27(g) "Culture" means the distinct ways of living and understanding the world that
138.28are used by a group of people and are transmitted from one generation to another or
138.29adopted by an individual.
138.30(h) "Diagnostic assessment" has the meaning given in Minnesota Rules, part
138.319505.0370, subpart 11.
138.32(i) "Family" means a person who is identified by the client or the client's parent or
138.33guardian as being important to the client's mental health treatment. Family may include,
138.34but is not limited to, parents, foster parents, children, spouse, committed partners, former
138.35spouses, persons related by blood or adoption, persons who are a part of the client's
138.36permanency plan, or persons who are presently residing together as a family unit.
139.1(j) "Foster care" has the meaning given in section 260C.007, subdivision 18.
139.2(k) "Foster family setting" means the foster home in which the license holder resides.
139.3(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part
139.49505.0370, subpart 15.
139.5(m) "Mental health practitioner" has the meaning given in Minnesota Rules, part
139.69505.0370, subpart 17.
139.7(n) "Mental health professional" has the meaning given in Minnesota Rules, part
139.89505.0370, subpart 18.
139.9(o) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370,
139.10subpart 20.
139.11(p) "Parent" has the meaning given in section 260C.007, subdivision 25.
139.12(q) "Psychoeducation services" means information or demonstration provided to
139.13an individual, family, or group to explain, educate, and support the individual, family, or
139.14group in understanding a child's symptoms of mental illness, the impact on the child's
139.15development, and needed components of treatment and skill development so that the
139.16individual, family, or group can help the child to prevent relapse, prevent the acquisition
139.17of comorbid disorders, and to achieve optimal mental health and long-term resilience.
139.18(r) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370,
139.19subpart 27.
139.20(s) "Team consultation and treatment planning" means the coordination of treatment
139.21plans and consultation among providers in a group concerning the treatment needs of the
139.22child, including disseminating the child's treatment service schedule to all members of the
139.23service team. Team members must include all mental health professionals working with
139.24the child, a parent, the child unless the team lead or parent deem it clinically inappropriate,
139.25and at least two of the following: an individualized education program case manager;
139.26probation agent; children's mental health case manager; child welfare worker, including
139.27adoption or guardianship worker; primary care provider; foster parent; and any other
139.28member of the child's service team.
139.29    Subd. 2. Determination of client eligibility. A client's eligibility to receive
139.30treatment foster care under this section shall be determined by An eligible recipient is an
139.31individual, from birth through age 20, who is currently placed in a foster home licensed
139.32under Minnesota Rules, parts 2960.3000 to 2960.3340, and has received a diagnostic
139.33assessment, and an evaluation of level of care needed, and development of an individual
139.34treatment plan, as defined in paragraphs (a) to (c) and (b).
139.35(a) The diagnostic assessment must:
140.1(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
140.2conducted by a psychiatrist, licensed psychologist, or licensed independent clinical social
140.3worker that is mental health professional or a clinical trainee;
140.4(2) determine whether or not a child meets the criteria for mental illness, as defined
140.5in Minnesota Rules, part 9505.0370, subpart 20;
140.6(3) document that intensive treatment services are medically necessary within a
140.7foster family setting to ameliorate identified symptoms and functional impairments;
140.8(4) be performed within 180 days prior to before the start of service; and
140.9(2) include current diagnoses on all five axes of the client's current mental health
140.10status;
140.11(3) determine whether or not a child meets the criteria for severe emotional
140.12disturbance in section 245.4871, subdivision 6, or for serious and persistent mental illness
140.13in section 245.462, subdivision 20; and
140.14(4) be completed annually until age 18. For individuals between age 18 and 21,
140.15unless a client's mental health condition has changed markedly since the client's most
140.16recent diagnostic assessment, annual updating is necessary. For the purpose of this section,
140.17"updating" means a written summary, including current diagnoses on all five axes, by a
140.18mental health professional of the client's current mental status and service needs.
140.19(5) be completed as either a standard or extended diagnostic assessment annually to
140.20determine continued eligibility for the service.
140.21(b) The evaluation of level of care must be conducted by the placing county with
140.22an instrument, tribe, or case manager in conjunction with the diagnostic assessment as
140.23described by Minnesota Rules, part 9505.0372, subpart 1, item B, using a validated tool
140.24 approved by the commissioner of human services and not subject to the rulemaking
140.25process, consistent with section 245.4885, subdivision 1, paragraph (d), the result of which
140.26evaluation demonstrates that the child requires intensive intervention without 24-hour
140.27medical monitoring. The commissioner shall update the list of approved level of care
140.28instruments tools annually and publish on the department's Web site.
140.29(c) The individual treatment plan must be:
140.30(1) based on the information in the client's diagnostic assessment;
140.31(2) developed through a child-centered, family driven planning process that identifies
140.32service needs and individualized, planned, and culturally appropriate interventions that
140.33contain specific measurable treatment goals and objectives for the client and treatment
140.34strategies for the client's family and foster family;
140.35(3) reviewed at least once every 90 days and revised; and
141.1(4) signed by the client or, if appropriate, by the client's parent or other person
141.2authorized by statute to consent to mental health services for the client.
141.3    Subd. 3. Eligible mental health services providers. (a) Eligible providers for
141.4intensive children's mental health services in a foster family setting must be certified
141.5by the state and have a service provision contract with a county board or a reservation
141.6tribal council and must be able to demonstrate the ability to provide all of the services
141.7required in this section.
141.8(b) For purposes of this section, a provider agency must have an individual
141.9placement agreement for each recipient and must be a licensed child placing agency, under
141.10Minnesota Rules, parts 9543.0010 to 9543.0150, and either be:
141.11(1) a county county-operated entity certified by the state;
141.12(2) an Indian Health Services facility operated by a tribe or tribal organization under
141.13funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
141.14Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
141.15(3) a noncounty entity under contract with a county board.
141.16(c) Certified providers that do not meet the service delivery standards required in
141.17this section shall be subject to a decertification process.
141.18(d) For the purposes of this section, all services delivered to a client must be
141.19provided by a mental health professional or a clinical trainee.
141.20    Subd. 4. Eligible provider responsibilities Service delivery payment
141.21requirements. (a) To be an eligible provider for payment under this section, a provider
141.22must develop and practice written policies and procedures for treatment foster care services
141.23 intensive treatment in foster care, consistent with subdivision 1, paragraph (b), clauses (1),
141.24(2), and (3) and comply with the following requirements in paragraphs (b) to (n).
141.25(b) In delivering services under this section, a treatment foster care provider must
141.26ensure that staff caseload size reasonably enables the provider to play an active role in
141.27service planning, monitoring, delivering, and reviewing for discharge planning to meet
141.28the needs of the client, the client's foster family, and the birth family, as specified in each
141.29client's individual treatment plan.
141.30(b) A qualified clinical supervisor, as defined in and performing in compliance with
141.31Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
141.32provision of services described in this section.
141.33(c) Each client receiving treatment services must receive an extended diagnostic
141.34assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within
141.3530 days of enrollment in this service unless the client has a previous extended diagnostic
142.1assessment that the client, parent, and mental health professional agree still accurately
142.2describes the client's current mental health functioning.
142.3(d) Each previous and current mental health, school, and physical health treatment
142.4provider must be contacted to request documentation of treatment and assessments that the
142.5eligible client has received and this information must be reviewed and incorporated into
142.6the diagnostic assessment and team consultation and treatment planning review process.
142.7(e) Each client receiving treatment must be assessed for a trauma history and
142.8the client's treatment plan must document how the results of the assessment will be
142.9incorporated into treatment.
142.10(f) Each client receiving treatment services must have an individual treatment plan
142.11that is reviewed, evaluated, and signed every 90 days using the team consultation and
142.12treatment planning process, as defined in subdivision 1a, paragraph (s).
142.13(g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided
142.14in accordance with the client's individual treatment plan.
142.15(h) Each client must have a crisis assistance plan within ten days of initiating
142.16services and must have access to clinical phone support 24 hours per day, seven days per
142.17week, during the course of treatment, and the crisis plan must demonstrate coordination
142.18with the local or regional mobile crisis intervention team.
142.19(i) Services must be delivered and documented at least three days per week, equaling
142.20at least six hours of treatment per week, unless reduced units of service are specified on
142.21the treatment plan as part of transition or on a discharge plan to another service or level of
142.22care. Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
142.23(j) Location of service delivery must be in the client's home, day care setting,
142.24school, or other community-based setting that is specified on the client's individualized
142.25treatment plan.
142.26(k) Treatment must be developmentally and culturally appropriate for the client.
142.27(l) Services must be delivered in continual collaboration and consultation with the
142.28client's medical providers and, in particular, with prescribers of psychotropic medications,
142.29including those prescribed on an off-label basis, and members of the service team must be
142.30aware of the medication regimen and potential side effects.
142.31(m) Parents, siblings, foster parents, and members of the child's permanency plan
142.32must be involved in treatment and service delivery unless otherwise noted in the treatment
142.33plan.
142.34(n) Transition planning for the child must be conducted starting with the first
142.35treatment plan and must be addressed throughout treatment to support the child's
142.36permanency plan and postdischarge mental health service needs.
143.1    Subd. 5. Service authorization. The commissioner will administer authorizations
143.2for services under this section in compliance with section 256B.0625, subdivision 25.
143.3    Subd. 6. Excluded services. (a) Services in clauses (1) to (4) (7) are not covered
143.4under this section and are not eligible for medical assistance payment as components of
143.5intensive treatment in foster care services, but may be billed separately:
143.6(1) treatment foster care services provided in violation of medical assistance policy
143.7in Minnesota Rules, part 9505.0220;
143.8(2) service components of children's therapeutic services and supports
143.9simultaneously provided by more than one treatment foster care provider;
143.10(3) home and community-based waiver services; and
143.11(4) treatment foster care services provided to a child without a level of care
143.12determination according to section 245.4885, subdivision 1.
143.13(1) inpatient psychiatric hospital treatment;
143.14(2) mental health targeted case management;
143.15(3) partial hospitalization;
143.16(4) medication management;
143.17(5) children's mental health day treatment services;
143.18(6) crisis response services under section 256B.0944; and
143.19(7) transportation.
143.20(b) Children receiving intensive treatment in foster care services are not eligible for
143.21medical assistance reimbursement for the following services while receiving intensive
143.22treatment in foster care:
143.23(1) mental health case management services under section 256B.0625, subdivision
143.2420 ; and
143.25(2) (1) psychotherapy and skill skills training components of children's therapeutic
143.26services and supports under section 256B.0625, subdivision 35b.;
143.27(2) mental health behavioral aide services as defined in section 256B.0943,
143.28subdivision 1, paragraph (m);
143.29(3) home and community-based waiver services;
143.30(4) mental health residential treatment; and
143.31(5) room and board costs as defined in section 256I.03, subdivision 6.
143.32    Subd. 7. Medical assistance payment and rate setting. The commissioner shall
143.33establish a single daily per-client encounter rate for intensive treatment in foster care
143.34services. The rate must be constructed to cover only eligible services delivered to an
143.35eligible recipient by an eligible provider, as prescribed in subdivision 1, paragraph (b).

144.1    Sec. 16. Minnesota Statutes 2012, section 256B.49, is amended by adding a
144.2subdivision to read:
144.3    Subd. 24. Waiver allocations for transition populations. (a) The commissioner
144.4shall make available additional waiver allocations and additional necessary resources
144.5to assure timely discharges from the Anoka Metro Regional Treatment Center and the
144.6Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
144.7(1) are otherwise eligible for the brain injury, community alternatives for disabled
144.8individuals, or community alternative care waivers under this section;
144.9(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
144.10the Minnesota Security Hospital;
144.11(3) whose discharge would be significantly delayed without the available waiver
144.12allocation; and
144.13(4) who have met treatment objectives and no longer meet hospital level of care.
144.14(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
144.15requirements of the federal approved waiver plan.
144.16(c) Any corporate foster care home developed under this subdivision must be
144.17considered an exception under section 245A.03, subdivision 7, paragraph (a).
144.18EFFECTIVE DATE.This section is effective July 1, 2015.

144.19    Sec. 17. Minnesota Statutes 2012, section 256B.761, is amended to read:
144.20256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
144.21(a) Effective for services rendered on or after July 1, 2001, payment for medication
144.22management provided to psychiatric patients, outpatient mental health services, day
144.23treatment services, home-based mental health services, and family community support
144.24services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
144.2550th percentile of 1999 charges.
144.26(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
144.27services provided by an entity that operates: (1) a Medicare-certified comprehensive
144.28outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
144.291993, with at least 33 percent of the clients receiving rehabilitation services in the most
144.30recent calendar year who are medical assistance recipients, will be increased by 38 percent,
144.31when those services are provided within the comprehensive outpatient rehabilitation
144.32facility and provided to residents of nursing facilities owned by the entity.
144.33(c) The commissioner shall establish three levels of payment for mental health
144.34diagnostic assessment, based on three levels of complexity. The aggregate payment under
145.1the tiered rates must not exceed the projected aggregate payments for mental health
145.2diagnostic assessment under the previous single rate. The new rate structure is effective
145.3January 1, 2011, or upon federal approval, whichever is later.
145.4(d) In addition to rate increases otherwise provided, the commissioner may
145.5restructure coverage policy and rates to improve access to adult rehabilitative mental
145.6health services under section 256B.0623 and related mental health support services under
145.7section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and
145.82016, the projected state share of increased costs due to this paragraph is transferred
145.9from adult mental health grants under sections 245.4661 and 256E.12. The transfer for
145.10fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments
145.11made to managed care plans and county-based purchasing plans under sections 256B.69,
145.12256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.

145.13    Sec. 18. STATE ASSISTANCE TO COUNTIES; TRANSITIONS FOR HIGH
145.14NEEDS POPULATIONS.
145.15(a) Effective immediately, the commissioner of human services shall work with
145.16counties that request assistance to assure timely discharge from Anoka Metro Regional
145.17Treatment Center and the Minnesota Security Hospital for individuals who are ready
145.18for discharge but for whom the county may not have provider resources or appropriate
145.19placement available. Special consideration must be given to uninsured individuals who are
145.20not eligible for medical assistance and who may need continued treatment, and individuals
145.21with complex needs and other factors that hinder county efforts to place the individual in a
145.22safe, affordable setting.
145.23(b) The commissioner shall assure that, given Olmstead court directives and the
145.24role family and friends play in treatment progress, metropolitan area residents are asked
145.25whether they wished to be placed in an Intensive Residential Treatment Service program
145.26at Willmar or Cambridge or to be placed in a location more accessible to family, friends,
145.27and health providers.

145.28    Sec. 19. INSTRUCTIONS TO THE COMMISSIONER.
145.29In consultation with labor organizations, the commissioner of human services shall
145.30develop clear and consistent standards for state-operated services programs to:
145.31(1) address direct service staffing shortages;
145.32(2) identify and help resolve workplace safety issues; and
145.33(3) elevate the use and visibility of performance measures and objectives related to
145.34overtime use.


146.3    Section 1. Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:
146.4    Subd. 7. Use of data. (a) Except as otherwise provided in subdivision 7a or sections
146.5244.052 and 299C.093, the data provided under this section is private data on individuals
146.6under section 13.02, subdivision 12.
146.7(b) The data may be used only for by law enforcement and corrections agencies for
146.8 law enforcement and corrections purposes.
146.9(c) The commissioner of human services is authorized to have access to the data for:
146.10(1) state-operated services, as defined in section 246.014, are also authorized to
146.11have access to the data for the purposes described in section 246.13, subdivision 2,
146.12paragraph (b); and
146.13(2) purposes of completing background studies under chapter 245C.

146.14    Sec. 2. Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision
146.15to read:
146.16    Subd. 4a. Agency background studies. (a) The commissioner shall develop
146.17and implement an electronic process for the regular transfer of new criminal history
146.18information that is added to the Minnesota court information system. The commissioner's
146.19system must include for review only information that relates to individuals who have been
146.20the subject of a background study under this chapter that remain affiliated with the agency
146.21that initiated the background study. For purposes of this paragraph, an individual remains
146.22affiliated with an agency that initiated the background study until the agency informs the
146.23commissioner that the individual is no longer affiliated. When any individual no longer
146.24affiliated according to this paragraph returns to a position requiring a background study
146.25under this chapter, the agency with whom the individual is again affiliated shall initiate
146.26a new background study regardless of the length of time the individual was no longer
146.27affiliated with the agency.
146.28(b) The commissioner shall develop and implement an online system for agencies that
146.29initiate background studies under this chapter to access and maintain records of background
146.30studies initiated by that agency. The system must show all active background study subjects
146.31affiliated with that agency and the status of each individual's background study. Each
146.32agency that initiates background studies must use this system to notify the commissioner
146.33of discontinued affiliation for purposes of the processes required under paragraph (a).

147.1    Sec. 3. Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:
147.2    Subdivision 1. Background studies conducted by Department of Human
147.3Services. (a) For a background study conducted by the Department of Human Services,
147.4the commissioner shall review:
147.5    (1) information related to names of substantiated perpetrators of maltreatment of
147.6vulnerable adults that has been received by the commissioner as required under section
147.7626.557, subdivision 9c , paragraph (j);
147.8    (2) the commissioner's records relating to the maltreatment of minors in licensed
147.9programs, and from findings of maltreatment of minors as indicated through the social
147.10service information system;
147.11    (3) information from juvenile courts as required in subdivision 4 for individuals
147.12listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
147.13    (4) information from the Bureau of Criminal Apprehension, including information
147.14regarding a background study subject's registration in Minnesota as a predatory offender
147.15under section 243.166;
147.16    (5) except as provided in clause (6), information from the national crime information
147.17system when the commissioner has reasonable cause as defined under section 245C.05,
147.18subdivision 5; and
147.19    (6) for a background study related to a child foster care application for licensure or
147.20adoptions, the commissioner shall also review:
147.21    (i) information from the child abuse and neglect registry for any state in which the
147.22background study subject has resided for the past five years; and
147.23    (ii) information from national crime information databases, when the background
147.24study subject is 18 years of age or older.
147.25    (b) Notwithstanding expungement by a court, the commissioner may consider
147.26information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
147.27received notice of the petition for expungement and the court order for expungement is
147.28directed specifically to the commissioner.
147.29    (c) The commissioner shall also review criminal history information received
147.30according to section 245C.04, subdivision 4a, from the Minnesota court information
147.31system that relates to individuals who have already been studied under this chapter and
147.32who remain affiliated with the agency that initiated the background study.

147.33    Sec. 4. Minnesota Statutes 2012, section 256B.04, subdivision 21, is amended to read:
147.34    Subd. 21. Provider enrollment. (a) If the commissioner or the Centers for
147.35Medicare and Medicaid Services determines that a provider is designated "high-risk," the
148.1commissioner may withhold payment from providers within that category upon initial
148.2enrollment for a 90-day period. The withholding for each provider must begin on the date
148.3of the first submission of a claim.
148.4(b) An enrolled provider that is also licensed by the commissioner under chapter
148.5245A must designate an individual as the entity's compliance officer. The compliance
148.6officer must:
148.7(1) develop policies and procedures to assure adherence to medical assistance laws
148.8and regulations and to prevent inappropriate claims submissions;
148.9(2) train the employees of the provider entity, and any agents or subcontractors of
148.10the provider entity including billers, on the policies and procedures under clause (1);
148.11(3) respond to allegations of improper conduct related to the provision or billing of
148.12medical assistance services, and implement action to remediate any resulting problems;
148.13(4) use evaluation techniques to monitor compliance with medical assistance laws
148.14and regulations;
148.15(5) promptly report to the commissioner any identified violations of medical
148.16assistance laws or regulations; and
148.17    (6) within 60 days of discovery by the provider of a medical assistance
148.18reimbursement overpayment, report the overpayment to the commissioner and make
148.19arrangements with the commissioner for the commissioner's recovery of the overpayment.
148.20The commissioner may require, as a condition of enrollment in medical assistance, that a
148.21provider within a particular industry sector or category establish a compliance program that
148.22contains the core elements established by the Centers for Medicare and Medicaid Services.
148.23(c) The commissioner may revoke the enrollment of an ordering or rendering
148.24provider for a period of not more than one year, if the provider fails to maintain and, upon
148.25request from the commissioner, provide access to documentation relating to written orders
148.26or requests for payment for durable medical equipment, certifications for home health
148.27services, or referrals for other items or services written or ordered by such provider, when
148.28the commissioner has identified a pattern of a lack of documentation. A pattern means a
148.29failure to maintain documentation or provide access to documentation on more than one
148.30occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
148.31provider under the provisions of section 256B.064.
148.32(d) The commissioner shall terminate or deny the enrollment of any individual or
148.33entity if the individual or entity has been terminated from participation in Medicare or
148.34under the Medicaid program or Children's Health Insurance Program of any other state.
148.35(e) As a condition of enrollment in medical assistance, the commissioner shall
148.36require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
149.1and Medicaid Services or the Minnesota Department of Human Services commissioner
149.2 permit the Centers for Medicare and Medicaid Services, its agents, or its designated
149.3contractors and the state agency, its agents, or its designated contractors to conduct
149.4unannounced on-site inspections of any provider location. The commissioner shall publish
149.5in the Minnesota Health Care Program Provider Manual a list of provider types designated
149.6"limited," "moderate," or "high-risk," based on the criteria and standards used to designate
149.7Medicare providers in Code of Federal Regulations, title 42, section 424.518. The list and
149.8criteria are not subject to the requirements of chapter 14. The commissioner's designations
149.9are not subject to administrative appeal.
149.10(f) As a condition of enrollment in medical assistance, the commissioner shall
149.11require that a high-risk provider, or a person with a direct or indirect ownership interest in
149.12the provider of five percent or higher, consent to criminal background checks, including
149.13fingerprinting, when required to do so under state law or by a determination by the
149.14commissioner or the Centers for Medicare and Medicaid Services that a provider is
149.15designated high-risk for fraud, waste, or abuse.
149.16(g) As a condition of enrollment, all durable medical equipment, prosthetics,
149.17orthotics, and supplies (DMEPOS) suppliers operating in Minnesota are required to name
149.18the Department of Human Services, in addition to the Centers for Medicare and Medicaid
149.19Services, as an obligee on all surety performance bonds required pursuant to section
149.204312(a) of the Balanced Budget Act of 1997, Public Law 105-33, amending Social
149.21Security Act, section 1834(a). The performance bond must also allow for recovery of
149.22costs and fees in pursuing a claim on the bond.
149.23(h) The Department of Human Services may require a provider to purchase a
149.24performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
149.25or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
149.26department determines there is significant evidence of or potential for fraud and abuse by
149.27the provider, or (3) the provider or category of providers is designated high-risk pursuant
149.28to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450, or the
149.29department otherwise finds it is in the best interest of the Medicaid program to do so. The
149.30performance bond must be in an amount of $100,000 or ten percent of the provider's
149.31payments from Medicaid during the immediately preceding 12 months, whichever is
149.32greater. The performance bond must name the Department of Human Services as an
149.33obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.
149.34EFFECTIVE DATE.This section is effective the day following final enactment.

150.1    Sec. 5. Minnesota Statutes 2012, section 256B.04, is amended by adding a subdivision
150.2to read:
150.3    Subd. 22. Application fee. (a) The commissioner must collect and retain federally
150.4required nonrefundable application fees to pay for provider screening activities in
150.5accordance with Code of Federal Regulations, title 42, section 455, subpart E. The
150.6enrollment application must be made under the procedures specified by the commissioner,
150.7in the form specified by the commissioner, and accompanied by an application fee
150.8described in paragraph (b), or a request for a hardship exception as described in the
150.9specified procedures. Application fees must be deposited in the provider screening account
150.10in the special revenue fund. Amounts in the provider screening account are appropriated
150.11to the commissioner for costs associated with the provider screening activities required
150.12in Code of Federal Regulations, title 42, section 455, subpart E. The commissioner
150.13shall conduct screening activities as required by Code of Federal Regulations, title 42,
150.14section 455, subpart E, and as otherwise provided by law, to include database checks,
150.15unannounced pre- and postenrollment site visits, fingerprinting, and criminal background
150.16studies. The commissioner must revalidate all providers under this subdivision at least
150.17once every five years.
150.18(b) The application fee under this subdivision is $532 for the calendar year 2013.
150.19For calendar year 2014 and subsequent years, the fee:
150.20(1) is adjusted by the percentage change to the consumer price index for all urban
150.21consumers, United States city average, for the 12-month period ending with June of the
150.22previous year. The resulting fee must be announced in the Federal Register;
150.23(2) is effective from January 1 to December 31 of a calendar year;
150.24(3) is required on the submission of an initial application, an application to establish
150.25a new practice location, an application for re-enrollment when the provider is not enrolled
150.26at the time of application of re-enrollment, or at revalidation when required by federal
150.27regulation; and
150.28(4) must be in the amount in effect for the calendar year during which the application
150.29for enrollment, new practice location, or re-enrollment is being submitted.
150.30(c) The application fee under this subdivision cannot be charged to:
150.31(1) providers who are enrolled in Medicare or who provide documentation of
150.32payment of the fee to, and enrollment with, another state;
150.33(2) providers who are enrolled but are required to submit new applications for
150.34purposes of re-enrollment; or
150.35(3) a provider who enrolls as an individual.
150.36EFFECTIVE DATE.This section is effective the day following final enactment.

151.1    Sec. 6. Minnesota Statutes 2012, section 256B.064, subdivision 1a, is amended to read:
151.2    Subd. 1a. Grounds for sanctions against vendors. The commissioner may
151.3impose sanctions against a vendor of medical care for any of the following: (1) fraud,
151.4theft, or abuse in connection with the provision of medical care to recipients of public
151.5assistance; (2) a pattern of presentment of false or duplicate claims or claims for services
151.6not medically necessary; (3) a pattern of making false statements of material facts for
151.7the purpose of obtaining greater compensation than that to which the vendor is legally
151.8entitled; (4) suspension or termination as a Medicare vendor; (5) refusal to grant the state
151.9agency access during regular business hours to examine all records necessary to disclose
151.10the extent of services provided to program recipients and appropriateness of claims for
151.11payment; (6) failure to repay an overpayment or a fine finally established under this
151.12section; and (7) failure to correct errors in the maintenance of health service or financial
151.13records for which a fine was imposed or after issuance of a warning by the commissioner;
151.14and (8) any reason for which a vendor could be excluded from participation in the
151.15Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act.
151.16The determination of services not medically necessary may be made by the commissioner
151.17in consultation with a peer advisory task force appointed by the commissioner on the
151.18recommendation of appropriate professional organizations. The task force expires as
151.19provided in section 15.059, subdivision 5.

151.20    Sec. 7. Minnesota Statutes 2012, section 256B.064, subdivision 1b, is amended to read:
151.21    Subd. 1b. Sanctions available. The commissioner may impose the following
151.22sanctions for the conduct described in subdivision 1a: suspension or withholding of
151.23payments to a vendor and suspending or terminating participation in the program, or
151.24imposition of a fine under subdivision 2, paragraph (f). When imposing sanctions under
151.25this section, the commissioner shall consider the nature, chronicity, or severity of the
151.26conduct and the effect of the conduct on the health and safety of persons served by the
151.27vendor. Regardless of imposition of sanctions, the commissioner may make a referral
151.28to the appropriate state licensing board.

151.29    Sec. 8. Minnesota Statutes 2012, section 256B.064, subdivision 2, is amended to read:
151.30    Subd. 2. Imposition of monetary recovery and sanctions. (a) The commissioner
151.31shall determine any monetary amounts to be recovered and sanctions to be imposed upon
151.32a vendor of medical care under this section. Except as provided in paragraphs (b) and
151.33(d), neither a monetary recovery nor a sanction will be imposed by the commissioner
151.34without prior notice and an opportunity for a hearing, according to chapter 14, on the
152.1commissioner's proposed action, provided that the commissioner may suspend or reduce
152.2payment to a vendor of medical care, except a nursing home or convalescent care facility,
152.3after notice and prior to the hearing if in the commissioner's opinion that action is
152.4necessary to protect the public welfare and the interests of the program.
152.5(b) Except when the commissioner finds good cause not to suspend payments under
152.6Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
152.7withhold or reduce payments to a vendor of medical care without providing advance
152.8notice of such withholding or reduction if either of the following occurs:
152.9(1) the vendor is convicted of a crime involving the conduct described in subdivision
152.101a; or
152.11(2) the commissioner determines there is a credible allegation of fraud for which an
152.12investigation is pending under the program. A credible allegation of fraud is an allegation
152.13which has been verified by the state, from any source, including but not limited to:
152.14(i) fraud hotline complaints;
152.15(ii) claims data mining; and
152.16(iii) patterns identified through provider audits, civil false claims cases, and law
152.17enforcement investigations.
152.18Allegations are considered to be credible when they have an indicia of reliability
152.19and the state agency has reviewed all allegations, facts, and evidence carefully and acts
152.20judiciously on a case-by-case basis.
152.21(c) The commissioner must send notice of the withholding or reduction of payments
152.22under paragraph (b) within five days of taking such action unless requested in writing by a
152.23law enforcement agency to temporarily withhold the notice. The notice must:
152.24(1) state that payments are being withheld according to paragraph (b);
152.25(2) set forth the general allegations as to the nature of the withholding action, but
152.26need not disclose any specific information concerning an ongoing investigation;
152.27(3) except in the case of a conviction for conduct described in subdivision 1a, state
152.28that the withholding is for a temporary period and cite the circumstances under which
152.29withholding will be terminated;
152.30(4) identify the types of claims to which the withholding applies; and
152.31(5) inform the vendor of the right to submit written evidence for consideration by
152.32the commissioner.
152.33The withholding or reduction of payments will not continue after the commissioner
152.34determines there is insufficient evidence of fraud by the vendor, or after legal proceedings
152.35relating to the alleged fraud are completed, unless the commissioner has sent notice of
152.36intention to impose monetary recovery or sanctions under paragraph (a).
153.1(d) The commissioner shall suspend or terminate a vendor's participation in the
153.2program without providing advance notice and an opportunity for a hearing when the
153.3suspension or termination is required because of the vendor's exclusion from participation
153.4in Medicare. Within five days of taking such action, the commissioner must send notice of
153.5the suspension or termination. The notice must:
153.6(1) state that suspension or termination is the result of the vendor's exclusion from
153.7Medicare;
153.8(2) identify the effective date of the suspension or termination; and
153.9(3) inform the vendor of the need to be reinstated to Medicare before reapplying
153.10for participation in the program.
153.11(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or
153.12sanction is to be imposed, a vendor may request a contested case, as defined in section
153.1314.02, subdivision 3 , by filing with the commissioner a written request of appeal. The
153.14appeal request must be received by the commissioner no later than 30 days after the date
153.15the notification of monetary recovery or sanction was mailed to the vendor. The appeal
153.16request must specify:
153.17(1) each disputed item, the reason for the dispute, and an estimate of the dollar
153.18amount involved for each disputed item;
153.19(2) the computation that the vendor believes is correct;
153.20(3) the authority in statute or rule upon which the vendor relies for each disputed item;
153.21(4) the name and address of the person or entity with whom contacts may be made
153.22regarding the appeal; and
153.23(5) other information required by the commissioner.
153.24(f) The commissioner may order a vendor to forfeit a fine for failure to fully
153.25document services according to standards in this chapter and Minnesota Rules, chapter
153.269505. Fines may be assessed when the commissioner has no evidence that services were
153.27not provided and services are partially documented in the health service or financial
153.28record, but specific required components of documentation are missing. The fine for
153.29incomplete documentation shall equal 20 percent of the amount paid on the claims for
153.30reimbursement submitted by the vendor, or up to $5,000, whichever is less.
153.31(g) The vendor shall pay the fine assessed on or before the payment date specified. If
153.32the vendor fails to pay the fine, the commissioner may withhold or reduce payments and
153.33recover the amount of the fine. A timely appeal shall stay payment of the fine until the
153.34commissioner issues a final order.

153.35    Sec. 9. Minnesota Statutes 2012, section 256B.0659, subdivision 21, is amended to read:
154.1    Subd. 21. Requirements for initial enrollment of personal care assistance
154.2provider agencies. (a) All personal care assistance provider agencies must provide, at the
154.3time of enrollment as a personal care assistance provider agency in a format determined
154.4by the commissioner, information and documentation that includes, but is not limited to,
154.5the following:
154.6    (1) the personal care assistance provider agency's current contact information
154.7including address, telephone number, and e-mail address;
154.8    (2) proof of surety bond coverage in the amount of $50,000 $100,000 or ten percent
154.9of the provider's payments from Medicaid in the previous year, whichever is less more.
154.10The performance bond must be in a form approved by the commissioner, must be renewed
154.11annually, and must allow for recovery of costs and fees in pursuing a claim on the bond;
154.12    (3) proof of fidelity bond coverage in the amount of $20,000;
154.13    (4) proof of workers' compensation insurance coverage;
154.14    (5) proof of liability insurance;
154.15    (6) a description of the personal care assistance provider agency's organization
154.16identifying the names of all owners, managing employees, staff, board of directors, and
154.17the affiliations of the directors, owners, or staff to other service providers;
154.18    (7) a copy of the personal care assistance provider agency's written policies and
154.19procedures including: hiring of employees; training requirements; service delivery;
154.20and employee and consumer safety including process for notification and resolution
154.21of consumer grievances, identification and prevention of communicable diseases, and
154.22employee misconduct;
154.23    (8) copies of all other forms the personal care assistance provider agency uses in
154.24the course of daily business including, but not limited to:
154.25    (i) a copy of the personal care assistance provider agency's time sheet if the time
154.26sheet varies from the standard time sheet for personal care assistance services approved
154.27by the commissioner, and a letter requesting approval of the personal care assistance
154.28provider agency's nonstandard time sheet;
154.29    (ii) the personal care assistance provider agency's template for the personal care
154.30assistance care plan; and
154.31    (iii) the personal care assistance provider agency's template for the written
154.32agreement in subdivision 20 for recipients using the personal care assistance choice
154.33option, if applicable;
154.34    (9) a list of all training and classes that the personal care assistance provider agency
154.35requires of its staff providing personal care assistance services;
155.1    (10) documentation that the personal care assistance provider agency and staff have
155.2successfully completed all the training required by this section;
155.3    (11) documentation of the agency's marketing practices;
155.4    (12) disclosure of ownership, leasing, or management of all residential properties
155.5that is used or could be used for providing home care services;
155.6    (13) documentation that the agency will use the following percentages of revenue
155.7generated from the medical assistance rate paid for personal care assistance services
155.8for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
155.9personal care assistance choice option and 72.5 percent of revenue from other personal
155.10care assistance providers. The revenue generated by the qualified professional and the
155.11reasonable costs associated with the qualified professional shall not be used in making
155.12this calculation; and
155.13    (14) effective May 15, 2010, documentation that the agency does not burden
155.14recipients' free exercise of their right to choose service providers by requiring personal
155.15care assistants to sign an agreement not to work with any particular personal care
155.16assistance recipient or for another personal care assistance provider agency after leaving
155.17the agency and that the agency is not taking action on any such agreements or requirements
155.18regardless of the date signed.
155.19    (b) Personal care assistance provider agencies shall provide the information specified
155.20in paragraph (a) to the commissioner at the time the personal care assistance provider
155.21agency enrolls as a vendor or upon request from the commissioner. The commissioner
155.22shall collect the information specified in paragraph (a) from all personal care assistance
155.23providers beginning July 1, 2009.
155.24    (c) All personal care assistance provider agencies shall require all employees in
155.25management and supervisory positions and owners of the agency who are active in the
155.26day-to-day management and operations of the agency to complete mandatory training
155.27as determined by the commissioner before enrollment of the agency as a provider.
155.28Employees in management and supervisory positions and owners who are active in
155.29the day-to-day operations of an agency who have completed the required training as
155.30an employee with a personal care assistance provider agency do not need to repeat
155.31the required training if they are hired by another agency, if they have completed the
155.32training within the past three years. By September 1, 2010, the required training must
155.33be available with meaningful access according to title VI of the Civil Rights Act and
155.34federal regulations adopted under that law or any guidance from the United States Health
155.35and Human Services Department. The required training must be available online or by
155.36electronic remote connection. The required training must provide for competency testing.
156.1Personal care assistance provider agency billing staff shall complete training about
156.2personal care assistance program financial management. This training is effective July 1,
156.32009. Any personal care assistance provider agency enrolled before that date shall, if it
156.4has not already, complete the provider training within 18 months of July 1, 2009. Any new
156.5owners or employees in management and supervisory positions involved in the day-to-day
156.6operations are required to complete mandatory training as a requisite of working for the
156.7agency. Personal care assistance provider agencies certified for participation in Medicare
156.8as home health agencies are exempt from the training required in this subdivision. When
156.9available, Medicare-certified home health agency owners, supervisors, or managers must
156.10successfully complete the competency test.
156.11EFFECTIVE DATE.This section is effective the day following final enactment.


156.14    Section 1. Minnesota Statutes 2012, section 256.9657, subdivision 2, is amended to read:
156.15    Subd. 2. Hospital surcharge. (a) Effective October 1, 1992, each Minnesota
156.16hospital except facilities of the federal Indian Health Service and regional treatment
156.17centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net
156.18patient revenues excluding net Medicare revenues reported by that provider to the health
156.19care cost information system according to the schedule in subdivision 4.
156.20(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 1.56
156.21percent.
156.22(c) Effective July 1, 2013, the surcharge under paragraph (b) is increased to 2.68
156.23percent for all nongovernment-owned hospitals.
156.24(d) Notwithstanding the Medicare cost finding and allowable cost principles, the
156.25hospital surcharge is not an allowable cost for purposes of rate setting under sections
156.26256.9685 to 256.9695.
156.27EFFECTIVE DATE.This section is effective July 1, 2013.

156.28    Sec. 2. Minnesota Statutes 2012, section 256.9685, subdivision 2, is amended to read:
156.29    Subd. 2. Federal requirements. (a) If it is determined that a provision of this
156.30section or section 256.9686, 256.969, or 256.9695 conflicts with existing or future
156.31requirements of the United States government with respect to federal financial participation
156.32in medical assistance, the federal requirements prevail. The commissioner may, in the
156.33aggregate, prospectively and retrospectively, reduce payment rates and payments to avoid
157.1reduced federal financial participation resulting from rates and payments determined by
157.2the commissioner that are in excess of the Medicare upper payment limitations.
157.3(b) For rates and payments determined by the commissioner to be in excess of the
157.4Medicare upper payment limits for the nongovernment-owned limit category, rates and
157.5payments shall be reduced to the limits according to clauses (1) to (4):
157.6(1) rates and payments under section 256.969, subdivision 3a, paragraph (j), shall be
157.7reduced proportionately;
157.8(2) if rates and payments remain above the limit, medical education payments under
157.9section 62J.692, subdivision 8, shall be the first reduction for the government-owned
157.10limit category;
157.11(3) if rates and payments remain above the limit, rates and payments not included
157.12under clause (1) shall be reduced in total; and
157.13(4) the state share of payments under clauses (1) and (2) shall be returned to the
157.14hospital.

157.15    Sec. 3. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
157.16    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
157.17assistance program must not be submitted until the recipient is discharged. However,
157.18the commissioner shall establish monthly interim payments for inpatient hospitals that
157.19have individual patient lengths of stay over 30 days regardless of diagnostic category.
157.20Except as provided in section 256.9693, medical assistance reimbursement for treatment
157.21of mental illness shall be reimbursed based on diagnostic classifications. Individual
157.22hospital payments established under this section and sections 256.9685, 256.9686, and
157.23256.9695 , in addition to third-party and recipient liability, for discharges occurring during
157.24the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
157.25inpatient services paid for the same period of time to the hospital. This payment limitation
157.26shall be calculated separately for medical assistance and general assistance medical
157.27care services. The limitation on general assistance medical care shall be effective for
157.28admissions occurring on or after July 1, 1991. Services that have rates established under
157.29subdivision 11 or 12, must be limited separately from other services. After consulting with
157.30the affected hospitals, the commissioner may consider related hospitals one entity and
157.31may merge the payment rates while maintaining separate provider numbers. The operating
157.32and property base rates per admission or per day shall be derived from the best Medicare
157.33and claims data available when rates are established. The commissioner shall determine
157.34the best Medicare and claims data, taking into consideration variables of recency of the
157.35data, audit disposition, settlement status, and the ability to set rates in a timely manner.
158.1The commissioner shall notify hospitals of payment rates by December 1 of the year
158.2preceding the rate year. The rate setting data must reflect the admissions data used to
158.3establish relative values. Base year changes from 1981 to the base year established for the
158.4rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
158.5to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
158.61. The commissioner may adjust base year cost, relative value, and case mix index data
158.7to exclude the costs of services that have been discontinued by the October 1 of the year
158.8preceding the rate year or that are paid separately from inpatient services. Inpatient stays
158.9that encompass portions of two or more rate years shall have payments established based
158.10on payment rates in effect at the time of admission unless the date of admission preceded
158.11the rate year in effect by six months or more. In this case, operating payment rates for
158.12services rendered during the rate year in effect and established based on the date of
158.13admission shall be adjusted to the rate year in effect by the hospital cost index.
158.14    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
158.15payment, before third-party liability and spenddown, made to hospitals for inpatient
158.16services is reduced by .5 percent from the current statutory rates.
158.17    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
158.18admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
158.19before third-party liability and spenddown, is reduced five percent from the current
158.20statutory rates. Mental health services within diagnosis related groups 424 to 432, and
158.21facilities defined under subdivision 16 are excluded from this paragraph.
158.22    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
158.23fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
158.24inpatient services before third-party liability and spenddown, is reduced 6.0 percent
158.25from the current statutory rates. Mental health services within diagnosis related groups
158.26424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
158.27Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
158.28assistance does not include general assistance medical care. Payments made to managed
158.29care plans shall be reduced for services provided on or after January 1, 2006, to reflect
158.30this reduction.
158.31    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
158.32fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
158.33to hospitals for inpatient services before third-party liability and spenddown, is reduced
158.343.46 percent from the current statutory rates. Mental health services with diagnosis related
158.35groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
159.1paragraph. Payments made to managed care plans shall be reduced for services provided
159.2on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
159.3    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
159.4fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
159.5to hospitals for inpatient services before third-party liability and spenddown, is reduced
159.61.9 percent from the current statutory rates. Mental health services with diagnosis related
159.7groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
159.8paragraph. Payments made to managed care plans shall be reduced for services provided
159.9on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
159.10    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
159.11for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
159.12inpatient services before third-party liability and spenddown, is reduced 1.79 percent
159.13from the current statutory rates. Mental health services with diagnosis related groups
159.14424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
159.15Payments made to managed care plans shall be reduced for services provided on or after
159.16July 1, 2011, to reflect this reduction.
159.17(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
159.18payment for fee-for-service admissions occurring on or after July 1, 2009, made to
159.19hospitals for inpatient services before third-party liability and spenddown, is reduced
159.20one percent from the current statutory rates. Facilities defined under subdivision 16 are
159.21excluded from this paragraph. Payments made to managed care plans shall be reduced for
159.22services provided on or after October 1, 2009, to reflect this reduction.
159.23(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
159.24payment for fee-for-service admissions occurring on or after July 1, 2011, made to
159.25hospitals for inpatient services before third-party liability and spenddown, is reduced
159.261.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
159.27excluded from this paragraph. Payments made to managed care plans shall be reduced for
159.28services provided on or after January 1, 2011, to reflect this reduction.
159.29(j) In order to offset the rateable reductions provided for in this subdivision, the total
159.30payment rate for medical assistance admissions for nongovernment-owned hospitals
159.31occurring on or after July 1, 2013, made to Minnesota hospitals for inpatient services
159.32before third-party liability and spenddown, shall be increased by 30 percent from the
159.33current statutory rates. The commissioner shall not adjust rates paid to a prepaid health
159.34plan under contract with the commissioner to reflect payments provided in this paragraph.
159.35The commissioner shall adjust rates and payments in excess of the Medicare upper limits
159.36on payments according to section 256.9685, subdivision 2.
160.1EFFECTIVE DATE.This section is effective July 1, 2013.

160.2    Sec. 4. Minnesota Statutes 2012, section 256.969, subdivision 29, is amended to read:
160.3    Subd. 29. Reimbursement for the fee increase for the early hearing detection
160.4and intervention program. (a) For admissions occurring on or after July 1, 2010,
160.5payment rates shall be adjusted to include the increase to the fee that is effective on July 1,
160.62010, for the early hearing detection and intervention program recipients under section
160.7144.125, subdivision 1 , that is paid by the hospital for public program recipients. This
160.8payment increase shall be in effect until the increase is fully recognized in the base year
160.9cost under subdivision 2b. This payment shall be included in payments to contracted
160.10managed care organizations.
160.11    (b) For admissions occurring on or after July 1, 2013, payment rates shall be
160.12adjusted to include the increase to the fee that is effective July 1, 2013, for the early
160.13hearing detection and intervention program recipients under section 144.125, subdivision
160.141 , that is paid by the hospital for public program recipients. This payment increase shall
160.15be in effect until the increase is fully recognized in the base year cost under subdivision
160.162b. This payment shall be included in payments to contracted managed care organizations.

160.17    Sec. 5. Minnesota Statutes 2012, section 256B.055, subdivision 14, is amended to read:
160.18    Subd. 14. Persons detained by law. (a) Medical assistance may be paid for an
160.19inmate of a correctional facility who is conditionally released as authorized under section
160.20241.26 , 244.065, or 631.425, if the individual does not require the security of a public
160.21detention facility and is housed in a halfway house or community correction center, or
160.22under house arrest and monitored by electronic surveillance in a residence approved
160.23by the commissioner of corrections, and if the individual meets the other eligibility
160.24requirements of this chapter.
160.25    (b) An individual who is enrolled in medical assistance, and who is charged with a
160.26crime and incarcerated for less than 12 months shall be suspended from eligibility at the
160.27time of incarceration until the individual is released. Upon release, medical assistance
160.28eligibility is reinstated without reapplication using a reinstatement process and form, if the
160.29individual is otherwise eligible.
160.30    (c) An individual, regardless of age, who is considered an inmate of a public
160.31institution as defined in Code of Federal Regulations, title 42, section 435.1010, and
160.32who meets the eligibility requirements in section 256B.056, is not eligible for medical
160.33assistance, except for covered services received while an inpatient in a medical institution
160.34as defined in the Code of Federal Regulations, title 42, section 435.1010. Security issues
161.1related to the inpatient treatment of an inmate are the responsibility of the entity with
161.2jurisdiction over the inmate.
161.3EFFECTIVE DATE.This section is effective January 1, 2014.

161.4    Sec. 6. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
161.5    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
161.6to citizens of the United States, qualified noncitizens as defined in this subdivision, and
161.7other persons residing lawfully in the United States. Citizens or nationals of the United
161.8States must cooperate in obtaining satisfactory documentary evidence of citizenship or
161.9nationality according to the requirements of the federal Deficit Reduction Act of 2005,
161.10Public Law 109-171.
161.11(b) "Qualified noncitizen" means a person who meets one of the following
161.12immigration criteria:
161.13(1) admitted for lawful permanent residence according to United States Code, title 8;
161.14(2) admitted to the United States as a refugee according to United States Code,
161.15title 8, section 1157;
161.16(3) granted asylum according to United States Code, title 8, section 1158;
161.17(4) granted withholding of deportation according to United States Code, title 8,
161.18section 1253(h);
161.19(5) paroled for a period of at least one year according to United States Code, title 8,
161.20section 1182(d)(5);
161.21(6) granted conditional entrant status according to United States Code, title 8,
161.22section 1153(a)(7);
161.23(7) determined to be a battered noncitizen by the United States Attorney General
161.24according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
161.25title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
161.26(8) is a child of a noncitizen determined to be a battered noncitizen by the United
161.27States Attorney General according to the Illegal Immigration Reform and Immigrant
161.28Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
161.29Public Law 104-200; or
161.30(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
161.31Law 96-422, the Refugee Education Assistance Act of 1980.
161.32(c) All qualified noncitizens who were residing in the United States before August
161.3322, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
161.34medical assistance with federal financial participation.
162.1(d) Beginning December 1, 1996, qualified noncitizens who entered the United
162.2States on or after August 22, 1996, and who otherwise meet the eligibility requirements
162.3of this chapter are eligible for medical assistance with federal participation for five years
162.4if they meet one of the following criteria:
162.5(1) refugees admitted to the United States according to United States Code, title 8,
162.6section 1157;
162.7(2) persons granted asylum according to United States Code, title 8, section 1158;
162.8(3) persons granted withholding of deportation according to United States Code,
162.9title 8, section 1253(h);
162.10(4) veterans of the United States armed forces with an honorable discharge for
162.11a reason other than noncitizen status, their spouses and unmarried minor dependent
162.12children; or
162.13(5) persons on active duty in the United States armed forces, other than for training,
162.14their spouses and unmarried minor dependent children.
162.15 Beginning July 1, 2010, children and pregnant women who are noncitizens
162.16described in paragraph (b) or who are lawfully present in the United States as defined
162.17in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
162.18eligibility requirements of this chapter, are eligible for medical assistance with federal
162.19financial participation as provided by the federal Children's Health Insurance Program
162.20Reauthorization Act of 2009, Public Law 111-3.
162.21(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
162.22are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
162.23subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
162.24Code, title 8, section 1101(a)(15).
162.25(f) Payment shall also be made for care and services that are furnished to noncitizens,
162.26regardless of immigration status, who otherwise meet the eligibility requirements of
162.27this chapter, if such care and services are necessary for the treatment of an emergency
162.28medical condition.
162.29(g) For purposes of this subdivision, the term "emergency medical condition" means
162.30a medical condition that meets the requirements of United States Code, title 42, section
162.311396b(v).
162.32(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
162.33of an emergency medical condition are limited to the following:
162.34(i) services delivered in an emergency room or by an ambulance service licensed
162.35under chapter 144E that are directly related to the treatment of an emergency medical
162.36condition;
163.1(ii) services delivered in an inpatient hospital setting following admission from an
163.2emergency room or clinic for an acute emergency condition; and
163.3(iii) follow-up services that are directly related to the original service provided
163.4to treat the emergency medical condition and are covered by the global payment made
163.5to the provider.
163.6    (2) Services for the treatment of emergency medical conditions do not include:
163.7(i) services delivered in an emergency room or inpatient setting to treat a
163.8nonemergency condition;
163.9(ii) organ transplants, stem cell transplants, and related care;
163.10(iii) services for routine prenatal care;
163.11(iv) continuing care, including long-term care, nursing facility services, home health
163.12care, adult day care, day training, or supportive living services;
163.13(v) elective surgery;
163.14(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
163.15part of an emergency room visit;
163.16(vii) preventative health care and family planning services;
163.17(viii) dialysis;
163.18(ix) chemotherapy or therapeutic radiation services;
163.19(x) (viii) rehabilitation services;
163.20(xi) (ix) physical, occupational, or speech therapy;
163.21(xii) (x) transportation services;
163.22(xiii) (xi) case management;
163.23(xiv) (xii) prosthetics, orthotics, durable medical equipment, or medical supplies;
163.24(xv) (xiii) dental services;
163.25(xvi) (xiv) hospice care;
163.26(xvii) (xv) audiology services and hearing aids;
163.27(xviii) (xvi) podiatry services;
163.28(xix) (xvii) chiropractic services;
163.29(xx) (xviii) immunizations;
163.30(xxi) (xix) vision services and eyeglasses;
163.31(xxii) (xx) waiver services;
163.32(xxiii) (xxi) individualized education programs; or
163.33(xxiv) (xxii) chemical dependency treatment.
163.34(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
163.35nonimmigrants, or lawfully present in the United States as defined in Code of Federal
163.36Regulations, title 8, section 103.12, are not covered by a group health plan or health
164.1insurance coverage according to Code of Federal Regulations, title 42, section 457.310,
164.2and who otherwise meet the eligibility requirements of this chapter, are eligible for
164.3medical assistance through the period of pregnancy, including labor and delivery, and 60
164.4days postpartum, to the extent federal funds are available under title XXI of the Social
164.5Security Act, and the state children's health insurance program.
164.6(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
164.7services from a nonprofit center established to serve victims of torture and are otherwise
164.8ineligible for medical assistance under this chapter are eligible for medical assistance
164.9without federal financial participation. These individuals are eligible only for the period
164.10during which they are receiving services from the center. Individuals eligible under this
164.11paragraph shall not be required to participate in prepaid medical assistance.
164.12(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
164.13emergency medical conditions under paragraph (f) except where coverage is prohibited
164.14under federal law:
164.15(1) dialysis services provided in a hospital or freestanding dialysis facility; and
164.16(2) surgery and the administration of chemotherapy, radiation, and related services
164.17necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission
164.18and requires surgery, chemotherapy, or radiation treatment.
164.19EFFECTIVE DATE.This section is effective July 1, 2013.

164.20    Sec. 7. Minnesota Statutes 2012, section 256B.0625, subdivision 9, is amended to read:
164.21    Subd. 9. Dental services. (a) Medical assistance covers dental services.
164.22(b) Medical assistance dental coverage for nonpregnant adults is limited to the
164.23following services:
164.24(1) comprehensive exams, limited to once every five years;
164.25(2) periodic exams, limited to one per year;
164.26(3) limited exams;
164.27(4) bitewing x-rays, limited to one per year;
164.28(5) periapical x-rays;
164.29(6) panoramic x-rays, limited to one every five years except (1) when medically
164.30necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
164.31or (2) once every two years for patients who cannot cooperate for intraoral film due to
164.32a developmental disability or medical condition that does not allow for intraoral film
164.33placement;
164.34(7) prophylaxis, limited to one per year;
164.35(8) application of fluoride varnish, limited to one per year;
165.1(9) posterior fillings, all at the amalgam rate;
165.2(10) anterior fillings;
165.3(11) endodontics, limited to root canals on the anterior and premolars only;
165.4(12) removable prostheses, each dental arch limited to one every six years;
165.5(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
165.6abscesses;
165.7(14) palliative treatment and sedative fillings for relief of pain; and
165.8(15) full-mouth debridement, limited to one every five years.
165.9(c) In addition to the services specified in paragraph (b), medical assistance
165.10covers the following services for adults, if provided in an outpatient hospital setting or
165.11freestanding ambulatory surgical center as part of outpatient dental surgery:
165.12(1) periodontics, limited to periodontal scaling and root planing once every two years;
165.13(2) general anesthesia; and
165.14(3) full-mouth survey once every five years.
165.15(d) Medical assistance covers medically necessary dental services for children and
165.16pregnant women. The following guidelines apply:
165.17(1) posterior fillings are paid at the amalgam rate;
165.18(2) application of sealants are covered once every five years per permanent molar for
165.19children only;
165.20(3) application of fluoride varnish is covered once every six months; and
165.21(4) orthodontia is eligible for coverage for children only.
165.22(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
165.23covers the following services for adults:
165.24(1) house calls or extended care facility calls for on-site delivery of covered services;
165.25(2) behavioral management when additional staff time is required to accommodate
165.26behavioral challenges and sedation is not used;
165.27(3) oral or IV sedation, if the covered dental service cannot be performed safely
165.28without it or would otherwise require the service to be performed under general anesthesia
165.29in a hospital or surgical center; and
165.30(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
165.31no more than four times per year.

165.32    Sec. 8. Minnesota Statutes 2012, section 256B.0625, subdivision 13e, is amended to
165.33read:
165.34    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment
165.35shall be the lower of the actual acquisition costs of the drugs or the maximum allowable
166.1cost by the commissioner plus the fixed dispensing fee; or the usual and customary price
166.2charged to the public. The amount of payment basis must be reduced to reflect all discount
166.3amounts applied to the charge by any provider/insurer agreement or contract for submitted
166.4charges to medical assistance programs. The net submitted charge may not be greater
166.5than the patient liability for the service. The pharmacy dispensing fee shall be $3.65,
166.6except that the dispensing fee for intravenous solutions which must be compounded by
166.7the pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and
166.8$30 per bag for total parenteral nutritional products dispensed in one liter quantities,
166.9or $44 per bag for total parenteral nutritional products dispensed in quantities greater
166.10than one liter. Actual acquisition cost includes quantity and other special discounts
166.11except time and cash discounts. The actual acquisition cost of a drug shall be estimated
166.12by the commissioner at wholesale acquisition cost plus four percent for independently
166.13owned pharmacies located in a designated rural area within Minnesota, and at wholesale
166.14acquisition cost plus two percent for all other pharmacies. A pharmacy is "independently
166.15owned" if it is one of four or fewer pharmacies under the same ownership nationally.
166.16A "designated rural area" means an area defined as a small rural area or isolated rural
166.17area according to the four-category classification of the Rural Urban Commuting Area
166.18system developed for the United States Health Resources and Services Administration.
166.19The actual acquisition cost of a drug acquired through the federal 340B Drug Pricing
166.20Program shall be estimated by the commissioner at wholesale acquisition cost minus 44
166.21percent. Wholesale acquisition cost is defined as the manufacturer's list price for a drug or
166.22biological to wholesalers or direct purchasers in the United States, not including prompt
166.23pay or other discounts, rebates, or reductions in price, for the most recent month for which
166.24information is available, as reported in wholesale price guides or other publications of
166.25drug or biological pricing data. The maximum allowable cost of a multisource drug may
166.26be set by the commissioner and it shall be comparable to, but no higher than, the maximum
166.27amount paid by other third-party payors in this state who have maximum allowable cost
166.28programs. Establishment of the amount of payment for drugs shall not be subject to the
166.29requirements of the Administrative Procedure Act.
166.30    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
166.31to pharmacists for legend drug prescriptions dispensed to residents of long-term care
166.32facilities when a unit dose blister card system, approved by the department, is used. Under
166.33this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. The
166.34National Drug Code (NDC) from the drug container used to fill the blister card must be
166.35identified on the claim to the department. The unit dose blister card containing the drug
166.36must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, that
167.1govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider will
167.2be required to credit the department for the actual acquisition cost of all unused drugs that
167.3are eligible for reuse. The commissioner may permit the drug clozapine to be dispensed in
167.4a quantity that is less than a 30-day supply.
167.5    (c) Whenever a maximum allowable cost has been set for a multisource drug,
167.6payment shall be the lower of the usual and customary price charged to the public or the
167.7maximum allowable cost established by the commissioner unless prior authorization
167.8for the brand name product has been granted according to the criteria established by
167.9the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the
167.10prescriber has indicated "dispense as written" on the prescription in a manner consistent
167.11with section 151.21, subdivision 2.
167.12    (d) The basis for determining the amount of payment for drugs administered in an
167.13outpatient setting shall be the lower of the usual and customary cost submitted by the
167.14provider or, 106 percent of the average sales price as determined by the United States
167.15Department of Health and Human Services pursuant to title XVIII, section 1847a of the
167.16federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
167.17set by the commissioner. If average sales price is unavailable, the amount of payment
167.18must be lower of the usual and customary cost submitted by the provider or, the wholesale
167.19acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the
167.20commissioner. The commissioner shall discount the payment rate for drugs obtained
167.21through the federal 340B Drug Pricing Program by 33 percent. The payment for drugs
167.22administered in an outpatient setting shall be made to the administering facility or
167.23practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
167.24outpatient setting is not eligible for direct reimbursement.
167.25    (e) The commissioner may negotiate lower reimbursement rates for specialty
167.26pharmacy products than the rates specified in paragraph (a). The commissioner may
167.27require individuals enrolled in the health care programs administered by the department
167.28to obtain specialty pharmacy products from providers with whom the commissioner has
167.29negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
167.30used by a small number of recipients or recipients with complex and chronic diseases
167.31that require expensive and challenging drug regimens. Examples of these conditions
167.32include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
167.33C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
167.34of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
167.35biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies
167.36that require complex care. The commissioner shall consult with the formulary committee
168.1to develop a list of specialty pharmacy products subject to this paragraph. In consulting
168.2with the formulary committee in developing this list, the commissioner shall take into
168.3consideration the population served by specialty pharmacy products, the current delivery
168.4system and standard of care in the state, and access to care issues. The commissioner shall
168.5have the discretion to adjust the reimbursement rate to prevent access to care issues.
168.6(f) Home infusion therapy services provided by home infusion therapy pharmacies
168.7must be paid at rates according to subdivision 8d.
168.8EFFECTIVE DATE.This section is effective January 1, 2014.

168.9    Sec. 9. Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to read:
168.10    Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical
168.11supplies and equipment. Separate payment outside of the facility's payment rate shall
168.12be made for wheelchairs and wheelchair accessories for recipients who are residents
168.13of intermediate care facilities for the developmentally disabled. Reimbursement for
168.14wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
168.15conditions and limitations as coverage for recipients who do not reside in institutions. A
168.16wheelchair purchased outside of the facility's payment rate is the property of the recipient.
168.17The commissioner may set reimbursement rates for specified categories of medical
168.18supplies at levels below the Medicare payment rate.
168.19(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
168.20must enroll as a Medicare provider.
168.21(c) When necessary to ensure access to durable medical equipment, prosthetics,
168.22orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
168.23enrollment requirement if:
168.24(1) the vendor supplies only one type of durable medical equipment, prosthetic,
168.25orthotic, or medical supply;
168.26(2) the vendor serves ten or fewer medical assistance recipients per year;
168.27(3) the commissioner finds that other vendors are not available to provide same or
168.28similar durable medical equipment, prosthetics, orthotics, or medical supplies; and
168.29(4) the vendor complies with all screening requirements in this chapter and Code of
168.30Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
168.31the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
168.32and Medicaid Services approved national accreditation organization as complying with
168.33the Medicare program's supplier and quality standards and the vendor serves primarily
168.34pediatric patients.
168.35(d) Durable medical equipment means a device or equipment that:
169.1(1) can withstand repeated use;
169.2(2) is generally not useful in the absence of an illness, injury, or disability; and
169.3(3) is provided to correct or accommodate a physiological disorder or physical
169.4condition or is generally used primarily for a medical purpose.
169.5(e) Electronic tablets may be considered durable medical equipment if the electronic
169.6tablet will be used as an augmentative and alternative communication system as defined
169.7under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
169.8must be locked in order to prevent use not related to communication.

169.9    Sec. 10. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
169.10subdivision to read:
169.11    Subd. 31b. Preferred diabetic testing supply program. (a) The commissioner
169.12shall adopt and implement a point of sale preferred diabetic testing supply program by
169.13January 1, 2014. Medical assistance coverage for diabetic testing supplies shall conform
169.14to the limitations established under the program. The commissioner may enter into a
169.15contract with a vendor for the purpose of participating in a preferred diabetic testing
169.16supply list and supplemental rebate program. The commissioner shall ensure that any
169.17contract meets all federal requirements and maximizes federal financial participation. The
169.18commissioner shall maintain an accurate and up-to-date list on the agency Web site.
169.19(b) The commissioner may add to, delete from, and otherwise modify the preferred
169.20diabetic testing supply program drug list after consulting with the Drug Formulary
169.21Committee and appropriate medial specialists and providing public notice and the
169.22opportunity for public comment.
169.23(c) The commissioner shall adopt and administer the preferred diabetic testing
169.24supply program as part of the administration of the diabetic testing supply rebate program.
169.25Reimbursement for diabetic testing supplies not on the preferred diabetic testing supply
169.26list may be subject to prior authorization.
169.27(d) All claims for diabetic testing supplies in categories on the preferred diabetic
169.28testing supply list must be submitted by enrolled pharmacy providers using the most
169.29current National Council of Prescription Drug Providers electronic claims standard.
169.30(e) For purposes of this subdivision, "preferred diabetic testing supply list" means a
169.31list of diabetic testing supplies selected by the commissioner, for which prior authorization
169.32is not required.
169.33(f) The commissioner shall seek any federal waivers or approvals necessary to
169.34implement this subdivision.

170.1    Sec. 11. Minnesota Statutes 2012, section 256B.0625, subdivision 39, is amended to
170.2read:
170.3    Subd. 39. Childhood immunizations. Providers who administer pediatric vaccines
170.4within the scope of their licensure, and who are enrolled as a medical assistance provider,
170.5must enroll in the pediatric vaccine administration program established by section 13631
170.6of the Omnibus Budget Reconciliation Act of 1993. Medical assistance shall pay an
170.7$8.50 fee per dose for administration of the vaccine to children eligible for medical
170.8assistance. Medical assistance does not pay for vaccines that are available at no cost from
170.9the pediatric vaccine administration program.

170.10    Sec. 12. Minnesota Statutes 2012, section 256B.0625, subdivision 58, is amended to
170.11read:
170.12    Subd. 58. Early and periodic screening, diagnosis, and treatment services.
170.13Medical assistance covers early and periodic screening, diagnosis, and treatment services
170.14(EPSDT). The payment amount for a complete EPSDT screening shall not include charges
170.15for vaccines that are available at no cost to the provider and shall not exceed the rate
170.16established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.

170.17    Sec. 13. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to read:
170.18    Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
170.19assistance benefit plan shall include the following cost-sharing for all recipients, effective
170.20for services provided on or after September 1, 2011:
170.21    (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
170.22of this subdivision, a visit means an episode of service which is required because of
170.23a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
170.24ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
170.25midwife, advanced practice nurse, audiologist, optician, or optometrist;
170.26    (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
170.27this co-payment shall be increased to $20 upon federal approval;
170.28    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
170.29subject to a $12 per month maximum for prescription drug co-payments. No co-payments
170.30shall apply to antipsychotic drugs when used for the treatment of mental illness;
170.31(4) effective January 1, 2012, a family deductible equal to the maximum amount
170.32allowed under Code of Federal Regulations, title 42, part 447.54; and
170.33    (5) for individuals identified by the commissioner with income at or below 100
170.34percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
171.1percent of family income. For purposes of this paragraph, family income is the total
171.2earned and unearned income of the individual and the individual's spouse, if the spouse is
171.3enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
171.4    (b) Recipients of medical assistance are responsible for all co-payments and
171.5deductibles in this subdivision.
171.6(c) Notwithstanding paragraph (b), the commissioner, through the contracting
171.7process under sections 256B.69 and 256B.692, may allow managed care plans and
171.8county-based purchasing plans to waive the family deductible under paragraph (a),
171.9clause (4). The value of the family deductible shall not be included in the capitation
171.10payment to managed care plans and county-based purchasing plans. Managed care plans
171.11and county-based purchasing plans shall certify annually to the commissioner the dollar
171.12value of the family deductible.
171.13(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
171.14the family deductible described under paragraph (a), clause (4), from individuals and
171.15allow long-term care and waivered service providers to assume responsibility for payment.
171.16(e) Notwithstanding paragraph (b), the commissioner, through the contracting
171.17process under section 256B.0756 shall allow the pilot program in Hennepin County to
171.18waive co-payments. The value of the co-payments shall not be included in the capitation
171.19amount to the managed care organization.

171.20    Sec. 14. Minnesota Statutes 2012, section 256B.0756, is amended to read:
171.21256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
171.22(a) The commissioner, upon federal approval of a new waiver request or amendment
171.23of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey
171.24County, or both, to test alternative and innovative integrated health care delivery networks.
171.25(b) Individuals eligible for the pilot program shall be individuals who are eligible for
171.26medical assistance under section 256B.055, subdivision 15, and who reside in Hennepin
171.27County or Ramsey County. The commissioner may identify individuals to be enrolled in
171.28the Hennepin County pilot program based on zip code in Hennepin County or whether the
171.29individuals would benefit from an integrated health care delivery network.
171.30(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
171.31health care delivery network in their county of residence. The integrated health care
171.32delivery network in Hennepin County shall be a network, such as an accountable care
171.33organization or a community-based collaborative care network, created by or including
171.34Hennepin County Medical Center. The integrated health care delivery network in Ramsey
172.1County shall be a network, such as an accountable care organization or community-based
172.2collaborative care network, created by or including Regions Hospital.
172.3(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for
172.4Hennepin County and 3,500 enrollees for Ramsey County.
172.5(e) (d) In developing a payment system for the pilot programs, the commissioner
172.6shall establish a total cost of care for the recipients enrolled in the pilot programs that
172.7equals the cost of care that would otherwise be spent for these enrollees in the prepaid
172.8medical assistance program.
172.9(f) Counties may transfer funds necessary to support the nonfederal share of
172.10payments for integrated health care delivery networks in their county. Such transfers per
172.11county shall not exceed 15 percent of the expected expenses for county enrollees.
172.12(g) (e) The commissioner shall apply to the federal government for, or as appropriate,
172.13cooperate with counties, providers, or other entities that are applying for any applicable
172.14grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
172.15Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
172.16111-152, that would further the purposes of or assist in the creation of an integrated health
172.17care delivery network for the purposes of this subdivision, including, but not limited to, a
172.18global payment demonstration or the community-based collaborative care network grants.

172.19    Sec. 15. Minnesota Statutes 2012, section 256B.69, subdivision 5c, is amended to read:
172.20    Subd. 5c. Medical education and research fund. (a) The commissioner of human
172.21services shall transfer each year to the medical education and research fund established
172.22under section 62J.692, an amount specified in this subdivision. The commissioner shall
172.23calculate the following:
172.24(1) an amount equal to the reduction in the prepaid medical assistance payments as
172.25specified in this clause. Until January 1, 2002, the county medical assistance capitation
172.26base rate prior to plan specific adjustments and after the regional rate adjustments under
172.27subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
172.28metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
172.29January 1, 2002, the county medical assistance capitation base rate prior to plan specific
172.30adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
172.31metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
172.32facility and elderly waiver payments and demonstration project payments operating
172.33under subdivision 23 are excluded from this reduction. The amount calculated under
172.34this clause shall not be adjusted for periods already paid due to subsequent changes to
172.35the capitation payments;
173.1(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
173.2section;
173.3(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
173.4paid under this section; and
173.5(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
173.6under this section.
173.7(b) This subdivision shall be effective upon approval of a federal waiver which
173.8allows federal financial participation in the medical education and research fund. The
173.9amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount
173.10transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under
173.11paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally
173.12reduce the amount specified under paragraph (a), clause (1).
173.13(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
173.14shall transfer $21,714,000 each fiscal year to the medical education and research fund.
173.15(d) Beginning September 1, 2011, of the amount in paragraph (a), following the
173.16transfer under paragraph (c), the commissioner shall transfer to the medical education
173.17research fund $23,936,000 in fiscal years 2012 and 2013 and $36,744,000 $49,552,000 in
173.18fiscal year 2014 and thereafter.

173.19    Sec. 16. Minnesota Statutes 2012, section 256B.69, subdivision 31, is amended to read:
173.20    Subd. 31. Payment reduction. (a) Beginning September 1, 2011, the commissioner
173.21shall reduce payments and limit future rate increases paid to managed care plans and
173.22county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved
173.23on a statewide aggregate basis by program. The commissioner may use competitive
173.24bidding, payment reductions, or other reductions to achieve the reductions and limits
173.25in this subdivision.
173.26    (b) Beginning September 1, 2011, the commissioner shall reduce payments to
173.27managed care plans and county-based purchasing plans as follows:
173.28    (1) 2.0 percent for medical assistance elderly basic care. This shall not apply
173.29to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
173.30services;
173.31    (2) 2.82 percent for medical assistance families and children;
173.32    (3) 10.1 percent for medical assistance adults without children; and
173.33    (4) 6.0 percent for MinnesotaCare families and children.
174.1    (c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed
174.2care plans and county-based purchasing plans for calendar year 2012 to a percentage of
174.3the rates in effect on August 31, 2011, as follows:
174.4    (1) 98 percent for medical assistance elderly basic care. This shall not apply to
174.5Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
174.6services;
174.7    (2) 97.18 percent for medical assistance families and children;
174.8    (3) 89.9 percent for medical assistance adults without children; and
174.9    (4) 94 percent for MinnesotaCare families and children.
174.10    (d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit
174.11the maximum annual trend increases to rates paid to managed care plans and county-based
174.12purchasing plans as follows:
174.13    (1) 7.5 percent for medical assistance elderly basic care. This shall not apply
174.14to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
174.15services;
174.16    (2) 5.0 percent for medical assistance special needs basic care;
174.17    (3) 2.0 percent for medical assistance families and children;
174.18    (4) 3.0 percent for medical assistance adults without children;
174.19    (5) 3.0 percent for MinnesotaCare families and children; and
174.20    (6) 3.0 percent for MinnesotaCare adults without children.
174.21    (e) The commissioner may limit trend increases to less than the maximum.
174.22Beginning July January 1, 2014, the commissioner shall limit the maximum annual trend
174.23increases to rates paid to managed care plans and county-based purchasing plans as
174.24follows for calendar years 2014 and 2015:
174.25    (1) 7.5 3.25 percent for medical assistance elderly basic care. This shall not apply
174.26to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
174.27services;
174.28    (2) 5.0 2.5 percent for medical assistance special needs basic care;
174.29    (3) 2.0 percent for medical assistance families and children;
174.30    (4) 3.0 percent for medical assistance adults without children;
174.31    (5) 3.0 percent for MinnesotaCare families and children; and
174.32    (6) 4.0 3.0 percent for MinnesotaCare adults without children.
174.33    The commissioner may limit trend increases to less than the maximum.

174.34    Sec. 17. Minnesota Statutes 2012, section 256B.76, subdivision 2, is amended to read:
175.1    Subd. 2. Dental reimbursement. (a) Effective for services rendered on or after
175.2October 1, 1992, the commissioner shall make payments for dental services as follows:
175.3    (1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
175.4percent above the rate in effect on June 30, 1992; and
175.5    (2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
175.6percentile of 1989, less the percent in aggregate necessary to equal the above increases.
175.7    (b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
175.8shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.
175.9    (c) Effective for services rendered on or after January 1, 2000, payment rates for
175.10dental services shall be increased by three percent over the rates in effect on December
175.1131, 1999.
175.12    (d) Effective for services provided on or after January 1, 2002, payment for
175.13diagnostic examinations and dental x-rays provided to children under age 21 shall be the
175.14lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.
175.15    (e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
175.162000, for managed care.
175.17(f) Effective for dental services rendered on or after October 1, 2010, by a
175.18state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
175.19on the Medicare principles of reimbursement. This payment shall be effective for services
175.20rendered on or after January 1, 2011, to recipients enrolled in managed care plans or
175.21county-based purchasing plans.
175.22(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics
175.23in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal
175.24year, a supplemental state payment equal to the difference between the total payments
175.25in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated
175.26services for the operation of the dental clinics.
175.27(h) If the cost-based payment system for state-operated dental clinics described in
175.28paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
175.29designated as critical access dental providers under subdivision 4, paragraph (b), and shall
175.30receive the critical access dental reimbursement rate as described under subdivision 4,
175.31paragraph (a).
175.32(i) Effective for services rendered on or after September 1, 2011, through June 30,
175.332013, payment rates for dental services shall be reduced by three percent. This reduction
175.34does not apply to state-operated dental clinics in paragraph (f).
175.35(j) Effective for services rendered on or after January 1, 2014, payment rates for
175.36dental services shall be increased by five percent from the rates in effect on December
176.131, 2013. This increase does not apply to state-operated dental clinics in paragraph (f),
176.2federally qualified health centers, rural health centers, and Indian health services. Effective
176.3January 1, 2014, payments made to managed care plans and county-based purchasing
176.4plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
176.5described in this paragraph.

176.6    Sec. 18. Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:
176.7    Subd. 4. Critical access dental providers. (a) Effective for dental services
176.8rendered on or after January 1, 2002, the commissioner shall increase reimbursements
176.9to dentists and dental clinics deemed by the commissioner to be critical access dental
176.10providers. For dental services rendered on or after July 1, 2007, the commissioner shall
176.11increase reimbursement by 30 percent above the reimbursement rate that would otherwise
176.12be paid to the critical access dental provider. The commissioner shall pay the managed
176.13care plans and county-based purchasing plans in amounts sufficient to reflect increased
176.14reimbursements to critical access dental providers as approved by the commissioner.
176.15    (b) The commissioner shall designate the following dentists and dental clinics as
176.16critical access dental providers:
176.17    (1) nonprofit community clinics that:
176.18    (i) have nonprofit status in accordance with chapter 317A;
176.19    (ii) have tax exempt status in accordance with the Internal Revenue Code, section
176.20501(c)(3);
176.21    (iii) are established to provide oral health services to patients who are low income,
176.22uninsured, have special needs, and are underserved;
176.23    (iv) have professional staff familiar with the cultural background of the clinic's
176.24patients;
176.25    (v) charge for services on a sliding fee scale designed to provide assistance to
176.26low-income patients based on current poverty income guidelines and family size;
176.27    (vi) do not restrict access or services because of a patient's financial limitations
176.28or public assistance status; and
176.29    (vii) have free care available as needed;
176.30    (2) federally qualified health centers, rural health clinics, and public health clinics;
176.31    (3) city or county owned and operated hospital-based dental clinics;
176.32    (4) a dental clinic or dental group that is part of a dental group owned and operated
176.33by a nonprofit corporation in accordance with chapter 317A with more than 10,000 dental
176.34group patient encounters per year with patients who are uninsured or covered by medical
176.35assistance, general assistance medical care, or MinnesotaCare, if more than 50 percent
177.1of the individual dental clinic's patient encounters per year are with patients who are
177.2uninsured or covered by medical assistance or MinnesotaCare; and
177.3    (5) a dental clinic owned and operated by the University of Minnesota or the
177.4Minnesota State Colleges and Universities system.; and
177.5    (6) private practicing dentists if:
177.6    (i) the dentist's office is located within a health professional shortage area as defined
177.7under Code of Federal Regulations, title 42, part 5, and United States Code, title 42,
177.8section 254E;
177.9    (ii) more than 50 percent of the dentist's patient encounters per year are with patients
177.10who are uninsured or covered by medical assistance or MinnesotaCare;
177.11    (iii) the dentist does not restrict access or services because of a patient's financial
177.12limitations or public assistance status; and
177.13    (iv) the level of service provided by the dentist is critical to maintaining adequate
177.14levels of patient access within the service area in which the dentist operates.
177.15    (c) The commissioner may designate a dentist or dental clinic as a critical access
177.16dental provider if the dentist or dental clinic is willing to provide care to patients covered
177.17by medical assistance, general assistance medical care, or MinnesotaCare at a level which
177.18significantly increases access to dental care in the service area.
177.19    (d) A designated critical access clinic shall receive the reimbursement rate specified
177.20in paragraph (a) for dental services provided off site at a private dental office if the
177.21following requirements are met:
177.22    (1) the designated critical access dental clinic is located within a health professional
177.23shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
177.24States Code, title 42, section 254E, and is located outside the seven-county metropolitan
177.25area;
177.26    (2) the designated critical access dental clinic is not able to provide the service
177.27and refers the patient to the off-site dentist;
177.28    (3) the service, if provided at the critical access dental clinic, would be reimbursed
177.29at the critical access reimbursement rate;
177.30    (4) the dentist and allied dental professionals providing the services off site are
177.31licensed and in good standing under chapter 150A;
177.32    (5) the dentist providing the services is enrolled as a medical assistance provider;
177.33    (6) the critical access dental clinic submits the claim for services provided off site
177.34and receives the payment for the services; and
178.1    (7) the critical access dental clinic maintains dental records for each claim submitted
178.2under this paragraph, including the name of the dentist, the off-site location, and the
178.3license number of the dentist and allied dental professionals providing the services.

178.4    Sec. 19. Minnesota Statutes 2012, section 256B.76, is amended by adding a
178.5subdivision to read:
178.6    Subd. 7. Payment for certain primary care services and immunization
178.7administration. Payment for certain primary care services and immunization
178.8administration services rendered on or after January 1, 2013, through December 31, 2014,
178.9shall be made in accordance with section 1902(a)(13) of the Social Security Act.

178.10    Sec. 20. Minnesota Statutes 2012, section 256B.764, is amended to read:
178.11256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
178.12    (a) Effective for services rendered on or after July 1, 2007, payment rates for family
178.13planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
178.14when these services are provided by a community clinic as defined in section 145.9268,
178.15subdivision 1.
178.16    (b) Effective for services rendered on or after July 1, 2013, payment rates for
178.17family planning services shall be increased by 20 percent over the rates in effect June
178.1830, 2013, when these services are provided by a community clinic as defined in section
178.19145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care
178.20and county-based purchasing plans to reflect this increase, and shall require plans to pass
178.21on the full amount of the rate increase to eligible community clinics, in the form of higher
178.22payment rates for family planning services.
178.23EFFECTIVE DATE.This section is effective July 1, 2013.

178.24    Sec. 21. Minnesota Statutes 2012, section 256B.766, is amended to read:
178.25256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
178.26(a) Effective for services provided on or after July 1, 2009, total payments for basic
178.27care services, shall be reduced by three percent, except that for the period July 1, 2009,
178.28through June 30, 2011, total payments shall be reduced by 4.5 percent for the medical
178.29assistance and general assistance medical care programs, prior to third-party liability and
178.30spenddown calculation. Effective July 1, 2010, the commissioner shall classify physical
178.31therapy services, occupational therapy services, and speech-language pathology and
178.32related services as basic care services. The reduction in this paragraph shall apply to
179.1physical therapy services, occupational therapy services, and speech-language pathology
179.2and related services provided on or after July 1, 2010.
179.3(b) Payments made to managed care plans and county-based purchasing plans shall
179.4be reduced for services provided on or after October 1, 2009, to reflect the reduction
179.5effective July 1, 2009, and payments made to the plans shall be reduced effective October
179.61, 2010, to reflect the reduction effective July 1, 2010.
179.7(c) Effective for services provided on or after September 1, 2011, through June 30,
179.82013, total payments for outpatient hospital facility fees shall be reduced by five percent
179.9from the rates in effect on August 31, 2011.
179.10(d) Effective for services provided on or after September 1, 2011, through June
179.1130, 2013, total payments for ambulatory surgery centers facility fees, medical supplies
179.12and durable medical equipment not subject to a volume purchase contract, prosthetics
179.13and orthotics, renal dialysis services, laboratory services, public health nursing services,
179.14physical therapy services, occupational therapy services, speech therapy services,
179.15eyeglasses not subject to a volume purchase contract, hearing aids not subject to a volume
179.16purchase contract, anesthesia services, and hospice services shall be reduced by three
179.17percent from the rates in effect on August 31, 2011.
179.18(e) This section does not apply to physician and professional services, inpatient
179.19hospital services, family planning services, mental health services, dental services,
179.20prescription drugs, medical transportation, federally qualified health centers, rural health
179.21centers, Indian health services, and Medicare cost-sharing.
179.22(f) For services provided on or after July 1, 2013, fee-for-service payments made
179.23to pediatric hospitals as referenced in the Social Security Act, section 1886(d)(1)(B)(iii)
179.24and nonstate government hospitals located in cities of the first class for the provision of
179.25outpatient basic care services to persons under age 21 shall be increased by one percent,
179.26subject to an aggregate spending limit under this paragraph of $450,000 for the biennium
179.27ending June 30, 2015.

179.28    Sec. 22. PAYMENT FOR MULTIPLE SERVICES PROVIDED ON THE SAME
179.29DAY.
179.30The commissioner of human services shall report by December 15, 2013, to the
179.31chairs and ranking minority members of the legislative committees with jurisdiction over
179.32health and human services policy and finance on the costs and savings to the medical
179.33assistance program of allowing medical assistance payment, including supplemental
179.34payments, for mental health services or dental services provided to a patient by a federally
180.1qualified health center, federally qualified health care center look-alike, or a rural health
180.2clinic on the same day as other covered health services furnished by the same provider.

180.3    Sec. 23. DENTAL ADMINISTRATION AND REIMBURSEMENT REPORT.
180.4(a) The commissioner of human services shall study the feasibility of a single
180.5administrator for all dental services provided under medical assistance and MinnesotaCare.
180.6Dental services shall include services provided through the prepaid medical assistance
180.7program and the fee-for-service system administered by the Department of Human
180.8Services. The commissioner's study shall address and include recommendations on:
180.9(1) possible administrative savings under a single administrator;
180.10(2) current reimbursement levels and alternative reimbursement that could target
180.11funding to assure greater access to dental services;
180.12(3) flexible scheduling and the coordination of referrals to encourage greater
180.13participation from private dental practitioners and clinics;
180.14(4) approaches to reduce emergency room visits; and
180.15(5) the use of a streamlined information system to provide information on patient
180.16eligibility and restrictions on benefits.
180.17(b) The commissioner shall also make recommendations on service delivery and
180.18reimbursement methods, including the continuation or modification of critical access dental
180.19provider payments under sections 256B.76, subdivision 4, and 256L.11, subdivision 7.
180.20(c) In conducting the study, the commissioner shall consult with dental providers
180.21currently providing services to enrollees of Minnesota health care programs, including
180.22those receiving enhanced payments through critical access dental provider payments,
180.23private practice dentists, safety net clinics, and the University of Minnesota Dental School.
180.24(d) The commissioner shall submit a report and recommendations relating to dental
180.25administration and reimbursement to the chairs and ranking minority members of the
180.26legislative committees with jurisdiction over health and human services policy and finance
180.27by December 15, 2013.

180.28    Sec. 24. REQUEST FOR INFORMATION; EMERGENCY MEDICAL
180.29ASSISTANCE.
180.30(a) The commissioner of human services shall issue a request for information (RFI)
180.31to identify and develop options for a program to provide emergency medical assistance
180.32recipients with coverage for medically necessary services not eligible for federal financial
180.33participation. The RFI must focus on providing coverage for nonemergent services
181.1for recipients who have two or more chronic conditions and have had two or more
181.2hospitalizations covered by emergency medical assistance in a one-year period.
181.3(b) The RFI must be issued by August 1, 2013, and require respondents to submit
181.4information to the commissioner by November 1, 2013. The RFI must request information
181.5on:
181.6(1) services necessary to reduce emergency department and inpatient hospital use for
181.7emergency medical assistance recipients;
181.8(2) methods of service delivery that promote efficiency and cost-effectiveness, and
181.9provide statewide access;
181.10(3) funding options for the services to be covered under the program;
181.11(4) coordination of service delivery and funding with services covered under
181.12emergency medical assistance;
181.13(5) options for program administration; and
181.14(6) methods to evaluate the program, including evaluation of cost-effectiveness and
181.15health outcomes for those emergency medical assistance recipients eligible for coverage
181.16of additional services under the program.
181.17(c) The commissioner shall make information submitted in response to the RFI
181.18available on the agency Web site. The commissioner, based on the responses to the RFI,
181.19shall submit recommendations on providing emergency medical assistance recipients
181.20with coverage for nonemergent services, as described in paragraph (a), to the chairs and
181.21ranking minority members of the legislative committees with jurisdiction over health and
181.22human services policy and finance by January 15, 2014.


181.25    Section 1. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
181.26    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
181.27initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
181.282960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
181.299555.6265, under this chapter for a physical location that will not be the primary residence
181.30of the license holder for the entire period of licensure. If a license is issued during this
181.31moratorium, and the license holder changes the license holder's primary residence away
181.32from the physical location of the foster care license, the commissioner shall revoke the
181.33license according to section 245A.07. Exceptions to the moratorium include:
181.34(1) foster care settings that are required to be registered under chapter 144D;
182.1(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
182.2and determined to be needed by the commissioner under paragraph (b);
182.3(3) new foster care licenses determined to be needed by the commissioner under
182.4paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or
182.5restructuring of state-operated services that limits the capacity of state-operated facilities;
182.6(4) new foster care licenses determined to be needed by the commissioner under
182.7paragraph (b) for persons requiring hospital level care; or
182.8(5) new foster care licenses determined to be needed by the commissioner for the
182.9transition of people from personal care assistance to the home and community-based
182.10services.
182.11(b) The commissioner shall determine the need for newly licensed foster care homes
182.12as defined under this subdivision. As part of the determination, the commissioner shall
182.13consider the availability of foster care capacity in the area in which the licensee seeks to
182.14operate, and the recommendation of the local county board. The determination by the
182.15commissioner must be final. A determination of need is not required for a change in
182.16ownership at the same address.
182.17(c) The commissioner shall study the effects of the license moratorium under this
182.18subdivision and shall report back to the legislature by January 15, 2011. This study shall
182.19include, but is not limited to the following:
182.20(1) the overall capacity and utilization of foster care beds where the physical location
182.21is not the primary residence of the license holder prior to and after implementation
182.22of the moratorium;
182.23(2) the overall capacity and utilization of foster care beds where the physical
182.24location is the primary residence of the license holder prior to and after implementation
182.25of the moratorium; and
182.26(3) the number of licensed and occupied ICF/MR beds prior to and after
182.27implementation of the moratorium.
182.28(d) (c) When a foster care recipient moves out of a foster home that is not the
182.29primary residence of the license holder according to section 256B.49, subdivision 15,
182.30paragraph (f), the county shall immediately inform the Department of Human Services
182.31Licensing Division. The department shall decrease the statewide licensed capacity for
182.32foster care settings where the physical location is not the primary residence of the license
182.33holder, if the voluntary changes described in paragraph (f) (e) are not sufficient to meet the
182.34savings required by reductions in licensed bed capacity under Laws 2011, First Special
182.35Session chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide
182.36long-term care residential services capacity within budgetary limits. Implementation of
183.1the statewide licensed capacity reduction shall begin on July 1, 2013. The commissioner
183.2shall delicense up to 128 beds by June 30, 2014, using the needs determination process.
183.3Under this paragraph, the commissioner has the authority to reduce unused licensed
183.4capacity of a current foster care program to accomplish the consolidation or closure of
183.5settings. A decreased licensed capacity according to this paragraph is not subject to appeal
183.6under this chapter.
183.7(e) (d) Residential settings that would otherwise be subject to the decreased license
183.8capacity established in paragraph (d) (c) shall be exempt under the following circumstances:
183.9(1) until August 1, 2013, the license holder's beds occupied by residents whose
183.10primary diagnosis is mental illness and the license holder is:
183.11(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
183.12health services (ARMHS) as defined in section 256B.0623;
183.13(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
183.149520.0870;
183.15(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
183.169520.0870; or
183.17(iv) a provider of intensive residential treatment services (IRTS) licensed under
183.18Minnesota Rules, parts 9520.0500 to 9520.0670; or
183.19(2) the license holder is certified under the requirements in subdivision 6a.
183.20(f) (e) A resource need determination process, managed at the state level, using the
183.21available reports required by section 144A.351, and other data and information shall
183.22be used to determine where the reduced capacity required under paragraph (d) (c) will
183.23be implemented. The commissioner shall consult with the stakeholders described in
183.24section 144A.351, and employ a variety of methods to improve the state's capacity to
183.25meet long-term care service needs within budgetary limits, including seeking proposals
183.26from service providers or lead agencies to change service type, capacity, or location to
183.27improve services, increase the independence of residents, and better meet needs identified
183.28by the long-term care services reports and statewide data and information. By February
183.291 of each 2013 and August 1 of 2014 and each following year, the commissioner shall
183.30provide information and data on the overall capacity of licensed long-term care services,
183.31actions taken under this subdivision to manage statewide long-term care services and
183.32supports resources, and any recommendations for change to the legislative committees
183.33with jurisdiction over health and human services budget.
183.34    (g) (f) At the time of application and reapplication for licensure, the applicant and the
183.35license holder that are subject to the moratorium or an exclusion established in paragraph
183.36(a) are required to inform the commissioner whether the physical location where the foster
184.1care will be provided is or will be the primary residence of the license holder for the entire
184.2period of licensure. If the primary residence of the applicant or license holder changes, the
184.3applicant or license holder must notify the commissioner immediately. The commissioner
184.4shall print on the foster care license certificate whether or not the physical location is the
184.5primary residence of the license holder.
184.6    (h) (g) License holders of foster care homes identified under paragraph (g) (f) that
184.7are not the primary residence of the license holder and that also provide services in the
184.8foster care home that are covered by a federally approved home and community-based
184.9services waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must
184.10inform the human services licensing division that the license holder provides or intends to
184.11provide these waiver-funded services. These license holders must be considered registered
184.12under section 256B.092, subdivision 11, paragraph (c), and this registration status must
184.13be identified on their license certificates.

184.14    Sec. 2. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
184.15to read:
184.16    Subd. 35. Commissioner must annually report certain prepaid medical
184.17assistance plan data. (a) The commissioner of human services and the commissioner
184.18of education may share private or nonpublic data to allow the commissioners to analyze
184.19the screening, diagnosis, and treatment of children with autism spectrum disorder and
184.20other developmental conditions. The commissioners may share the individual-level data
184.21necessary to:
184.22    (1) measure the prevalence of autism spectrum disorder and other developmental
184.23conditions;
184.24    (2) analyze the effectiveness of existing policies and procedures in the early
184.25identification of children with autism spectrum disorder and other developmental
184.26conditions;
184.27    (3) assess the effectiveness of screening, diagnosis, and treatment to allow children
184.28with autism spectrum disorder and other developmental conditions to meet developmental
184.29and social-emotional milestones;
184.30    (4) identify and address disparities in screening, diagnosis, and treatment related
184.31to the native language or race and ethnicity of the child;
184.32    (5) measure the effectiveness of public health care programs in addressing the medical
184.33needs of children with autism spectrum disorder and other developmental conditions; and
184.34    (6) determine the capacity of educational systems and health care systems to meet
184.35the needs of children with autism spectrum disorder and other developmental conditions.
185.1    (b) The commissioner of human services shall use the data shared with the
185.2commissioner of education under this subdivision to improve public health care program
185.3performance in early screening, diagnosis, and treatment for children once data are
185.4available and shall report on the results and any summary data, as defined in section 13.02,
185.5subdivision 19, on the department's public Web site by September 30 each year.

185.6    Sec. 3. Minnesota Statutes 2012, section 256.9657, subdivision 3a, is amended to read:
185.7    Subd. 3a. ICF/MR ICF/DD license surcharge. (a) Effective July 1, 2003, each
185.8non-state-operated facility as defined under section 256B.501, subdivision 1, shall pay
185.9to the commissioner an annual surcharge according to the schedule in subdivision 4,
185.10paragraph (d). The annual surcharge shall be $1,040 per licensed bed. If the number of
185.11licensed beds is reduced, the surcharge shall be based on the number of remaining licensed
185.12beds the second month following the receipt of timely notice by the commissioner of
185.13human services that beds have been delicensed. The facility must notify the commissioner
185.14of health in writing when beds are delicensed. The commissioner of health must notify
185.15the commissioner of human services within ten working days after receiving written
185.16notification. If the notification is received by the commissioner of human services by
185.17the 15th of the month, the invoice for the second following month must be reduced to
185.18recognize the delicensing of beds. The commissioner may reduce, and may subsequently
185.19restore, the surcharge under this subdivision based on the commissioner's determination of
185.20a permissible surcharge.
185.21(b) Effective July 1, 2013, the surcharge under paragraph (a) is increased to$3,679
185.22per licensed bed.
185.23EFFECTIVE DATE.This section is effective July 1, 2013.

185.24    Sec. 4. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to read:
185.25    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a)
185.26It is the policy of the state of Minnesota to ensure that individuals with disabilities or
185.27chronic illness are served in the most integrated setting appropriate to their needs and have
185.28the necessary information to make informed choices about home and community-based
185.29service options.
185.30    (b) Individuals under 65 years of age who are admitted to a nursing facility from a
185.31hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.
185.32    (c) Individuals under 65 years of age who are admitted to nursing facilities with
185.33only a telephone screening must receive a face-to-face assessment from the long-term
186.1care consultation team member of the county in which the facility is located or from the
186.2recipient's county case manager within 40 calendar days of admission.
186.3    (d) Individuals under 65 years of age who are admitted to a nursing facility
186.4without preadmission screening according to the exemption described in subdivision 4b,
186.5paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
186.6a face-to-face assessment within 40 days of admission.
186.7    (e) At the face-to-face assessment, the long-term care consultation team member or
186.8county case manager must perform the activities required under subdivision 3b.
186.9    (f) For individuals under 21 years of age, a screening interview which recommends
186.10nursing facility admission must be face-to-face and approved by the commissioner before
186.11the individual is admitted to the nursing facility.
186.12    (g) In the event that an individual under 65 years of age is admitted to a nursing
186.13facility on an emergency basis, the county must be notified of the admission on the
186.14next working day, and a face-to-face assessment as described in paragraph (c) must be
186.15conducted within 40 calendar days of admission.
186.16    (h) At the face-to-face assessment, the long-term care consultation team member or
186.17the case manager must present information about home and community-based options,
186.18including consumer-directed options, so the individual can make informed choices. If the
186.19individual chooses home and community-based services, the long-term care consultation
186.20team member or case manager must complete a written relocation plan within 20 working
186.21days of the visit. The plan shall describe the services needed to move out of the facility
186.22and a time line for the move which is designed to ensure a smooth transition to the
186.23individual's home and community.
186.24    (i) An individual under 65 years of age residing in a nursing facility shall receive a
186.25face-to-face assessment at least every 12 months to review the person's service choices
186.26and available alternatives unless the individual indicates, in writing, that annual visits are
186.27not desired. In this case, the individual must receive a face-to-face assessment at least
186.28once every 36 months for the same purposes.
186.29    (j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
186.30county agencies directly for face-to-face assessments for individuals under 65 years of age
186.31who are being considered for placement or residing in a nursing facility. Until September
186.3230, 2013, payments for individuals under 65 years of age shall be made as described
186.33in this subdivision.

186.34    Sec. 5. Minnesota Statutes 2012, section 256B.0911, subdivision 6, is amended to read:
187.1    Subd. 6. Payment for long-term care consultation services. (a) Until September
187.230, 2013, payment for long-term care consultation face-to-face assessment shall be made
187.3as described in this subdivision.
187.4    (b) The total payment for each county must be paid monthly by certified nursing
187.5facilities in the county. The monthly amount to be paid by each nursing facility for each
187.6fiscal year must be determined by dividing the county's annual allocation for long-term
187.7care consultation services by 12 to determine the monthly payment and allocating the
187.8monthly payment to each nursing facility based on the number of licensed beds in the
187.9nursing facility. Payments to counties in which there is no certified nursing facility must be
187.10made by increasing the payment rate of the two facilities located nearest to the county seat.
187.11    (b) (c) The commissioner shall include the total annual payment determined under
187.12paragraph (a) for each nursing facility reimbursed under section 256B.431, 256B.434,
187.13or 256B.441.
187.14    (c) (d) In the event of the layaway, delicensure and decertification, or removal from
187.15layaway of 25 percent or more of the beds in a facility, the commissioner may adjust the
187.16per diem payment amount in paragraph (b) (c) and may adjust the monthly payment
187.17amount in paragraph (a). The effective date of an adjustment made under this paragraph
187.18shall be on or after the first day of the month following the effective date of the layaway,
187.19delicensure and decertification, or removal from layaway.
187.20    (d) (e) Payments for long-term care consultation services are available to the county
187.21or counties to cover staff salaries and expenses to provide the services described in
187.22subdivision 1a. The county shall employ, or contract with other agencies to employ,
187.23within the limits of available funding, sufficient personnel to provide long-term care
187.24consultation services while meeting the state's long-term care outcomes and objectives as
187.25defined in subdivision 1. The county shall be accountable for meeting local objectives
187.26as approved by the commissioner in the biennial home and community-based services
187.27quality assurance plan on a form provided by the commissioner.
187.28    (e) (f) Notwithstanding section 256B.0641, overpayments attributable to payment
187.29of the screening costs under the medical assistance program may not be recovered from
187.30a facility.
187.31    (f) (g) The commissioner of human services shall amend the Minnesota medical
187.32assistance plan to include reimbursement for the local consultation teams.
187.33    (g) (h) Until the alternative payment methodology in paragraph (h) (i) is implemented,
187.34the county may bill, as case management services, assessments, support planning, and
187.35follow-along provided to persons determined to be eligible for case management under
188.1Minnesota health care programs. No individual or family member shall be charged for an
188.2initial assessment or initial support plan development provided under subdivision 3a or 3b.
188.3(h) (i) The commissioner shall develop an alternative payment methodology,
188.4effective on October 1, 2013, for long-term care consultation services that includes
188.5the funding available under this subdivision, and for assessments authorized under
188.6sections 256B.092 and 256B.0659. In developing the new payment methodology, the
188.7commissioner shall consider the maximization of other funding sources, including federal
188.8administrative reimbursement through federal financial participation funding, for all
188.9long-term care consultation and preadmission screening activity. The alternative payment
188.10methodology shall include the use of the appropriate time studies and the state financing
188.11of nonfederal share as part of the state's medical assistance program.

188.12    Sec. 6. Minnesota Statutes 2012, section 256B.0916, is amended by adding a
188.13subdivision to read:
188.14    Subd. 11. Excess spending. County and tribal agencies are responsible for spending
188.15in excess of the allocation made by the commissioner. In the event a county or tribal
188.16agency spends in excess of the allocation made by the commissioner for a given allocation
188.17period, they must submit a corrective action plan to the commissioner. The plan must state
188.18the actions the agency will take to correct their overspending for the year following the
188.19period when the overspending occurred. Failure to correct overspending shall result in
188.20recoupment of spending in excess of the allocation. Nothing in this subdivision shall be
188.21construed as reducing the county's responsibility to offer and make available feasible
188.22home and community-based options to eligible waiver recipients within the resources
188.23allocated to them for that purpose.

188.24    Sec. 7. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
188.25    Subd. 11. Residential support services. (a) Upon federal approval, there is
188.26established a new service called residential support that is available on the community
188.27alternative care, community alternatives for disabled individuals, developmental
188.28disabilities, and brain injury waivers. Existing waiver service descriptions must be
188.29modified to the extent necessary to ensure there is no duplication between other services.
188.30Residential support services must be provided by vendors licensed as a community
188.31residential setting as defined in section 245A.11, subdivision 8.
188.32    (b) Residential support services must meet the following criteria:
188.33    (1) providers of residential support services must own or control the residential site;
188.34    (2) the residential site must not be the primary residence of the license holder;
189.1    (3) the residential site must have a designated program supervisor responsible for
189.2program oversight, development, and implementation of policies and procedures;
189.3    (4) the provider of residential support services must provide supervision, training,
189.4and assistance as described in the person's coordinated service and support plan; and
189.5    (5) the provider of residential support services must meet the requirements of
189.6licensure and additional requirements of the person's coordinated service and support plan.
189.7    (c) Providers of residential support services that meet the definition in paragraph
189.8(a) must be registered using a process determined by the commissioner beginning July
189.91, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
189.102960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
189.119555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
189.127 , paragraph (g) (f), are considered registered under this section.

189.13    Sec. 8. Minnesota Statutes 2012, section 256B.092, subdivision 12, is amended to read:
189.14    Subd. 12. Waivered services statewide priorities. (a) The commissioner shall
189.15establish statewide priorities for individuals on the waiting list for developmental
189.16disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must
189.17include, but are not limited to, individuals who continue to have a need for waiver services
189.18after they have maximized the use of state plan services and other funding resources,
189.19including natural supports, prior to accessing waiver services, and who meet at least one
189.20of the following criteria:
189.21(1) have unstable living situations due to the age, incapacity, or sudden loss of
189.22the primary caregivers;
189.23(2) are moving from an institution due to bed closures;
189.24(3) experience a sudden closure of their current living arrangement;
189.25(4) require protection from confirmed abuse, neglect, or exploitation;
189.26(5) experience a sudden change in need that can no longer be met through state plan
189.27services or other funding resources alone; or
189.28(6) meet other priorities established by the department.
189.29(b) When allocating resources to lead agencies, the commissioner must take into
189.30consideration the number of individuals waiting who meet statewide priorities and the
189.31lead agencies' current use of waiver funds and existing service options. The commissioner
189.32has the authority to transfer funds between counties, groups of counties, and tribes to
189.33accommodate statewide priorities and resource needs while accounting for a necessary
189.34base level reserve amount for each county, group of counties, and tribe.
190.1(c) The commissioner shall evaluate the impact of the use of statewide priorities and
190.2provide recommendations to the legislature on whether to continue the use of statewide
190.3priorities in the November 1, 2011, annual report required by the commissioner in sections
190.4256B.0916, subdivision 7, and 256B.49, subdivision 21.

190.5    Sec. 9. [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
190.6    Subdivision 1. Purpose. This section creates a new benefit available under the
190.7medical assistance state plan when federal approval consistent with the provisions in
190.8subdivision 11 is obtained for a 1915(i) waiver pursuant to the Affordable Care Act, section
190.92402(c), amending United States Code, title 42, section 1396n(i)(1), or other option to
190.10provide early intensive intervention to a child with an autism spectrum disorder diagnosis.
190.11This benefit must provide coverage for diagnosis, multidisciplinary assessment, ongoing
190.12progress evaluation, and medically necessary treatment of autism spectrum disorder.
190.13    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
190.14this subdivision have the meanings given.
190.15    (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
190.16current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
190.17    (c) "Child" means a person under the age of seven, or for two years at any age under
190.18age 18 if the person was not diagnosed with autism spectrum disorder before age five, or a
190.19person under age 18 pursuant to subdivision 12.
190.20    (d) "Commissioner" means the commissioner of human services, unless otherwise
190.21specified.
190.22    (e) "Early intensive intervention benefit" means autism treatment options based in
190.23behavioral and developmental science, which may include modalities such as applied
190.24behavior analysis, developmental treatment approaches, and naturalistic and parent
190.25training models.
190.26    (f) "Generalizable goals" means results or gains that are observed during a variety
190.27of activities with different people, such as providers, family members, other adults, and
190.28children, and in different environments including, but not limited to, clinics, homes,
190.29schools, and the community.
190.30    Subd. 3. Initial eligibility. This benefit is available to a child enrolled in medical
190.31assistance who:
190.32    (1) has an autism spectrum disorder diagnosis;
190.33    (2) has had a diagnostic assessment described in subdivision 5, which recommends
190.34early intensive intervention services;
191.1    (3) meets the criteria for medically necessary autism early intensive intervention
191.2services; and
191.3    (4) declines to enroll in the state services described in section 252.27.
191.4    Subd. 4. Diagnosis. (a) A diagnosis must:
191.5    (1) be based upon current DSM criteria including direct observations of the child
191.6and reports from parents or primary caregivers;
191.7    (2) be completed by a professional who has expertise and training in autism spectrum
191.8disorder and child development and who is a licensed physician, nurse practitioner, or
191.9a licensed mental health professional until the commissioner's assessment required in
191.10subdivision 8, clause (7), shows there are adequate professionals to avoid access problems
191.11or delays in diagnosis for young children if two professionals are required for a diagnosis
191.12pursuant to clause (3); and
191.13    (3) be completed by both a medical and mental health professional who have expertise
191.14and training in autism spectrum disorder and child development when the assessment in
191.15subdivision 8, clause (7), demonstrates that there are sufficient professionals available.
191.16    (b) Additional diagnostic assessment information including from special education
191.17evaluations and licensed school personnel, and from professionals licensed in the fields of
191.18medicine, speech and language, psychology, occupational therapy, and physical therapy
191.19may be considered.
191.20    Subd. 5. Diagnostic assessment. The following information and assessments must
191.21be performed, reviewed, and relied upon for the eligibility determination, treatment and
191.22services recommendations, and treatment plan development for the child:
191.23    (1) an assessment of the child's developmental skills, functional behavior, needs,
191.24and capacities based on direct observation of the child which must be administered by
191.25a licensed mental health professional and may also include observations from family
191.26members, licensed school personnel, child care providers, or other caregivers, as well as
191.27any medical or assessment information from other licensed professionals such as the
191.28child's physician, rehabilitation therapists, or mental health professionals; and
191.29    (2) an assessment of parental or caregiver capacity to participate in therapy including
191.30the type and level of parental or caregiver involvement and training recommended.
191.31    Subd. 6. Treatment plan. (a) Each child's treatment plan must be:
191.32    (1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
191.33    (2) coordinated with medically necessary occupational, physical, and speech and
191.34language therapies, special education, and other services the child and family are receiving;
191.35    (3) family-centered;
191.36    (4) culturally sensitive; and
192.1    (5) individualized based on the child's developmental status and the child's and
192.2family's identified needs.
192.3    (b) The treatment plan must specify the:
192.4    (1) child's goals which are developmentally appropriate, functional, and
192.5generalizable;
192.6    (2) treatment modality;
192.7    (3) treatment intensity;
192.8    (4) setting; and
192.9    (5) level and type of parental or caregiver involvement.
192.10    (c) The treatment must be supervised by a professional with expertise and training in
192.11autism and child development who is a licensed physician, nurse practitioner, or mental
192.12health professional.
192.13    (d) The treatment plan must be submitted to the commissioner for approval in a
192.14manner determined by the commissioner for this purpose.
192.15    (e) Services authorized must be consistent with the child's approved treatment plan.
192.16    Subd. 7. Ongoing eligibility. (a) An independent progress evaluation conducted
192.17by a licensed mental health professional with expertise and training in autism spectrum
192.18disorder and child development must be completed after each six months of treatment,
192.19or more frequently as determined by the commissioner, to determine if progress is being
192.20made toward achieving generalizable gains and meeting functional goals contained in
192.21the treatment plan.
192.22    (b) The progress evaluation must include:
192.23    (1) the treating provider's report;
192.24    (2) parental or caregiver input;
192.25    (3) an independent observation of the child which can be performed by the child's
192.26licensed special education staff;
192.27    (4) any treatment plan modifications; and
192.28    (5) recommendations for continued treatment services.
192.29    (c) Progress evaluations must be submitted to the commissioner in a manner
192.30determined by the commissioner for this purpose.
192.31    (d) A child who continues to achieve generalizable gains and treatment goals as
192.32specified in the treatment plan is eligible to continue receiving this benefit.
192.33    (e) A child's treatment shall continue during the progress evaluation and during an
192.34appeal if continuation of services pending appeal have been requested pursuant to section
192.35256.045, subdivision 10.
193.1    Subd. 8. Refining the benefit with stakeholders. The commissioner must develop
193.2the implementation details of the benefit in consultation with stakeholders and consider
193.3recommendations from the Health Services Advisory Council, the Department of Human
193.4Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum
193.5Disorder Task Force, and the Interagency Task Force of the Departments of Health,
193.6Education, and Human Services. The commissioner must release these details for a 30-day
193.7public comment period prior to submission to the federal government for approval. The
193.8implementation details include, but are not limited to, the following components:
193.9    (1) a definition of the qualifications, standards, and roles of the treatment team,
193.10including recommendations after stakeholder consultation on whether board-certified
193.11behavior analysts and other types of professionals trained in autism spectrum disorder and
193.12child development should be added as mental health or other professionals for treatment
193.13supervision or other function under medical assistance;
193.14    (2) development of initial, uniform parameters for comprehensive multidisciplinary
193.15diagnostic assessment information and progress evaluation standards;
193.16    (3) the design of an effective and consistent process for assessing parent and
193.17caregiver capacity to participate in the child's early intervention treatment and methods of
193.18involving the parents in the treatment of the child;
193.19    (4) formulation of a collaborative process in which professionals have opportunities
193.20to collectively inform the comprehensive, multidisciplinary diagnostic assessment and
193.21progress evaluation processes and standards to support quality improvement of early
193.22intensive intervention services;
193.23    (5) coordination of this benefit and its interaction with other services provided by the
193.24Departments of Human Services, Health, and Education;
193.25    (6) evaluation, on an ongoing basis, of research regarding the program and treatment
193.26modalities provided to children under this benefit; and
193.27    (7) determination of the availability of licensed medical and mental health
193.28professionals with expertise and training in autism spectrum disorder throughout the state
193.29in order to assess whether there are sufficient professionals to require involvement of
193.30both a medical and mental health professional to provide access and prevent delay in the
193.31diagnosis and treatment of young children so as to implement subdivision 4, paragraph
193.32(a), and to ensure treatment is effective, timely, and accessible.
193.33    Subd. 9. Revision of treatment options. (a) The commissioner may revise covered
193.34treatment options as needed based on outcome data and other evidence.
193.35    (b) Before the changes become effective, the commissioner must provide public
193.36notice of the changes, the reasons for the change, and a 30-day public comment period
194.1to those who request notice through an electronic list accessible to the public on the
194.2department's Web site.
194.3    Subd. 10. Coordination between agencies. The commissioners of human services
194.4and education must develop the capacity to coordinate services and information including
194.5diagnostic, functional, developmental, medical, and educational assessments; service
194.6delivery; and progress evaluations across health and education sectors.
194.7    Subd. 11. Federal approval of the autism benefit. The provisions of subdivision 9
194.8shall apply to state plan services under Title XIX of the Social Security Act when federal
194.9approval is granted under a 1915(i) waiver or other authority which allows children
194.10eligible for medical assistance through the TEFRA option under section 256B.055,
194.11subdivision 12, to qualify and includes children eligible for medical assistance in families
194.12over 150 percent of the federal poverty guidelines.
194.13    Subd. 12. Local school districts option to continue treatment. (a) A local school
194.14district may contract with the commissioner of human services to pay the state share of
194.15the benefits described under this section to continue this treatment as part of the special
194.16education services offered to all students in the district diagnosed with an autism spectrum
194.17disorder.
194.18    (b) A local school district may utilize third-party billing to seek reimbursement
194.19for the district for any services paid by the district under this section for which private
194.20insurance coverage was available to the child.
194.21EFFECTIVE DATE.The autism benefit under subdivisions 1 to 7, 9, and 12, is
194.22effective upon federal approval for the benefit under a 1915(i) waiver or other federal
194.23authority needed to meet the requirements of subdivision 11, but no earlier than March 1,
194.242014. Subdivisions 8, 10, and 11 are effective July 1, 2013.

194.25    Sec. 10. Minnesota Statutes 2012, section 256B.095, is amended to read:
194.26256B.095 QUALITY ASSURANCE SYSTEM ESTABLISHED.
194.27    (a) Effective July 1, 1998, a quality assurance system for persons with developmental
194.28disabilities, which includes an alternative quality assurance licensing system for programs,
194.29is established in Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice,
194.30Steele, Wabasha, and Winona Counties for the purpose of improving the quality of
194.31services provided to persons with developmental disabilities. A county, at its option, may
194.32choose to have all programs for persons with developmental disabilities located within
194.33the county licensed under chapter 245A using standards determined under the alternative
195.1quality assurance licensing system or may continue regulation of these programs under the
195.2licensing system operated by the commissioner. The project expires on June 30, 2014.
195.3    (b) Effective July 1, 2003, a county not listed in paragraph (a) may apply to
195.4participate in the quality assurance system established under paragraph (a). The
195.5commission established under section 256B.0951 may, at its option, allow additional
195.6counties to participate in the system.
195.7    (c) Effective July 1, 2003, any county or group of counties not listed in paragraph (a)
195.8may establish a quality assurance system under this section. A new system established
195.9under this section shall have the same rights and duties as the system established
195.10under paragraph (a). A new system shall be governed by a commission under section
195.11256B.0951 . The commissioner shall appoint the initial commission members based
195.12on recommendations from advocates, families, service providers, and counties in the
195.13geographic area included in the new system. Counties that choose to participate in a
195.14new system shall have the duties assigned under section 256B.0952. The new system
195.15shall establish a quality assurance process under section 256B.0953. The provisions of
195.16section 256B.0954 shall apply to a new system established under this paragraph. The
195.17commissioner shall delegate authority to a new system established under this paragraph
195.18according to section 256B.0955.
195.19    (d) Effective July 1, 2007, the quality assurance system may be expanded to include
195.20programs for persons with disabilities and older adults.
195.21(e) Effective July 1, 2013, a provider of service located in a county listed in
195.22paragraph (a) that is a non-opted-in county may opt-in to the quality assurance system
195.23provided the county where services are provided indicates its agreement with a county
195.24with a delegation agreement with the Department of Human Services.
195.25EFFECTIVE DATE.This section is effective July 1, 2013.

195.26    Sec. 11. Minnesota Statutes 2012, section 256B.0951, subdivision 1, is amended to read:
195.27    Subdivision 1. Membership. The Quality Assurance Commission is established.
195.28The commission consists of at least 14 but not more than 21 members as follows: at
195.29least three but not more than five members representing advocacy organizations; at
195.30least three but not more than five members representing consumers, families, and their
195.31legal representatives; at least three but not more than five members representing service
195.32providers; at least three but not more than five members representing counties; and the
195.33commissioner of human services or the commissioner's designee. The first commission
195.34shall establish membership guidelines for the transition and recruitment of membership for
195.35the commission's ongoing existence. Members of the commission who do not receive a
196.1salary or wages from an employer for time spent on commission duties may receive a per
196.2diem payment when performing commission duties and functions. All members may be
196.3reimbursed for expenses related to commission activities. Notwithstanding the provisions
196.4of section 15.059, subdivision 5, the commission expires on June 30, 2014.

196.5    Sec. 12. Minnesota Statutes 2012, section 256B.0951, subdivision 4, is amended to read:
196.6    Subd. 4. Commission's authority to recommend variances of licensing
196.7standards. The commission may recommend to the commissioners of human services
196.8and health variances from the standards governing licensure of programs for persons with
196.9developmental disabilities in order to improve the quality of services by implementing
196.10an alternative developmental disabilities licensing system if the commission determines
196.11that the alternative licensing system does not adversely affect the health or safety of
196.12persons being served by the licensed program nor compromise the qualifications of staff
196.13to provide services.

196.14    Sec. 13. Minnesota Statutes 2012, section 256B.0952, subdivision 1, is amended to read:
196.15    Subdivision 1. Notification. Counties or providers shall give notice to the
196.16commission and commissioners of human services and health of intent to join the
196.17alternative quality assurance licensing system. A county or provider choosing to participate
196.18in the alternative quality assurance licensing system commits to participate for three years.

196.19    Sec. 14. Minnesota Statutes 2012, section 256B.0952, subdivision 5, is amended to read:
196.20    Subd. 5. Quality assurance teams. Quality assurance teams shall be comprised
196.21of county staff; providers; consumers, families, and their legal representatives; members
196.22of advocacy organizations; and other involved community members. Team members
196.23must satisfactorily complete the training program approved by the commission and must
196.24demonstrate performance-based competency. Team members are not considered to be
196.25county employees for purposes of workers' compensation, unemployment insurance, or
196.26state retirement laws solely on the basis of participation on a quality assurance team. The
196.27county may pay A per diem may be paid to team members for time spent on alternative
196.28quality assurance process matters. All team members may be reimbursed for expenses
196.29related to their participation in the alternative process.

196.30    Sec. 15. Minnesota Statutes 2012, section 256B.097, subdivision 1, is amended to read:
196.31    Subdivision 1. Scope. (a) In order to improve the quality of services provided to
196.32Minnesotans with disabilities and to meet the requirements of the federally approved home
197.1and community-based waivers under section 1915c of the Social Security Act, a State
197.2Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving
197.3disability services is enacted. This system is a partnership between the Department of
197.4Human Services and the State Quality Council established under subdivision 3.
197.5    (b) This system is a result of the recommendations from the Department of Human
197.6Services' licensing and alternative quality assurance study mandated under Laws 2005,
197.7First Special Session chapter 4, article 7, section 57, and presented to the legislature
197.8in February 2007.
197.9    (c) The disability services eligible under this section include:
197.10    (1) the home and community-based services waiver programs for persons with
197.11developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
197.12including brain injuries and services for those who qualify for nursing facility level of care
197.13or hospital facility level of care and any other services licensed under chapter 245D;
197.14    (2) home care services under section 256B.0651;
197.15    (3) family support grants under section 252.32;
197.16    (4) consumer support grants under section 256.476;
197.17    (5) semi-independent living services under section 252.275; and
197.18    (6) services provided through an intermediate care facility for the developmentally
197.19disabled.
197.20    (d) For purposes of this section, the following definitions apply:
197.21    (1) "commissioner" means the commissioner of human services;
197.22    (2) "council" means the State Quality Council under subdivision 3;
197.23    (3) "Quality Assurance Commission" means the commission under section
197.24256B.0951 ; and
197.25    (4) "system" means the State Quality Assurance, Quality Improvement and
197.26Licensing System under this section.

197.27    Sec. 16. Minnesota Statutes 2012, section 256B.097, subdivision 3, is amended to read:
197.28    Subd. 3. State Quality Council. (a) There is hereby created a State Quality
197.29Council which must define regional quality councils, and carry out a community-based,
197.30person-directed quality review component, and a comprehensive system for effective
197.31incident reporting, investigation, analysis, and follow-up.
197.32    (b) By August 1, 2011, the commissioner of human services shall appoint the
197.33members of the initial State Quality Council. Members shall include representatives
197.34from the following groups:
197.35    (1) disability service recipients and their family members;
198.1    (2) during the first two four years of the State Quality Council, there must be at least
198.2three members from the Region 10 stakeholders. As regional quality councils are formed
198.3under subdivision 4, each regional quality council shall appoint one member;
198.4    (3) disability service providers;
198.5    (4) disability advocacy groups; and
198.6    (5) county human services agencies and staff from the Department of Human
198.7Services and Ombudsman for Mental Health and Developmental Disabilities.
198.8    (c) Members of the council who do not receive a salary or wages from an employer
198.9for time spent on council duties may receive a per diem payment when performing council
198.10duties and functions.
198.11    (d) The State Quality Council shall:
198.12    (1) assist the Department of Human Services in fulfilling federally mandated
198.13obligations by monitoring disability service quality and quality assurance and
198.14improvement practices in Minnesota;
198.15    (2) establish state quality improvement priorities with methods for achieving results
198.16and provide an annual report to the legislative committees with jurisdiction over policy
198.17and funding of disability services on the outcomes, improvement priorities, and activities
198.18undertaken by the commission during the previous state fiscal year;
198.19(3) identify issues pertaining to financial and personal risk that impede Minnesotans
198.20with disabilities from optimizing choice of community-based services; and
198.21(4) recommend to the chairs and ranking minority members of the legislative
198.22committees with jurisdiction over human services and civil law by January 15, 2013
198.23 2014, statutory and rule changes related to the findings under clause (3) that promote
198.24individualized service and housing choices balanced with appropriate individualized
198.25protection.
198.26    (e) The State Quality Council, in partnership with the commissioner, shall:
198.27    (1) approve and direct implementation of the community-based, person-directed
198.28system established in this section;
198.29    (2) recommend an appropriate method of funding this system, and determine the
198.30feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;
198.31    (3) approve measurable outcomes in the areas of health and safety, consumer
198.32evaluation, education and training, providers, and systems;
198.33    (4) establish variable licensure periods not to exceed three years based on outcomes
198.34achieved; and
198.35    (5) in cooperation with the Quality Assurance Commission, design a transition plan
198.36for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.
199.1    (f) The State Quality Council shall notify the commissioner of human services that a
199.2facility, program, or service has been reviewed by quality assurance team members under
199.3subdivision 4, paragraph (b), clause (13), and qualifies for a license.
199.4    (g) The State Quality Council, in partnership with the commissioner, shall establish
199.5an ongoing review process for the system. The review shall take into account the
199.6comprehensive nature of the system which is designed to evaluate the broad spectrum of
199.7licensed and unlicensed entities that provide services to persons with disabilities. The
199.8review shall address efficiencies and effectiveness of the system.
199.9    (h) The State Quality Council may recommend to the commissioner certain
199.10variances from the standards governing licensure of programs for persons with disabilities
199.11in order to improve the quality of services so long as the recommended variances do
199.12not adversely affect the health or safety of persons being served or compromise the
199.13qualifications of staff to provide services.
199.14    (i) The safety standards, rights, or procedural protections referenced under
199.15subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make
199.16recommendations to the commissioner or to the legislature in the report required under
199.17paragraph (c) regarding alternatives or modifications to the safety standards, rights, or
199.18procedural protections referenced under subdivision 2, paragraph (c).
199.19    (j) The State Quality Council may hire staff to perform the duties assigned in this
199.20subdivision.

199.21    Sec. 17. Minnesota Statutes 2012, section 256B.431, subdivision 44, is amended to read:
199.22    Subd. 44. Property rate increase increases for a facility in Bloomington effective
199.23November 1, 2010 certain nursing facilities. (a) Notwithstanding any other law to the
199.24contrary, money available for moratorium projects under section 144A.073, subdivision
199.2511 , shall be used, effective November 1, 2010, to fund an approved moratorium exception
199.26project for a nursing facility in Bloomington licensed for 137 beds as of November 1,
199.272010, up to a total property rate adjustment of $19.33.
199.28(b) Effective June 1, 2012, any nursing facility in McLeod County licensed for 110
199.29beds shall have its replacement-cost-new limit under subdivision 17e adjusted to allow
199.30$1,129,463 of a completed construction project to increase the property payment rate.
199.31Notwithstanding any other law to the contrary, money available under section 144A.073,
199.32subdivision 11, after the completion of the moratorium exception approval process in 2013
199.33under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to the
199.34medical assistance budget for the increase in the replacement-cost-new limit.
200.1    (c) Effective July 1, 2013, or later, any boarding care facility in Hennepin
200.2County licensed for 100 beds shall be allowed to receive a property rate adjustment
200.3for a construction project that takes action to come into compliance with Minnesota
200.4Department of Labor and Industry elevator upgrade requirements, with costs below the
200.5minimum threshold under subdivision 16. Only costs related to the construction project
200.6that brings the facility into compliance with the elevator requirements shall be allowed.
200.7Notwithstanding any other law to the contrary, money available under section 144A.073,
200.8subdivision 11, after the completion of the moratorium exception approval process in
200.92013 under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to
200.10the medical assistance program.
200.11EFFECTIVE DATE.Paragraph (b) is effective retroactively from June 1, 2012.

200.12    Sec. 18. Minnesota Statutes 2012, section 256B.434, subdivision 4, is amended to read:
200.13    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which
200.14have their payment rates determined under this section rather than section 256B.431, the
200.15commissioner shall establish a rate under this subdivision. The nursing facility must enter
200.16into a written contract with the commissioner.
200.17    (b) A nursing facility's case mix payment rate for the first rate year of a facility's
200.18contract under this section is the payment rate the facility would have received under
200.19section 256B.431.
200.20    (c) A nursing facility's case mix payment rates for the second and subsequent years
200.21of a facility's contract under this section are the previous rate year's contract payment
200.22rates plus an inflation adjustment and, for facilities reimbursed under this section or
200.23section 256B.431, an adjustment to include the cost of any increase in Health Department
200.24licensing fees for the facility taking effect on or after July 1, 2001. The index for the
200.25inflation adjustment must be based on the change in the Consumer Price Index-All Items
200.26(United States City average) (CPI-U) forecasted by the commissioner of management and
200.27budget's national economic consultant, as forecasted in the fourth quarter of the calendar
200.28year preceding the rate year. The inflation adjustment must be based on the 12-month
200.29period from the midpoint of the previous rate year to the midpoint of the rate year for
200.30which the rate is being determined. For the rate years beginning on July 1, 1999, July 1,
200.312000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006,
200.32July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall
200.33apply only to the property-related payment rate. For the rate years beginning on October
200.341, 2011, and October 1, 2012, October 1, 2013, October 1, 2014, October 1, 2015, and
200.35October 1, 2016, the rate adjustment under this paragraph shall be suspended. Beginning
201.1in 2005, adjustment to the property payment rate under this section and section 256B.431
201.2shall be effective on October 1. In determining the amount of the property-related payment
201.3rate adjustment under this paragraph, the commissioner shall determine the proportion of
201.4the facility's rates that are property-related based on the facility's most recent cost report.
201.5    (d) The commissioner shall develop additional incentive-based payments of up to
201.6five percent above a facility's operating payment rate for achieving outcomes specified
201.7in a contract. The commissioner may solicit contract amendments and implement those
201.8which, on a competitive basis, best meet the state's policy objectives. The commissioner
201.9shall limit the amount of any incentive payment and the number of contract amendments
201.10under this paragraph to operate the incentive payments within funds appropriated for this
201.11purpose. The contract amendments may specify various levels of payment for various
201.12levels of performance. Incentive payments to facilities under this paragraph may be in the
201.13form of time-limited rate adjustments or onetime supplemental payments. In establishing
201.14the specified outcomes and related criteria, the commissioner shall consider the following
201.15state policy objectives:
201.16    (1) successful diversion or discharge of residents to the residents' prior home or other
201.17community-based alternatives;
201.18    (2) adoption of new technology to improve quality or efficiency;
201.19    (3) improved quality as measured in the Nursing Home Report Card;
201.20    (4) reduced acute care costs; and
201.21    (5) any additional outcomes proposed by a nursing facility that the commissioner
201.22finds desirable.
201.23    (e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
201.24take action to come into compliance with existing or pending requirements of the life
201.25safety code provisions or federal regulations governing sprinkler systems must receive
201.26reimbursement for the costs associated with compliance if all of the following conditions
201.27are met:
201.28    (1) the expenses associated with compliance occurred on or after January 1, 2005,
201.29and before December 31, 2008;
201.30    (2) the costs were not otherwise reimbursed under subdivision 4f or section
201.31144A.071 or 144A.073; and
201.32    (3) the total allowable costs reported under this paragraph are less than the minimum
201.33threshold established under section 256B.431, subdivision 15, paragraph (e), and
201.34subdivision 16.
201.35The commissioner shall use money appropriated for this purpose to provide to qualifying
201.36nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
202.12008. Nursing facilities that have spent money or anticipate the need to spend money
202.2to satisfy the most recent life safety code requirements by (1) installing a sprinkler
202.3system or (2) replacing all or portions of an existing sprinkler system may submit to the
202.4commissioner by June 30, 2007, on a form provided by the commissioner the actual
202.5costs of a completed project or the estimated costs, based on a project bid, of a planned
202.6project. The commissioner shall calculate a rate adjustment equal to the allowable
202.7costs of the project divided by the resident days reported for the report year ending
202.8September 30, 2006. If the costs from all projects exceed the appropriation for this
202.9purpose, the commissioner shall allocate the money appropriated on a pro rata basis to the
202.10qualifying facilities by reducing the rate adjustment determined for each facility by an
202.11equal percentage. Facilities that used estimated costs when requesting the rate adjustment
202.12shall report to the commissioner by January 31, 2009, on the use of this money on a
202.13form provided by the commissioner. If the nursing facility fails to provide the report, the
202.14commissioner shall recoup the money paid to the facility for this purpose. If the facility
202.15reports expenditures allowable under this subdivision that are less than the amount received
202.16in the facility's annualized rate adjustment, the commissioner shall recoup the difference.

202.17    Sec. 19. Minnesota Statutes 2012, section 256B.434, is amended by adding a
202.18subdivision to read:
202.19    Subd. 19a. Nursing facility rate adjustments beginning October 1, 2013. (a)
202.20For the rate year beginning October 1, 2013, the commissioner shall make available to
202.21each nursing facility reimbursed under this section a three percent operating payment
202.22rate increase.
202.23(b) Seventy-five percent of the money resulting from the rate adjustment under
202.24paragraph (a) must be used for increases in compensation-related costs for employees
202.25directly employed by the nursing facility on or after the effective date of the rate
202.26adjustment, except:
202.27(1) the administrator;
202.28(2) persons employed in the central office of a corporation that has an ownership
202.29interest in the nursing facility or exercises control over the nursing facility; and
202.30(3) persons paid by the nursing facility under a management contract.
202.31(c) The commissioner shall allow as compensation-related costs all costs for:
202.32(1) wages and salaries;
202.33(2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
202.34compensation;
203.1(3) the employer's share of health and dental insurance, life insurance, disability
203.2insurance, long-term care insurance, uniform allowance, and pensions; and
203.3(4) other benefits provided and workforce needs including the recruiting and training
203.4of employees, subject to the approval of the commissioner.
203.5(d) The portion of the rate adjustment under paragraph (a) that is not subject to the
203.6requirements of paragraph (b) shall be provided to nursing facilities effective October 1.
203.7Nursing facilities may apply for the portion of the rate adjustment under paragraph (a)
203.8that is subject to the requirements in paragraph (b). The application must be submitted
203.9to the commissioner within six months of the effective date of the rate adjustment, and
203.10the nursing facility must provide additional information required by the commissioner
203.11within nine months of the effective date of the rate adjustment. The commissioner must
203.12respond to all applications within three weeks of receipt. The commissioner may waive
203.13the deadlines in this paragraph under extraordinary circumstances, to be determined at the
203.14sole discretion of the commissioner. The application must contain:
203.15(1) an estimate of the amounts of money that must be used as specified in paragraph
203.16(b);
203.17(2) a detailed distribution plan specifying the allowable compensation-related and
203.18wage increases the nursing facility will implement to use the funds available in clause (1);
203.19(3) a description of how the nursing facility will notify eligible employees of
203.20the contents of the approved application, which must provide for giving each eligible
203.21employee a copy of the approved application, excluding the information required in clause
203.22(1), or posting a copy of the approved application, excluding the information required in
203.23clause (1), for a period of at least six weeks in an area of the nursing facility to which all
203.24eligible employees have access; and
203.25(4) instructions for employees who believe they have not received the
203.26compensation-related or wage increases specified in clause (2), as approved by the
203.27commissioner, and which must include a mailing address, e-mail address, and the
203.28telephone number that may be used by the employee to contact the commissioner or the
203.29commissioner's representative.
203.30(e) For the October 1, 2013, rate increase, the commissioner shall ensure that cost
203.31increases in distribution plans under paragraph (d), clause (2), that may be included in
203.32approved applications, comply with the following requirements:
203.33(1) a portion of the costs resulting from tenure-related wage or salary increases
203.34may be considered to be allowable wage increases, according to formulas that the
203.35commissioner shall provide, where employee retention is above the average statewide
203.36rate of retention of direct care employees;
204.1(2) the annualized amount of increases in costs for the employer's share of health
204.2and dental insurance, life insurance, disability insurance, and workers' compensation
204.3shall be allowable compensation-related increases if they are effective on or after April
204.41, 2013, and prior to April 1, 2014; and
204.5(3) for nursing facilities in which employees are represented by an exclusive
204.6bargaining representative, the commissioner shall approve the application only upon
204.7receipt of a letter of acceptance of the distribution plan, in regard to members of the
204.8bargaining unit, signed by the exclusive bargaining agent and dated after May 25, 2013.
204.9Upon receipt of the letter of acceptance, the commissioner shall deem all requirements of
204.10this provision as having been met in regard to the members of the bargaining unit.
204.11(f) The commissioner shall review applications received under paragraph (e) and
204.12shall provide the portion of the rate adjustment under paragraph (b) if the requirements
204.13of this statute have been met. The rate adjustment shall be effective October 1.
204.14Notwithstanding paragraph (a), if the approved application distributes less money than is
204.15available, the amount of the rate adjustment shall be reduced so that the amount of money
204.16made available is equal to the amount to be distributed.
204.17(g) The increase in this subdivision shall be applied as a total percentage to
204.18operating rates effective September 30, 2013, except that they shall not increase any
204.19performance-based incentive payments under section 256B.434, subdivision 4, paragraph
204.20(d), awarded prior to the effective date of the rate adjustment. Facilities receiving equitable
204.21cost-sharing for publicly owned nursing facilities program rate adjustments under section
204.22256B.441, subdivision 55a, must have rate increases under this paragraph computed based
204.23on rates in effect before the increases given under section 256B.441, subdivision 55a.

204.24    Sec. 20. Minnesota Statutes 2012, section 256B.437, subdivision 6, is amended to read:
204.25    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human
204.26services shall calculate the amount of the planned closure rate adjustment available under
204.27subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):
204.28(1) the amount available is the net reduction of nursing facility beds multiplied
204.29by $2,080;
204.30(2) the total number of beds in the nursing facility or facilities receiving the planned
204.31closure rate adjustment must be identified;
204.32(3) capacity days are determined by multiplying the number determined under
204.33clause (2) by 365; and
204.34(4) the planned closure rate adjustment is the amount available in clause (1), divided
204.35by capacity days determined under clause (3).
205.1(b) A planned closure rate adjustment under this section is effective on the first day
205.2of the month following completion of closure of the facility designated for closure in
205.3the application and becomes part of the nursing facility's total operating external fixed
205.4 payment rate.
205.5(c) Applicants may use the planned closure rate adjustment to allow for a property
205.6payment for a new nursing facility or an addition to an existing nursing facility or as
205.7an operating payment external fixed rate adjustment. Applications approved under this
205.8subdivision are exempt from other requirements for moratorium exceptions under section
205.9144A.073 , subdivisions 2 and 3.
205.10(d) Upon the request of a closing facility, the commissioner must allow the facility a
205.11closure rate adjustment as provided under section 144A.161, subdivision 10.
205.12(e) A facility that has received a planned closure rate adjustment may reassign it
205.13to another facility that is under the same ownership at any time within three years of its
205.14effective date. The amount of the adjustment shall be computed according to paragraph (a).
205.15(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
205.16the commissioner shall recalculate planned closure rate adjustments for facilities that
205.17delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
205.18bed dollar amount. The recalculated planned closure rate adjustment shall be effective
205.19from the date the per bed dollar amount is increased.
205.20(g) For planned closures approved after June 30, 2009, the commissioner of human
205.21services shall calculate the amount of the planned closure rate adjustment available under
205.22subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).
205.23(h) Beginning Between July 16, 2011, and June 30, 2013, the commissioner shall no
205.24longer not accept applications for planned closure rate adjustments under subdivision 3.

205.25    Sec. 21. Minnesota Statutes 2012, section 256B.441, subdivision 13, is amended to read:
205.26    Subd. 13. External fixed costs. "External fixed costs" means costs related to the
205.27nursing home surcharge under section 256.9657, subdivision 1; licensure fees under
205.28section 144.122; until September 30, 2013, long-term care consultation fees under
205.29section 256B.0911, subdivision 6; family advisory council fee under section 144A.33;
205.30scholarships under section 256B.431, subdivision 36; planned closure rate adjustments
205.31under section 256B.437; or single bed room incentives under section 256B.431,
205.32subdivision 42 ; property taxes and property insurance; and PERA.

205.33    Sec. 22. Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:
206.1    Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
206.2shall calculate a payment rate for external fixed costs.
206.3    (a) For a facility licensed as a nursing home, the portion related to section 256.9657
206.4shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
206.5home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
206.6result of its number of nursing home beds divided by its total number of licensed beds.
206.7    (b) The portion related to the licensure fee under section 144.122, paragraph (d),
206.8shall be the amount of the fee divided by actual resident days.
206.9    (c) The portion related to scholarships shall be determined under section 256B.431,
206.10subdivision 36.
206.11    (d) Until September 30, 2013, the portion related to long-term care consultation shall
206.12be determined according to section 256B.0911, subdivision 6.
206.13    (e) The portion related to development and education of resident and family advisory
206.14councils under section 144A.33 shall be $5 divided by 365.
206.15    (f) The portion related to planned closure rate adjustments shall be as determined
206.16under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.
206.17Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
206.18be included in the payment rate for external fixed costs beginning October 1, 2016.
206.19Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
206.20longer be included in the payment rate for external fixed costs beginning on October 1 of
206.21the first year not less than two years after their effective date.
206.22    (g) The portions related to property insurance, real estate taxes, special assessments,
206.23and payments made in lieu of real estate taxes directly identified or allocated to the nursing
206.24facility shall be the actual amounts divided by actual resident days.
206.25    (h) The portion related to the Public Employees Retirement Association shall be
206.26actual costs divided by resident days.
206.27    (i) The single bed room incentives shall be as determined under section 256B.431,
206.28subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
206.29no longer be included in the payment rate for external fixed costs beginning October 1,
206.302016. Single bed room incentives that take effect on or after October 1, 2014, shall no
206.31longer be included in the payment rate for external fixed costs beginning on October 1 of
206.32the first year not less than two years after their effective date.
206.33    (j) The payment rate for external fixed costs shall be the sum of the amounts in
206.34paragraphs (a) to (i).

206.35    Sec. 23. Minnesota Statutes 2012, section 256B.49, subdivision 11a, is amended to read:
207.1    Subd. 11a. Waivered services statewide priorities. (a) The commissioner shall
207.2establish statewide priorities for individuals on the waiting list for community alternative
207.3care, community alternatives for disabled individuals, and brain injury waiver services,
207.4as of January 1, 2010. The statewide priorities must include, but are not limited to,
207.5individuals who continue to have a need for waiver services after they have maximized the
207.6use of state plan services and other funding resources, including natural supports, prior to
207.7accessing waiver services, and who meet at least one of the following criteria:
207.8(1) have unstable living situations due to the age, incapacity, or sudden loss of
207.9the primary caregivers;
207.10(2) are moving from an institution due to bed closures;
207.11(3) experience a sudden closure of their current living arrangement;
207.12(4) require protection from confirmed abuse, neglect, or exploitation;
207.13(5) experience a sudden change in need that can no longer be met through state plan
207.14services or other funding resources alone; or
207.15(6) meet other priorities established by the department.
207.16(b) When allocating resources to lead agencies, the commissioner must take into
207.17consideration the number of individuals waiting who meet statewide priorities and the
207.18lead agencies' current use of waiver funds and existing service options. The commissioner
207.19has the authority to transfer funds between counties, groups of counties, and tribes to
207.20accommodate statewide priorities and resource needs while accounting for a necessary
207.21base level reserve amount for each county, group of counties, and tribe.
207.22(c) The commissioner shall evaluate the impact of the use of statewide priorities and
207.23provide recommendations to the legislature on whether to continue the use of statewide
207.24priorities in the November 1, 2011, annual report required by the commissioner in sections
207.25256B.0916, subdivision 7, and 256B.49, subdivision 21.

207.26    Sec. 24. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
207.27    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
207.28shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
207.29With the permission of the recipient or the recipient's designated legal representative,
207.30the recipient's current provider of services may submit a written report outlining their
207.31recommendations regarding the recipient's care needs prepared by a direct service
207.32employee with at least 20 hours of service to that client. The person conducting the
207.33assessment or reassessment must notify the provider of the date by which this information
207.34is to be submitted. This information shall be provided to the person conducting the
208.1assessment and the person or the person's legal representative and must be considered
208.2prior to the finalization of the assessment or reassessment.
208.3(b) There must be a determination that the client requires a hospital level of care or a
208.4nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
208.5(d), at initial and subsequent assessments to initiate and maintain participation in the
208.6waiver program.
208.7(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
208.8appropriate to determine nursing facility level of care for purposes of medical assistance
208.9payment for nursing facility services, only face-to-face assessments conducted according
208.10to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
208.11determination or a nursing facility level of care determination must be accepted for
208.12purposes of initial and ongoing access to waiver services payment.
208.13(d) Recipients who are found eligible for home and community-based services under
208.14this section before their 65th birthday may remain eligible for these services after their
208.1565th birthday if they continue to meet all other eligibility factors.
208.16(e) The commissioner shall develop criteria to identify recipients whose level of
208.17functioning is reasonably expected to improve and reassess these recipients to establish
208.18a baseline assessment. Recipients who meet these criteria must have a comprehensive
208.19transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
208.20reassessed every six months until there has been no significant change in the recipient's
208.21functioning for at least 12 months. Upon federal approval, if the recipient is able to have
208.22the recipient's needs met through alternative services in a less restrictive setting, the
208.23case manager shall help the recipient develop a plan to transition to an appropriate less
208.24restrictive setting. After there has been no significant change in the recipient's functioning
208.25for at least 12 months, reassessments of the recipient's strengths, informal support systems,
208.26and need for services shall be conducted at least every 12 months and at other times
208.27when there has been a significant change in the recipient's functioning. Counties, case
208.28managers, and service providers are responsible for conducting these reassessments and
208.29shall complete the reassessments out of existing funds.
208.30EFFECTIVE DATE.This section is effective January 1, 2014.

208.31    Sec. 25. Minnesota Statutes 2012, section 256B.49, subdivision 15, is amended to read:
208.32    Subd. 15. Coordinated service and support plan; comprehensive transitional
208.33service plan; maintenance service plan. (a) Each recipient of home and community-based
208.34waivered services shall be provided a copy of the written coordinated service and support
208.35plan which meets the requirements in section 256B.092, subdivision 1b.
209.1(b) In developing the comprehensive transitional service plan, the individual
209.2receiving services, the case manager, and the guardian, if applicable, will identify the
209.3transitional service plan fundamental service outcome and anticipated timeline to achieve
209.4this outcome. Within the first 20 days following a recipient's request for an assessment or
209.5reassessment, the transitional service planning team must be identified. A team leader must
209.6be identified who will be responsible for assigning responsibility and communicating with
209.7team members to ensure implementation of the transition plan and ongoing assessment and
209.8communication process. The team leader should be an individual, such as the case manager
209.9or guardian, who has the opportunity to follow the recipient to the next level of service.
209.10Within ten days following an assessment, a comprehensive transitional service plan
209.11must be developed incorporating elements of a comprehensive functional assessment and
209.12including short-term measurable outcomes and timelines for achievement of and reporting
209.13on these outcomes. Functional milestones must also be identified and reported according
209.14to the timelines agreed upon by the transitional service planning team. In addition, the
209.15comprehensive transitional service plan must identify additional supports that may assist
209.16in the achievement of the fundamental service outcome such as the development of greater
209.17natural community support, increased collaboration among agencies, and technological
209.18supports.
209.19The timelines for reporting on functional milestones will prompt a reassessment of
209.20services provided, the units of services, rates, and appropriate service providers. It is
209.21the responsibility of the transitional service planning team leader to review functional
209.22milestone reporting to determine if the milestones are consistent with observable skills
209.23and that milestone achievement prompts any needed changes to the comprehensive
209.24transitional service plan.
209.25For those whose fundamental transitional service outcome involves the need to
209.26procure housing, a plan for the recipient to seek the resources necessary to secure the least
209.27restrictive housing possible should be incorporated into the plan, including employment
209.28and public supports such as housing access and shelter needy funding.
209.29(c) Counties and other agencies responsible for funding community placement and
209.30ongoing community supportive services are responsible for the implementation of the
209.31comprehensive transitional service plans. Oversight responsibilities include both ensuring
209.32effective transitional service delivery and efficient utilization of funding resources.
209.33(d) Following one year of transitional services, the transitional services planning team
209.34will make a determination as to whether or not the individual receiving services requires
209.35the current level of continuous and consistent support in order to maintain the recipient's
209.36current level of functioning. Recipients who are determined to have not had a significant
210.1change in functioning for 12 months must move from a transitional to a maintenance
210.2service plan. Recipients on a maintenance service plan must be reassessed to determine if
210.3the recipient would benefit from a transitional service plan at least every 12 months and at
210.4other times when there has been a significant change in the recipient's functioning. This
210.5assessment should consider any changes to technological or natural community supports.
210.6(e) When a county is evaluating denials, reductions, or terminations of home and
210.7community-based services under section 256B.49 for an individual, the case manager
210.8shall offer to meet with the individual or the individual's guardian in order to discuss
210.9the prioritization of service needs within the coordinated service and support plan,
210.10comprehensive transitional service plan, or maintenance service plan. The reduction in
210.11the authorized services for an individual due to changes in funding for waivered services
210.12may not exceed the amount needed to ensure medically necessary services to meet the
210.13individual's health, safety, and welfare.
210.14(f) At the time of reassessment, local agency case managers shall assess each recipient
210.15of community alternatives for disabled individuals or brain injury waivered services
210.16currently residing in a licensed adult foster home that is not the primary residence of the
210.17license holder, or in which the license holder is not the primary caregiver, to determine if
210.18that recipient could appropriately be served in a community-living setting. If appropriate
210.19for the recipient, the case manager shall offer the recipient, through a person-centered
210.20planning process, the option to receive alternative housing and service options. In the
210.21event that the recipient chooses to transfer from the adult foster home, the vacated bed
210.22shall not be filled with another recipient of waiver services and group residential housing
210.23and the licensed capacity shall be reduced accordingly, unless the savings required by the
210.24licensed bed closure reductions under Laws 2011, First Special Session chapter 9, article 7,
210.25sections 1 and 40, paragraph (f), for foster care settings where the physical location is not
210.26the primary residence of the license holder are met through voluntary changes described
210.27in section 245A.03, subdivision 7, paragraph (f) (e), or as provided under paragraph (a),
210.28clauses (3) and (4). If the adult foster home becomes no longer viable due to these transfers,
210.29the county agency, with the assistance of the department, shall facilitate a consolidation of
210.30settings or closure. This reassessment process shall be completed by July 1, 2013.

210.31    Sec. 26. Minnesota Statutes 2012, section 256B.49, is amended by adding a
210.32subdivision to read:
210.33    Subd. 25. Excess allocations. County and tribal agencies will be responsible for
210.34authorizations in excess of the allocation made by the commissioner. In the event a county
210.35or tribal agency authorizes in excess of the allocation made by the commissioner for a
211.1given allocation period, they must submit a corrective action plan to the commissioner.
211.2The plan must state the actions the agency will take to correct their over-authorization for
211.3the year following the period when the over-authorization occurred. Failure to correct
211.4over-authorizations shall result in recoupment of authorizations in excess of the allocation.
211.5Nothing in this subdivision shall be construed as reducing the county's responsibility to
211.6offer and make available feasible home and community-based options to eligible waiver
211.7recipients within the resources allocated to them for that purpose.

211.8    Sec. 27. Minnesota Statutes 2012, section 256B.492, is amended to read:
211.9256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
211.10WITH DISABILITIES.
211.11(a) Individuals receiving services under a home and community-based waiver under
211.12section 256B.092 or 256B.49 may receive services in the following settings:
211.13(1) an individual's own home or family home;
211.14(2) a licensed adult foster care setting of up to five people; and
211.15(3) community living settings as defined in section 256B.49, subdivision 23, where
211.16individuals with disabilities may reside in all of the units in a building of four or fewer
211.17units, and no more than the greater of four or 25 percent of the units in a multifamily
211.18building of more than four units, unless required by the Housing Opportunities for Persons
211.19with AIDS program.
211.20(b) The settings in paragraph (a) must not:
211.21(1) be located in a building that is a publicly or privately operated facility that
211.22provides institutional treatment or custodial care;
211.23(2) be located in a building on the grounds of or adjacent to a public or private
211.24institution;
211.25(3) be a housing complex designed expressly around an individual's diagnosis or
211.26disability, unless required by the Housing Opportunities for Persons with AIDS program;
211.27(4) be segregated based on a disability, either physically or because of setting
211.28characteristics, from the larger community; and
211.29(5) have the qualities of an institution which include, but are not limited to:
211.30regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
211.31agreed to and documented in the person's individual service plan shall not result in a
211.32residence having the qualities of an institution as long as the restrictions for the person are
211.33not imposed upon others in the same residence and are the least restrictive alternative,
211.34imposed for the shortest possible time to meet the person's needs.
212.1(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
212.2individuals receive services under a home and community-based waiver as of July 1,
212.32012, and the setting does not meet the criteria of this section.
212.4(d) Notwithstanding paragraph (c), a program in Hennepin County established as
212.5part of a Hennepin County demonstration project is qualified for the exception allowed
212.6under paragraph (c).
212.7(e) The commissioner shall submit an amendment to the waiver plan no later than
212.8December 31, 2012.

212.9    Sec. 28. Minnesota Statutes 2012, section 256B.493, subdivision 2, is amended to read:
212.10    Subd. 2. Planned closure process needs determination. The commissioner shall
212.11announce and implement a program for planned closure of adult foster care homes. Planned
212.12closure shall be the preferred method for achieving necessary budgetary savings required by
212.13the licensed bed closure budget reduction in section 245A.03, subdivision 7, paragraph (d)
212.14 (c). If additional closures are required to achieve the necessary savings, the commissioner
212.15shall use the process and priorities in section 245A.03, subdivision 7, paragraph (d) (c).

212.16    Sec. 29. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
212.17subdivision to read:
212.18    Subd. 14. Rate increase effective June 1, 2013. For rate periods beginning on or
212.19after June 1, 2013, the commissioner shall increase the total operating payment rate for
212.20each facility reimbursed under this section by $7.81 per day. The increase shall not be
212.21subject to any annual percentage increase.
212.22EFFECTIVE DATE.This section is effective June 1, 2013.

212.23    Sec. 30. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
212.24subdivision to read:
212.25    Subd. 15. ICF/DD rate increases effective July 1, 2013. (a) Notwithstanding
212.26subdivision 12, for each facility reimbursed under this section, for the rate period
212.27beginning July 1, 2013, the commissioner shall increase operating payments equal to two
212.28percent of the operating payment rates in effect on June 30, 2013.
212.29(b) For each facility, the commissioner shall apply the rate increase based on
212.30occupied beds, using the percentage specified in this subdivision multiplied by the total
212.31payment rate, including the variable rate, but excluding the property-related payment
212.32rate in effect on the preceding date. The total rate increase shall include the adjustment
212.33provided in section 256B.501, subdivision 12.

213.1    Sec. 31. Minnesota Statutes 2012, section 256B.69, is amended by adding a
213.2subdivision to read:
213.3    Subd. 32a. Initiatives to improve early screening, diagnosis, and treatment of
213.4children with autism spectrum disorder and other developmental conditions. (a) The
213.5commissioner shall require managed care plans and county-based purchasing plans, as
213.6a condition of contract, to implement strategies that facilitate access for young children
213.7between the ages of one and three years to periodic developmental and social-emotional
213.8screenings, as recommended by the Minnesota Interagency Developmental Screening
213.9Task Force, and that those children who do not meet milestones are provided access to
213.10appropriate evaluation and assessment, including treatment recommendations, expected to
213.11improve the child's functioning, with the goal of meeting milestones by age five.
213.12    (b) The managed care plans must report the following data annually:
213.13    (1) the number of children who received a diagnostic assessment;
213.14    (2) the total number of children ages one to six with a diagnosis of autism spectrum
213.15disorder who received treatments;
213.16    (3) the number of children identified under clause (2) reported by each 12-month
213.17age group beginning with age one and ending with age six;
213.18    (4) the types of treatments provided to children identified under clause (2) listed by
213.19billing code, including the number of units billed for each child;
213.20    (5) barriers to providing screening, diagnosis, and treatment of young children
213.21between the ages of one and three years and any strategies implemented to address
213.22those barriers; and
213.23    (6) recommendations on how to measure and report on the effectiveness of the
213.24strategies implemented to facilitate access for young children to provide developmental
213.25and social-emotional screening, diagnosis, and treatment.

213.26    Sec. 32. Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision
213.273, as amended by Laws 2012, chapter 247, article 4, section 43, is amended to read:

213.28

Subd. 3.Forecasted Programs

213.29The amounts that may be spent from this
213.30appropriation for each purpose are as follows:

213.31

(a) MFIP/DWP Grants

213.32	Appropriations by Fund
213.33	General	84,680,000	91,978,000
213.34	Federal TANF	84,425,000	75,417,000

214.1

(b) MFIP Child Care Assistance Grants

55,456,000

30,923,000

214.2

(c) General Assistance Grants

49,192,000

46,938,000

214.3General Assistance Standard. The
214.4commissioner shall set the monthly standard
214.5of assistance for general assistance units
214.6consisting of an adult recipient who is
214.7childless and unmarried or living apart
214.8from parents or a legal guardian at $203.
214.9The commissioner may reduce this amount
214.10according to Laws 1997, chapter 85, article
214.113, section 54.
214.12Emergency General Assistance. The
214.13amount appropriated for emergency general
214.14assistance funds is limited to no more than
214.15$6,689,812 in fiscal year 2012 and $6,729,812
214.16in fiscal year 2013. Funds to counties shall
214.17be allocated by the commissioner using the
214.18allocation method specified in Minnesota
214.19Statutes, section 256D.06.

214.20

(d) Minnesota Supplemental Aid Grants

38,095,000

39,120,000

214.21

(e) Group Residential Housing Grants

121,080,000

129,238,000

214.22

(f) MinnesotaCare Grants

295,046,000

317,272,000

214.23This appropriation is from the health care
214.24access fund.

214.25

(g) Medical Assistance Grants

4,501,582,000

4,437,282,000

214.26Managed Care Incentive Payments. The
214.27commissioner shall not make managed care
214.28incentive payments for expanding preventive
214.29services during fiscal years beginning July 1,
214.302011, and July 1, 2012.
214.31Reduction of Rates for Congregate
214.32Living for Individuals with Lower Needs.
214.33Beginning October 1, 2011, lead agencies
215.1must reduce rates in effect on January 1, 2011,
215.2by ten percent for individuals with lower
215.3needs living in foster care settings where the
215.4license holder does not share the residence
215.5with recipients on the CADI and DD waivers
215.6and customized living settings for CADI.
215.7Lead agencies shall consult with providers to
215.8review individual service plans and identify
215.9changes or modifications to reduce the
215.10utilization of services while maintaining the
215.11health and safety of the individual receiving
215.12services. Lead agencies must adjust contracts
215.13within 60 days of the effective date. If
215.14federal waiver approval is obtained under
215.15the long-term care realignment waiver
215.16application submitted on February 13,
215.172012, and federal financial participation is
215.18authorized for the alternative care program,
215.19the commissioner shall adjust this payment
215.20rate reduction from ten to five percent for
215.21services rendered on or after July 1, 2012, or
215.22the first day of the month following federal
215.23approval, whichever is later. Effective
215.24August 1, 2013, this provision does not apply
215.25to individuals whose primary diagnosis is
215.26mental illness and who are living in foster
215.27care settings where the license holder is
215.28also (1) a provider of assertive community
215.29treatment (ACT) or adult rehabilitative
215.30mental health services (ARMHS) as defined
215.31in Minnesota Statutes, section 256B.0623;
215.32(2) a mental health center or mental health
215.33clinic certified under Minnesota Rules, parts
215.349520.0750 to 9520.0870; or (3) a provider
215.35of intensive residential treatment services
216.1(IRTS) licensed under Minnesota Rules,
216.2parts 9520.0500 to 9520.0670.
216.3Reduction of Lead Agency Waiver
216.4Allocations to Implement Rate Reductions
216.5for Congregate Living for Individuals
216.6with Lower Needs. Beginning October 1,
216.72011, the commissioner shall reduce lead
216.8agency waiver allocations to implement the
216.9reduction of rates for individuals with lower
216.10needs living in foster care settings where the
216.11license holder does not share the residence
216.12with recipients on the CADI and DD waivers
216.13and customized living settings for CADI.
216.14Reduce customized living and 24-hour
216.15customized living component rates.
216.16Effective July 1, 2011, the commissioner
216.17shall reduce elderly waiver customized living
216.18and 24-hour customized living component
216.19service spending by five percent through
216.20reductions in component rates and service
216.21rate limits. The commissioner shall adjust
216.22the elderly waiver capitation payment
216.23rates for managed care organizations paid
216.24under Minnesota Statutes, section 256B.69,
216.25subdivisions 6a and 23, to reflect reductions
216.26in component spending for customized living
216.27services and 24-hour customized living
216.28services under Minnesota Statutes, section
216.29256B.0915, subdivisions 3e and 3h, for the
216.30contract period beginning January 1, 2012.
216.31To implement the reduction specified in
216.32this provision, capitation rates paid by the
216.33commissioner to managed care organizations
216.34under Minnesota Statutes, section 256B.69,
216.35shall reflect a ten percent reduction for the
216.36specified services for the period January 1,
217.12012, to June 30, 2012, and a five percent
217.2reduction for those services on or after July
217.31, 2012.
217.4Limit Growth in the Developmental
217.5Disability Waiver. The commissioner
217.6shall limit growth in the developmental
217.7disability waiver to six diversion allocations
217.8per month beginning July 1, 2011, through
217.9June 30, 2013, and 15 diversion allocations
217.10per month beginning July 1, 2013, through
217.11June 30, 2015. Waiver allocations shall
217.12be targeted to individuals who meet the
217.13priorities for accessing waiver services
217.14identified in Minnesota Statutes, 256B.092,
217.15subdivision 12 . The limits do not include
217.16conversions from intermediate care facilities
217.17for persons with developmental disabilities.
217.18Notwithstanding any contrary provisions in
217.19this article, this paragraph expires June 30,
217.202015.
217.21Limit Growth in the Community
217.22Alternatives for Disabled Individuals
217.23Waiver. The commissioner shall limit
217.24growth in the community alternatives for
217.25disabled individuals waiver to 60 allocations
217.26per month beginning July 1, 2011, through
217.27June 30, 2013, and 85 allocations per
217.28month beginning July 1, 2013, through
217.29June 30, 2015. Waiver allocations must
217.30be targeted to individuals who meet the
217.31priorities for accessing waiver services
217.32identified in Minnesota Statutes, section
217.33256B.49, subdivision 11a . The limits include
217.34conversions and diversions, unless the
217.35commissioner has approved a plan to convert
217.36funding due to the closure or downsizing
218.1of a residential facility or nursing facility
218.2to serve directly affected individuals on
218.3the community alternatives for disabled
218.4individuals waiver. Notwithstanding any
218.5contrary provisions in this article, this
218.6paragraph expires June 30, 2015.
218.7Personal Care Assistance Relative
218.8Care. The commissioner shall adjust the
218.9capitation payment rates for managed care
218.10organizations paid under Minnesota Statutes,
218.11section 256B.69, to reflect the rate reductions
218.12for personal care assistance provided by
218.13a relative pursuant to Minnesota Statutes,
218.14section 256B.0659, subdivision 11. This rate
218.15reduction is effective July 1, 2013.

218.16

(h) Alternative Care Grants

46,421,000

46,035,000

218.17Alternative Care Transfer. Any money
218.18allocated to the alternative care program that
218.19is not spent for the purposes indicated does
218.20not cancel but shall be transferred to the
218.21medical assistance account.

218.22

(i) Chemical Dependency Entitlement Grants

94,675,000

93,298,000

218.23EFFECTIVE DATE.This section is effective August 1, 2013.

218.24    Sec. 33. RECOMMENDATIONS FOR CONCENTRATION LIMITS ON HOME
218.25AND COMMUNITY-BASED SETTINGS.
218.26The commissioner of human services shall consult with the Minnesota Olmstead
218.27subcabinet, advocates, providers, and city representatives to develop recommendations
218.28on concentration limits on home and community-based settings, as defined in
218.29Minnesota Statutes, section 256B.492, as well as any other exceptions to the definition.
218.30The recommendations must be consistent with Minnesota's Olmstead plan. The
218.31recommendations and proposed legislation must be submitted to the chairs and ranking
218.32minority members of the legislative committees with jurisdiction over health and human
218.33services policy and finance by February 1, 2014.

219.1    Sec. 34. PROVIDER RATE AND GRANT INCREASES EFFECTIVE JULY
219.21, 2013.
219.3(a) The commissioner of human services shall increase reimbursement rates, grants,
219.4allocations, individual limits, and rate limits, as applicable, by two percent for the rate
219.5period beginning July 1, 2013, for services rendered on or after those dates. County or
219.6tribal contracts for services specified in this section must be amended to pass through
219.7these rate increases within 60 days of the effective date.
219.8(b) The rate changes described in this section must be provided to:
219.9(1) home and community-based waivered services for persons with developmental
219.10disabilities or related conditions, including consumer-directed community supports, under
219.11Minnesota Statutes, section 256B.501;
219.12(2) waivered services under community alternatives for disabled individuals,
219.13including consumer-directed community supports, under Minnesota Statutes, section
219.14256B.49;
219.15(3) community alternative care waivered services, including consumer-directed
219.16community supports, under Minnesota Statutes, section 256B.49;
219.17(4) traumatic brain injury waivered services, including consumer-directed
219.18community supports, under Minnesota Statutes, section 256B.49;
219.19(5) home and community-based waivered services for the elderly under Minnesota
219.20Statutes, section 256B.0915;
219.21(6) nursing services and home health services under Minnesota Statutes, section
219.22256B.0625, subdivision 6a;
219.23(7) personal care services and qualified professional supervision of personal care
219.24services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
219.25(8) private duty nursing services under Minnesota Statutes, section 256B.0625,
219.26subdivision 7;
219.27(9) day training and habilitation services for adults with developmental disabilities
219.28or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
219.29additional cost of rate adjustments on day training and habilitation services, provided as a
219.30social service, under Minnesota Statutes, section 256M.60;
219.31(10) alternative care services under Minnesota Statutes, section 256B.0913;
219.32(11) living skills training programs for persons with intractable epilepsy who need
219.33assistance in the transition to independent living under Laws 1988, chapter 689;
219.34(12) semi-independent living services (SILS) under Minnesota Statutes, section
219.35252.275, including SILS funding under county social services grants formerly funded
219.36under Minnesota Statutes, chapter 256I;
220.1(13) consumer support grants under Minnesota Statutes, section 256.476;
220.2(14) family support grants under Minnesota Statutes, section 252.32;
220.3(15) housing access grants under Minnesota Statutes, section 256B.0658;
220.4(16) self-advocacy grants under Laws 2009, chapter 101; and
220.5(17) technology grants under Laws 2009, chapter 79.
220.6(c) A managed care plan receiving state payments for the services in this section
220.7must include these increases in their payments to providers. To implement the rate increase
220.8in this section, capitation rates paid by the commissioner to managed care organizations
220.9under Minnesota Statutes, section 256B.69, shall reflect a two percent increase for the
220.10specified services for the period beginning July 1, 2013.
220.11(d) Counties shall increase the budget for each recipient of consumer-directed
220.12community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).

220.13    Sec. 35. TRAINING OF AUTISM SERVICE PROVIDERS.
220.14    The commissioners of health and human services shall ensure that the departments'
220.15autism-related service providers receive training in culturally appropriate approaches to
220.16serving the Somali, Latino, Hmong, and Indigenous American Indian communities, and
220.17other cultural groups experiencing a disproportionate incidence of autism.

220.18    Sec. 36. DIRECTION TO COMMISSIONER.
220.19    By January 1, 2014, the commissioner of human services shall apply to the federal
220.20Centers for Medicare and Medicaid Services for a waiver or other authority to provide
220.21applied behavioral analysis services to children with autism spectrum disorder and related
220.22conditions under the medical assistance program.
220.23EFFECTIVE DATE.This section is effective the day following final enactment.

220.24    Sec. 37. RECOMMENDATIONS ON RAISING THE ASSET LIMITS FOR
220.25SENIORS AND PERSONS WITH DISABILITIES.
220.26The commissioner of human services shall consult with interested stakeholders to
220.27develop recommendations to increase the asset limit a reasonable amount considering
220.28changes since the limit was established for (1) individuals who are not homeowners and (2)
220.29homeowners eligible for medical assistance due to disability or age who are not residing in
220.30a nursing facility, intermediate care facility for persons with developmental disabilities,
220.31or other institution whose costs for room and board are covered by medical assistance or
220.32state funds. The recommendations must be provided to the legislative committees with
220.33jurisdiction over health and human services policy and finance by February 1, 2014.

221.1    Sec. 38. NURSING HOME LEVEL OF CARE REPORT.
221.2(a) The commissioner of human services shall report on the impact of the nursing
221.3facility level of care to be implemented January 1, 2014, including the following:
221.4(1) the number of individuals who lose eligibility for home and community-based
221.5services waivers under Minnesota Statutes, sections 256B.0915 and 256B.49, and
221.6alternative care under Minnesota Statutes, section 256B.0913;
221.7    (2) the number of individuals who lose eligibility for medical assistance; and
221.8    (3) for individuals reported under clauses (1) and (2), and to the extent possible:
221.9    (i) their living situation before and after nursing facility level of care implementation;
221.10and
221.11    (ii) the programs or services they received before and after nursing facility level of
221.12care implementation, including, but not limited to, personal care assistant services and
221.13essential community supports.
221.14(b) The commissioner of human services shall report to the chairs of the legislative
221.15committees with jurisdiction over health and human services policy and finance with the
221.16information required under paragraph (a). A preliminary report shall be submitted on
221.17October 1, 2014, and a final report shall be submitted February 15, 2015.

221.18    Sec. 39. HOME AND COMMUNITY-BASED SERVICES REPORT CARD.
221.19    (a) The commissioner of human services shall work with existing advisory groups
221.20to develop recommendations for a home and community-based services report card.
221.21The advisory committee shall consider the requirements from the Minnesota Consumer
221.22Information Guide under Minnesota Statutes, section 144G.06, as a base for development
221.23of a home and community-based services report card to compare the housing options
221.24available to consumers. Other items to be considered by the advisory committee in
221.25developing recommendations include:
221.26    (1) defining the goal of the report card;
221.27    (2) measuring outcomes, consumer information, and options for pay for performance;
221.28    (3) developing separate measures for programs for the elderly population and for
221.29persons with disabilities;
221.30    (4) identifying sources of information that are standardized and contain sufficient
221.31data;
221.32    (5) identifying the financial support needed to create and publicize the housing
221.33information guide, and ongoing funding for data collection and staffing to monitor,
221.34report, and analyze data;
222.1    (6) recognizing that home and community-based services settings exist with
222.2significant variations as to size, settings, and services available;
222.3    (7) ensuring that consumer choice and consumer information is retained and valued;
222.4and
222.5    (8) considering the applicability of these measures on providers based on payer
222.6source, size, and population served.
222.7    (b) The workgroup shall discuss whether additional funding, resources, or research
222.8is needed. The workgroup shall report recommendations to the legislative committees
222.9with jurisdiction over health and human services policy and finance by August 1, 2014.
222.10The report card shall be available on July 1, 2015.

222.11    Sec. 40. REPEALER.
222.12(a) Minnesota Statutes 2012, sections 256B.14, subdivision 3a; and 256B.5012,
222.13subdivision 13; and Laws 2011, First Special Session chapter 9, article 7, section 54, as
222.14amended by Laws 2012, chapter 247, article 4, section 42, and Laws 2012, chapter 298,
222.15section 3, are repealed.
222.16(b) Minnesota Statutes 2012, section 256B.096, subdivisions 1, 2, 3, and 4, are
222.17repealed.


222.20    Section 1. Minnesota Statutes 2012, section 145C.01, subdivision 7, is amended to read:
222.21    Subd. 7. Health care facility. "Health care facility" means a hospital or other entity
222.22licensed under sections 144.50 to 144.58, a nursing home licensed to serve adults under
222.23section 144A.02, a home care provider licensed under sections 144A.43 to 144A.47,
222.24an adult foster care provider licensed under chapter 245A and Minnesota Rules, parts
222.259555.5105 to 9555.6265, a community residential setting licensed under chapter 245D, or
222.26a hospice provider licensed under sections 144A.75 to 144A.755.

222.27    Sec. 2. Minnesota Statutes 2012, section 243.166, subdivision 4b, is amended to read:
222.28    Subd. 4b. Health care facility; notice of status. (a) For the purposes of this
222.29subdivision, "health care facility" means a facility:
222.30(1) licensed by the commissioner of health as a hospital, boarding care home or
222.31supervised living facility under sections 144.50 to 144.58, or a nursing home under
222.32chapter 144A;
223.1(2) registered by the commissioner of health as a housing with services establishment
223.2as defined in section 144D.01; or
223.3(3) licensed by the commissioner of human services as a residential facility under
223.4chapter 245A to provide adult foster care, adult mental health treatment, chemical
223.5dependency treatment to adults, or residential services to persons with developmental
223.6 disabilities.
223.7(b) Prior to admission to a health care facility, a person required to register under
223.8this section shall disclose to:
223.9(1) the health care facility employee processing the admission the person's status
223.10as a registered predatory offender under this section; and
223.11(2) the person's corrections agent, or if the person does not have an assigned
223.12corrections agent, the law enforcement authority with whom the person is currently
223.13required to register, that inpatient admission will occur.
223.14(c) A law enforcement authority or corrections agent who receives notice under
223.15paragraph (b) or who knows that a person required to register under this section is
223.16planning to be admitted and receive, or has been admitted and is receiving health care
223.17at a health care facility shall notify the administrator of the facility and deliver a fact
223.18sheet to the administrator containing the following information: (1) name and physical
223.19description of the offender; (2) the offender's conviction history, including the dates of
223.20conviction; (3) the risk level classification assigned to the offender under section 244.052,
223.21if any; and (4) the profile of likely victims.
223.22(d) Except for a hospital licensed under sections 144.50 to 144.58, if a health care
223.23facility receives a fact sheet under paragraph (c) that includes a risk level classification for
223.24the offender, and if the facility admits the offender, the facility shall distribute the fact
223.25sheet to all residents at the facility. If the facility determines that distribution to a resident
223.26is not appropriate given the resident's medical, emotional, or mental status, the facility
223.27shall distribute the fact sheet to the patient's next of kin or emergency contact.

223.28    Sec. 3. [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY
223.29MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
223.30    Subdivision 1. Rules. The commissioner of human services shall, within 24 months
223.31of enactment of this section, adopt rules governing the use of positive support strategies,
223.32safety interventions, and emergency use of manual restraint in facilities and services
223.33licensed under chapter 245D.
223.34    Subd. 2. Data collection. (a) The commissioner shall, with stakeholder input,
223.35develop data collection elements specific to incidents on the use of controlled procedures
224.1with persons receiving services from providers regulated under Minnesota Rules, parts
224.29525.2700 to 9525.2810, and incidents involving persons receiving services from
224.3providers identified to be licensed under chapter 245D effective January 1, 2014. Providers
224.4shall report the data in a format and at a frequency provided by the commissioner of
224.5human services.
224.6(b) Beginning July 1, 2013, providers regulated under Minnesota Rules, parts
224.79525.2700 to 9525.2810, shall submit data regarding the use of all controlled procedures
224.8in a format and at a frequency provided by the commissioner.

224.9    Sec. 4. Minnesota Statutes 2012, section 245A.02, subdivision 10, is amended to read:
224.10    Subd. 10. Nonresidential program. "Nonresidential program" means care,
224.11supervision, rehabilitation, training or habilitation of a person provided outside the
224.12person's own home and provided for fewer than 24 hours a day, including adult day
224.13care programs; and chemical dependency or chemical abuse programs that are located
224.14in a nursing home or hospital and receive public funds for providing chemical abuse or
224.15chemical dependency treatment services under chapter 254B. Nonresidential programs
224.16include home and community-based services and semi-independent living services for
224.17persons with developmental disabilities or persons age 65 and older that are provided in
224.18or outside of a person's own home under chapter 245D.

224.19    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 14, is amended to read:
224.20    Subd. 14. Residential program. "Residential program" means a program
224.21that provides 24-hour-a-day care, supervision, food, lodging, rehabilitation, training,
224.22education, habilitation, or treatment outside a person's own home, including a program
224.23in an intermediate care facility for four or more persons with developmental disabilities;
224.24and chemical dependency or chemical abuse programs that are located in a hospital
224.25or nursing home and receive public funds for providing chemical abuse or chemical
224.26dependency treatment services under chapter 254B. Residential programs include home
224.27and community-based services for persons with developmental disabilities or persons age
224.2865 and older that are provided in or outside of a person's own home under chapter 245D.

224.29    Sec. 6. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
224.30    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an initial
224.31license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340,
224.32or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under
224.33this chapter for a physical location that will not be the primary residence of the license
225.1holder for the entire period of licensure. If a license is issued during this moratorium, and
225.2the license holder changes the license holder's primary residence away from the physical
225.3location of the foster care license, the commissioner shall revoke the license according
225.4to section 245A.07. The commissioner shall not issue an initial license for a community
225.5residential setting licensed under chapter 245D. Exceptions to the moratorium include:
225.6(1) foster care settings that are required to be registered under chapter 144D;
225.7(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
225.8community residential setting licenses replacing adult foster care licenses in existence on
225.9December 31, 2013, and determined to be needed by the commissioner under paragraph (b);
225.10(3) new foster care licenses or community residential setting licenses determined to
225.11be needed by the commissioner under paragraph (b) for the closure of a nursing facility,
225.12ICF/MR, or regional treatment center, or restructuring of state-operated services that
225.13limits the capacity of state-operated facilities;
225.14(4) new foster care licenses or community residential setting licenses determined
225.15to be needed by the commissioner under paragraph (b) for persons requiring hospital
225.16level care; or
225.17(5) new foster care licenses or community residential setting licenses determined to
225.18be needed by the commissioner for the transition of people from personal care assistance
225.19to the home and community-based services.
225.20(b) The commissioner shall determine the need for newly licensed foster care
225.21homes or community residential settings as defined under this subdivision. As part of the
225.22determination, the commissioner shall consider the availability of foster care capacity in
225.23the area in which the licensee seeks to operate, and the recommendation of the local
225.24county board. The determination by the commissioner must be final. A determination of
225.25need is not required for a change in ownership at the same address.
225.26(c) The commissioner shall study the effects of the license moratorium under this
225.27subdivision and shall report back to the legislature by January 15, 2011. This study shall
225.28include, but is not limited to the following:
225.29(1) the overall capacity and utilization of foster care beds where the physical location
225.30is not the primary residence of the license holder prior to and after implementation
225.31of the moratorium;
225.32(2) the overall capacity and utilization of foster care beds where the physical
225.33location is the primary residence of the license holder prior to and after implementation
225.34of the moratorium; and
225.35(3) the number of licensed and occupied ICF/MR beds prior to and after
225.36implementation of the moratorium.
226.1(d) When a foster care recipient resident served by the program moves out of a
226.2foster home that is not the primary residence of the license holder according to section
226.3256B.49, subdivision 15 , paragraph (f), or the community residential setting, the county
226.4shall immediately inform the Department of Human Services Licensing Division.
226.5The department shall decrease the statewide licensed capacity for foster care settings
226.6where the physical location is not the primary residence of the license holder, or for
226.7community residential settings, if the voluntary changes described in paragraph (f) are
226.8not sufficient to meet the savings required by reductions in licensed bed capacity under
226.9Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f),
226.10and maintain statewide long-term care residential services capacity within budgetary
226.11limits. Implementation of the statewide licensed capacity reduction shall begin on July
226.121, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the
226.13needs determination process. Under this paragraph, the commissioner has the authority
226.14to reduce unused licensed capacity of a current foster care program, or the community
226.15residential settings, to accomplish the consolidation or closure of settings. A decreased
226.16licensed capacity according to this paragraph is not subject to appeal under this chapter.
226.17(e) Residential settings that would otherwise be subject to the decreased license
226.18capacity established in paragraph (d) shall be exempt under the following circumstances:
226.19(1) until August 1, 2013, the license holder's beds occupied by residents whose
226.20primary diagnosis is mental illness and the license holder is:
226.21(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
226.22health services (ARMHS) as defined in section 256B.0623;
226.23(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
226.249520.0870;
226.25(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
226.269520.0870; or
226.27(iv) a provider of intensive residential treatment services (IRTS) licensed under
226.28Minnesota Rules, parts 9520.0500 to 9520.0670; or
226.29(2) the license holder is certified under the requirements in subdivision 6a or section
226.30245D.33.
226.31(f) A resource need determination process, managed at the state level, using the
226.32available reports required by section 144A.351, and other data and information shall
226.33be used to determine where the reduced capacity required under paragraph (d) will be
226.34implemented. The commissioner shall consult with the stakeholders described in section
226.35144A.351 , and employ a variety of methods to improve the state's capacity to meet
226.36long-term care service needs within budgetary limits, including seeking proposals from
227.1service providers or lead agencies to change service type, capacity, or location to improve
227.2services, increase the independence of residents, and better meet needs identified by the
227.3long-term care services reports and statewide data and information. By February 1 of each
227.4year, the commissioner shall provide information and data on the overall capacity of
227.5licensed long-term care services, actions taken under this subdivision to manage statewide
227.6long-term care services and supports resources, and any recommendations for change to
227.7the legislative committees with jurisdiction over health and human services budget.
227.8    (g) At the time of application and reapplication for licensure, the applicant and the
227.9license holder that are subject to the moratorium or an exclusion established in paragraph
227.10(a) are required to inform the commissioner whether the physical location where the foster
227.11care will be provided is or will be the primary residence of the license holder for the entire
227.12period of licensure. If the primary residence of the applicant or license holder changes, the
227.13applicant or license holder must notify the commissioner immediately. The commissioner
227.14shall print on the foster care license certificate whether or not the physical location is the
227.15primary residence of the license holder.
227.16    (h) License holders of foster care homes identified under paragraph (g) that are not
227.17the primary residence of the license holder and that also provide services in the foster care
227.18home that are covered by a federally approved home and community-based services
227.19waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must inform the
227.20human services licensing division that the license holder provides or intends to provide
227.21these waiver-funded services. These license holders must be considered registered under
227.22section 256B.092, subdivision 11, paragraph (c), and this registration status must be
227.23identified on their license certificates.

227.24    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 8, is amended to read:
227.25    Subd. 8. Excluded providers seeking licensure. Nothing in this section shall
227.26prohibit a program that is excluded from licensure under subdivision 2, paragraph
227.27(a), clause (28) (26), from seeking licensure. The commissioner shall ensure that any
227.28application received from such an excluded provider is processed in the same manner as
227.29all other applications for child care center licensure.

227.30    Sec. 8. Minnesota Statutes 2012, section 245A.042, subdivision 3, is amended to read:
227.31    Subd. 3. Implementation. (a) The commissioner shall implement the
227.32responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
227.33only within the limits of available appropriations or other administrative cost recovery
227.34methodology.
228.1(b) The licensure of home and community-based services according to this section
228.2shall be implemented January 1, 2014. License applications shall be received and
228.3processed on a phased-in schedule as determined by the commissioner beginning July
228.41, 2013. Licenses will be issued thereafter upon the commissioner's determination that
228.5the application is complete according to section 245A.04.
228.6(c) Within the limits of available appropriations or other administrative cost recovery
228.7methodology, implementation of compliance monitoring must be phased in after January
228.81, 2014.
228.9(1) Applicants who do not currently hold a license issued under this chapter 245B
228.10 must receive an initial compliance monitoring visit after 12 months of the effective date of
228.11the initial license for the purpose of providing technical assistance on how to achieve and
228.12maintain compliance with the applicable law or rules governing the provision of home and
228.13community-based services under chapter 245D. If during the review the commissioner
228.14finds that the license holder has failed to achieve compliance with an applicable law or
228.15rule and this failure does not imminently endanger the health, safety, or rights of the
228.16persons served by the program, the commissioner may issue a licensing review report with
228.17recommendations for achieving and maintaining compliance.
228.18(2) Applicants who do currently hold a license issued under this chapter must receive
228.19a compliance monitoring visit after 24 months of the effective date of the initial license.
228.20(d) Nothing in this subdivision shall be construed to limit the commissioner's
228.21authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
228.22or make issue correction orders and make a license conditional for failure to comply with
228.23applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
228.24of the violation of law or rule and the effect of the violation on the health, safety, or
228.25rights of persons served by the program.

228.26    Sec. 9. Minnesota Statutes 2012, section 245A.08, subdivision 2a, is amended to read:
228.27    Subd. 2a. Consolidated contested case hearings. (a) When a denial of a license
228.28under section 245A.05 or a licensing sanction under section 245A.07, subdivision 3, is
228.29based on a disqualification for which reconsideration was requested and which was not
228.30set aside under section 245C.22, the scope of the contested case hearing shall include the
228.31disqualification and the licensing sanction or denial of a license, unless otherwise specified
228.32in this subdivision. When the licensing sanction or denial of a license is based on a
228.33determination of maltreatment under section 626.556 or 626.557, or a disqualification for
228.34serious or recurring maltreatment which was not set aside, the scope of the contested case
228.35hearing shall include the maltreatment determination, disqualification, and the licensing
229.1sanction or denial of a license, unless otherwise specified in this subdivision. In such
229.2cases, a fair hearing under section 256.045 shall not be conducted as provided for in
229.3sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d.
229.4    (b) Except for family child care and child foster care, reconsideration of a
229.5maltreatment determination under sections 626.556, subdivision 10i, and 626.557,
229.6subdivision 9d, and reconsideration of a disqualification under section 245C.22, shall
229.7not be conducted when:
229.8    (1) a denial of a license under section 245A.05, or a licensing sanction under section
229.9245A.07 , is based on a determination that the license holder is responsible for maltreatment
229.10or the disqualification of a license holder is based on serious or recurring maltreatment;
229.11    (2) the denial of a license or licensing sanction is issued at the same time as the
229.12maltreatment determination or disqualification; and
229.13    (3) the license holder appeals the maltreatment determination or disqualification,
229.14and denial of a license or licensing sanction. In these cases, a fair hearing shall not be
229.15conducted under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision
229.169d. The scope of the contested case hearing must include the maltreatment determination,
229.17disqualification, and denial of a license or licensing sanction.
229.18    Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
229.19determination or disqualification, but does not appeal the denial of a license or a licensing
229.20sanction, reconsideration of the maltreatment determination shall be conducted under
229.21sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
229.22disqualification shall be conducted under section 245C.22. In such cases, a fair hearing
229.23shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
229.24626.557, subdivision 9d .
229.25    (c) In consolidated contested case hearings regarding sanctions issued in family child
229.26care, child foster care, family adult day services, and adult foster care, and community
229.27residential settings, the county attorney shall defend the commissioner's orders in
229.28accordance with section 245A.16, subdivision 4.
229.29    (d) The commissioner's final order under subdivision 5 is the final agency action
229.30on the issue of maltreatment and disqualification, including for purposes of subsequent
229.31background studies under chapter 245C and is the only administrative appeal of the final
229.32agency determination, specifically, including a challenge to the accuracy and completeness
229.33of data under section 13.04.
229.34    (e) When consolidated hearings under this subdivision involve a licensing sanction
229.35based on a previous maltreatment determination for which the commissioner has issued
229.36a final order in an appeal of that determination under section 256.045, or the individual
230.1failed to exercise the right to appeal the previous maltreatment determination under
230.2section 626.556, subdivision 10i, or 626.557, subdivision 9d, the commissioner's order is
230.3conclusive on the issue of maltreatment. In such cases, the scope of the administrative
230.4law judge's review shall be limited to the disqualification and the licensing sanction or
230.5denial of a license. In the case of a denial of a license or a licensing sanction issued to
230.6a facility based on a maltreatment determination regarding an individual who is not the
230.7license holder or a household member, the scope of the administrative law judge's review
230.8includes the maltreatment determination.
230.9    (f) The hearings of all parties may be consolidated into a single contested case
230.10hearing upon consent of all parties and the administrative law judge, if:
230.11    (1) a maltreatment determination or disqualification, which was not set aside under
230.12section 245C.22, is the basis for a denial of a license under section 245A.05 or a licensing
230.13sanction under section 245A.07;
230.14    (2) the disqualified subject is an individual other than the license holder and upon
230.15whom a background study must be conducted under section 245C.03; and
230.16    (3) the individual has a hearing right under section 245C.27.
230.17    (g) When a denial of a license under section 245A.05 or a licensing sanction under
230.18section 245A.07 is based on a disqualification for which reconsideration was requested
230.19and was not set aside under section 245C.22, and the individual otherwise has no hearing
230.20right under section 245C.27, the scope of the administrative law judge's review shall
230.21include the denial or sanction and a determination whether the disqualification should
230.22be set aside, unless section 245C.24 prohibits the set-aside of the disqualification. In
230.23determining whether the disqualification should be set aside, the administrative law judge
230.24shall consider the factors under section 245C.22, subdivision 4, to determine whether the
230.25individual poses a risk of harm to any person receiving services from the license holder.
230.26    (h) Notwithstanding section 245C.30, subdivision 5, when a licensing sanction
230.27under section 245A.07 is based on the termination of a variance under section 245C.30,
230.28subdivision 4 , the scope of the administrative law judge's review shall include the sanction
230.29and a determination whether the disqualification should be set aside, unless section
230.30245C.24 prohibits the set-aside of the disqualification. In determining whether the
230.31disqualification should be set aside, the administrative law judge shall consider the factors
230.32under section 245C.22, subdivision 4, to determine whether the individual poses a risk of
230.33harm to any person receiving services from the license holder.

230.34    Sec. 10. Minnesota Statutes 2012, section 245A.10, is amended to read:
230.35245A.10 FEES.
231.1    Subdivision 1. Application or license fee required, programs exempt from fee.
231.2(a) Unless exempt under paragraph (b), the commissioner shall charge a fee for evaluation
231.3of applications and inspection of programs which are licensed under this chapter.
231.4(b) Except as provided under subdivision 2, no application or license fee shall be
231.5charged for child foster care, adult foster care, or family and group family child care, or
231.6a community residential setting.
231.7    Subd. 2. County fees for background studies and licensing inspections. (a) For
231.8purposes of family and group family child care licensing under this chapter, a county
231.9agency may charge a fee to an applicant or license holder to recover the actual cost of
231.10background studies, but in any case not to exceed $100 annually. A county agency may
231.11also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
231.12license or $100 for a two-year license.
231.13    (b) A county agency may charge a fee to a legal nonlicensed child care provider or
231.14applicant for authorization to recover the actual cost of background studies completed
231.15under section 119B.125, but in any case not to exceed $100 annually.
231.16    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
231.17    (1) in cases of financial hardship;
231.18    (2) if the county has a shortage of providers in the county's area;
231.19    (3) for new providers; or
231.20    (4) for providers who have attained at least 16 hours of training before seeking
231.21initial licensure.
231.22    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
231.23an installment basis for up to one year. If the provider is receiving child care assistance
231.24payments from the state, the provider may have the fees under paragraph (a) or (b)
231.25deducted from the child care assistance payments for up to one year and the state shall
231.26reimburse the county for the county fees collected in this manner.
231.27    (e) For purposes of adult foster care and child foster care licensing, and licensing
231.28the physical plant of a community residential setting, under this chapter, a county agency
231.29may charge a fee to a corporate applicant or corporate license holder to recover the actual
231.30cost of licensing inspections, not to exceed $500 annually.
231.31    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the
231.32following circumstances:
231.33(1) in cases of financial hardship;
231.34(2) if the county has a shortage of providers in the county's area; or
231.35(3) for new providers.
232.1    Subd. 3. Application fee for initial license or certification. (a) For fees required
232.2under subdivision 1, an applicant for an initial license or certification issued by the
232.3commissioner shall submit a $500 application fee with each new application required
232.4under this subdivision. An applicant for an initial day services facility license under
232.5chapter 245D shall submit a $250 application fee with each new application. The
232.6application fee shall not be prorated, is nonrefundable, and is in lieu of the annual license
232.7or certification fee that expires on December 31. The commissioner shall not process an
232.8application until the application fee is paid.
232.9(b) Except as provided in clauses (1) to (4) (3), an applicant shall apply for a license
232.10to provide services at a specific location.
232.11(1) For a license to provide residential-based habilitation services to persons with
232.12developmental disabilities under chapter 245B, an applicant shall submit an application
232.13for each county in which the services will be provided. Upon licensure, the license
232.14holder may provide services to persons in that county plus no more than three persons
232.15at any one time in each of up to ten additional counties. A license holder in one county
232.16may not provide services under the home and community-based waiver for persons with
232.17developmental disabilities to more than three people in a second county without holding
232.18a separate license for that second county. Applicants or licensees providing services
232.19under this clause to not more than three persons remain subject to the inspection fees
232.20established in section 245A.10, subdivision 2, for each location. The license issued by
232.21the commissioner must state the name of each additional county where services are being
232.22provided to persons with developmental disabilities. A license holder must notify the
232.23commissioner before making any changes that would alter the license information listed
232.24under section 245A.04, subdivision 7, paragraph (a), including any additional counties
232.25where persons with developmental disabilities are being served. For a license to provide
232.26home and community-based services to persons with disabilities or age 65 and older under
232.27chapter 245D, an applicant shall submit an application to provide services statewide.
232.28(2) For a license to provide supported employment, crisis respite, or
232.29semi-independent living services to persons with developmental disabilities under chapter
232.30245B, an applicant shall submit a single application to provide services statewide.
232.31(3) For a license to provide independent living assistance for youth under section
232.32245A.22 , an applicant shall submit a single application to provide services statewide.
232.33(4) (3) For a license for a private agency to provide foster care or adoption services
232.34under Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single
232.35application to provide services statewide.
233.1(c) The initial application fee charged under this subdivision does not include the
233.2temporary license surcharge under section 16E.22.
233.3    Subd. 4. License or certification fee for certain programs. (a) Child care centers
233.4shall pay an annual nonrefundable license fee based on the following schedule:

233.5		Licensed Capacity	Child Care CenterLicense Fee
233.6		1 to 24 persons	$200
233.7		25 to 49 persons	$300
233.8		50 to 74 persons	$400
233.9		75 to 99 persons	$500
233.10		100 to 124 persons	$600
233.11		125 to 149 persons	$700
233.12		150 to 174 persons	$800
233.13		175 to 199 persons	$900
233.14		200 to 224 persons	$1,000
233.15		225 or more persons	$1,100

233.16    (b) A day training and habilitation program serving persons with developmental
233.17disabilities or related conditions shall pay an annual nonrefundable license fee based on
233.18the following schedule:

233.19		Licensed Capacity	License Fee
233.20		1 to 24 persons	$800
233.21		25 to 49 persons	$1,000
233.22		50 to 74 persons	$1,200
233.23		75 to 99 persons	$1,400
233.24		100 to 124 persons	$1,600
233.25		125 to 149 persons	$1,800
233.26		150 or more persons	$2,000

233.27Except as provided in paragraph (c), when a day training and habilitation program
233.28serves more than 50 percent of the same persons in two or more locations in a community,
233.29the day training and habilitation program shall pay a license fee based on the licensed
233.30capacity of the largest facility and the other facility or facilities shall be charged a license
233.31fee based on a licensed capacity of a residential program serving one to 24 persons.
233.32    (c) When a day training and habilitation program serving persons with developmental
233.33disabilities or related conditions seeks a single license allowed under section 245B.07,
233.34subdivision 12, clause (2) or (3), the licensing fee must be based on the combined licensed
233.35capacity for each location.
233.36(d) A program licensed to provide supported employment services to persons
233.37with developmental disabilities under chapter 245B shall pay an annual nonrefundable
233.38license fee of $650.
234.1(e) A program licensed to provide crisis respite services to persons with
234.2developmental disabilities under chapter 245B shall pay an annual nonrefundable license
234.3fee of $700.
234.4(f) A program licensed to provide semi-independent living services to persons
234.5with developmental disabilities under chapter 245B shall pay an annual nonrefundable
234.6license fee of $700.
234.7(g) A program licensed to provide residential-based habilitation services under the
234.8home and community-based waiver for persons with developmental disabilities shall pay
234.9an annual license fee that includes a base rate of $690 plus $60 times the number of clients
234.10served on the first day of July of the current license year.
234.11(h) A residential program certified by the Department of Health as an intermediate
234.12care facility for persons with developmental disabilities (ICF/MR) and a noncertified
234.13residential program licensed to provide health or rehabilitative services for persons
234.14with developmental disabilities shall pay an annual nonrefundable license fee based on
234.15the following schedule:

234.16		Licensed Capacity	License Fee
234.17		1 to 24 persons	$535
234.18		25 to 49 persons	$735
234.19		50 or more persons	$935

234.20(b) A program licensed to provide one or more of the home and community-based
234.21services and supports identified under chapter 245D to persons with disabilities or age
234.2265 and older, shall pay an annual nonrefundable license fee that includes a base rate of
234.23$2,250, plus $92 times the number of persons served, on average, greater than 40 hours per
234.24week for the month of June of the current license year for programs serving ten or more
234.25persons. The fee is limited to a maximum of 200 persons, regardless of the actual number
234.26of persons served. Programs serving nine or fewer persons pay only half of the base rate.
234.27(c) A facility licensed under chapter 245D to provide day services shall pay an
234.28annual nonrefundable license fee of $100.
234.29(i) (d) A chemical dependency treatment program licensed under Minnesota Rules,
234.30parts 9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an
234.31annual nonrefundable license fee based on the following schedule:

234.32		Licensed Capacity	License Fee
234.33		1 to 24 persons	$600
234.34		25 to 49 persons	$800
234.35		50 to 74 persons	$1,000
234.36		75 to 99 persons	$1,200
234.37		100 or more persons	$1,400

235.1(j) (e) A chemical dependency program licensed under Minnesota Rules, parts
235.29530.6510 to 9530.6590, to provide detoxification services shall pay an annual
235.3nonrefundable license fee based on the following schedule:

235.4		Licensed Capacity	License Fee
235.5		1 to 24 persons	$760
235.6		25 to 49 persons	$960
235.7		50 or more persons	$1,160

235.8(k) (f) Except for child foster care, a residential facility licensed under Minnesota
235.9Rules, chapter 2960, to serve children shall pay an annual nonrefundable license fee
235.10based on the following schedule:

235.11		Licensed Capacity	License Fee
235.12		1 to 24 persons	$1,000
235.13		25 to 49 persons	$1,100
235.14		50 to 74 persons	$1,200
235.15		75 to 99 persons	$1,300
235.16		100 or more persons	$1,400

235.17(l) (g) A residential facility licensed under Minnesota Rules, parts 9520.0500 to
235.189520.0670, to serve persons with mental illness shall pay an annual nonrefundable license
235.19fee based on the following schedule:

235.20		Licensed Capacity	License Fee
235.21		1 to 24 persons	$2,525
235.22		25 or more persons	$2,725

235.23(m) (h) A residential facility licensed under Minnesota Rules, parts 9570.2000 to
235.249570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable
235.25license fee based on the following schedule:

235.26		Licensed Capacity	License Fee
235.27		1 to 24 persons	$450
235.28		25 to 49 persons	$650
235.29		50 to 74 persons	$850
235.30		75 to 99 persons	$1,050
235.31		100 or more persons	$1,250

235.32(n) (i) A program licensed to provide independent living assistance for youth under
235.33section 245A.22 shall pay an annual nonrefundable license fee of $1,500.
235.34(o) (j) A private agency licensed to provide foster care and adoption services under
235.35Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable
235.36license fee of $875.
236.1(p) (k) A program licensed as an adult day care center licensed under Minnesota
236.2Rules, parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based
236.3on the following schedule:

236.4		Licensed Capacity	License Fee
236.5		1 to 24 persons	$500
236.6		25 to 49 persons	$700
236.7		50 to 74 persons	$900
236.8		75 to 99 persons	$1,100
236.9		100 or more persons	$1,300

236.10(q) (l) A program licensed to provide treatment services to persons with sexual
236.11psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts
236.129515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.
236.13(r) (m) A mental health center or mental health clinic requesting certification for
236.14purposes of insurance and subscriber contract reimbursement under Minnesota Rules,
236.15parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,550 per year. If the
236.16mental health center or mental health clinic provides services at a primary location with
236.17satellite facilities, the satellite facilities shall be certified with the primary location without
236.18an additional charge.
236.19    Subd. 6. License not issued until license or certification fee is paid. The
236.20commissioner shall not issue a license or certification until the license or certification fee
236.21is paid. The commissioner shall send a bill for the license or certification fee to the billing
236.22address identified by the license holder. If the license holder does not submit the license or
236.23certification fee payment by the due date, the commissioner shall send the license holder
236.24a past due notice. If the license holder fails to pay the license or certification fee by the
236.25due date on the past due notice, the commissioner shall send a final notice to the license
236.26holder informing the license holder that the program license will expire on December 31
236.27unless the license fee is paid before December 31. If a license expires, the program is no
236.28longer licensed and, unless exempt from licensure under section 245A.03, subdivision 2,
236.29must not operate after the expiration date. After a license expires, if the former license
236.30holder wishes to provide licensed services, the former license holder must submit a new
236.31license application and application fee under subdivision 3.
236.32    Subd. 7. Human services licensing fees to recover expenditures. Notwithstanding
236.33section 16A.1285, subdivision 2, related to activities for which the commissioner charges
236.34a fee, the commissioner must plan to fully recover direct expenditures for licensing
236.35activities under this chapter over a five-year period. The commissioner may have
236.36anticipated expenditures in excess of anticipated revenues in a biennium by using surplus
236.37revenues accumulated in previous bienniums.
237.1    Subd. 8. Deposit of license fees. A human services licensing account is created in
237.2the state government special revenue fund. Fees collected under subdivisions 3 and 4 must
237.3be deposited in the human services licensing account and are annually appropriated to the
237.4commissioner for licensing activities authorized under this chapter.
237.5EFFECTIVE DATE.This section is effective July 1, 2013.

237.6    Sec. 11. Minnesota Statutes 2012, section 245A.11, subdivision 2a, is amended to read:
237.7    Subd. 2a. Adult foster care and community residential setting license capacity.
237.8(a) The commissioner shall issue adult foster care and community residential setting
237.9 licenses with a maximum licensed capacity of four beds, including nonstaff roomers and
237.10boarders, except that the commissioner may issue a license with a capacity of five beds,
237.11including roomers and boarders, according to paragraphs (b) to (f).
237.12(b) An adult foster care The license holder may have a maximum license capacity
237.13of five if all persons in care are age 55 or over and do not have a serious and persistent
237.14mental illness or a developmental disability.
237.15(c) The commissioner may grant variances to paragraph (b) to allow a foster care
237.16provider facility with a licensed capacity of five persons to admit an individual under the
237.17age of 55 if the variance complies with section 245A.04, subdivision 9, and approval of
237.18the variance is recommended by the county in which the licensed foster care provider
237.19 facility is located.
237.20(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
237.21bed for emergency crisis services for a person with serious and persistent mental illness
237.22or a developmental disability, regardless of age, if the variance complies with section
237.23245A.04, subdivision 9 , and approval of the variance is recommended by the county in
237.24which the licensed foster care provider facility is located.
237.25(e) The commissioner may grant a variance to paragraph (b) to allow for the use of a
237.26fifth bed for respite services, as defined in section 245A.02, for persons with disabilities,
237.27regardless of age, if the variance complies with sections 245A.03, subdivision 7, and
237.28245A.04, subdivision 9 , and approval of the variance is recommended by the county in
237.29which the licensed foster care provider facility is licensed located. Respite care may be
237.30provided under the following conditions:
237.31(1) staffing ratios cannot be reduced below the approved level for the individuals
237.32being served in the home on a permanent basis;
237.33(2) no more than two different individuals can be accepted for respite services in
237.34any calendar month and the total respite days may not exceed 120 days per program in
237.35any calendar year;
238.1(3) the person receiving respite services must have his or her own bedroom, which
238.2could be used for alternative purposes when not used as a respite bedroom, and cannot be
238.3the room of another person who lives in the foster care home facility; and
238.4(4) individuals living in the foster care home facility must be notified when the
238.5variance is approved. The provider must give 60 days' notice in writing to the residents
238.6and their legal representatives prior to accepting the first respite placement. Notice must
238.7be given to residents at least two days prior to service initiation, or as soon as the license
238.8holder is able if they receive notice of the need for respite less than two days prior to
238.9initiation, each time a respite client will be served, unless the requirement for this notice is
238.10waived by the resident or legal guardian.
238.11(f) The commissioner may issue an adult foster care or community residential setting
238.12 license with a capacity of five adults if the fifth bed does not increase the overall statewide
238.13capacity of licensed adult foster care or community residential setting beds in homes that
238.14are not the primary residence of the license holder, as identified in a plan submitted to the
238.15commissioner by the county, when the capacity is recommended by the county licensing
238.16agency of the county in which the facility is located and if the recommendation verifies that:
238.17(1) the facility meets the physical environment requirements in the adult foster
238.18care licensing rule;
238.19(2) the five-bed living arrangement is specified for each resident in the resident's:
238.20(i) individualized plan of care;
238.21(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
238.22(iii) individual resident placement agreement under Minnesota Rules, part
238.239555.5105, subpart 19, if required;
238.24(3) the license holder obtains written and signed informed consent from each
238.25resident or resident's legal representative documenting the resident's informed choice
238.26to remain living in the home and that the resident's refusal to consent would not have
238.27resulted in service termination; and
238.28(4) the facility was licensed for adult foster care before March 1, 2011.
238.29(g) The commissioner shall not issue a new adult foster care license under paragraph
238.30(f) after June 30, 2016. The commissioner shall allow a facility with an adult foster care
238.31license issued under paragraph (f) before June 30, 2016, to continue with a capacity of five
238.32adults if the license holder continues to comply with the requirements in paragraph (f).

238.33    Sec. 12. Minnesota Statutes 2012, section 245A.11, subdivision 7, is amended to read:
238.34    Subd. 7. Adult foster care; variance for alternate overnight supervision. (a) The
238.35commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts
239.1requiring a caregiver to be present in an adult foster care home during normal sleeping
239.2hours to allow for alternative methods of overnight supervision. The commissioner may
239.3grant the variance if the local county licensing agency recommends the variance and the
239.4county recommendation includes documentation verifying that:
239.5    (1) the county has approved the license holder's plan for alternative methods of
239.6providing overnight supervision and determined the plan protects the residents' health,
239.7safety, and rights;
239.8    (2) the license holder has obtained written and signed informed consent from
239.9each resident or each resident's legal representative documenting the resident's or legal
239.10representative's agreement with the alternative method of overnight supervision; and
239.11    (3) the alternative method of providing overnight supervision, which may include
239.12the use of technology, is specified for each resident in the resident's: (i) individualized
239.13plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if
239.14required; or (iii) individual resident placement agreement under Minnesota Rules, part
239.159555.5105, subpart 19, if required.
239.16    (b) To be eligible for a variance under paragraph (a), the adult foster care license
239.17holder must not have had a conditional license issued under section 245A.06, or any
239.18other licensing sanction issued under section 245A.07 during the prior 24 months based
239.19on failure to provide adequate supervision, health care services, or resident safety in
239.20the adult foster care home.
239.21    (c) A license holder requesting a variance under this subdivision to utilize
239.22technology as a component of a plan for alternative overnight supervision may request
239.23the commissioner's review in the absence of a county recommendation. Upon receipt of
239.24such a request from a license holder, the commissioner shall review the variance request
239.25with the county.
239.26(d) A variance granted by the commissioner according to this subdivision before
239.27January 1, 2014, to a license holder for an adult foster care home must transfer with the
239.28license when the license converts to a community residential setting license under chapter
239.29245D. The terms and conditions of the variance remain in effect as approved at the time
239.30the variance was granted.

239.31    Sec. 13. Minnesota Statutes 2012, section 245A.11, subdivision 7a, is amended to read:
239.32    Subd. 7a. Alternate overnight supervision technology; adult foster care license
239.33 and community residential setting licenses. (a) The commissioner may grant an
239.34applicant or license holder an adult foster care or community residential setting license
239.35for a residence that does not have a caregiver in the residence during normal sleeping
240.1hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, or section
240.2245D.02, subdivision 33b, but uses monitoring technology to alert the license holder
240.3when an incident occurs that may jeopardize the health, safety, or rights of a foster
240.4care recipient. The applicant or license holder must comply with all other requirements
240.5under Minnesota Rules, parts 9555.5105 to 9555.6265, or applicable requirements under
240.6chapter 245D, and the requirements under this subdivision. The license printed by the
240.7commissioner must state in bold and large font:
240.8    (1) that the facility is under electronic monitoring; and
240.9    (2) the telephone number of the county's common entry point for making reports of
240.10suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
240.11(b) Applications for a license under this section must be submitted directly to
240.12the Department of Human Services licensing division. The licensing division must
240.13immediately notify the host county and lead county contract agency and the host county
240.14licensing agency. The licensing division must collaborate with the county licensing
240.15agency in the review of the application and the licensing of the program.
240.16    (c) Before a license is issued by the commissioner, and for the duration of the
240.17license, the applicant or license holder must establish, maintain, and document the
240.18implementation of written policies and procedures addressing the requirements in
240.19paragraphs (d) through (f).
240.20    (d) The applicant or license holder must have policies and procedures that:
240.21    (1) establish characteristics of target populations that will be admitted into the home,
240.22and characteristics of populations that will not be accepted into the home;
240.23    (2) explain the discharge process when a foster care recipient resident served by the
240.24program requires overnight supervision or other services that cannot be provided by the
240.25license holder due to the limited hours that the license holder is on site;
240.26    (3) describe the types of events to which the program will respond with a physical
240.27presence when those events occur in the home during time when staff are not on site, and
240.28how the license holder's response plan meets the requirements in paragraph (e), clause
240.29(1) or (2);
240.30    (4) establish a process for documenting a review of the implementation and
240.31effectiveness of the response protocol for the response required under paragraph (e),
240.32clause (1) or (2). The documentation must include:
240.33    (i) a description of the triggering incident;
240.34    (ii) the date and time of the triggering incident;
240.35    (iii) the time of the response or responses under paragraph (e), clause (1) or (2);
240.36    (iv) whether the response met the resident's needs;
241.1    (v) whether the existing policies and response protocols were followed; and
241.2    (vi) whether the existing policies and protocols are adequate or need modification.
241.3    When no physical presence response is completed for a three-month period, the
241.4license holder's written policies and procedures must require a physical presence response
241.5drill to be conducted for which the effectiveness of the response protocol under paragraph
241.6(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
241.7    (5) establish that emergency and nonemergency phone numbers are posted in a
241.8prominent location in a common area of the home where they can be easily observed by a
241.9person responding to an incident who is not otherwise affiliated with the home.
241.10    (e) The license holder must document and include in the license application which
241.11response alternative under clause (1) or (2) is in place for responding to situations that
241.12present a serious risk to the health, safety, or rights of people receiving foster care services
241.13in the home residents served by the program:
241.14    (1) response alternative (1) requires only the technology to provide an electronic
241.15notification or alert to the license holder that an event is underway that requires a response.
241.16Under this alternative, no more than ten minutes will pass before the license holder will be
241.17physically present on site to respond to the situation; or
241.18    (2) response alternative (2) requires the electronic notification and alert system under
241.19alternative (1), but more than ten minutes may pass before the license holder is present on
241.20site to respond to the situation. Under alternative (2), all of the following conditions are met:
241.21    (i) the license holder has a written description of the interactive technological
241.22applications that will assist the license holder in communicating with and assessing the
241.23needs related to the care, health, and safety of the foster care recipients. This interactive
241.24technology must permit the license holder to remotely assess the well being of the foster
241.25care recipient resident served by the program without requiring the initiation of the
241.26foster care recipient. Requiring the foster care recipient to initiate a telephone call does
241.27not meet this requirement;
241.28(ii) the license holder documents how the remote license holder is qualified and
241.29capable of meeting the needs of the foster care recipients and assessing foster care
241.30recipients' needs under item (i) during the absence of the license holder on site;
241.31(iii) the license holder maintains written procedures to dispatch emergency response
241.32personnel to the site in the event of an identified emergency; and
241.33    (iv) each foster care recipient's resident's individualized plan of care, individual
241.34service plan coordinated service and support plan under section sections 256B.0913,
241.35subdivision 8; 256B.0915, subdivision 6; 256B.092, subdivision 1b; and 256B.49,
241.36subdivision 15, if required, or individual resident placement agreement under Minnesota
242.1Rules, part 9555.5105, subpart 19, if required, identifies the maximum response time,
242.2which may be greater than ten minutes, for the license holder to be on site for that foster
242.3care recipient resident.
242.4    (f) Each foster care recipient's resident's placement agreement, individual service
242.5agreement, and plan must clearly state that the adult foster care or community residential
242.6setting license category is a program without the presence of a caregiver in the residence
242.7during normal sleeping hours; the protocols in place for responding to situations that
242.8present a serious risk to the health, safety, or rights of foster care recipients residents
242.9served by the program under paragraph (e), clause (1) or (2); and a signed informed
242.10consent from each foster care recipient resident served by the program or the person's
242.11legal representative documenting the person's or legal representative's agreement with
242.12placement in the program. If electronic monitoring technology is used in the home, the
242.13informed consent form must also explain the following:
242.14    (1) how any electronic monitoring is incorporated into the alternative supervision
242.15system;
242.16    (2) the backup system for any electronic monitoring in times of electrical outages or
242.17other equipment malfunctions;
242.18    (3) how the caregivers or direct support staff are trained on the use of the technology;
242.19    (4) the event types and license holder response times established under paragraph (e);
242.20    (5) how the license holder protects the foster care recipient's each resident's privacy
242.21related to electronic monitoring and related to any electronically recorded data generated
242.22by the monitoring system. A foster care recipient resident served by the program may
242.23not be removed from a program under this subdivision for failure to consent to electronic
242.24monitoring. The consent form must explain where and how the electronically recorded
242.25data is stored, with whom it will be shared, and how long it is retained; and
242.26    (6) the risks and benefits of the alternative overnight supervision system.
242.27    The written explanations under clauses (1) to (6) may be accomplished through
242.28cross-references to other policies and procedures as long as they are explained to the
242.29person giving consent, and the person giving consent is offered a copy.
242.30(g) Nothing in this section requires the applicant or license holder to develop or
242.31maintain separate or duplicative policies, procedures, documentation, consent forms, or
242.32individual plans that may be required for other licensing standards, if the requirements of
242.33this section are incorporated into those documents.
242.34(h) The commissioner may grant variances to the requirements of this section
242.35according to section 245A.04, subdivision 9.
243.1(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
243.2under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
243.3contractors affiliated with the license holder.
243.4(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to
243.5remotely determine what action the license holder needs to take to protect the well-being
243.6of the foster care recipient.
243.7(k) The commissioner shall evaluate license applications using the requirements
243.8in paragraphs (d) to (f). The commissioner shall provide detailed application forms,
243.9including a checklist of criteria needed for approval.
243.10(l) To be eligible for a license under paragraph (a), the adult foster care or community
243.11residential setting license holder must not have had a conditional license issued under
243.12section 245A.06 or any licensing sanction under section 245A.07 during the prior 24
243.13months based on failure to provide adequate supervision, health care services, or resident
243.14safety in the adult foster care home or community residential setting.
243.15(m) The commissioner shall review an application for an alternative overnight
243.16supervision license within 60 days of receipt of the application. When the commissioner
243.17receives an application that is incomplete because the applicant failed to submit required
243.18documents or that is substantially deficient because the documents submitted do not meet
243.19licensing requirements, the commissioner shall provide the applicant written notice
243.20that the application is incomplete or substantially deficient. In the written notice to the
243.21applicant, the commissioner shall identify documents that are missing or deficient and
243.22give the applicant 45 days to resubmit a second application that is substantially complete.
243.23An applicant's failure to submit a substantially complete application after receiving
243.24notice from the commissioner is a basis for license denial under section 245A.05. The
243.25commissioner shall complete subsequent review within 30 days.
243.26(n) Once the application is considered complete under paragraph (m), the
243.27commissioner will approve or deny an application for an alternative overnight supervision
243.28license within 60 days.
243.29(o) For the purposes of this subdivision, "supervision" means:
243.30(1) oversight by a caregiver or direct support staff as specified in the individual
243.31resident's place agreement or coordinated service and support plan and awareness of the
243.32resident's needs and activities; and
243.33(2) the presence of a caregiver or direct support staff in a residence during normal
243.34sleeping hours, unless a determination has been made and documented in the individual's
243.35 coordinated service and support plan that the individual does not require the presence of a
243.36caregiver or direct support staff during normal sleeping hours.

244.1    Sec. 14. Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to read:
244.2    Subd. 7b. Adult foster care data privacy and security. (a) An adult foster care
244.3 or community residential setting license holder who creates, collects, records, maintains,
244.4stores, or discloses any individually identifiable recipient data, whether in an electronic
244.5or any other format, must comply with the privacy and security provisions of applicable
244.6privacy laws and regulations, including:
244.7(1) the federal Health Insurance Portability and Accountability Act of 1996
244.8(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
244.9title 45, part 160, and subparts A and E of part 164; and
244.10(2) the Minnesota Government Data Practices Act as codified in chapter 13.
244.11(b) For purposes of licensure, the license holder shall be monitored for compliance
244.12with the following data privacy and security provisions:
244.13(1) the license holder must control access to data on foster care recipients residents
244.14served by the program according to the definitions of public and private data on individuals
244.15under section 13.02; classification of the data on individuals as private under section
244.1613.46, subdivision 2 ; and control over the collection, storage, use, access, protection,
244.17and contracting related to data according to section 13.05, in which the license holder is
244.18assigned the duties of a government entity;
244.19(2) the license holder must provide each foster care recipient resident served by
244.20the program with a notice that meets the requirements under section 13.04, in which
244.21the license holder is assigned the duties of the government entity, and that meets the
244.22requirements of Code of Federal Regulations, title 45, part 164.52. The notice shall
244.23describe the purpose for collection of the data, and to whom and why it may be disclosed
244.24pursuant to law. The notice must inform the recipient individual that the license holder
244.25uses electronic monitoring and, if applicable, that recording technology is used;
244.26(3) the license holder must not install monitoring cameras in bathrooms;
244.27(4) electronic monitoring cameras must not be concealed from the foster care
244.28recipients residents served by the program; and
244.29(5) electronic video and audio recordings of foster care recipients residents served
244.30by the program shall be stored by the license holder for five days unless: (i) a foster care
244.31recipient resident served by the program or legal representative requests that the recording
244.32be held longer based on a specific report of alleged maltreatment; or (ii) the recording
244.33captures an incident or event of alleged maltreatment under section 626.556 or 626.557 or
244.34a crime under chapter 609. When requested by a recipient resident served by the program
244.35 or when a recording captures an incident or event of alleged maltreatment or a crime, the
244.36license holder must maintain the recording in a secured area for no longer than 30 days
245.1to give the investigating agency an opportunity to make a copy of the recording. The
245.2investigating agency will maintain the electronic video or audio recordings as required in
245.3section 626.557, subdivision 12b.
245.4(c) The commissioner shall develop, and make available to license holders and
245.5county licensing workers, a checklist of the data privacy provisions to be monitored
245.6for purposes of licensure.

245.7    Sec. 15. Minnesota Statutes 2012, section 245A.11, subdivision 8, is amended to read:
245.8    Subd. 8. Community residential setting license. (a) The commissioner shall
245.9establish provider standards for residential support services that integrate service standards
245.10and the residential setting under one license. The commissioner shall propose statutory
245.11language and an implementation plan for licensing requirements for residential support
245.12services to the legislature by January 15, 2012, as a component of the quality outcome
245.13standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
245.14(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
245.15for services in settings licensed as adult foster care under Minnesota Rules, parts 9555.5105
245.16to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 2960.3340;
245.17and meeting the provisions of section 256B.092, subdivision 11, paragraph (b) section
245.18245D.02, subdivision 4a, must be required to obtain a community residential setting license.

245.19    Sec. 16. Minnesota Statutes 2012, section 245A.16, subdivision 1, is amended to read:
245.20    Subdivision 1. Delegation of authority to agencies. (a) County agencies and
245.21private agencies that have been designated or licensed by the commissioner to perform
245.22licensing functions and activities under section 245A.04 and background studies for family
245.23child care under chapter 245C; to recommend denial of applicants under section 245A.05;
245.24to issue correction orders, to issue variances, and recommend a conditional license under
245.25section 245A.06, or to recommend suspending or revoking a license or issuing a fine under
245.26section 245A.07, shall comply with rules and directives of the commissioner governing
245.27those functions and with this section. The following variances are excluded from the
245.28delegation of variance authority and may be issued only by the commissioner:
245.29    (1) dual licensure of family child care and child foster care, dual licensure of child
245.30and adult foster care, and adult foster care and family child care;
245.31    (2) adult foster care maximum capacity;
245.32    (3) adult foster care minimum age requirement;
245.33    (4) child foster care maximum age requirement;
246.1    (5) variances regarding disqualified individuals except that county agencies may
246.2issue variances under section 245C.30 regarding disqualified individuals when the county
246.3is responsible for conducting a consolidated reconsideration according to sections 245C.25
246.4and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
246.5and a disqualification based on serious or recurring maltreatment; and
246.6    (6) the required presence of a caregiver in the adult foster care residence during
246.7normal sleeping hours; and
246.8    (7) variances for community residential setting licenses under chapter 245D.
246.9Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency
246.10must not grant a license holder a variance to exceed the maximum allowable family child
246.11care license capacity of 14 children.
246.12    (b) County agencies must report information about disqualification reconsiderations
246.13under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
246.14granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
246.15prescribed by the commissioner.
246.16    (c) For family day care programs, the commissioner may authorize licensing reviews
246.17every two years after a licensee has had at least one annual review.
246.18    (d) For family adult day services programs, the commissioner may authorize
246.19licensing reviews every two years after a licensee has had at least one annual review.
246.20    (e) A license issued under this section may be issued for up to two years.

246.21    Sec. 17. Minnesota Statutes 2012, section 245D.02, is amended to read:
246.22245D.02 DEFINITIONS.
246.23    Subdivision 1. Scope. The terms used in this chapter have the meanings given
246.24them in this section.
246.25    Subd. 2. Annual and annually. "Annual" and "annually" have the meaning given
246.26in section 245A.02, subdivision 2b.
246.27    Subd. 2a. Authorized representative. "Authorized representative" means a parent,
246.28family member, advocate, or other adult authorized by the person or the person's legal
246.29representative, to serve as a representative in connection with the provision of services
246.30licensed under this chapter. This authorization must be in writing or by another method
246.31that clearly indicates the person's free choice. The authorized representative must have no
246.32financial interest in the provision of any services included in the person's service delivery
246.33plan and must be capable of providing the support necessary to assist the person in the use
246.34of home and community-based services licensed under this chapter.
247.1    Subd. 3. Case manager. "Case manager" means the individual designated
247.2to provide waiver case management services, care coordination, or long-term care
247.3consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
247.4or successor provisions.
247.5    Subd. 3a. Certification. "Certification" means the commissioner's written
247.6authorization for a license holder to provide specialized services based on certification
247.7standards in section 245D.33. The term certification and its derivatives have the same
247.8meaning and may be substituted for the term licensure and its derivatives in this chapter
247.9and chapter 245A.
247.10    Subd. 4. Commissioner. "Commissioner" means the commissioner of the
247.11Department of Human Services or the commissioner's designated representative.
247.12    Subd. 4a. Community residential setting. "Community residential setting" means
247.13a residential program as identified in section 245A.11, subdivision 8, where residential
247.14supports and services identified in section 245D.03, subdivision 1, paragraph (c), clause
247.15(3), items (i) and (ii), are provided and the license holder is the owner, lessor, or tenant
247.16of the facility licensed according to this chapter, and the license holder does not reside
247.17in the facility.
247.18    Subd. 4b. Coordinated service and support plan. "Coordinated service and support
247.19plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915, subdivision
247.206; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor provisions.
247.21    Subd. 4c. Coordinated service and support plan addendum. "Coordinated
247.22service and support plan addendum" means the documentation that this chapter requires
247.23of the license holder for each person receiving services.
247.24    Subd. 4d. Corporate foster care. "Corporate foster care" means a child foster
247.25residence setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340,
247.26or an adult foster care home licensed according to Minnesota Rules, parts 9555.5105 to
247.279555.6265, where the license holder does not live in the home.
247.28    Subd. 4e. Cultural competence or culturally competent. "Cultural competence"
247.29or "culturally competent" means the ability and the will to respond to the unique needs of
247.30a person that arise from the person's culture and the ability to use the person's culture as a
247.31resource or tool to assist with the intervention and help meet the person's needs.
247.32    Subd. 4f. Day services facility. "Day services facility" means a facility licensed
247.33according to this chapter at which persons receive day services licensed under this chapter
247.34from the license holder's direct support staff for a cumulative total of more than 30 days
247.35within any 12-month period and the license holder is the owner, lessor, or tenant of the
247.36facility.
248.1    Subd. 5. Department. "Department" means the Department of Human Services.
248.2    Subd. 6. Direct contact. "Direct contact" has the meaning given in section 245C.02,
248.3subdivision 11 , and is used interchangeably with the term "direct support service."
248.4    Subd. 6a. Direct support staff or staff. "Direct support staff" or "staff" means
248.5employees of the license holder who have direct contact with persons served by the
248.6program and includes temporary staff or subcontractors, regardless of employer, providing
248.7program services for hire under the control of the license holder who have direct contact
248.8with persons served by the program.
248.9    Subd. 7. Drug. "Drug" has the meaning given in section 151.01, subdivision 5.
248.10    Subd. 8. Emergency. "Emergency" means any event that affects the ordinary
248.11daily operation of the program including, but not limited to, fires, severe weather, natural
248.12disasters, power failures, or other events that threaten the immediate health and safety of
248.13a person receiving services and that require calling 911, emergency evacuation, moving
248.14to an emergency shelter, or temporary closure or relocation of the program to another
248.15facility or service site for more than 24 hours.
248.16    Subd. 8a. Emergency use of manual restraint. "Emergency use of manual
248.17restraint" means using a manual restraint when a person poses an imminent risk of
248.18physical harm to self or others and is the least restrictive intervention that would achieve
248.19safety. Property damage, verbal aggression, or a person's refusal to receive or participate
248.20in treatment or programming on their own, do not constitute an emergency.
248.21    Subd. 8b. Expanded support team. "Expanded support team" means the members
248.22of the support team defined in subdivision 46, and a licensed health or mental health
248.23professional or other licensed, certified, or qualified professionals or consultants working
248.24with the person and included in the team at the request of the person or the person's legal
248.25representative.
248.26    Subd. 8c. Family foster care. "Family foster care" means a child foster family
248.27setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340, or an adult
248.28foster care home licensed according to Minnesota Rules, parts 9555.5105 to 9555.6265,
248.29where the license holder lives in the home.
248.30    Subd. 9. Health services. "Health services" means any service or treatment
248.31consistent with the physical and mental health needs of the person, such as medication
248.32administration and monitoring, medical, dental, nutritional, health monitoring, wellness
248.33education, and exercise.
248.34    Subd. 10. Home and community-based services. "Home and community-based
248.35services" means the services subject to the provisions of this chapter identified in section
248.36245D.03, subdivision 1, and as defined in:
249.1(1) the federal federally approved waiver plans governed by United States Code,
249.2title 42, sections 1396 et seq., or the state's alternative care program according to section
249.3256B.0913, including the waivers for persons with disabilities under section 256B.49,
249.4subdivision 11, including the brain injury (BI) waiver, plan; the community alternative
249.5care (CAC) waiver, plan; the community alternatives for disabled individuals (CADI)
249.6waiver, plan; the developmental disability (DD) waiver, plan under section 256B.092,
249.7subdivision 5; the elderly waiver (EW), and plan under section 256B.0915, subdivision 1;
249.8or successor plans respective to each waiver; or
249.9(2) the alternative care (AC) program under section 256B.0913.
249.10    Subd. 11. Incident. "Incident" means an occurrence that affects the which involves
249.11a person and requires the program to make a response that is not a part of the program's
249.12 ordinary provision of services to a that person, and includes any of the following:
249.13(1) serious injury of a person as determined by section 245.91, subdivision 6;
249.14(2) a person's death;
249.15(3) any medical emergency, unexpected serious illness, or significant unexpected
249.16change in an illness or medical condition, or the mental health status of a person that
249.17requires calling the program to call 911 or a mental health crisis intervention team,
249.18physician treatment, or hospitalization;
249.19(4) any mental health crisis that requires the program to call 911 or a mental health
249.20crisis intervention team;
249.21(5) an act or situation involving a person that requires the program to call 911,
249.22law enforcement, or the fire department;
249.23(4) (6) a person's unauthorized or unexplained absence from a program;
249.24(5) (7) physical aggression conduct by a person receiving services against another
249.25person receiving services that causes physical pain, injury, or persistent emotional distress,
249.26including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting,
249.27pushing, and spitting;:
249.28(i) is so severe, pervasive, or objectively offensive that it substantially interferes with
249.29a person's opportunities to participate in or receive service or support;
249.30(ii) places the person in actual and reasonable fear of harm;
249.31(iii) places the person in actual and reasonable fear of damage to property of the
249.32person; or
249.33(iv) substantially disrupts the orderly operation of the program;
249.34(6) (8) any sexual activity between persons receiving services involving force or
249.35coercion as defined under section 609.341, subdivisions 3 and 14; or
249.36(9) any emergency use of manual restraint as identified in section 245D.061; or
250.1(7) (10) a report of alleged or suspected child or vulnerable adult maltreatment
250.2under section 626.556 or 626.557.
250.3    Subd. 11a. Intermediate care facility for persons with developmental disabilities
250.4or ICF/DD. "Intermediate care facility for persons with developmental disabilities" or
250.5"ICF/DD" means a residential program licensed to serve four or more persons with
250.6developmental disabilities under section 252.28 and chapter 245A and licensed as a
250.7supervised living facility under chapter 144, which together are certified by the Department
250.8of Health as an intermediate care facility for persons with developmental disabilities.
250.9    Subd. 11b. Least restrictive alternative. "Least restrictive alternative" means
250.10the alternative method for providing supports and services that is the least intrusive and
250.11most normalized given the level of supervision and protection required for the person.
250.12This level of supervision and protection allows risk taking to the extent that there is no
250.13reasonable likelihood that serious harm will happen to the person or others.
250.14    Subd. 12. Legal representative. "Legal representative" means the parent of a
250.15person who is under 18 years of age, a court-appointed guardian, or other representative
250.16with legal authority to make decisions about services for a person. Other representatives
250.17with legal authority to make decisions include but are not limited to a health care agent or
250.18an attorney-in-fact authorized through a health care directive or power of attorney.
250.19    Subd. 13. License. "License" has the meaning given in section 245A.02,
250.20subdivision 8 .
250.21    Subd. 14. Licensed health professional. "Licensed health professional" means a
250.22person licensed in Minnesota to practice those professions described in section 214.01,
250.23subdivision 2 .
250.24    Subd. 15. License holder. "License holder" has the meaning given in section
250.25245A.02, subdivision 9 .
250.26    Subd. 16. Medication. "Medication" means a prescription drug or over-the-counter
250.27drug. For purposes of this chapter, "medication" includes dietary supplements.
250.28    Subd. 17. Medication administration. "Medication administration" means
250.29performing the following set of tasks to ensure a person takes both prescription and
250.30over-the-counter medications and treatments according to orders issued by appropriately
250.31licensed professionals, and includes the following:
250.32(1) checking the person's medication record;
250.33(2) preparing the medication for administration;
250.34(3) administering the medication to the person;
250.35(4) documenting the administration of the medication or the reason for not
250.36administering the medication; and
251.1(5) reporting to the prescriber or a nurse any concerns about the medication,
251.2including side effects, adverse reactions, effectiveness, or the person's refusal to take the
251.3medication or the person's self-administration of the medication.
251.4    Subd. 18. Medication assistance. "Medication assistance" means providing verbal
251.5or visual reminders to take regularly scheduled medication, which includes either of
251.6the following:
251.7(1) bringing to the person and opening a container of previously set up medications
251.8and emptying the container into the person's hand or opening and giving the medications
251.9in the original container to the person, or bringing to the person liquids or food to
251.10accompany the medication; or
251.11(2) providing verbal or visual reminders to perform regularly scheduled treatments
251.12and exercises.
251.13    Subd. 19. Medication management. "Medication management" means the
251.14provision of any of the following:
251.15(1) medication-related services to a person;
251.16(2) medication setup;
251.17(3) medication administration;
251.18(4) medication storage and security;
251.19(5) medication documentation and charting;
251.20(6) verification and monitoring of effectiveness of systems to ensure safe medication
251.21handling and administration;
251.22(7) coordination of medication refills;
251.23(8) handling changes to prescriptions and implementation of those changes;
251.24(9) communicating with the pharmacy; or
251.25(10) coordination and communication with prescriber.
251.26For the purposes of this chapter, medication management does not mean "medication
251.27therapy management services" as identified in section 256B.0625, subdivision 13h.
251.28    Subd. 20. Mental health crisis intervention team. "Mental health crisis
251.29intervention team" means a mental health crisis response providers provider as identified
251.30in section 256B.0624, subdivision 2, paragraph (d), for adults, and in section 256B.0944,
251.31subdivision 1 , paragraph (d), for children.
251.32    Subd. 20a. Most integrated setting. "Most integrated setting" means a setting that
251.33enables individuals with disabilities to interact with nondisabled persons to the fullest
251.34extent possible.
252.1    Subd. 21. Over-the-counter drug. "Over-the-counter drug" means a drug that
252.2is not required by federal law to bear the statement "Caution: Federal law prohibits
252.3dispensing without prescription."
252.4    Subd. 21a. Outcome. "Outcome" means the behavior, action, or status attained by
252.5the person that can be observed, measured, and determined reliable and valid.
252.6    Subd. 22. Person. "Person" has the meaning given in section 245A.02, subdivision
252.711 .
252.8    Subd. 23. Person with a disability. "Person with a disability" means a person
252.9determined to have a disability by the commissioner's state medical review team as
252.10identified in section 256B.055, subdivision 7, the Social Security Administration, or
252.11the person is determined to have a developmental disability as defined in Minnesota
252.12Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section
252.13252.27, subdivision 1a .
252.14    Subd. 23a. Physician. "Physician" means a person who is licensed under chapter
252.15147.
252.16    Subd. 24. Prescriber. "Prescriber" means a licensed practitioner as defined in
252.17section 151.01, subdivision 23, person who is authorized under section sections 148.235;
252.18151.01, subdivision 23; or 151.37 to prescribe drugs. For the purposes of this chapter, the
252.19term "prescriber" is used interchangeably with "physician."
252.20    Subd. 25. Prescription drug. "Prescription drug" has the meaning given in section
252.21151.01, subdivision 17 16 .
252.22    Subd. 26. Program. "Program" means either the nonresidential or residential
252.23program as defined in section 245A.02, subdivisions 10 and 14.
252.24    Subd. 27. Psychotropic medication. "Psychotropic medication" means any
252.25medication prescribed to treat the symptoms of mental illness that affect thought processes,
252.26mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic
252.27(neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and
252.28stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder.
252.29Other miscellaneous medications are considered to be a psychotropic medication when
252.30they are specifically prescribed to treat a mental illness or to control or alter behavior.
252.31    Subd. 28. Restraint. "Restraint" means physical or mechanical limiting of the free
252.32and normal movement of body or limbs.
252.33    Subd. 29. Seclusion. "Seclusion" means separating a person from others in a way
252.34that prevents social contact and prevents the person from leaving the situation if he or she
252.35chooses the placement of a person alone in a room from which exit is prohibited by a staff
253.1person or a mechanism such as a lock, a device, or an object positioned to hold the door
253.2closed or otherwise prevent the person from leaving the room.
253.3    Subd. 29a. Self-determination. "Self-determination" means the person makes
253.4decisions independently, plans for the person's own future, determines how money is spent
253.5for the person's supports, and takes responsibility for making these decisions. If a person
253.6has a legal representative, the legal representative's decision-making authority is limited to
253.7the scope of authority granted by the court or allowed in the document authorizing the
253.8legal representative to act.
253.9    Subd. 29b. Semi-independent living services. "Semi-independent living services"
253.10has the meaning given in section 252.275.
253.11    Subd. 30. Service. "Service" means care, training, supervision, counseling,
253.12consultation, or medication assistance assigned to the license holder in the coordinated
253.13service and support plan.
253.14    Subd. 31. Service plan. "Service plan" means the individual service plan or
253.15individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
253.16or successor provisions, and includes any support plans or service needs identified as
253.17a result of long-term care consultation, or a support team meeting that includes the
253.18participation of the person, the person's legal representative, and case manager, or assigned
253.19to a license holder through an authorized service agreement.
253.20    Subd. 32. Service site. "Service site" means the location where the service is
253.21provided to the person, including, but not limited to, a facility licensed according to
253.22chapter 245A; a location where the license holder is the owner, lessor, or tenant; a person's
253.23own home; or a community-based location.
253.24    Subd. 33. Staff. "Staff" means an employee who will have direct contact with a
253.25person served by the facility, agency, or program.
253.26    Subd. 33a. Supervised living facility. "Supervised living facility" has the meaning
253.27given in Minnesota Rules, part 4665.0100, subpart 10.
253.28    Subd. 33b. Supervision. (a) "Supervision" means:
253.29(1) oversight by direct support staff as specified in the person's coordinated service
253.30and support plan or coordinated service and support plan addendum and awareness of
253.31the person's needs and activities;
253.32(2) responding to situations that present a serious risk to the health, safety, or rights
253.33of the person while services are being provided; and
253.34(3) the presence of direct support staff at a service site while services are being
253.35provided, unless a determination has been made and documented in the person's coordinated
254.1service and support plan or coordinated service and support plan addendum that the person
254.2does not require the presence of direct support staff while services are being provided.
254.3(b) For the purposes of this definition, "while services are being provided," means
254.4any period of time during which the license holder will seek reimbursement for services.
254.5    Subd. 34. Support team. "Support team" means the service planning team
254.6identified in section 256B.49, subdivision 15, or the interdisciplinary team identified in
254.7Minnesota Rules, part 9525.0004, subpart 14.
254.8    Subd. 34a. Time out. "Time out" means removing a person involuntarily from an
254.9ongoing activity to a room, either locked or unlocked, or otherwise separating a person
254.10from others in a way that prevents social contact and prevents the person from leaving
254.11the situation if the person chooses. For the purpose of chapter 245D, "time out" does
254.12not mean voluntary removal or self-removal for the purpose of calming, prevention of
254.13escalation, or de-escalation of behavior for a period of up to 15 minutes. "Time out"
254.14does not include a person voluntarily moving from an ongoing activity to an unlocked
254.15room or otherwise separating from a situation or social contact with others if the person
254.16chooses. For the purposes of this definition, "voluntarily" means without being forced,
254.17compelled, or coerced.
254.18    Subd. 35. Unit of government. "Unit of government" means every city, county,
254.19town, school district, other political subdivisions of the state, and any agency of the state
254.20or the United States, and includes any instrumentality of a unit of government.
254.21    Subd. 35a. Treatment. "Treatment" means the provision of care, other than
254.22medications, ordered or prescribed by a licensed health or mental health professional,
254.23provided to a person to cure, rehabilitate, or ease symptoms.
254.24    Subd. 36. Volunteer. "Volunteer" means an individual who, under the direction of the
254.25license holder, provides direct services without pay to a person served by the license holder.
254.26EFFECTIVE DATE.This section is effective January 1, 2014.

254.27    Sec. 18. Minnesota Statutes 2012, section 245D.03, is amended to read:
254.28245D.03 APPLICABILITY AND EFFECT.
254.29    Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of
254.30home and community-based services to persons with disabilities and persons age 65 and
254.31older pursuant to this chapter. The licensing standards in this chapter govern the provision
254.32of the following basic support services: and intensive support services.
254.33(1) housing access coordination as defined under the current BI, CADI, and DD
254.34waiver plans or successor plans;
255.1(2) respite services as defined under the current CADI, BI, CAC, DD, and EW
255.2waiver plans or successor plans when the provider is an individual who is not an employee
255.3of a residential or nonresidential program licensed by the Department of Human Services
255.4or the Department of Health that is otherwise providing the respite service;
255.5(3) behavioral programming as defined under the current BI and CADI waiver
255.6plans or successor plans;
255.7(4) specialist services as defined under the current DD waiver plan or successor plans;
255.8(5) companion services as defined under the current BI, CADI, and EW waiver
255.9plans or successor plans, excluding companion services provided under the Corporation
255.10for National and Community Services Senior Companion Program established under the
255.11Domestic Volunteer Service Act of 1973, Public Law 98-288;
255.12(6) personal support as defined under the current DD waiver plan or successor plans;
255.13(7) 24-hour emergency assistance, on-call and personal emergency response as
255.14defined under the current CADI and DD waiver plans or successor plans;
255.15(8) night supervision services as defined under the current BI waiver plan or
255.16successor plans;
255.17(9) homemaker services as defined under the current CADI, BI, CAC, DD, and EW
255.18waiver plans or successor plans, excluding providers licensed by the Department of Health
255.19under chapter 144A and those providers providing cleaning services only;
255.20(10) independent living skills training as defined under the current BI and CADI
255.21waiver plans or successor plans;
255.22(11) prevocational services as defined under the current BI and CADI waiver plans
255.23or successor plans;
255.24(12) structured day services as defined under the current BI waiver plan or successor
255.25plans; or
255.26(13) supported employment as defined under the current BI and CADI waiver plans
255.27or successor plans.
255.28(b) Basic support services provide the level of assistance, supervision, and care that
255.29is necessary to ensure the health and safety of the person and do not include services that
255.30are specifically directed toward the training, treatment, habilitation, or rehabilitation of
255.31the person. Basic support services include:
255.32(1) in-home and out-of-home respite care services as defined in section 245A.02,
255.33subdivision 15, and under the brain injury, community alternative care, community
255.34alternatives for disabled individuals, developmental disability, and elderly waiver plans;
255.35(2) companion services as defined under the brain injury, community alternatives for
255.36disabled individuals, and elderly waiver plans, excluding companion services provided
256.1under the Corporation for National and Community Services Senior Companion Program
256.2established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
256.3(3) personal support as defined under the developmental disability waiver plan;
256.4(4) 24-hour emergency assistance, personal emergency response as defined under the
256.5community alternatives for disabled individuals and developmental disability waiver plans;
256.6(5) night supervision services as defined under the brain injury waiver plan; and
256.7(6) homemaker services as defined under the community alternatives for disabled
256.8individuals, brain injury, community alternative care, developmental disability, and elderly
256.9waiver plans, excluding providers licensed by the Department of Health under chapter
256.10144A and those providers providing cleaning services only.
256.11(c) Intensive support services provide assistance, supervision, and care that is
256.12necessary to ensure the health and safety of the person and services specifically directed
256.13toward the training, habilitation, or rehabilitation of the person. Intensive support services
256.14include:
256.15(1) intervention services, including:
256.16(i) behavioral support services as defined under the brain injury and community
256.17alternatives for disabled individuals waiver plans;
256.18(ii) in-home or out-of-home crisis respite services as defined under the developmental
256.19disability waiver plan; and
256.20(iii) specialist services as defined under the current developmental disability waiver
256.21plan;
256.22(2) in-home support services, including:
256.23(i) in-home family support and supported living services as defined under the
256.24developmental disability waiver plan;
256.25(ii) independent living services training as defined under the brain injury and
256.26community alternatives for disabled individuals waiver plans; and
256.27(iii) semi-independent living services;
256.28(3) residential supports and services, including:
256.29(i) supported living services as defined under the developmental disability waiver
256.30plan provided in a family or corporate child foster care residence, a family adult foster
256.31care residence, a community residential setting, or a supervised living facility;
256.32(ii) foster care services as defined in the brain injury, community alternative care,
256.33and community alternatives for disabled individuals waiver plans provided in a family or
256.34corporate child foster care residence, a family adult foster care residence, or a community
256.35residential setting; and
257.1(iii) residential services provided in a supervised living facility that is certified by
257.2the Department of Health as an ICF/DD;
257.3(4) day services, including:
257.4(i) structured day services as defined under the brain injury waiver plan;
257.5(ii) day training and habilitation services under sections 252.40 to 252.46, and as
257.6defined under the developmental disability waiver plan; and
257.7(iii) prevocational services as defined under the brain injury and community
257.8alternatives for disabled individuals waiver plans; and
257.9(5) supported employment as defined under the brain injury, developmental
257.10disability, and community alternatives for disabled individuals waiver plans.
257.11    Subd. 2. Relationship to other standards governing home and community-based
257.12services. (a) A license holder governed by this chapter is also subject to the licensure
257.13requirements under chapter 245A.
257.14(b) A license holder concurrently providing child foster care services licensed
257.15according to Minnesota Rules, chapter 2960, to the same person receiving a service licensed
257.16under this chapter is exempt from section 245D.04 as it applies to the person. A corporate
257.17or family child foster care site controlled by a license holder and providing services
257.18governed by this chapter is exempt from compliance with section 245D.04. This exemption
257.19applies to foster care homes where at least one resident is receiving residential supports
257.20and services licensed according to this chapter. This chapter does not apply to corporate or
257.21family child foster care homes that do not provide services licensed under this chapter.
257.22(c) A family adult foster care site controlled by a license holder and providing
257.23services governed by this chapter is exempt from compliance with Minnesota Rules, parts
257.249555.6185; 9555.6225, subpart 8; 9555.6235, item C; 9555.6245; 9555.6255, subpart
257.252; and 9555.6265. These exemptions apply to family adult foster care homes where at
257.26least one resident is receiving residential supports and services licensed according to this
257.27chapter. This chapter does not apply to family adult foster care homes that do not provide
257.28services licensed under this chapter.
257.29(d) A license holder providing services licensed according to this chapter in a
257.30supervised living facility is exempt from compliance with sections 245D.04; 245D.05,
257.31subdivision 2; and 245D.06, subdivision 2, clauses (1), (4), and (5).
257.32(e) A license holder providing residential services to persons in an ICF/DD is exempt
257.33from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision
257.342, clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09,
257.35subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.
258.1(c) (f) A license holder concurrently providing home care homemaker services
258.2registered licensed according to sections 144A.43 to 144A.49 to the same person receiving
258.3home management services licensed under this chapter and registered according to chapter
258.4144A is exempt from compliance with section 245D.04 as it applies to the person.
258.5(d) A license holder identified in subdivision 1, clauses (1), (5), and (9), is exempt
258.6from compliance with sections 245A.65, subdivision 2, paragraph (a), and 626.557,
258.7subdivision 14 , paragraph (b).
258.8(e) Notwithstanding section 245D.06, subdivision 5, a license holder providing
258.9structured day, prevocational, or supported employment services under this chapter
258.10and day training and habilitation or supported employment services licensed under
258.11chapter 245B within the same program is exempt from compliance with this chapter
258.12when the license holder notifies the commissioner in writing that the requirements under
258.13chapter 245B will be met for all persons receiving these services from the program. For
258.14the purposes of this paragraph, if the license holder has obtained approval from the
258.15commissioner for an alternative inspection status according to section 245B.031, that
258.16approval will apply to all persons receiving services in the program.
258.17(g) Nothing in this chapter prohibits a license holder from concurrently serving
258.18persons without disabilities or people who are or are not age 65 and older, provided this
258.19chapter's standards are met as well as other relevant standards.
258.20(h) The documentation required under sections 245D.07 and 245D.071 must meet
258.21the individual program plan requirements identified in section 256B.092 or successor
258.22provisions.
258.23    Subd. 3. Variance. If the conditions in section 245A.04, subdivision 9, are met,
258.24the commissioner may grant a variance to any of the requirements in this chapter, except
258.25sections 245D.04, and 245D.10, subdivision 4, paragraph (b) 245D.06, subdivision 4,
258.26paragraph (b), and 245D.061, subdivision 3, or provisions governing data practices and
258.27information rights of persons.
258.28    Subd. 4. License holders with multiple 245D licenses. (a) When a person changes
258.29service from one license to a different license held by the same license holder, the license
258.30holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).
258.31(b) When a staff person begins providing direct service under one or more licenses
258.32held by the same license holder, other than the license for which staff orientation was
258.33initially provided according to section 245D.09, subdivision 4, the license holder is
258.34exempt from those staff orientation requirements, except the staff person must review each
258.35person's service plan and medication administration procedures in accordance with section
258.36245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.
259.1    Subd. 5. Program certification. An applicant or a license holder may apply for
259.2program certification as identified in section 245D.33.
259.3EFFECTIVE DATE.This section is effective January 1, 2014.

259.4    Sec. 19. Minnesota Statutes 2012, section 245D.04, is amended to read:
259.5245D.04 SERVICE RECIPIENT RIGHTS.
259.6    Subdivision 1. License holder responsibility for individual rights of persons
259.7served by the program. The license holder must:
259.8(1) provide each person or each person's legal representative with a written notice
259.9that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of
259.10those rights within five working days of service initiation and annually thereafter;
259.11(2) make reasonable accommodations to provide this information in other formats
259.12or languages as needed to facilitate understanding of the rights by the person and the
259.13person's legal representative, if any;
259.14(3) maintain documentation of the person's or the person's legal representative's
259.15receipt of a copy and an explanation of the rights; and
259.16(4) ensure the exercise and protection of the person's rights in the services provided
259.17by the license holder and as authorized in the coordinated service and support plan.
259.18    Subd. 2. Service-related rights. A person's service-related rights include the right to:
259.19(1) participate in the development and evaluation of the services provided to the
259.20person;
259.21(2) have services and supports identified in the coordinated service and support plan
259.22and the coordinated service and support plan addendum provided in a manner that respects
259.23and takes into consideration the person's preferences according to the requirements in
259.24sections 245D.07 and 245D.071;
259.25(3) refuse or terminate services and be informed of the consequences of refusing
259.26or terminating services;
259.27(4) know, in advance, limits to the services available from the license holder,
259.28including the license holder's knowledge, skill, and ability to meet the person's service and
259.29support needs based on the information required in section 245D.031, subdivision 2;
259.30(5) know conditions and terms governing the provision of services, including the
259.31license holder's admission criteria and policies and procedures related to temporary
259.32service suspension and service termination;
259.33(6) a coordinated transfer to ensure continuity of care when there will be a change
259.34in the provider;
260.1(7) know what the charges are for services, regardless of who will be paying for the
260.2services, and be notified of changes in those charges;
260.3(7) (8) know, in advance, whether services are covered by insurance, government
260.4funding, or other sources, and be told of any charges the person or other private party
260.5may have to pay; and
260.6(8) (9) receive services from an individual who is competent and trained, who has
260.7professional certification or licensure, as required, and who meets additional qualifications
260.8identified in the person's coordinated service and support plan. or coordinated service and
260.9support plan addendum.
260.10    Subd. 3. Protection-related rights. (a) A person's protection-related rights include
260.11the right to:
260.12(1) have personal, financial, service, health, and medical information kept private,
260.13and be advised of disclosure of this information by the license holder;
260.14(2) access records and recorded information about the person in accordance with
260.15applicable state and federal law, regulation, or rule;
260.16(3) be free from maltreatment;
260.17(4) be free from restraint, time out, or seclusion used for a purpose other than except
260.18for emergency use of manual restraint to protect the person from imminent danger to self
260.19or others according to the requirements in section 245D.06;
260.20(5) receive services in a clean and safe environment when the license holder is the
260.21owner, lessor, or tenant of the service site;
260.22(6) be treated with courtesy and respect and receive respectful treatment of the
260.23person's property;
260.24(7) reasonable observance of cultural and ethnic practice and religion;
260.25(8) be free from bias and harassment regarding race, gender, age, disability,
260.26spirituality, and sexual orientation;
260.27(9) be informed of and use the license holder's grievance policy and procedures,
260.28including knowing how to contact persons responsible for addressing problems and to
260.29appeal under section 256.045;
260.30(10) know the name, telephone number, and the Web site, e-mail, and street
260.31addresses of protection and advocacy services, including the appropriate state-appointed
260.32ombudsman, and a brief description of how to file a complaint with these offices;
260.33(11) assert these rights personally, or have them asserted by the person's family,
260.34authorized representative, or legal representative, without retaliation;
260.35(12) give or withhold written informed consent to participate in any research or
260.36experimental treatment;
261.1(13) associate with other persons of the person's choice;
261.2(14) personal privacy; and
261.3(15) engage in chosen activities.
261.4(b) For a person residing in a residential site licensed according to chapter 245A,
261.5or where the license holder is the owner, lessor, or tenant of the residential service site,
261.6protection-related rights also include the right to:
261.7(1) have daily, private access to and use of a non-coin-operated telephone for local
261.8calls and long-distance calls made collect or paid for by the person;
261.9(2) receive and send, without interference, uncensored, unopened mail or electronic
261.10correspondence or communication; and
261.11(3) have use of and free access to common areas in the residence; and
261.12(4) privacy for visits with the person's spouse, next of kin, legal counsel, religious
261.13advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
261.14privacy in the person's bedroom.
261.15(c) Restriction of a person's rights under subdivision 2, clause (10), or paragraph (a),
261.16clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure
261.17the health, safety, and well-being of the person. Any restriction of those rights must be
261.18documented in the person's coordinated service and support plan for the person and or
261.19coordinated service and support plan addendum. The restriction must be implemented
261.20in the least restrictive alternative manner necessary to protect the person and provide
261.21support to reduce or eliminate the need for the restriction in the most integrated setting
261.22and inclusive manner. The documentation must include the following information:
261.23(1) the justification for the restriction based on an assessment of the person's
261.24vulnerability related to exercising the right without restriction;
261.25(2) the objective measures set as conditions for ending the restriction;
261.26(3) a schedule for reviewing the need for the restriction based on the conditions for
261.27ending the restriction to occur, at a minimum, every three months for persons who do not
261.28have a legal representative and annually for persons who do have a legal representative
261.29 semiannually from the date of initial approval, at a minimum, or more frequently if
261.30requested by the person, the person's legal representative, if any, and case manager; and
261.31(4) signed and dated approval for the restriction from the person, or the person's
261.32legal representative, if any. A restriction may be implemented only when the required
261.33approval has been obtained. Approval may be withdrawn at any time. If approval is
261.34withdrawn, the right must be immediately and fully restored.
261.35EFFECTIVE DATE.This section is effective January 1, 2014.

262.1    Sec. 20. Minnesota Statutes 2012, section 245D.05, is amended to read:
262.2245D.05 HEALTH SERVICES.
262.3    Subdivision 1. Health needs. (a) The license holder is responsible for providing
262.4 meeting health services service needs assigned in the coordinated service and support plan
262.5and or the coordinated service and support plan addendum, consistent with the person's
262.6health needs. The license holder is responsible for promptly notifying the person or
262.7 the person's legal representative, if any, and the case manager of changes in a person's
262.8physical and mental health needs affecting assigned health services service needs assigned
262.9to the license holder in the coordinated service and support plan or the coordinated service
262.10and support plan addendum, when discovered by the license holder, unless the license
262.11holder has reason to know the change has already been reported. The license holder
262.12must document when the notice is provided.
262.13(b) When assigned in the service plan, If responsibility for meeting the person's
262.14health service needs has been assigned to the license holder in the coordinated service and
262.15support plan or the coordinated service and support plan addendum, the license holder is
262.16required to must maintain documentation on how the person's health needs will be met,
262.17including a description of the procedures the license holder will follow in order to:
262.18(1) provide medication administration, assistance or medication assistance, or
262.19medication management administration according to this chapter;
262.20(2) monitor health conditions according to written instructions from the person's
262.21physician or a licensed health professional;
262.22(3) assist with or coordinate medical, dental, and other health service appointments; or
262.23(4) use medical equipment, devices, or adaptive aides or technology safely and
262.24correctly according to written instructions from the person's physician or a licensed
262.25health professional.
262.26    Subd. 1a. Medication setup. For the purposes of this subdivision, "medication
262.27setup" means the arranging of medications according to instructions from the pharmacy,
262.28the prescriber, or a licensed nurse, for later administration when the license holder
262.29is assigned responsibility for medication assistance or medication administration in
262.30the coordinated service and support plan or the coordinated service and support plan
262.31addendum. A prescription label or the prescriber's written or electronically recorded order
262.32for the prescription is sufficient to constitute written instructions from the prescriber. The
262.33license holder must document in the person's medication administration record: dates
262.34of setup, name of medication, quantity of dose, times to be administered, and route of
262.35administration at time of setup; and, when the person will be away from home, to whom
262.36the medications were given.
263.1    Subd. 1b. Medication assistance. If responsibility for medication assistance
263.2is assigned to the license holder in the coordinated service and support plan or the
263.3coordinated service and support plan addendum, the license holder must ensure that
263.4the requirements of subdivision 2, paragraph (b), have been met when staff provides
263.5medication assistance to enable a person to self-administer medication or treatment when
263.6the person is capable of directing the person's own care, or when the person's legal
263.7representative is present and able to direct care for the person. For the purposes of this
263.8subdivision, "medication assistance" means any of the following:
263.9(1) bringing to the person and opening a container of previously set up medications,
263.10emptying the container into the person's hand, or opening and giving the medications in
263.11the original container to the person;
263.12(2) bringing to the person liquids or food to accompany the medication; or
263.13(3) providing reminders to take regularly scheduled medication or perform regularly
263.14scheduled treatments and exercises.
263.15    Subd. 2. Medication administration. (a) If responsibility for medication
263.16administration is assigned to the license holder in the coordinated service and support plan
263.17or the coordinated service and support plan addendum, the license holder must implement
263.18the following medication administration procedures to ensure a person takes medications
263.19and treatments as prescribed:
263.20(1) checking the person's medication record;
263.21(2) preparing the medication as necessary;
263.22(3) administering the medication or treatment to the person;
263.23(4) documenting the administration of the medication or treatment or the reason for
263.24not administering the medication or treatment; and
263.25(5) reporting to the prescriber or a nurse any concerns about the medication or
263.26treatment, including side effects, effectiveness, or a pattern of the person refusing to
263.27take the medication or treatment as prescribed. Adverse reactions must be immediately
263.28reported to the prescriber or a nurse.
263.29(b)(1) The license holder must ensure that the following criteria requirements in
263.30clauses (2) to (4) have been met before staff that is not a licensed health professional
263.31administers administering medication or treatment:.
263.32(1) (2) The license holder must obtain written authorization has been obtained from
263.33the person or the person's legal representative to administer medication or treatment
263.34orders; and must obtain reauthorization annually as needed. If the person or the person's
263.35legal representative refuses to authorize the license holder to administer medication, the
264.1medication must not be administered. The refusal to authorize medication administration
264.2must be reported to the prescriber as expediently as possible.
264.3(2) (3) The staff person has completed responsible for administering the medication
264.4or treatment must complete medication administration training according to section
264.5245D.09, subdivision 4 , paragraph 4a, paragraphs (a) and (c), clause (2); and, as applicable
264.6to the person, paragraph (d).
264.7(3) The medication or treatment will be administered under administration
264.8procedures established for the person in consultation with a licensed health professional.
264.9written instruction from the person's physician may constitute the medication
264.10administration procedures. A prescription label or the prescriber's order for the
264.11prescription is sufficient to constitute written instructions from the prescriber. A licensed
264.12health professional may delegate medication administration procedures.
264.13(4) For a license holder providing intensive support services, the medication or
264.14treatment must be administered according to the license holder's medication administration
264.15policy and procedures as required under section 245D.11, subdivision 2, clause (3).
264.16(b) (c) The license holder must ensure the following information is documented in
264.17the person's medication administration record:
264.18(1) the information on the current prescription label or the prescriber's current written
264.19or electronically recorded order or prescription that includes directions for the person's
264.20name, description of the medication or treatment to be provided, and the frequency and
264.21other information needed to safely and correctly administering administer the medication
264.22or treatment to ensure effectiveness;
264.23(2) information on any discomforts, risks, or other side effects that are reasonable to
264.24expect, and any contraindications to its use. This information must be readily available
264.25to all staff administering the medication;
264.26(3) the possible consequences if the medication or treatment is not taken or
264.27administered as directed;
264.28(4) instruction from the prescriber on when and to whom to report the following:
264.29(i) if the a dose of medication or treatment is not administered or treatment is not
264.30performed as prescribed, whether by error by the staff or the person or by refusal by
264.31the person; and
264.32(ii) the occurrence of possible adverse reactions to the medication or treatment;
264.33(5) notation of any occurrence of a dose of medication not being administered or
264.34treatment not performed as prescribed, whether by error by the staff or the person or by
264.35refusal by the person, or of adverse reactions, and when and to whom the report was
264.36made; and
265.1(6) notation of when a medication or treatment is started, administered, changed, or
265.2discontinued.
265.3(c) The license holder must ensure that the information maintained in the medication
265.4administration record is current and is regularly reviewed with the person or the person's
265.5legal representative and the staff administering the medication to identify medication
265.6administration issues or errors. At a minimum, the review must be conducted every three
265.7months or more often if requested by the person or the person's legal representative.
265.8Based on the review, the license holder must develop and implement a plan to correct
265.9medication administration issues or errors. If issues or concerns are identified related to
265.10the medication itself, the license holder must report those as required under subdivision 4.
265.11    Subd. 3. Medication assistance. The license holder must ensure that the
265.12requirements of subdivision 2, paragraph (a), have been met when staff provides assistance
265.13to enable a person to self-administer medication when the person is capable of directing
265.14the person's own care, or when the person's legal representative is present and able to
265.15direct care for the person.
265.16    Subd. 4. Reviewing and reporting medication and treatment issues. The
265.17following medication administration issues must be reported to the person or the person's
265.18legal representative and case manager as they occur or following timelines established
265.19in the person's service plan or as requested in writing by the person or the person's legal
265.20representative, or the case manager: (a) When assigned responsibility for medication
265.21administration, the license holder must ensure that the information maintained in
265.22the medication administration record is current and is regularly reviewed to identify
265.23medication administration errors. At a minimum, the review must be conducted every
265.24three months, or more frequently as directed in the coordinated service and support plan
265.25or coordinated service and support plan addendum or as requested by the person or the
265.26person's legal representative. Based on the review, the license holder must develop and
265.27implement a plan to correct patterns of medication administration errors when identified.
265.28(b) If assigned responsibility for medication assistance or medication administration,
265.29the license holder must report the following to the person's legal representative and case
265.30manager as they occur or as otherwise directed in the coordinated service and support plan
265.31or the coordinated service and support plan addendum:
265.32(1) any reports made to the person's physician or prescriber required under
265.33subdivision 2, paragraph (b) (c), clause (4);
265.34(2) a person's refusal or failure to take or receive medication or treatment as
265.35prescribed; or
265.36(3) concerns about a person's self-administration of medication or treatment.
266.1    Subd. 5. Injectable medications. Injectable medications may be administered
266.2according to a prescriber's order and written instructions when one of the following
266.3conditions has been met:
266.4(1) a registered nurse or licensed practical nurse will administer the subcutaneous or
266.5intramuscular injection;
266.6(2) a supervising registered nurse with a physician's order has delegated the
266.7administration of subcutaneous injectable medication to an unlicensed staff member
266.8and has provided the necessary training; or
266.9(3) there is an agreement signed by the license holder, the prescriber, and the
266.10person or the person's legal representative specifying what subcutaneous injections may
266.11be given, when, how, and that the prescriber must retain responsibility for the license
266.12holder's giving the injections. A copy of the agreement must be placed in the person's
266.13service recipient record.
266.14Only licensed health professionals are allowed to administer psychotropic
266.15medications by injection.
266.16EFFECTIVE DATE.This section is effective January 1, 2014.

266.17    Sec. 21. [245D.051] PSYCHOTROPIC MEDICATION USE AND
266.18MONITORING.
266.19    Subdivision 1. Conditions for psychotropic medication administration. (a)
266.20When a person is prescribed a psychotropic medication and the license holder is assigned
266.21responsibility for administration of the medication in the person's coordinated service
266.22and support plan or the coordinated service and support plan addendum, the license
266.23holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05,
266.24subdivision 2, are met.
266.25(b) Use of the medication must be included in the person's coordinated service and
266.26support plan or in the coordinated service and support plan addendum and based on a
266.27prescriber's current written or electronically recorded prescription.
266.28(c) The license holder must develop, implement, and maintain the following
266.29documentation in the person's coordinated service and support plan addendum according
266.30to the requirements in sections 245D.07 and 245D.071:
266.31(1) a description of the target symptoms that the psychotropic medication is to
266.32alleviate; and
266.33(2) documentation methods the license holder will use to monitor and measure
266.34changes in the target symptoms that are to be alleviated by the psychotropic medication if
266.35required by the prescriber. The license holder must collect and report on medication and
267.1symptom-related data as instructed by the prescriber. The license holder must provide
267.2the monitoring data to the expanded support team for review every three months, or as
267.3otherwise requested by the person or the person's legal representative.
267.4For the purposes of this section, "target symptom" refers to any perceptible
267.5diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic
267.6and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
267.7successive editions that has been identified for alleviation.
267.8(d) If a person is prescribed a psychotropic medication, monitoring the use of the
267.9psychotropic medication must be assigned to the license holder in the coordinated service
267.10and support plan or the coordinated service and support plan addendum. The assigned
267.11license holder must monitor the psychotropic medication as required by this section.
267.12    Subd. 2. Refusal to authorize psychotropic medication. If the person or the
267.13person's legal representative refuses to authorize the administration of a psychotropic
267.14medication as ordered by the prescriber, the license holder must follow the requirement
267.15in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal
267.16to the prescriber, the license holder must follow any directives or orders given by the
267.17prescriber. A court order must be obtained to override the refusal. Refusal to authorize
267.18administration of a specific psychotropic medication is not grounds for service termination
267.19and does not constitute an emergency. A decision to terminate services must be reached in
267.20compliance with section 245D.10, subdivision 3.
267.21EFFECTIVE DATE.This section is effective January 1, 2014.

267.22    Sec. 22. Minnesota Statutes 2012, section 245D.06, is amended to read:
267.23245D.06 PROTECTION STANDARDS.
267.24    Subdivision 1. Incident response and reporting. (a) The license holder must
267.25respond to all incidents under section 245D.02, subdivision 11, that occur while providing
267.26services to protect the health and safety of and minimize risk of harm to the person.
267.27(b) The license holder must maintain information about and report incidents to the
267.28person's legal representative or designated emergency contact and case manager within 24
267.29hours of an incident occurring while services are being provided, or within 24 hours of
267.30discovery or receipt of information that an incident occurred, unless the license holder
267.31has reason to know that the incident has already been reported, or as otherwise directed
267.32in a person's coordinated service and support plan or coordinated service and support
267.33plan addendum. An incident of suspected or alleged maltreatment must be reported as
268.1required under paragraph (d), and an incident of serious injury or death must be reported
268.2as required under paragraph (e).
268.3(c) When the incident involves more than one person, the license holder must not
268.4disclose personally identifiable information about any other person when making the report
268.5to each person and case manager unless the license holder has the consent of the person.
268.6(d) Within 24 hours of reporting maltreatment as required under section 626.556
268.7or 626.557, the license holder must inform the case manager of the report unless there is
268.8reason to believe that the case manager is involved in the suspected maltreatment. The
268.9license holder must disclose the nature of the activity or occurrence reported and the
268.10agency that received the report.
268.11(e) The license holder must report the death or serious injury of the person to the legal
268.12representative, if any, and case manager, as required in paragraph (b) and to the Department
268.13of Human Services Licensing Division, and the Office of Ombudsman for Mental Health
268.14and Developmental Disabilities as required under section 245.94, subdivision 2a, within
268.1524 hours of the death, or receipt of information that the death occurred, unless the license
268.16holder has reason to know that the death has already been reported.
268.17(f) When a death or serious injury occurs in a facility certified as an intermediate
268.18care facility for persons with developmental disabilities, the death or serious injury must
268.19be reported to the Department of Health, Office of Health Facility Complaints, and the
268.20Office of Ombudsman for Mental Health and Developmental Disabilities, as required
268.21under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
268.22know that the death has already been reported.
268.23(f) (g) The license holder must conduct a an internal review of incident reports of
268.24deaths and serious injuries that occurred while services were being provided and that
268.25were not reported by the program as alleged or suspected maltreatment, for identification
268.26of incident patterns, and implementation of corrective action as necessary to reduce
268.27occurrences. The review must include an evaluation of whether related policies and
268.28procedures were followed, whether the policies and procedures were adequate, whether
268.29there is a need for additional staff training, whether the reported event is similar to past
268.30events with the persons or the services involved, and whether there is a need for corrective
268.31action by the license holder to protect the health and safety of persons receiving services.
268.32Based on the results of this review, the license holder must develop, document, and
268.33implement a corrective action plan designed to correct current lapses and prevent future
268.34lapses in performance by staff or the license holder, if any.
268.35(h) The license holder must verbally report the emergency use of manual restraint of
268.36a person as required in paragraph (b), within 24 hours of the occurrence. The license holder
269.1must ensure the written report and internal review of all incident reports of the emergency
269.2use of manual restraints are completed according to the requirements in section 245D.061.
269.3    Subd. 2. Environment and safety. The license holder must:
269.4(1) ensure the following when the license holder is the owner, lessor, or tenant
269.5of the an unlicensed service site:
269.6(i) the service site is a safe and hazard-free environment;
269.7(ii) doors are locked or toxic substances or dangerous items normally accessible are
269.8inaccessible to persons served by the program are stored in locked cabinets, drawers, or
269.9containers only to protect the safety of a person receiving services and not as a substitute
269.10for staff supervision or interactions with a person who is receiving services. If doors are
269.11locked or toxic substances or dangerous items normally accessible to persons served by the
269.12program are stored in locked cabinets, drawers, or containers are made inaccessible, the
269.13license holder must justify and document how this determination was made in consultation
269.14with the person or person's legal representative, and how access will otherwise be provided
269.15to the person and all other affected persons receiving services; and document an assessment
269.16of the physical plant, its environment, and its population identifying the risk factors which
269.17require toxic substances or dangerous items to be inaccessible and a statement of specific
269.18measures to be taken to minimize the safety risk to persons receiving services;
269.19(iii) doors are locked from the inside to prevent a person from exiting only when
269.20necessary to protect the safety of a person receiving services and not as a substitute for
269.21staff supervision or interactions with the person. If doors are locked from the inside, the
269.22license holder must document an assessment of the physical plant, the environment and
269.23the population served, identifying the risk factors which require the use of locked doors,
269.24and a statement of specific measures to be taken to minimize the safety risk to persons
269.25receiving services at the service site; and
269.26(iii) (iv) a staff person is available on site who is trained in basic first aid and, when
269.27required in a person's coordinated service and support plan or coordinated service and
269.28support plan addendum, cardiopulmonary resuscitation, whenever persons are present and
269.29staff are required to be at the site to provide direct service. The training must include
269.30in-person instruction, hands-on practice, and an observed skills assessment under the
269.31direct supervision of a first aid instructor;
269.32(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
269.33license holder in good condition when used to provide services;
269.34(3) follow procedures to ensure safe transportation, handling, and transfers of the
269.35person and any equipment used by the person, when the license holder is responsible for
269.36transportation of a person or a person's equipment;
270.1(4) be prepared for emergencies and follow emergency response procedures to
270.2ensure the person's safety in an emergency; and
270.3(5) follow universal precautions and sanitary practices, including hand washing, for
270.4infection prevention and control, and to prevent communicable diseases.
270.5    Subd. 3. Compliance with fire and safety codes. When services are provided at a
270.6 service site licensed according to chapter 245A or where the license holder is the owner,
270.7lessor, or tenant of the service site, the license holder must document compliance with
270.8applicable building codes, fire and safety codes, health rules, and zoning ordinances, or
270.9document that an appropriate waiver has been granted.
270.10    Subd. 4. Funds and property. (a) Whenever the license holder assists a person
270.11with the safekeeping of funds or other property according to section 245A.04, subdivision
270.1213 , the license holder must have obtain written authorization to do so from the person or
270.13the person's legal representative and the case manager. Authorization must be obtained
270.14within five working days of service initiation and renewed annually thereafter. At the time
270.15initial authorization is obtained, the license holder must survey, document, and implement
270.16the preferences of the person or the person's legal representative and the case manager
270.17for frequency of receiving a statement that itemizes receipts and disbursements of funds
270.18or other property. The license holder must document changes to these preferences when
270.19they are requested.
270.20(b) A license holder or staff person may not accept powers-of-attorney from a
270.21person receiving services from the license holder for any purpose, and may not accept an
270.22appointment as guardian or conservator of a person receiving services from the license
270.23holder. This does not apply to license holders that are Minnesota counties or other
270.24units of government or to staff persons employed by license holders who were acting
270.25as power-of-attorney, guardian, or conservator attorney-in-fact for specific individuals
270.26prior to April 23, 2012 implementation of this chapter. The license holder must maintain
270.27documentation of the power-of-attorney, guardianship, or conservatorship in the service
270.28recipient record.
270.29(c) Upon the transfer or death of a person, any funds or other property of the person
270.30must be surrendered to the person or the person's legal representative, or given to the
270.31executor or administrator of the estate in exchange for an itemized receipt.
270.32    Subd. 5. Prohibitions. (a) The license holder is prohibited from using psychotropic
270.33medication chemical restraints, mechanical restraint practices, manual restraints, time out,
270.34or seclusion as a substitute for adequate staffing, for a behavioral or therapeutic program
270.35to reduce or eliminate behavior, as punishment, or for staff convenience, or for any reason
270.36other than as prescribed.
271.1(b) The license holder is prohibited from using restraints or seclusion under any
271.2circumstance, unless the commissioner has approved a variance request from the license
271.3holder that allows for the emergency use of restraints and seclusion according to terms
271.4and conditions approved in the variance. Applicants and license holders who have
271.5reason to believe they may be serving an individual who will need emergency use of
271.6restraints or seclusion may request a variance on the application or reapplication, and
271.7the commissioner shall automatically review the request for a variance as part of the
271.8application or reapplication process. License holders may also request the variance any
271.9time after issuance of a license. In the event a license holder uses restraint or seclusion for
271.10any reason without first obtaining a variance as required, the license holder must report
271.11the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the
271.12occurrence and request the required variance.
271.13(b) For the purposes of this subdivision, "chemical restraint" means the
271.14administration of a drug or medication to control the person's behavior or restrict the
271.15person's freedom of movement and is not a standard treatment of dosage for the person's
271.16medical or psychological condition.
271.17(c) For the purposes of this subdivision, "mechanical restraint practice" means the
271.18use of any adaptive equipment or safety device to control the person's behavior or restrict
271.19the person's freedom of movement and not as ordered by a licensed health professional.
271.20Mechanical restraint practices include, but are not limited to, the use of bed rails or similar
271.21devices on a bed to prevent the person from getting out of bed, chairs that prevent a person
271.22from rising, or placing a person in a wheelchair so close to a wall that the wall prevents
271.23the person from rising. Wrist bands or devices on clothing that trigger electronic alarms to
271.24warn staff that a person is leaving a room or area do not, in and of themselves, restrict
271.25freedom of movement and should not be considered restraints.
271.26(d) A license holder must not use manual restraints, time out, or seclusion under any
271.27circumstance, except for emergency use of manual restraints according to the requirements
271.28in section 245D.061 or the use of controlled procedures with a person with a developmental
271.29disability as governed by Minnesota Rules, parts 9525.2700 to 9525.2810, or its successor
271.30provisions. License holders implementing nonemergency use of manual restraint, or any
271.31other programmatic use of mechanical restraint, time out, or seclusion with persons who
271.32do not have a developmental disability that is not subject to the requirements of Minnesota
271.33Rules, parts 9525.2700 to 9525.2810, must submit a variance request to the commissioner
271.34for continued use of the procedure within three months of implementation of this chapter.
271.35EFFECTIVE DATE.This section is effective January 1, 2014.

272.1    Sec. 23. [245D.061] EMERGENCY USE OF MANUAL RESTRAINTS.
272.2    Subdivision 1. Standards for emergency use of manual restraints. Except
272.3for the emergency use of controlled procedures with a person with a developmental
272.4disability as governed by Minnesota Rules, part 9525.2770, or its successor provisions,
272.5the license holder must ensure that emergency use of manual restraints complies with the
272.6requirements of this chapter and the license holder's policy and procedures as required
272.7under subdivision 10.
272.8    Subd. 2. Definitions. (a) The terms used in this section have the meaning given
272.9them in this subdivision.
272.10(b) "Manual restraint" means physical intervention intended to hold a person
272.11immobile or limit a person's voluntary movement by using body contact as the only source
272.12of physical restraint.
272.13(c) "Mechanical restraint" means the use of devices, materials, or equipment attached
272.14or adjacent to the person's body, or the use of practices which restrict freedom of movement
272.15or normal access to one's body or body parts, or limits a person's voluntary movement
272.16or holds a person immobile as an intervention precipitated by a person's behavior. The
272.17term does apply to mechanical restraint used to prevent injury with persons who engage in
272.18self-injurious behaviors, such as head-banging, gouging, or other actions resulting in tissue
272.19damage that have caused or could cause medical problems resulting from the self-injury.
272.20    Subd. 3. Conditions for emergency use of manual restraint. Emergency use of
272.21manual restraint must meet the following conditions:
272.22(1) immediate intervention must be needed to protect the person or others from
272.23imminent risk of physical harm; and
272.24(2) the type of manual restraint used must be the least restrictive intervention to
272.25eliminate the immediate risk of harm and effectively achieve safety. The manual restraint
272.26must end when the threat of harm ends.
272.27    Subd. 4. Permitted instructional techniques and therapeutic conduct. (a) Use of
272.28physical contact as therapeutic conduct or as an instructional technique as identified in
272.29paragraphs (b) and (c), is permitted and is not subject to the requirements of this section
272.30when such use is addressed in a person's coordinated service and support plan addendum
272.31and the required conditions have been met. For the purposes of this subdivision,
272.32"therapeutic conduct" has the meaning given in section 626.5572, subdivision 20.
272.33(b) Physical contact or instructional techniques must use the least restrictive
272.34alternative possible to meet the needs of the person and may be used:
272.35(1) to calm or comfort a person by holding that person with no resistance from
272.36that person;
273.1(2) to protect a person known to be at risk of injury due to frequent falls as a result of
273.2a medical condition; or
273.3(3) to position a person with physical disabilities in a manner specified in the
273.4person's coordinated service and support plan addendum.
273.5(c) Restraint may be used as therapeutic conduct:
273.6(1) to allow a licensed health care professional to safely conduct a medical
273.7examination or to provide medical treatment ordered by a licensed health care professional
273.8to a person necessary to promote healing or recovery from an acute, meaning short-term,
273.9medical condition;
273.10(2) to facilitate the person's completion of a task or response when the person does
273.11not resist or the person's resistance is minimal in intensity and duration;
273.12(3) to briefly block or redirect a person's limbs or body without holding the person
273.13or limiting the person's movement to interrupt the person's behavior that may result in
273.14injury to self or others; or
273.15(4) to assist in the safe evacuation of a person in the event of an emergency or to
273.16redirect a person who is at imminent risk of harm in a dangerous situation.
273.17(d) A plan for using restraint as therapeutic conduct must be developed according to
273.18the requirements in sections 245D.07 and 245D.071, and must include methods to reduce
273.19or eliminate the use of and need for restraint.
273.20    Subd. 5. Restrictions when implementing emergency use of manual restraint.
273.21(a) Emergency use of manual restraint procedures must not:
273.22(1) be implemented with a child in a manner that constitutes sexual abuse, neglect,
273.23physical abuse, or mental injury, as defined in section 626.556, subdivision 2;
273.24(2) be implemented with an adult in a manner that constitutes abuse or neglect as
273.25defined in section 626.5572, subdivisions 2 and 17;
273.26(3) be implemented in a manner that violates a person's rights and protections
273.27identified in section 245D.04;
273.28(4) restrict a person's normal access to a nutritious diet, drinking water, adequate
273.29ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping
273.30conditions, or necessary clothing, or to any protection required by state licensing standards
273.31and federal regulations governing the program;
273.32(5) deny the person visitation or ordinary contact with legal counsel, a legal
273.33representative, or next of kin;
273.34(6) be used as a substitute for adequate staffing, for the convenience of staff, as
273.35punishment, or as a consequence if the person refuses to participate in the treatment
273.36or services provided by the program; or
274.1(7) use prone restraint. For the purposes of this section, "prone restraint" means use
274.2of manual restraint that places a person in a face-down position. This does not include
274.3brief physical holding of a person who, during an emergency use of manual restraint, rolls
274.4into a prone position, and the person is restored to a standing, sitting, or side-lying position
274.5as quickly as possible. Applying back or chest pressure while a person is in the prone or
274.6supine position or face-up is prohibited.
274.7    Subd. 6. Monitoring emergency use of manual restraint. The license holder shall
274.8monitor a person's health and safety during an emergency use of a manual restraint. Staff
274.9monitoring the procedure must not be the staff implementing the procedure when possible.
274.10The license holder shall complete a monitoring form, approved by the commissioner, for
274.11each incident involving the emergency use of a manual restraint.
274.12    Subd. 7. Reporting emergency use of manual restraint incident. (a) Within
274.13three calendar days after an emergency use of a manual restraint, the staff person who
274.14implemented the emergency use must report in writing to the designated coordinator the
274.15following information about the emergency use:
274.16(1) the staff and persons receiving services who were involved in the incident
274.17leading up to the emergency use of manual restraint;
274.18(2) a description of the physical and social environment, including who was present
274.19before and during the incident leading up to the emergency use of manual restraint;
274.20(3) a description of what less restrictive alternative measures were attempted to
274.21de-escalate the incident and maintain safety before the manual restraint was implemented
274.22that identifies when, how, and how long the alternative measures were attempted before
274.23manual restraint was implemented;
274.24(4) a description of the mental, physical, and emotional condition of the person who
274.25was restrained, and other persons involved in the incident leading up to, during, and
274.26following the manual restraint;
274.27(5) whether there was any injury to the person who was restrained or other persons
274.28involved in the incident, including staff, before or as a result of the use of manual
274.29restraint; and
274.30(6) whether there was an attempt to debrief with the staff, and, if not contraindicated,
274.31with the person who was restrained and other persons who were involved in or who
274.32witnessed the restraint, following the incident and the outcome of the debriefing. If the
274.33debriefing was not conducted at the time the incident report was made, the report should
274.34identify whether a debriefing is planned.
275.1(b) Each single incident of emergency use of manual restraint must be reported
275.2separately. For the purposes of this subdivision, an incident of emergency use of manual
275.3restraint is a single incident when the following conditions have been met:
275.4(1) after implementing the manual restraint, staff attempt to release the person at the
275.5moment staff believe the person's conduct no longer poses an imminent risk of physical
275.6harm to self or others and less restrictive strategies can be implemented to maintain safety;
275.7(2) upon the attempt to release the restraint, the person's behavior immediately
275.8re-escalates; and
275.9(3) staff must immediately reimplement the restraint in order to maintain safety.
275.10    Subd. 8. Internal review of emergency use of manual restraint. (a) Within five
275.11working days of the emergency use of manual restraint, the license holder must complete
275.12an internal review of each report of emergency use of manual restraint. The review must
275.13include an evaluation of whether:
275.14(1) the person's service and support strategies developed according to sections
275.15245D.07 and 245D.071 need to be revised;
275.16(2) related policies and procedures were followed;
275.17(3) the policies and procedures were adequate;
275.18(4) there is a need for additional staff training;
275.19(5) the reported event is similar to past events with the persons, staff, or the services
275.20involved; and
275.21(6) there is a need for corrective action by the license holder to protect the health
275.22and safety of persons.
275.23(b) Based on the results of the internal review, the license holder must develop,
275.24document, and implement a corrective action plan for the program designed to correct
275.25current lapses and prevent future lapses in performance by individuals or the license
275.26holder, if any. The corrective action plan, if any, must be implemented within 30 days of
275.27the internal review being completed.
275.28    Subd. 9. Expanded support team review. (a) Within five working days after the
275.29completion of the internal review required in subdivision 8, the license holder must consult
275.30with the expanded support team following the emergency use of manual restraint to:
275.31(1) discuss the incident reported in subdivision 7, to define the antecedent or event
275.32that gave rise to the behavior resulting in the manual restraint and identify the perceived
275.33function the behavior served; and
275.34(2) determine whether the person's coordinated service and support plan addendum
275.35needs to be revised according to sections 245D.07 and 245D.071 to positively and
276.1effectively help the person maintain stability and to reduce or eliminate future occurrences
276.2requiring emergency use of manual restraint.
276.3    Subd. 10. Emergency use of manual restraints policy and procedures. The
276.4license holder must develop, document, and implement a policy and procedures that
276.5promote service recipient rights and protect health and safety during the emergency use of
276.6manual restraints. The policy and procedures must comply with the requirements of this
276.7section and must specify the following:
276.8(1) a description of the positive support strategies and techniques staff must use to
276.9attempt to de-escalate a person's behavior before it poses an imminent risk of physical
276.10harm to self or others;
276.11(2) a description of the types of manual restraints the license holder allows staff to
276.12use on an emergency basis, if any. If the license holder will not allow the emergency use
276.13of manual restraint, the policy and procedure must identify the alternative measures the
276.14license holder will require staff to use when a person's conduct poses an imminent risk of
276.15physical harm to self or others and less restrictive strategies would not achieve safety;
276.16(3) instructions for safe and correct implementation of the allowed manual restraint
276.17procedures;
276.18(4) the training that staff must complete and the timelines for completion, before they
276.19may implement an emergency use of manual restraint. In addition to the training on this
276.20policy and procedure and the orientation and annual training required in section 245D.09,
276.21subdivision 4, the training for emergency use of manual restraint must incorporate the
276.22following subjects:
276.23(i) alternatives to manual restraint procedures, including techniques to identify
276.24events and environmental factors that may escalate conduct that poses an imminent risk of
276.25physical harm to self or others;
276.26(ii) de-escalation methods, positive support strategies, and how to avoid power
276.27struggles;
276.28(iii) simulated experiences of administering and receiving manual restraint
276.29procedures allowed by the license holder on an emergency basis;
276.30(iv) how to properly identify thresholds for implementing and ceasing restrictive
276.31procedures;
276.32(v) how to recognize, monitor, and respond to the person's physical signs of distress,
276.33including positional asphyxia;
276.34(vi) the physiological and psychological impact on the person and the staff when
276.35restrictive procedures are used;
276.36(vii) the communicative intent of behaviors; and
277.1(viii) relationship building;
277.2(5) the procedures and forms to be used to monitor the emergency use of manual
277.3restraints, including what must be monitored and the frequency of monitoring per
277.4each incident of emergency use of manual restraint, and the person or position who is
277.5responsible for monitoring the use;
277.6(6) the instructions, forms, and timelines required for completing and submitting an
277.7incident report by the person or persons who implemented the manual restraint; and
277.8(7) the procedures and timelines for conducting the internal review and the expanded
277.9support team review, and the person or position responsible for completing the reviews and
277.10who is responsible for ensuring that corrective action is taken or the person's coordinated
277.11service and support plan addendum is revised, when determined necessary.
277.12EFFECTIVE DATE.This section is effective January 1, 2014.

277.13    Sec. 24. Minnesota Statutes 2012, section 245D.07, is amended to read:
277.14245D.07 SERVICE NEEDS PLANNING AND DELIVERY.
277.15    Subdivision 1. Provision of services. The license holder must provide services as
277.16specified assigned in the coordinated service and support plan and assigned to the license
277.17holder. The provision of services must comply with the requirements of this chapter and
277.18the federal waiver plans.
277.19    Subd. 1a. Person-centered planning and service delivery. (a) The license holder
277.20must provide services in response to the person's identified needs, interests, preferences,
277.21and desired outcomes as specified in the coordinated service and support plan, the
277.22coordinated service and support plan addendum, and in compliance with the requirements
277.23of this chapter. License holders providing intensive support services must also provide
277.24outcome-based services according to the requirements in section 245D.071.
277.25(b) Services must be provided in a manner that supports the person's preferences,
277.26daily needs, and activities and accomplishment of the person's personal goals and service
277.27outcomes, consistent with the principles of:
277.28(1) person-centered service planning and delivery that:
277.29(i) identifies and supports what is important to the person as well as what is
277.30important for the person, including preferences for when, how, and by whom direct
277.31support service is provided;
277.32(ii) uses that information to identify outcomes the person desires; and
277.33(iii) respects each person's history, dignity, and cultural background;
277.34(2) self-determination that supports and provides:
278.1(i) opportunities for the development and exercise of functional and age-appropriate
278.2skills, decision making and choice, personal advocacy, and communication; and
278.3(ii) the affirmation and protection of each person's civil and legal rights;
278.4(3) providing the most integrated setting and inclusive service delivery that supports,
278.5promotes, and allows:
278.6(i) inclusion and participation in the person's community as desired by the person
278.7in a manner that enables the person to interact with nondisabled persons to the fullest
278.8extent possible and supports the person in developing and maintaining a role as a valued
278.9community member;
278.10(ii) opportunities for self-sufficiency as well as developing and maintaining social
278.11relationships and natural supports; and
278.12(iii) a balance between risk and opportunity, meaning the least restrictive supports or
278.13interventions necessary are provided in the most integrated settings in the most inclusive
278.14manner possible to support the person to engage in activities of the person's own choosing
278.15that may otherwise present a risk to the person's health, safety, or rights.
278.16    Subd. 2. Service planning requirements for basic support services. (a) License
278.17holders providing basic support services must meet the requirements of this subdivision.
278.18(b) Within 15 days of service initiation the license holder must complete a
278.19preliminary coordinated service and support plan addendum based on the coordinated
278.20service and support plan.
278.21(c) Within 60 days of service initiation the license holder must review and revise as
278.22needed the preliminary coordinated service and support plan addendum to document the
278.23services that will be provided including how, when, and by whom services will be provided,
278.24and the person responsible for overseeing the delivery and coordination of services.
278.25(d) The license holder must participate in service planning and support team
278.26meetings related to for the person following stated timelines established in the person's
278.27 coordinated service and support plan or as requested by the support team, the person, or
278.28the person's legal representative, the support team or the expanded support team.
278.29    Subd. 3. Reports. The license holder must provide written reports regarding the
278.30person's progress or status as requested by the person, the person's legal representative, the
278.31case manager, or the team.
278.32EFFECTIVE DATE.This section is effective January 1, 2014.

278.33    Sec. 25. [245D.071] SERVICE PLANNING AND DELIVERY; INTENSIVE
278.34SUPPORT SERVICES.
279.1    Subdivision 1. Requirements for intensive support services. A license holder
279.2providing intensive support services identified in section 245D.03, subdivision 1,
279.3paragraph (c), must comply with the requirements in section 245D.07, subdivisions 1
279.4and 3, and this section.
279.5    Subd. 2. Abuse prevention. Prior to or upon initiating services, the license holder
279.6must develop, document, and implement an abuse prevention plan according to section
279.7245A.65, subdivision 2.
279.8    Subd. 3. Assessment and initial service planning. (a) Within 15 days of service
279.9initiation the license holder must complete a preliminary coordinated service and support
279.10plan addendum based on the coordinated service and support plan.
279.11(b) Within 45 days of service initiation the license holder must meet with the person,
279.12the person's legal representative, the case manager, and other members of the support team
279.13or expanded support team to assess and determine the following based on the person's
279.14coordinated service and support plan and the requirements in subdivision 4 and section
279.15245D.07, subdivision 1a:
279.16(1) the scope of the services to be provided to support the person's daily needs
279.17and activities;
279.18(2) the person's desired outcomes and the supports necessary to accomplish the
279.19person's desired outcomes;
279.20(3) the person's preferences for how services and supports are provided;
279.21(4) whether the current service setting is the most integrated setting available and
279.22appropriate for the person; and
279.23(5) how services must be coordinated across other providers licensed under this
279.24chapter serving the same person to ensure continuity of care for the person.
279.25(c) Within the scope of services, the license holder must, at a minimum, assess
279.26the following areas:
279.27(1) the person's ability to self-manage health and medical needs to maintain or
279.28improve physical, mental, and emotional well-being, including, when applicable, allergies,
279.29seizures, choking, special dietary needs, chronic medical conditions, self-administration
279.30of medication or treatment orders, preventative screening, and medical and dental
279.31appointments;
279.32(2) the person's ability to self-manage personal safety to avoid injury or accident in
279.33the service setting, including, when applicable, risk of falling, mobility, regulating water
279.34temperature, community survival skills, water safety skills, and sensory disabilities; and
279.35(3) the person's ability to self-manage symptoms or behavior that may otherwise
279.36result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to
280.1(7), suspension or termination of services by the license holder, or other symptoms
280.2or behaviors that may jeopardize the health and safety of the person or others. The
280.3assessments must produce information about the person that is descriptive of the person's
280.4overall strengths, functional skills and abilities, and behaviors or symptoms.
280.5    Subd. 4. Service outcomes and supports. (a) Within ten working days of the
280.645-day meeting, the license holder must develop and document the service outcomes and
280.7supports based on the assessments completed under subdivision 3 and the requirements
280.8in section 245D.07, subdivision 1a. The outcomes and supports must be included in the
280.9coordinated service and support plan addendum.
280.10(b) The license holder must document the supports and methods to be implemented
280.11to support the accomplishment of outcomes related to acquiring, retaining, or improving
280.12skills. The documentation must include:
280.13(1) the methods or actions that will be used to support the person and to accomplish
280.14the service outcomes, including information about:
280.15(i) any changes or modifications to the physical and social environments necessary
280.16when the service supports are provided;
280.17(ii) any equipment and materials required; and
280.18(iii) techniques that are consistent with the person's communication mode and
280.19learning style;
280.20(2) the measurable and observable criteria for identifying when the desired outcome
280.21has been achieved and how data will be collected;
280.22(3) the projected starting date for implementing the supports and methods and
280.23the date by which progress towards accomplishing the outcomes will be reviewed and
280.24evaluated; and
280.25(4) the names of the staff or position responsible for implementing the supports
280.26and methods.
280.27(c) Within 20 working days of the 45-day meeting, the license holder must obtain
280.28dated signatures from the person or the person's legal representative and case manager
280.29to document completion and approval of the assessment and coordinated service and
280.30support plan addendum.
280.31    Subd. 5. Progress reviews. (a) The license holder must give the person or the
280.32person's legal representative and case manager an opportunity to participate in the ongoing
280.33review and development of the methods used to support the person and accomplish
280.34outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
280.35the person's support team or expanded support team, must meet with the person, the
280.36person's legal representative, and the case manager, and participate in progress review
281.1meetings following stated timelines established in the person's coordinated service and
281.2support plan or coordinated service and support plan addendum or within 30 days of a
281.3written request by the person, the person's legal representative, or the case manager,
281.4at a minimum of once per year.
281.5(b) The license holder must summarize the person's progress toward achieving the
281.6identified outcomes and make recommendations and identify the rationale for changing,
281.7continuing, or discontinuing implementation of supports and methods identified in
281.8subdivision 4 in a written report sent to the person or the person's legal representative
281.9and case manager five working days prior to the review meeting, unless the person, the
281.10person's legal representative, or the case manager request to receive the report at the
281.11time of the meeting.
281.12(c) Within ten working days of the progress review meeting, the license holder
281.13must obtain dated signatures from the person or the person's legal representative and
281.14the case manager to document approval of any changes to the coordinated service and
281.15support plan addendum.
281.16EFFECTIVE DATE.This section is effective January 1, 2014.

281.17    Sec. 26. [245D.081] PROGRAM COORDINATION, EVALUATION, AND
281.18OVERSIGHT.
281.19    Subdivision 1. Program coordination and evaluation. (a) The license holder
281.20is responsible for:
281.21(1) coordination of service delivery and evaluation for each person served by the
281.22program as identified in subdivision 2; and
281.23(2) program management and oversight that includes evaluation of the program
281.24quality and program improvement for services provided by the license holder as identified
281.25in subdivision 3.
281.26(b) The same person may perform the functions in paragraph (a) if the work and
281.27education qualifications are met in subdivisions 2 and 3.
281.28    Subd. 2. Coordination and evaluation of individual service delivery. (a) Delivery
281.29and evaluation of services provided by the license holder must be coordinated by a
281.30designated staff person. The designated coordinator must provide supervision, support,
281.31and evaluation of activities that include:
281.32(1) oversight of the license holder's responsibilities assigned in the person's
281.33coordinated service and support plan and the coordinated service and support plan
281.34addendum;
282.1(2) taking the action necessary to facilitate the accomplishment of the outcomes
282.2according to the requirements in section 245D.07;
282.3(3) instruction and assistance to direct support staff implementing the coordinated
282.4service and support plan and the service outcomes, including direct observation of service
282.5delivery sufficient to assess staff competency; and
282.6(4) evaluation of the effectiveness of service delivery, methodologies, and progress on
282.7the person's outcomes based on the measurable and observable criteria for identifying when
282.8the desired outcome has been achieved according to the requirements in section 245D.07.
282.9(b) The license holder must ensure that the designated coordinator is competent to
282.10perform the required duties identified in paragraph (a) through education and training in
282.11human services and disability-related fields, and work experience in providing direct care
282.12services and supports to persons with disabilities. The designated coordinator must have
282.13the skills and ability necessary to develop effective plans and to design and use data
282.14systems to measure effectiveness of services and supports. The license holder must verify
282.15and document competence according to the requirements in section 245D.09, subdivision
282.163. The designated coordinator must minimally have:
282.17(1) a baccalaureate degree in a field related to human services, and one year of
282.18full-time work experience providing direct care services to persons with disabilities or
282.19persons age 65 and older;
282.20(2) an associate degree in a field related to human services, and two years of
282.21full-time work experience providing direct care services to persons with disabilities or
282.22persons age 65 and older;
282.23(3) a diploma in a field related to human services from an accredited postsecondary
282.24institution and three years of full-time work experience providing direct care services to
282.25persons with disabilities or persons age 65 and older; or
282.26(4) a minimum of 50 hours of education and training related to human services
282.27and disabilities; and
282.28(5) four years of full-time work experience providing direct care services to persons
282.29with disabilities or persons age 65 and older under the supervision of a staff person who
282.30meets the qualifications identified in clauses (1) to (3).
282.31    Subd. 3. Program management and oversight. (a) The license holder must
282.32designate a managerial staff person or persons to provide program management and
282.33oversight of the services provided by the license holder. The designated manager is
282.34responsible for the following:
282.35(1) maintaining a current understanding of the licensing requirements sufficient to
282.36ensure compliance throughout the program as identified in section 245A.04, subdivision
283.11, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21,
283.2paragraph (b);
283.3(2) ensuring the duties of the designated coordinator are fulfilled according to the
283.4requirements in subdivision 2;
283.5(3) ensuring the program implements corrective action identified as necessary
283.6by the program following review of incident and emergency reports according to the
283.7requirements in section 245D.11, subdivision 2, clause (7). An internal review of
283.8incident reports of alleged or suspected maltreatment must be conducted according to the
283.9requirements in section 245A.65, subdivision 1, paragraph (b);
283.10(4) evaluation of satisfaction of persons served by the program, the person's legal
283.11representative, if any, and the case manager, with the service delivery and progress
283.12towards accomplishing outcomes identified in sections 245D.07 and 245D.071, and
283.13ensuring and protecting each person's rights as identified in section 245D.04;
283.14(5) ensuring staff competency requirements are met according to the requirements in
283.15section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
283.16according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
283.17(6) ensuring corrective action is taken when ordered by the commissioner and that
283.18the terms and condition of the license and any variances are met; and
283.19(7) evaluating the information identified in clauses (1) to (6) to develop, document,
283.20and implement ongoing program improvements.
283.21(b) The designated manager must be competent to perform the duties as required and
283.22must minimally meet the education and training requirements identified in subdivision
283.232, paragraph (b), and have a minimum of three years of supervisory level experience in
283.24a program providing direct support services to persons with disabilities or persons age
283.2565 and older.
283.26EFFECTIVE DATE.This section is effective January 1, 2014.

283.27    Sec. 27. Minnesota Statutes 2012, section 245D.09, is amended to read:
283.28245D.09 STAFFING STANDARDS.
283.29    Subdivision 1. Staffing requirements. The license holder must provide the level of
283.30 direct service support staff sufficient supervision, assistance, and training necessary:
283.31(1) to ensure the health, safety, and protection of rights of each person; and
283.32(2) to be able to implement the responsibilities assigned to the license holder in each
283.33person's coordinated service and support plan or identified in the coordinated service and
283.34support plan addendum, according to the requirements of this chapter.
284.1    Subd. 2. Supervision of staff having direct contact. Except for a license holder
284.2who is the sole direct service support staff, the license holder must provide adequate
284.3supervision of staff providing direct service support to ensure the health, safety, and
284.4protection of rights of each person and implementation of the responsibilities assigned to
284.5the license holder in each person's service plan coordinated service and support plan or
284.6coordinated service and support plan addendum.
284.7    Subd. 3. Staff qualifications. (a) The license holder must ensure that staff providing
284.8direct support, or staff who have responsibilities related to supervising or managing the
284.9provision of direct support service, is competent as demonstrated through skills and
284.10knowledge training, experience, and education to meet the person's needs and additional
284.11requirements as written in the coordinated service and support plan or coordinated
284.12service and support plan addendum, or when otherwise required by the case manager or
284.13the federal waiver plan. The license holder must verify and maintain evidence of staff
284.14competency, including documentation of:
284.15(1) education and experience qualifications relevant to the job responsibilities
284.16assigned to the staff and the needs of the general population of persons served by the
284.17program, including a valid degree and transcript, or a current license, registration, or
284.18certification, when a degree or licensure, registration, or certification is required by this
284.19chapter or in the coordinated service and support plan or coordinated service and support
284.20plan addendum;
284.21(2) completion of required demonstrated competency in the orientation and training
284.22 areas required under this chapter, including and when applicable, completion of continuing
284.23education required to maintain professional licensure, registration, or certification
284.24requirements. Competency in these areas is determined by the license holder through
284.25knowledge testing and observed skill assessment conducted by the trainer or instructor; and
284.26(3) except for a license holder who is the sole direct service support staff, periodic
284.27 performance evaluations completed by the license holder of the direct service support staff
284.28person's ability to perform the job functions based on direct observation.
284.29(b) Staff under 18 years of age may not perform overnight duties or administer
284.30medication.
284.31    Subd. 4. Orientation to program requirements. (a) Except for a license holder
284.32who does not supervise any direct service support staff, within 90 days of hiring direct
284.33service staff 60 days of hire, unless stated otherwise, the license holder must provide
284.34and ensure completion of orientation for direct support staff that combines supervised
284.35on-the-job training with review of and instruction on in the following areas:
284.36(1) the job description and how to complete specific job functions, including:
285.1(i) responding to and reporting incidents as required under section 245D.06,
285.2subdivision 1; and
285.3(ii) following safety practices established by the license holder and as required in
285.4section 245D.06, subdivision 2;
285.5(2) the license holder's current policies and procedures required under this chapter,
285.6including their location and access, and staff responsibilities related to implementation
285.7of those policies and procedures;
285.8(3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the
285.9federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
285.10responsibilities related to complying with data privacy practices;
285.11(4) the service recipient rights under section 245D.04, and staff responsibilities
285.12related to ensuring the exercise and protection of those rights according to the requirements
285.13in section 245D.04;
285.14(5) sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment
285.15reporting and service planning for children and vulnerable adults, and staff responsibilities
285.16related to protecting persons from maltreatment and reporting maltreatment. This
285.17orientation must be provided within 72 hours of first providing direct contact services and
285.18annually thereafter according to section 245A.65, subdivision 3;
285.19(6) what constitutes use of restraints, seclusion, and psychotropic medications,
285.20and staff responsibilities related to the prohibitions of their use the principles of
285.21person-centered service planning and delivery as identified in section 245D.07, subdivision
285.221a, and how they apply to direct support service provided by the staff person; and
285.23(7) other topics as determined necessary in the person's coordinated service and
285.24support plan by the case manager or other areas identified by the license holder.
285.25(b) License holders who provide direct service themselves must complete the
285.26orientation required in paragraph (a), clauses (3) to (7).
285.27    Subd. 4a. Orientation to individual service recipient needs. (c) (a) Before
285.28providing having unsupervised direct service to contact with a person served by the
285.29program, or for whom the staff person has not previously provided direct service support,
285.30or any time the plans or procedures identified in clauses (1) and (2) paragraphs (b) to
285.31(f) are revised, the staff person must review and receive instruction on the following
285.32as it relates requirements in paragraphs (b) to (f) as they relate to the staff person's job
285.33functions for that person:.
285.34(b) Orientation training and competency evaluation of direct care staff in a program
285.35providing 24-hour care for a client with corporate supervision must be provided under
286.1the direction of a registered nurse. Training and competency evaluations must include
286.2the following:
286.3(1) documentation requirements for all services provided;
286.4(2) reports of changes in the client's condition to the supervisor designated by the
286.5home care provider;
286.6(3) basic infection control, including blood-borne pathogens;
286.7(4) maintenance of a clean and safe environment;
286.8(5) appropriate and safe techniques in personal hygiene and grooming, including
286.9hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities
286.10of daily living (ADLs);
286.11(6) an understanding of what constitutes a healthy diet according to data from the
286.12Centers for Disease Control and the skills necessary to prepare that diet;
286.13(7) skills necessary to provide appropriate support in instrumental activities of
286.14daily living (IADLs); and
286.15(8) demonstrated competence in providing first aid.
286.16(1) (c) The staff person must review and receive instruction on the person's
286.17 coordinated service and support plan or coordinated service and support plan addendum as
286.18it relates to the responsibilities assigned to the license holder, and when applicable, the
286.19person's individual abuse prevention plan according to section 245A.65, to achieve and
286.20demonstrate an understanding of the person as a unique individual, and how to implement
286.21those plans; and.
286.22(2) (d) The staff person must review and receive instruction on medication
286.23administration procedures established for the person when medication administration is
286.24 assigned to the license holder according to section 245D.05, subdivision 1, paragraph
286.25(b). Unlicensed staff may administer medications only after successful completion of a
286.26medication administration training, from a training curriculum developed by a registered
286.27nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
286.28practitioner, physician's assistant, or physician incorporating. The training curriculum
286.29must incorporate an observed skill assessment conducted by the trainer to ensure staff
286.30demonstrate the ability to safely and correctly follow medication procedures.
286.31Medication administration must be taught by a registered nurse, clinical nurse
286.32specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
286.33service initiation or any time thereafter, the person has or develops a health care condition
286.34that affects the service options available to the person because the condition requires:
286.35(i) (1) specialized or intensive medical or nursing supervision; and
287.1(ii) (2) nonmedical service providers to adapt their services to accommodate the
287.2health and safety needs of the person; and.
287.3(iii) necessary training in order to meet the health service needs of the person as
287.4determined by the person's physician.
287.5(e) The staff person must review and receive instruction on the safe and correct
287.6operation of medical equipment used by the person to sustain life, including but not
287.7limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
287.8by a licensed health care professional or a manufacturer's representative and incorporate
287.9an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
287.10operate the equipment according to the treatment orders and the manufacturer's instructions.
287.11(f) The staff person must review and receive instruction on what constitutes use of
287.12restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
287.13related to the prohibitions of their use according to the requirements in section 245D.06,
287.14subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
287.15or undesired behavior and why they are not safe, and the safe and correct use of manual
287.16restraint on an emergency basis according to the requirements in section 245D.061.
287.17(g) In the event of an emergency service initiation, the license holder must ensure
287.18the training required in this subdivision occurs within 72 hours of the direct support staff
287.19person first having unsupervised contact with the person receiving services. The license
287.20holder must document the reason for the unplanned or emergency service initiation and
287.21maintain the documentation in the person's service recipient record.
287.22(h) License holders who provide direct support services themselves must complete
287.23the orientation required in subdivision 4, clauses (3) to (7).
287.24    Subd. 5. Annual training. (a) A license holder must provide annual training to
287.25direct service support staff on the topics identified in subdivision 4, paragraph (a), clauses
287.26(3) to (6) (7), and subdivision 4a, paragraphs (a) to (h). A license holder providing 24-hour
287.27care with corporate supervision must provide a minimum of 24 hours of annual training
287.28to direct service staff in topics described in subdivisions 4, clauses (1) to (7), and 4a,
287.29paragraphs (a) to (h). Training on relevant topics received from sources other than the
287.30license holder may count toward training requirements.
287.31(b) A license holder providing behavioral programming, specialist services, personal
287.32support, 24-hour emergency assistance, night supervision, independent living skills,
287.33structured day, prevocational, or supported employment services must provide a minimum
287.34of eight hours of annual training to direct service staff that addresses:
287.35(1) topics related to the general health, safety, and service needs of the population
287.36served by the license holder; and
288.1(2) other areas identified by the license holder or in the person's current service plan.
288.2Training on relevant topics received from sources other than the license holder
288.3may count toward training requirements.
288.4(c) When the license holder is the owner, lessor, or tenant of the service site and
288.5whenever a person receiving services is present at the site, the license holder must have
288.6a staff person available on site who is trained in basic first aid and, when required in a
288.7person's service plan, cardiopulmonary resuscitation.
288.8    Subd. 5a. Alternative sources of training. Orientation or training received by the
288.9staff person from sources other than the license holder in the same subjects as identified
288.10in subdivision 4 may count toward the orientation and annual training requirements if
288.11received in the 12-month period before the staff person's date of hire. The license holder
288.12must maintain documentation of the training received from other sources and of each staff
288.13person's competency in the required area according to the requirements in subdivision 3.
288.14    Subd. 6. Subcontractors and temporary staff. If the license holder uses a
288.15subcontractor or temporary staff to perform services licensed under this chapter on the
288.16license holder's behalf, the license holder must ensure that the subcontractor or temporary
288.17staff meets and maintains compliance with all requirements under this chapter that apply
288.18to the services to be provided, including training, orientation, and supervision necessary
288.19to fulfill their responsibilities. The license holder must ensure that a background study
288.20has been completed according to the requirements in sections 245C.03, subdivision 1,
288.21and 245C.04. Subcontractors and temporary staff hired by the license holder must meet
288.22the Minnesota licensing requirements applicable to the disciplines in which they are
288.23providing services. The license holder must maintain documentation that the applicable
288.24requirements have been met.
288.25    Subd. 7. Volunteers. The license holder must ensure that volunteers who provide
288.26direct support services to persons served by the program receive the training, orientation,
288.27and supervision necessary to fulfill their responsibilities. The license holder must ensure
288.28that a background study has been completed according to the requirements in sections
288.29245C.03, subdivision 1, and 245C.04. The license holder must maintain documentation
288.30that the applicable requirements have been met.
288.31    Subd. 8. Staff orientation and training plan. The license holder must develop
288.32a staff orientation and training plan documenting when and how compliance with
288.33subdivisions 4, 4a, and 5 will be met.
288.34EFFECTIVE DATE.This section is effective January 1, 2014.

288.35    Sec. 28. [245D.091] INTERVENTION SERVICES.
289.1    Subdivision 1. Licensure requirements. An individual meeting the staff
289.2qualification requirements of this section who is an employee of a program licensed
289.3according to this chapter and providing behavioral support services, specialist services,
289.4or crisis respite services is not required to hold a separate license under this chapter.
289.5An individual meeting the staff qualifications of this section who is not providing these
289.6services as an employee of a program licensed according to this chapter must obtain a
289.7license according to this chapter.
289.8    Subd. 2. Behavior professional qualifications. A behavior professional, as defined
289.9in the brain injury and community alternatives for disabled individuals waiver plans or
289.10successor plans, must have competencies in areas related to:
289.11(1) ethical considerations;
289.12(2) functional assessment;
289.13(3) functional analysis;
289.14(4) measurement of behavior and interpretation of data;
289.15(5) selecting intervention outcomes and strategies;
289.16(6) behavior reduction and elimination strategies that promote least restrictive
289.17approved alternatives;
289.18(7) data collection;
289.19(8) staff and caregiver training;
289.20(9) support plan monitoring;
289.21(10) co-occurring mental disorders or neuro-cognitive disorder;
289.22(11) demonstrated expertise with populations being served; and
289.23(12) must be a:
289.24(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the
289.25Board of Psychology competencies in the above identified areas;
289.26(ii) clinical social worker licensed as an independent clinical social worker under
289.27chapter 148D, or a person with a master's degree in social work from an accredited college
289.28or university, with at least 4,000 hours of post-master's supervised experience in the
289.29delivery of clinical services in the areas identified in clauses (1) to (11);
289.30(iii) physician licensed under chapter 147 and certified by the American Board
289.31of Psychiatry and Neurology or eligible for board certification in psychiatry with
289.32competencies in the areas identified in clauses (1) to (11);
289.33(iv) licensed professional clinical counselor licensed under sections 148B.29 to
289.34148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery
289.35of clinical services who has demonstrated competencies in the areas identified in clauses
289.36(1) to (11);
290.1(v) person with a master's degree from an accredited college or university in one
290.2of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
290.3supervised experience in the delivery of clinical services with demonstrated competencies
290.4in the areas identified in clauses (1) to (11); or
290.5(vi) registered nurse who is licensed under sections 148.171 to 148.285, and who is
290.6certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and
290.7mental health nursing by a national nurse certification organization, or who has a master's
290.8degree in nursing or one of the behavioral sciences or related fields from an accredited
290.9college or university or its equivalent, with at least 4,000 hours of post-master's supervised
290.10experience in the delivery of clinical services.
290.11    Subd. 3. Behavior analyst qualifications. (a) A behavior analyst, as defined in
290.12the brain injury and community alternatives for disabled individuals waiver plans or
290.13successor plans, must:
290.14(1) have obtained a baccalaureate degree, master's degree, or a PhD in a social
290.15services discipline; or
290.16(2) meet the qualifications of a mental health practitioner as defined in section
290.17245.462, subdivision 17.
290.18(b) In addition, a behavior analyst must:
290.19(1) have four years of supervised experience working with individuals who exhibit
290.20challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder;
290.21(2) have received ten hours of instruction in functional assessment and functional
290.22analysis;
290.23(3) have received 20 hours of instruction in the understanding of the function of
290.24behavior;
290.25(4) have received ten hours of instruction on design of positive practices behavior
290.26support strategies;
290.27(5) have received 20 hours of instruction on the use of behavior reduction approved
290.28strategies used only in combination with behavior positive practices strategies;
290.29(6) be determined by a behavior professional to have the training and prerequisite
290.30skills required to provide positive practice strategies as well as behavior reduction
290.31approved and permitted intervention to the person who receives behavioral support; and
290.32(7) be under the direct supervision of a behavior professional.
290.33    Subd. 4. Behavior specialist qualifications. (a) A behavior specialist, as defined
290.34in the brain injury and community alternatives for disabled individuals waiver plans or
290.35successor plans, must meet the following qualifications:
290.36(1) have an associate's degree in a social services discipline; or
291.1(2) have two years of supervised experience working with individuals who exhibit
291.2challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder.
291.3(b) In addition, a behavior specialist must:
291.4(1) have received a minimum of four hours of training in functional assessment;
291.5(2) have received 20 hours of instruction in the understanding of the function of
291.6behavior;
291.7(3) have received ten hours of instruction on design of positive practices behavioral
291.8support strategies;
291.9(4) be determined by a behavior professional to have the training and prerequisite
291.10skills required to provide positive practices strategies as well as behavior reduction
291.11approved intervention to the person who receives behavioral support; and
291.12(5) be under the direct supervision of a behavior professional.
291.13    Subd. 5. Specialist services qualifications. An individual providing specialist
291.14services, as defined in the developmental disabilities waiver plan or successor plan, must
291.15have:
291.16(1) the specific experience and skills required of the specialist to meet the needs of
291.17the person identified by the person's service planning team; and
291.18(2) the qualifications of the specialist identified in the person's coordinated service
291.19and support plan.
291.20EFFECTIVE DATE.This section is effective January 1, 2014.

291.21    Sec. 29. [245D.095] RECORD REQUIREMENTS.
291.22    Subdivision 1. Record-keeping systems. The license holder must ensure that the
291.23content and format of service recipient, personnel, and program records are uniform and
291.24legible according to the requirements of this chapter.
291.25    Subd. 2. Admission and discharge register. The license holder must keep a written
291.26or electronic register, listing in chronological order the dates and names of all persons
291.27served by the program who have been admitted, discharged, or transferred, including
291.28service terminations initiated by the license holder and deaths.
291.29    Subd. 3. Service recipient record. (a) The license holder must maintain a record of
291.30current services provided to each person on the premises where the services are provided
291.31or coordinated. When the services are provided in a licensed facility, the records must
291.32be maintained at the facility, otherwise the records must be maintained at the license
291.33holder's program office. The license holder must protect service recipient records against
291.34loss, tampering, or unauthorized disclosure according to the requirements in sections
291.3513.01 to 13.10 and 13.46.
292.1(b) The license holder must maintain the following information for each person:
292.2(1) an admission form signed by the person or the person's legal representative
292.3that includes:
292.4(i) identifying information, including the person's name, date of birth, address,
292.5and telephone number; and
292.6(ii) the name, address, and telephone number of the person's legal representative, if
292.7any, and a primary emergency contact, the case manager, and family members or others as
292.8identified by the person or case manager;
292.9(2) service information, including service initiation information, verification of the
292.10person's eligibility for services, documentation verifying that services have been provided
292.11as identified in the coordinated service and support plan or coordinated service and support
292.12plan addendum according to paragraph (a), and date of admission or readmission;
292.13(3) health information, including medical history, special dietary needs, and
292.14allergies, and when the license holder is assigned responsibility for meeting the person's
292.15health service needs according to section 245D.05:
292.16(i) current orders for medication, treatments, or medical equipment and a signed
292.17authorization from the person or the person's legal representative to administer or assist in
292.18administering the medication or treatments, if applicable;
292.19(ii) a signed statement authorizing the license holder to act in a medical emergency
292.20when the person's legal representative, if any, cannot be reached or is delayed in arriving;
292.21(iii) medication administration procedures;
292.22(iv) a medication administration record documenting the implementation of the
292.23medication administration procedures, the medication administration record reviews, and
292.24including any agreements for administration of injectable medications by the license
292.25holder according to the requirements in section 245D.05; and
292.26(v) a medical appointment schedule when the license holder is assigned
292.27responsibility for assisting with medical appointments;
292.28(4) the person's current coordinated service and support plan or that portion of the
292.29plan assigned to the license holder;
292.30(5) copies of the individual abuse prevention plan and assessments as required under
292.31section 245D.071, subdivisions 2 and 3;
292.32(6) a record of other service providers serving the person when the person's
292.33coordinated service and support plan or coordinated service and support plan addendum
292.34identifies the need for coordination between the service providers, that includes a contact
292.35person and telephone numbers, services being provided, and names of staff responsible for
292.36coordination;
293.1(7) documentation of orientation to service recipient rights according to section
293.2245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
293.3section 245A.65, subdivision 1, paragraph (c);
293.4(8) copies of authorizations to handle a person's funds, according to section 245D.06,
293.5subdivision 4, paragraph (a);
293.6(9) documentation of complaints received and grievance resolution;
293.7(10) incident reports involving the person, required under section 245D.06,
293.8subdivision 1;
293.9(11) copies of written reports regarding the person's status when requested according
293.10to section 245D.07, subdivision 3, progress review reports as required under section
293.11245D.071, subdivision 5, progress or daily log notes that are recorded by the program,
293.12and reports received from other agencies involved in providing services or care to the
293.13person; and
293.14(12) discharge summary, including service termination notice and related
293.15documentation, when applicable.
293.16    Subd. 4. Access to service recipient records. The license holder must ensure that
293.17the following people have access to the information in subdivision 1 in accordance with
293.18applicable state and federal law, regulation, or rule:
293.19(1) the person, the person's legal representative, and anyone properly authorized
293.20by the person;
293.21(2) the person's case manager;
293.22(3) staff providing services to the person unless the information is not relevant to
293.23carrying out the coordinated service and support plan or coordinated service and support
293.24plan addendum; and
293.25(4) the county child or adult foster care licensor, when services are also licensed as
293.26child or adult foster care.
293.27    Subd. 5. Personnel records. (a) The license holder must maintain a personnel
293.28record of each employee to document and verify staff qualifications, orientation, and
293.29training. The personnel record must include:
293.30(1) the employee's date of hire, completed application, an acknowledgement signed
293.31by the employee that job duties were reviewed with the employee and the employee
293.32understands those duties, and documentation that the employee meets the position
293.33requirements as determined by the license holder;
293.34 (2) documentation of staff qualifications, orientation, training, and performance
293.35evaluations as required under section 245D.09, subdivisions 3 to 5, including the date
294.1the training was completed, the number of hours per subject area, and the name of the
294.2trainer or instructor; and
294.3(3) a completed background study as required under chapter 245C.
294.4(b) For employees hired after January 1, 2014, the license holder must maintain
294.5documentation in the personnel record or elsewhere, sufficient to determine the date of the
294.6employee's first supervised direct contact with a person served by the program, and the
294.7date of first unsupervised direct contact with a person served by the program.
294.8EFFECTIVE DATE.This section is effective January 1, 2014.

294.9    Sec. 30. Minnesota Statutes 2012, section 245D.10, is amended to read:
294.10245D.10 POLICIES AND PROCEDURES.
294.11    Subdivision 1. Policy and procedure requirements. The A license holder
294.12 providing either basic or intensive supports and services must establish, enforce, and
294.13maintain policies and procedures as required in this chapter, chapter 245A, and other
294.14applicable state and federal laws and regulations governing the provision of home and
294.15community-based services licensed according to this chapter.
294.16    Subd. 2. Grievances. The license holder must establish policies and procedures
294.17that provide promote service recipient rights by providing a simple complaint process for
294.18persons served by the program and their authorized representatives to bring a grievance that:
294.19(1) provides staff assistance with the complaint process when requested, and the
294.20addresses and telephone numbers of outside agencies to assist the person;
294.21(2) allows the person to bring the complaint to the highest level of authority in the
294.22program if the grievance cannot be resolved by other staff members, and that provides
294.23the name, address, and telephone number of that person;
294.24(3) requires the license holder to promptly respond to all complaints affecting a
294.25person's health and safety. For all other complaints, the license holder must provide an
294.26initial response within 14 calendar days of receipt of the complaint. All complaints must
294.27be resolved within 30 calendar days of receipt or the license holder must document the
294.28reason for the delay and a plan for resolution;
294.29(4) requires a complaint review that includes an evaluation of whether:
294.30(i) related policies and procedures were followed and adequate;
294.31(ii) there is a need for additional staff training;
294.32(iii) the complaint is similar to past complaints with the persons, staff, or services
294.33involved; and
295.1(iv) there is a need for corrective action by the license holder to protect the health
295.2and safety of persons receiving services;
295.3(5) based on the review in clause (4), requires the license holder to develop,
295.4document, and implement a corrective action plan designed to correct current lapses and
295.5prevent future lapses in performance by staff or the license holder, if any;
295.6(6) provides a written summary of the complaint and a notice of the complaint
295.7resolution to the person and case manager that:
295.8(i) identifies the nature of the complaint and the date it was received;
295.9(ii) includes the results of the complaint review;
295.10(iii) identifies the complaint resolution, including any corrective action; and
295.11(7) requires that the complaint summary and resolution notice be maintained in the
295.12service recipient record.
295.13    Subd. 3. Service suspension and service termination. (a) The license holder must
295.14establish policies and procedures for temporary service suspension and service termination
295.15that promote continuity of care and service coordination with the person and the case
295.16manager and with other licensed caregivers, if any, who also provide support to the person.
295.17(b) The policy must include the following requirements:
295.18(1) the license holder must notify the person or the person's legal representative and
295.19case manager in writing of the intended termination or temporary service suspension, and
295.20the person's right to seek a temporary order staying the termination of service according to
295.21the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);
295.22(2) notice of the proposed termination of services, including those situations
295.23that began with a temporary service suspension, must be given at least 60 days before
295.24the proposed termination is to become effective when a license holder is providing
295.25independent living skills training, structured day, prevocational or supported employment
295.26services to the person intensive supports and services identified in section 245D.03,
295.27subdivision 1, paragraph (c), and 30 days prior to termination for all other services
295.28licensed under this chapter;
295.29(3) the license holder must provide information requested by the person or case
295.30manager when services are temporarily suspended or upon notice of termination;
295.31(4) prior to giving notice of service termination or temporary service suspension,
295.32the license holder must document actions taken to minimize or eliminate the need for
295.33service suspension or termination;
295.34(5) during the temporary service suspension or service termination notice period,
295.35the license holder will work with the appropriate county agency to develop reasonable
295.36alternatives to protect the person and others;
296.1(6) the license holder must maintain information about the service suspension or
296.2termination, including the written termination notice, in the service recipient record; and
296.3(7) the license holder must restrict temporary service suspension to situations in
296.4which the person's behavior causes immediate and serious danger to the health and safety
296.5of the person or others conduct poses an imminent risk of physical harm to self or others
296.6and less restrictive or positive support strategies would not achieve safety.
296.7    Subd. 4. Availability of current written policies and procedures. (a) The license
296.8holder must review and update, as needed, the written policies and procedures required
296.9under this chapter.
296.10(b)(1) The license holder must inform the person and case manager of the policies
296.11and procedures affecting a person's rights under section 245D.04, and provide copies of
296.12those policies and procedures, within five working days of service initiation.
296.13(2) If a license holder only provides basic services and supports, this includes the:
296.14(i) grievance policy and procedure required under subdivision 2; and
296.15(ii) service suspension and termination policy and procedure required under
296.16subdivision 3.
296.17(3) For all other license holders this includes the:
296.18(i) policies and procedures in clause (2);
296.19(ii) emergency use of manual restraints policy and procedure required under
296.20subdivision 3a; and
296.21(iii) data privacy requirements under section 245D.11, subdivision 3.
296.22(c) The license holder must provide a written notice at least 30 days before
296.23implementing any revised policies and procedures procedural revisions to policies
296.24 affecting a person's service-related or protection-related rights under section 245D.04 and
296.25maltreatment reporting policies and procedures. The notice must explain the revision that
296.26was made and include a copy of the revised policy and procedure. The license holder
296.27must document the reason reasonable cause for not providing the notice at least 30 days
296.28before implementing the revisions.
296.29(d) Before implementing revisions to required policies and procedures, the license
296.30holder must inform all employees of the revisions and provide training on implementation
296.31of the revised policies and procedures.
296.32(e) The license holder must annually notify all persons, or their legal representatives,
296.33and case managers of any procedural revisions to policies required under this chapter,
296.34other than those in paragraph (c). Upon request, the license holder must provide the
296.35person, or the person's legal representative, and case manager with copies of the revised
296.36policies and procedures.
297.1EFFECTIVE DATE.This section is effective January 1, 2014.

297.2    Sec. 31. [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT
297.3SERVICES.
297.4    Subdivision 1. Policy and procedure requirements. A license holder providing
297.5intensive support services as identified in section 245D.03, subdivision 1, paragraph (c),
297.6must establish, enforce, and maintain policies and procedures as required in this section.
297.7    Subd. 2. Health and safety. The license holder must establish policies and
297.8procedures that promote health and safety by ensuring:
297.9(1) use of universal precautions and sanitary practices in compliance with section
297.10245D.06, subdivision 2, clause (5);
297.11(2) if the license holder operates a residential program, health service coordination
297.12and care according to the requirements in section 245D.05, subdivision 1;
297.13(3) safe medication assistance and administration according to the requirements
297.14in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
297.15consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
297.16doctor and require completion of medication administration training according to the
297.17requirements in section 245D.09, subdivision 4a, paragraph (c). Medication assistance
297.18and administration includes, but is not limited to:
297.19(i) providing medication-related services for a person;
297.20(ii) medication setup;
297.21(iii) medication administration;
297.22(iv) medication storage and security;
297.23(v) medication documentation and charting;
297.24(vi) verification and monitoring of effectiveness of systems to ensure safe medication
297.25handling and administration;
297.26(vii) coordination of medication refills;
297.27(viii) handling changes to prescriptions and implementation of those changes;
297.28(ix) communicating with the pharmacy; and
297.29(x) coordination and communication with prescriber;
297.30(4) safe transportation, when the license holder is responsible for transportation of
297.31persons, with provisions for handling emergency situations according to the requirements
297.32in section 245D.06, subdivision 2, clauses (2) to (4);
297.33(5) a plan for ensuring the safety of persons served by the program in emergencies as
297.34defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
297.35to the license holder. A license holder with a community residential setting or a day service
298.1facility license must ensure the policy and procedures comply with the requirements in
298.2section 245D.22, subdivision 4;
298.3(6) a plan for responding to all incidents as defined in section 245D.02, subdivision
298.411; and reporting all incidents required to be reported according to section 245D.06,
298.5subdivision 1. The plan must:
298.6(i) provide the contact information of a source of emergency medical care and
298.7transportation; and
298.8(ii) require staff to first call 911 when the staff believes a medical emergency may be
298.9life threatening, or to call the mental health crisis intervention team when the person is
298.10experiencing a mental health crisis; and
298.11(7) a procedure for the review of incidents and emergencies to identify trends or
298.12patterns, and corrective action if needed. The license holder must establish and maintain
298.13a record-keeping system for the incident and emergency reports. Each incident and
298.14emergency report file must contain a written summary of the incident. The license holder
298.15must conduct a review of incident reports for identification of incident patterns, and
298.16implementation of corrective action as necessary to reduce occurrences. Each incident
298.17report must include:
298.18(i) the name of the person or persons involved in the incident. It is not necessary
298.19to identify all persons affected by or involved in an emergency unless the emergency
298.20resulted in an incident;
298.21(ii) the date, time, and location of the incident or emergency;
298.22(iii) a description of the incident or emergency;
298.23(iv) a description of the response to the incident or emergency and whether a person's
298.24coordinated service and support plan addendum or program policies and procedures were
298.25implemented as applicable;
298.26(v) the name of the staff person or persons who responded to the incident or
298.27emergency; and
298.28(vi) the determination of whether corrective action is necessary based on the results
298.29of the review.
298.30    Subd. 3. Data privacy. The license holder must establish policies and procedures that
298.31promote service recipient rights by ensuring data privacy according to the requirements in:
298.32(1) the Minnesota Government Data Practices Act, section 13.46, and all other
298.33applicable Minnesota laws and rules in handling all data related to the services provided;
298.34and
298.35(2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the
298.36extent that the license holder performs a function or activity involving the use of protected
299.1health information as defined under Code of Federal Regulations, title 45, section 164.501,
299.2including, but not limited to, providing health care services; health care claims processing
299.3or administration; data analysis, processing, or administration; utilization review; quality
299.4assurance; billing; benefit management; practice management; repricing; or as otherwise
299.5provided by Code of Federal Regulations, title 45, section 160.103. The license holder
299.6must comply with the Health Insurance Portability and Accountability Act of 1996 and
299.7its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164,
299.8and all applicable requirements.
299.9    Subd. 4. Admission criteria. The license holder must establish policies and
299.10procedures that promote continuity of care by ensuring that admission or service initiation
299.11criteria:
299.12(1) is consistent with the license holder's registration information identified in the
299.13requirements in section 245D.031, subdivision 2, and with the service-related rights
299.14identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);
299.15(2) identifies the criteria to be applied in determining whether the license holder
299.16can develop services to meet the needs specified in the person's coordinated service and
299.17support plan;
299.18(3) requires a license holder providing services in a health care facility to comply
299.19with the requirements in section 243.166, subdivision 4b, to provide notification to
299.20residents when a registered predatory offender is admitted into the program or to a
299.21potential admission when the facility was already serving a registered predatory offender.
299.22For purposes of this clause, "health care facility" means a facility licensed by the
299.23commissioner as a residential facility under chapter 245A to provide adult foster care or
299.24residential services to persons with disabilities; and
299.25(4) requires that when a person or the person's legal representative requests services
299.26from the license holder, a refusal to admit the person must be based on an evaluation of
299.27the person's assessed needs and the license holder's lack of capacity to meet the needs of
299.28the person. The license holder must not refuse to admit a person based solely on the
299.29type of residential services the person is receiving, or solely on the person's severity of
299.30disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of
299.31communication skills, physical disabilities, toilet habits, behavioral disorders, or past
299.32failure to make progress. Documentation of the basis for refusal must be provided to the
299.33person or the person's legal representative and case manager upon request.
299.34EFFECTIVE DATE.This section is effective January 1, 2014.

300.1    Sec. 32. [245D.21] FACILITY LICENSURE REQUIREMENTS AND
300.2APPLICATION PROCESS.
300.3    Subdivision 1. Community residential settings and day service facilities. For
300.4purposes of this section, "facility" means both a community residential setting and day
300.5service facility and the physical plant.
300.6    Subd. 2. Inspections and code compliance. (a) Physical plants must comply with
300.7applicable state and local fire, health, building, and zoning codes.
300.8(b)(1) The facility must be inspected by a fire marshal or their delegate within
300.912 months before initial licensure to verify that it meets the applicable occupancy
300.10requirements as defined in the State Fire Code and that the facility complies with the fire
300.11safety standards for that occupancy code contained in the State Fire Code.
300.12(2) The fire marshal inspection of a community residential setting must verify the
300.13residence is a dwelling unit within a residential occupancy as defined in section 9.117 of
300.14the State Fire Code. A home safety checklist, approved by the commissioner, must be
300.15completed for a community residential setting by the license holder and the commissioner
300.16before the satellite license is reissued.
300.17(3) The facility shall be inspected according to the facility capacity specified on the
300.18initial application form.
300.19(4) If the commissioner has reasonable cause to believe that a potentially hazardous
300.20condition may be present or the licensed capacity is increased, the commissioner shall
300.21request a subsequent inspection and written report by a fire marshal to verify the absence
300.22of hazard.
300.23(5) Any condition cited by a fire marshal, building official, or health authority as
300.24hazardous or creating an immediate danger of fire or threat to health and safety must be
300.25corrected before a license is issued by the department, and for community residential
300.26settings, before a license is reissued.
300.27(c) The facility must maintain in a permanent file the reports of health, fire, and
300.28other safety inspections.
300.29(d) The facility's plumbing, ventilation, heating, cooling, lighting, and other
300.30fixtures and equipment, including elevators or food service, if provided, must conform to
300.31applicable health, sanitation, and safety codes and regulations.
300.32EFFECTIVE DATE.This section is effective January 1, 2014.

300.33    Sec. 33. [245D.22] FACILITY SANITATION AND HEALTH.
300.34    Subdivision 1. General maintenance. The license holder must maintain the interior
300.35and exterior of buildings, structures, or enclosures used by the facility, including walls,
301.1floors, ceilings, registers, fixtures, equipment, and furnishings in good repair and in a
301.2sanitary and safe condition. The facility must be clean and free from accumulations of
301.3dirt, grease, garbage, peeling paint, mold, vermin, and insects. The license holder must
301.4correct building and equipment deterioration, safety hazards, and unsanitary conditions.
301.5    Subd. 2. Hazards and toxic substances. (a) The license holder must ensure that
301.6service sites owned or leased by the license holder are free from hazards that would
301.7threaten the health or safety of a person receiving services by ensuring the requirements
301.8in paragraphs (b) to (h) are met.
301.9(b) Chemicals, detergents, and other hazardous or toxic substances must not be
301.10stored with food products or in any way that poses a hazard to persons receiving services.
301.11(c) The license holder must install handrails and nonslip surfaces on interior and
301.12exterior runways, stairways, and ramps according to the applicable building code.
301.13(d) If there are elevators in the facility, the license holder must have elevators
301.14inspected each year. The date of the inspection, any repairs needed, and the date the
301.15necessary repairs were made must be documented.
301.16(e) The license holder must keep stairways, ramps, and corridors free of obstructions.
301.17(f) Outside property must be free from debris and safety hazards. Exterior stairs and
301.18walkways must be kept free of ice and snow.
301.19(g) Heating, ventilation, air conditioning units, and other hot surfaces and moving
301.20parts of machinery must be shielded or enclosed.
301.21(h) Use of dangerous items or equipment by persons served by the program must be
301.22allowed in accordance with the person's coordinated service and support plan addendum
301.23or the program abuse prevention plan, if not addressed in the coordinated service and
301.24support plan addendum.
301.25    Subd. 3. Storage and disposal of medication. Schedule II controlled substances in
301.26the facility that are named in section 152.02, subdivision 3, must be stored in a locked
301.27storage area permitting access only by persons and staff authorized to administer the
301.28medication. This must be incorporated into the license holder's medication administration
301.29policy and procedures required under section 245D.11, subdivision 2, clause (3).
301.30Medications must be disposed of according to the Environmental Protection Agency
301.31recommendations.
301.32    Subd. 4. First aid must be available on site. (a) A staff person trained in first aid
301.33must be available on site and, when required in a person's coordinated service and support
301.34plan or coordinated service and support plan addendum, cardiopulmonary resuscitation,
301.35whenever persons are present and staff are required to be at the site to provide direct
302.1service. The training must include in-person instruction, hands-on practice, and an
302.2observed skills assessment under the direct supervision of a first aid instructor.
302.3(b) A facility must have first aid kits readily available for use by, and that meets
302.4the needs of, persons receiving services and staff. At a minimum, the first aid kit must
302.5be equipped with accessible first aid supplies including bandages, sterile compresses,
302.6scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
302.7adhesive tape, and first aid manual.
302.8    Subd. 5. Emergencies. (a) The license holder must have a written plan for
302.9responding to emergencies as defined in section 245D.02, subdivision 8, to ensure the
302.10safety of persons served in the facility. The plan must include:
302.11(1) procedures for emergency evacuation and emergency sheltering, including:
302.12(i) how to report a fire or other emergency;
302.13(ii) procedures to notify, relocate, and evacuate occupants, including use of adaptive
302.14procedures or equipment to assist with the safe evacuation of persons with physical or
302.15sensory disabilities; and
302.16(iii) instructions on closing off the fire area, using fire extinguishers, and activating
302.17and responding to alarm systems;
302.18(2) a floor plan that identifies:
302.19(i) the location of fire extinguishers;
302.20(ii) the location of audible or visual alarm systems, including but not limited to
302.21manual fire alarm boxes, smoke detectors, fire alarm enunciators and controls, and
302.22sprinkler systems;
302.23(iii) the location of exits, primary and secondary evacuation routes, and accessible
302.24egress routes, if any; and
302.25(iv) the location of emergency shelter within the facility;
302.26(3) a site plan that identifies:
302.27(i) designated assembly points outside the facility;
302.28(ii) the locations of fire hydrants; and
302.29(iii) the routes of fire department access;
302.30(4) the responsibilities each staff person must assume in case of emergency;
302.31(5) procedures for conducting quarterly drills each year and recording the date of
302.32each drill in the file of emergency plans;
302.33(6) procedures for relocation or service suspension when services are interrupted
302.34for more than 24 hours;
302.35(7) for a community residential setting with three or more dwelling units, a floor
302.36plan that identifies the location of enclosed exit stairs; and
303.1(8) an emergency escape plan for each resident.
303.2(b) The license holder must:
303.3(1) maintain a log of quarterly fire drills on file in the facility;
303.4(2) provide an emergency response plan that is readily available to staff and persons
303.5receiving services;
303.6(3) inform each person of a designated area within the facility where the person
303.7should go to for emergency shelter during severe weather and the designated assembly
303.8points outside the facility; and
303.9(4) maintain emergency contact information for persons served at the facility that
303.10can be readily accessed in an emergency.
303.11    Subd. 6. Emergency equipment. The facility must have a flashlight and a portable
303.12radio or television set that do not require electricity and can be used if a power failure
303.13occurs.
303.14    Subd. 7. Telephone and posted numbers. A facility must have a non-coin operated
303.15telephone that is readily accessible. A list of emergency numbers must be posted in a
303.16prominent location. When an area has a 911 number or a mental health crisis intervention
303.17team number, both numbers must be posted and the emergency number listed must be
303.18911. In areas of the state without a 911 number, the numbers listed must be those of the
303.19local fire department, police department, emergency transportation, and poison control
303.20center. The names and telephone numbers of each person's representative, physician, and
303.21dentist must be readily available.
303.22EFFECTIVE DATE.This section is effective January 1, 2014.

303.23    Sec. 34. [245D.23] COMMUNITY RESIDENTIAL SETTINGS; SATELLITE
303.24LICENSURE REQUIREMENTS AND APPLICATION PROCESS.
303.25    Subdivision 1. Separate satellite license required for separate sites. (a) A license
303.26holder providing residential support services must obtain a separate satellite license for
303.27each community residential setting located at separate addresses when the community
303.28residential settings are to be operated by the same license holder. For purposes of this
303.29chapter, a community residential setting is a satellite of the home and community-based
303.30services license.
303.31(b) Community residential settings are permitted single-family use homes. After a
303.32license has been issued, the commissioner shall notify the local municipality where the
303.33residence is located of the approved license.
303.34    Subd. 2. Notification to local agency. The license holder must notify the local
303.35agency within 24 hours of the onset of changes in a residence resulting from construction,
304.1remodeling, or damages requiring repairs that require a building permit or may affect a
304.2licensing requirement in this chapter.
304.3    Subd. 3. Alternate overnight supervision. A license holder granted an alternate
304.4overnight supervision technology adult foster care license according to section 245A.11,
304.5subdivision 7a, that converts to a community residential setting satellite license according
304.6to this chapter must retain that designation.
304.7EFFECTIVE DATE.This section is effective January 1, 2014.

304.8    Sec. 35. [245D.24] COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL
304.9PLANT AND ENVIRONMENT.
304.10    Subdivision 1. Occupancy. The residence must meet the definition of a dwelling
304.11unit in a residential occupancy.
304.12    Subd. 2. Common area requirements. The living area must be provided with an
304.13adequate number of furnishings for the usual functions of daily living and social activities.
304.14The dining area must be furnished to accommodate meals shared by all persons living in
304.15the residence. These furnishings must be in good repair and functional to meet the daily
304.16needs of the persons living in the residence.
304.17    Subd. 3. Bedrooms. (a) People receiving services must mutually consent, in
304.18writing, to sharing a bedroom with one another. No more than two people receiving
304.19services may share one bedroom.
304.20(b) A single occupancy bedroom must have at least 80 square feet of floor space with
304.21a 7-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor
304.22space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and
304.23other habitable rooms by floor to ceiling walls containing no openings except doorways
304.24and must not serve as a corridor to another room used in daily living.
304.25(c) A person's personal possessions and items for the person's own use are the only
304.26items permitted to be stored in a person's bedroom.
304.27(d) Unless otherwise documented through assessment as a safety concern for the
304.28person, each person must be provided with the following furnishings:
304.29(1) a separate bed of proper size and height for the convenience and comfort of the
304.30person, with a clean mattress in good repair;
304.31(2) clean bedding appropriate for the season for each person;
304.32(3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal
304.33possessions and clothing; and
304.34(4) a mirror for grooming.
305.1(e) When possible, a person must be allowed to have items of furniture that the
305.2person personally owns in the bedroom, unless doing so would interfere with safety
305.3precautions, violate a building or fire code, or interfere with another person's use of the
305.4bedroom. A person may choose to not have a cabinet, dresser, shelves, or a mirror in the
305.5bedroom, as otherwise required under paragraph (d), clause (3) or (4). A person may
305.6choose to use a mattress other than an innerspring mattress and may choose to not have
305.7the mattress on a mattress frame or support. If a person chooses not to have a piece of
305.8required furniture, the license holder must document this choice and is not required to
305.9provide the item. If a person chooses to use a mattress other than an innerspring mattress
305.10or chooses to not have a mattress frame or support, the license holder must document this
305.11choice and allow the alternative desired by the person.
305.12(f) A person must be allowed to bring personal possessions into the bedroom
305.13and other designated storage space, if such space is available, in the residence. The
305.14person must be allowed to accumulate possessions to the extent the residence is able to
305.15accommodate them, unless doing so is contraindicated for the person's physical or mental
305.16health, would interfere with safety precautions or another person's use of the bedroom, or
305.17would violate a building or fire code. The license holder must allow for locked storage
305.18of personal items. Any restriction on the possession or locked storage of personal items,
305.19including requiring a person to use a lock provided by the license holder, must comply
305.20with section 245D.04, subdivision 3, paragraph (c), and allow the person to be present if
305.21and when the license holder opens the lock.
305.22EFFECTIVE DATE.This section is effective January 1, 2014.

305.23    Sec. 36. [245D.25] COMMUNITY RESIDENTIAL SETTINGS; FOOD AND
305.24WATER.
305.25    Subdivision 1. Water. Potable water from privately owned wells must be tested
305.26annually by a Department of Health-certified laboratory for coliform bacteria and nitrate
305.27nitrogens to verify safety. The health authority may require retesting and corrective
305.28measures if results exceed state water standards in Minnesota Rules, chapter 4720, or in
305.29the event of a flooding or incident which may put the well at risk of contamination. To
305.30prevent scalding, the water temperature of faucets must not exceed 120 degrees Fahrenheit.
305.31    Subd. 2. Food. Food served must meet any special dietary needs of a person as
305.32prescribed by the person's physician or dietitian. Three nutritionally balanced meals a day
305.33must be served or made available to persons, and nutritious snacks must be available
305.34between meals.
306.1    Subd. 3. Food safety. Food must be obtained, handled, and properly stored to
306.2prevent contamination, spoilage, or a threat to the health of a person.
306.3EFFECTIVE DATE.This section is effective January 1, 2014.

306.4    Sec. 37. [245D.26] COMMUNITY RESIDENTIAL SETTINGS; SANITATION
306.5AND HEALTH.
306.6    Subdivision 1. Goods provided by the license holder. Individual clean bed linens
306.7appropriate for the season and the person's comfort, including towels and wash cloths,
306.8must be available for each person. Usual or customary goods for the operation of a
306.9residence which are communally used by all persons receiving services living in the
306.10residence must be provided by the license holder, including household items for meal
306.11preparation, cleaning supplies to maintain the cleanliness of the residence, window
306.12coverings on windows for privacy, toilet paper, and hand soap.
306.13    Subd. 2. Personal items. Personal health and hygiene items must be stored in a
306.14safe and sanitary manner.
306.15    Subd. 3. Pets and service animals. Pets and service animals housed within
306.16the residence must be immunized and maintained in good health as required by local
306.17ordinances and state law. The license holder must ensure that the person and the person's
306.18representative is notified before admission of the presence of pets in the residence.
306.19    Subd. 4. Smoking in the residence. License holders must comply with the
306.20requirements of the Minnesota Clean Indoor Air Act, sections 144.411 to 144.417, when
306.21smoking is permitted in the residence.
306.22    Subd. 5. Weapons. Weapons and ammunition must be stored separately in locked
306.23areas that are inaccessible to a person receiving services. For purposes of this subdivision,
306.24"weapons" means firearms and other instruments or devices designed for and capable of
306.25producing bodily harm.
306.26EFFECTIVE DATE.This section is effective January 1, 2014.

306.27    Sec. 38. [245D.27] DAY SERVICES FACILITIES; SATELLITE LICENSURE
306.28REQUIREMENTS AND APPLICATION PROCESS.
306.29Except for day service facilities on the same or adjoining lot, the license holder
306.30providing day services must apply for a separate license for each facility-based service
306.31site when the license holder is the owner, lessor, or tenant of the service site at which
306.32persons receive day services and the license holder's employees who provide day services
306.33are present for a cumulative total of more than 30 days within any 12-month period. For
307.1purposes of this chapter, a day services facility license is a satellite license of the day
307.2services program. A day services program may operate multiple licensed day service
307.3facilities in one or more counties in the state. For the purposes of this section, "adjoining
307.4lot" means day services facilities that are next door to or across the street from one another.
307.5EFFECTIVE DATE.This section is effective January 1, 2014.

307.6    Sec. 39. [245D.28] DAY SERVICES FACILITIES; PHYSICAL PLANT AND
307.7SPACE REQUIREMENTS.
307.8    Subdivision 1. Facility capacity and useable space requirements. (a) The facility
307.9capacity of each day service facility must be determined by the amount of primary space
307.10available, the scheduling of activities at other service sites, and the space requirements of
307.11all persons receiving services at the facility, not just the licensed services. The facility
307.12capacity must specify the maximum number of persons that may receive services on
307.13site at any one time.
307.14(b) When a facility is located in a multifunctional organization, the facility may
307.15share common space with the multifunctional organization if the required available
307.16primary space for use by persons receiving day services is maintained while the facility is
307.17operating. The license holder must comply at all times with all applicable fire and safety
307.18codes under section 245A.04, subdivision 2a, and adequate supervision requirements
307.19under section 245D.31 for all persons receiving day services.
307.20(c) A day services facility must have a minimum of 40 square feet of primary
307.21space available for each consumer who is present at the site at any one time. Primary
307.22space does not include:
307.23(1) common areas, such as hallways, stairways, closets, utility areas, bathrooms,
307.24and kitchens;
307.25(2) floor areas beneath stationary equipment; or
307.26(3) any space occupied by persons associated with the multifunctional organization
307.27while persons receiving day services are using common space.
307.28    Subd. 2. Individual personal articles. Each person must be provided space in a
307.29closet, cabinet, on a shelf, or a coat hook for storage of personal items for the person's own
307.30use while receiving services at the facility, unless doing so would interfere with safety
307.31precautions, another person's work space, or violate a building or fire code.
307.32EFFECTIVE DATE.This section is effective January 1, 2014.

308.1    Sec. 40. [245D.29] DAY SERVICES FACILITIES; HEALTH AND SAFETY
308.2REQUIREMENTS.
308.3    Subdivision 1. Refrigeration. If the license holder provides refrigeration at service
308.4sites owned or leased by the license holder for storing perishable foods and perishable
308.5portions of bag lunches, whether the foods are supplied by the license holder or the
308.6persons receiving services, the refrigeration must have a temperature of 40 degrees
308.7Fahrenheit or less.
308.8    Subd. 2. Drinking water. Drinking water must be available to all persons
308.9receiving services. If a person is unable to request or obtain drinking water, it must be
308.10provided according to that person's individual needs. Drinking water must be provided in
308.11single-service containers or from drinking fountains accessible to all persons.
308.12    Subd. 3. Individuals who become ill during the day. There must be an area in
308.13which a person receiving services can rest if:
308.14(1) the person becomes ill during the day;
308.15(2) the person does not live in a licensed residential site;
308.16(3) the person requires supervision; and
308.17(4) there is not a caretaker immediately available. Supervision must be provided
308.18until the caretaker arrives to bring the person home.
308.19    Subd. 4. Safety procedures. The license holder must establish general written
308.20safety procedures that include criteria for selecting, training, and supervising persons who
308.21work with hazardous machinery, tools, or substances. Safety procedures specific to each
308.22person's activities must be explained and be available in writing to all staff members
308.23and persons receiving services.
308.24EFFECTIVE DATE.This section is effective January 1, 2014.

308.25    Sec. 41. [245D.31] DAY SERVICES FACILITIES; STAFF RATIO AND
308.26FACILITY COVERAGE.
308.27    Subdivision 1. Scope. This section applies only to facility-based day services.
308.28    Subd. 2. Factors. (a) The number of direct support service staff members that a
308.29license holder must have on duty at the facility at a given time to meet the minimum
308.30staffing requirements established in this section varies according to:
308.31(1) the number of persons who are enrolled and receiving direct support services
308.32at that given time;
308.33(2) the staff ratio requirement established under subdivision 3 for each person who
308.34is present; and
309.1(3) whether the conditions described in subdivision 8 exist and warrant additional
309.2staffing beyond the number determined to be needed under subdivision 7.
309.3(b) The commissioner must consider the factors in paragraph (a) in determining a
309.4license holder's compliance with the staffing requirements and must further consider
309.5whether the staff ratio requirement established under subdivision 3 for each person
309.6receiving services accurately reflects the person's need for staff time.
309.7    Subd. 3. Staff ratio requirement for each person receiving services. The case
309.8manager, in consultation with the interdisciplinary team, must determine at least once each
309.9year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
309.10services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
309.11assigned each person and the documentation of how the ratio was arrived at must be kept
309.12in each person's individual service plan. Documentation must include an assessment of the
309.13person with respect to the characteristics in subdivisions 4, 5, and 6 recorded on a standard
309.14assessment form required by the commissioner.
309.15    Subd. 4. Person requiring staff ratio of one to four. A person must be assigned a
309.16staff ratio requirement of one to four if:
309.17(1) on a daily basis the person requires total care and monitoring or constant
309.18hand-over-hand physical guidance to successfully complete at least three of the following
309.19activities: toileting, communicating basic needs, eating, ambulating; or is not capable of
309.20taking appropriate action for self-preservation under emergency conditions; or
309.21(2) the person engages in conduct that poses an imminent risk of physical harm to
309.22self or others at a documented level of frequency, intensity, or duration requiring frequent
309.23daily ongoing intervention and monitoring as established in the person's coordinated
309.24service and support plan or coordinated service and support plan addendum.
309.25    Subd. 5. Person requiring staff ratio of one to eight. A person must be assigned a
309.26staff ratio requirement of one to eight if:
309.27(1) the person does not meet the requirements in subdivision 4; and
309.28(2) on a daily basis the person requires verbal prompts or spot checks and minimal
309.29or no physical assistance to successfully complete at least four of the following activities:
309.30toileting, communicating basic needs, eating, ambulating, or taking appropriate action for
309.31self-preservation under emergency conditions.
309.32    Subd. 6. Person requiring staff ratio of one to six. A person who does not have
309.33any of the characteristics described in subdivision 4 or 5 must be assigned a staff ratio
309.34requirement of one to six.
309.35    Subd. 7. Determining number of direct support service staff required. The
309.36minimum number of direct support service staff members required at any one time to
310.1meet the combined staff ratio requirements of the persons present at that time can be
310.2determined by the following steps:
310.3(1) assign each person in attendance the three-digit decimal below that corresponds
310.4to the staff ratio requirement assigned to that person. A staff ratio requirement of one to
310.5four equals 0.250. A staff ratio requirement of one to eight equals 0.125. A staff ratio
310.6requirement of one to six equals 0.166. A staff ratio requirement of one to ten equals 0.100;
310.7(2) add all of the three-digit decimals (one three-digit decimal for every person in
310.8attendance) assigned in clause (1);
310.9(3) when the sum in clause (2) falls between two whole numbers, round off the sum
310.10to the larger of the two whole numbers; and
310.11(4) the larger of the two whole numbers in clause (3) equals the number of direct
310.12support service staff members needed to meet the staff ratio requirements of the persons
310.13in attendance.
310.14    Subd. 8. Staff to be included in calculating minimum staffing requirement.
310.15Only staff providing direct support must be counted as staff members in calculating the
310.16staff-to-participant ratio. A volunteer may be counted as a staff providing direct support
310.17in calculating the staff-to-participant ratio if the volunteer meets the same standards
310.18and requirements as paid staff. No person receiving services must be counted as or be
310.19substituted for a staff member in calculating the staff-to-participant ratio.
310.20    Subd. 9. Conditions requiring additional direct support staff. The license holder
310.21must increase the number of direct support staff members present at any one time beyond
310.22the number arrived at in subdivision 4 if necessary when any one or combination of the
310.23following circumstances can be documented by the commissioner as existing:
310.24(1) the health and safety needs of the persons receiving services cannot be met by
310.25the number of staff members available under the staffing pattern in effect even though the
310.26number has been accurately calculated under subdivision 7; or
310.27(2) the person's conduct frequently presents an imminent risk of physical harm to
310.28self or others.
310.29    Subd. 10. Supervision requirements. (a) At no time must one direct support
310.30staff member be assigned responsibility for supervision and training of more than ten
310.31persons receiving supervision and training, except as otherwise stated in each person's risk
310.32management plan.
310.33(b) In the temporary absence of the director or a supervisor, a direct support staff
310.34member must be designated to supervise the center.
310.35    Subd. 11. Multifunctional programs. A multifunctional program may count other
310.36employees of the organization besides direct support staff of the day service facility in
311.1calculating the staff to participant ratio if the employee is assigned to the day services
311.2facility for a specified amount of time, during which the employee is not assigned to
311.3another organization or program.
311.4EFFECTIVE DATE.This section is effective January 1, 2014.

311.5    Sec. 42. [245D.32] ALTERNATIVE LICENSING INSPECTIONS.
311.6    Subdivision 1. Eligibility for an alternative licensing inspection. (a) A license
311.7holder providing services licensed under this chapter, with a qualifying accreditation and
311.8meeting the eligibility criteria in paragraphs (b) and (c) may request approval for an
311.9alternative licensing inspection when all services provided under the license holder's
311.10license are accredited. A license holder with a qualifying accreditation and meeting
311.11the eligibility criteria in paragraphs (b) and (c) may request approval for an alternative
311.12licensing inspection for individual community residential settings or day services facilities
311.13licensed under this chapter.
311.14(b) In order to be eligible for an alternative licensing inspection, the program must
311.15have had at least one inspection by the commissioner following issuance of the initial
311.16license. For programs operating a day services facility, each facility must have had at least
311.17one on-site inspection by the commissioner following issuance of the initial license.
311.18(c) In order to be eligible for an alternative licensing inspection, the program must
311.19have been in "substantial and consistent compliance" at the time of the last licensing
311.20inspection and during the current licensing period. For purposes of this section, substantial
311.21and consistent compliance means:
311.22(1) the license holder's license was not made conditional, suspended, or revoked;
311.23(2) there have been no substantiated allegations of maltreatment against the license
311.24holder;
311.25(3) there were no program deficiencies identified that would jeopardize the health,
311.26safety, or rights of persons being served; and
311.27(4) the license holder maintained substantial compliance with the other requirements
311.28of chapters 245A and 245C and other applicable laws and rules.
311.29(d) For the purposes of this section, the license holder's license includes services
311.30licensed under this chapter that were previously licensed under chapter 245B until
311.31December 31, 2013.
311.32    Subd. 2. Qualifying accreditation. The commissioner must accept a three-year
311.33accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF)
311.34as a qualifying accreditation.
312.1    Subd. 3. Request for approval of an alternative inspection status. (a) A request
312.2for an alternative inspection must be made on the forms and in the manner prescribed
312.3by the commissioner. When submitting the request, the license holder must submit all
312.4documentation issued by the accrediting body verifying that the license holder has obtained
312.5and maintained the qualifying accreditation and has complied with recommendations
312.6or requirements from the accrediting body during the period of accreditation. Based
312.7on the request and the additional required materials, the commissioner may approve
312.8an alternative inspection status.
312.9(b) The commissioner must notify the license holder in writing that the request for
312.10an alternative inspection status has been approved. Approval must be granted until the
312.11end of the qualifying accreditation period.
312.12(c) The license holder must submit a written request for approval to be renewed
312.13one month before the end of the current approval period according to the requirements
312.14in paragraph (a). If the license holder does not submit a request to renew approval as
312.15required, the commissioner must conduct a licensing inspection.
312.16    Subd. 4. Programs approved for alternative licensing inspection; deemed
312.17compliance licensing requirements. (a) A license holder approved for alternative
312.18licensing inspection under this section is required to maintain compliance with all
312.19licensing standards according to this chapter.
312.20(b) A license holder approved for alternative licensing inspection under this section
312.21must be deemed to be in compliance with all the requirements of this chapter, and the
312.22commissioner must not perform routine licensing inspections.
312.23(c) Upon receipt of a complaint regarding the services of a license holder approved
312.24for alternative licensing inspection under this section, the commissioner must investigate
312.25the complaint and may take any action as provided under section 245A.06 or 245A.07.
312.26    Subd. 5. Investigations of alleged or suspected maltreatment. Nothing in this
312.27section changes the commissioner's responsibilities to investigate alleged or suspected
312.28maltreatment of a minor under section 626.556 or a vulnerable adult under section 626.557.
312.29    Subd. 6. Termination or denial of subsequent approval. Following approval of
312.30an alternative licensing inspection, the commissioner may terminate or deny subsequent
312.31approval of an alternative licensing inspection if the commissioner determines that:
312.32(1) the license holder has not maintained the qualifying accreditation;
312.33(2) the commissioner has substantiated maltreatment for which the license holder or
312.34facility is determined to be responsible during the qualifying accreditation period; or
313.1(3) during the qualifying accreditation period, the license holder has been issued
313.2an order for conditional license, fine, suspension, or license revocation that has not been
313.3reversed upon appeal.
313.4    Subd. 7. Appeals. The commissioner's decision that the conditions for approval for
313.5an alternative licensing inspection have not been met is final and not subject to appeal
313.6under the provisions of chapter 14.
313.7    Subd. 8. Commissioner's programs. Home and community-based services licensed
313.8under this chapter for which the commissioner is the license holder with a qualifying
313.9accreditation are excluded from being approved for an alternative licensing inspection.
313.10EFFECTIVE DATE.This section is effective January 1, 2014.

313.11    Sec. 43. [245D.33] ADULT MENTAL HEALTH CERTIFICATION STANDARDS.
313.12(a) The commissioner of human services shall issue a mental health certification
313.13for services licensed under this chapter, when a license holder is determined to have met
313.14the requirements under paragraph (b). This certification is voluntary for license holders.
313.15The certification shall be printed on the license and identified on the commissioner's
313.16public Web site.
313.17(b) The requirements for certification are:
313.18(1) all staff have received at least seven hours of annual training covering all of
313.19the following topics:
313.20(i) mental health diagnoses;
313.21(ii) mental health crisis response and de-escalation techniques;
313.22(iii) recovery from mental illness;
313.23(iv) treatment options, including evidence-based practices;
313.24(v) medications and their side effects;
313.25(vi) co-occurring substance abuse and health conditions; and
313.26(vii) community resources;
313.27(2) a mental health professional, as defined in section 245.462, subdivision 18, or a
313.28mental health practitioner as defined in section 245.462, subdivision 17, is available
313.29for consultation and assistance;
313.30(3) there is a plan and protocol in place to address a mental health crisis; and
313.31(4) each person's individual service and support plan identifies who is providing
313.32clinical services and their contact information, and includes an individual crisis prevention
313.33and management plan developed with the person.
313.34(c) License holders seeking certification under this section must request this
313.35certification on forms and in the manner prescribed by the commissioner.
314.1(d) If the commissioner finds that the license holder has failed to comply with the
314.2certification requirements under paragraph (b), the commissioner may issue a correction
314.3order and an order of conditional license in accordance with section 245A.06 or may
314.4issue a sanction in accordance with section 245A.07, including and up to removal of
314.5the certification.
314.6(e) A denial of the certification or the removal of the certification based on a
314.7determination that the requirements under paragraph (b) have not been met is not subject to
314.8appeal. A license holder that has been denied a certification or that has had a certification
314.9removed may again request certification when the license holder is in compliance with the
314.10requirements of paragraph (b).
314.11EFFECTIVE DATE.This section is effective January 1, 2014.

314.12    Sec. 44. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
314.13    Subd. 11. Residential support services. (a) Upon federal approval, there is
314.14established a new service called residential support that is available on the community
314.15alternative care, community alternatives for disabled individuals, developmental
314.16disabilities, and brain injury waivers. Existing waiver service descriptions must be
314.17modified to the extent necessary to ensure there is no duplication between other services.
314.18Residential support services must be provided by vendors licensed as a community
314.19residential setting as defined in section 245A.11, subdivision 8, a foster care setting
314.20licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or an adult foster care
314.21setting licensed under Minnesota Rules, parts 9555.5105 to 9555.6265.
314.22    (b) Residential support services must meet the following criteria:
314.23    (1) providers of residential support services must own or control the residential site;
314.24    (2) the residential site must not be the primary residence of the license holder;
314.25    (3) (1) the residential site must have a designated program supervisor person
314.26 responsible for program management, oversight, development, and implementation of
314.27policies and procedures;
314.28    (4) (2) the provider of residential support services must provide supervision, training,
314.29and assistance as described in the person's coordinated service and support plan; and
314.30    (5) (3) the provider of residential support services must meet the requirements of
314.31licensure and additional requirements of the person's coordinated service and support plan.
314.32    (c) Providers of residential support services that meet the definition in paragraph (a)
314.33must be registered using a process determined by the commissioner beginning July 1, 2009
314.34 must be licensed according to chapter 245D. Providers licensed to provide child foster care
314.35under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult foster care licensed under
315.1Minnesota Rules, parts 9555.5105 to 9555.6265, and that meet the requirements in section
315.2245A.03, subdivision 7 , paragraph (g), are considered registered under this section.

315.3    Sec. 45. Minnesota Statutes 2012, section 256B.4912, subdivision 1, is amended to read:
315.4    Subdivision 1. Provider qualifications. (a) For the home and community-based
315.5waivers providing services to seniors and individuals with disabilities under sections
315.6256B.0913, 256B.0915, 256B.092, and 256B.49, the commissioner shall establish:
315.7(1) agreements with enrolled waiver service providers to ensure providers meet
315.8Minnesota health care program requirements;
315.9(2) regular reviews of provider qualifications, and including requests of proof of
315.10documentation; and
315.11(3) processes to gather the necessary information to determine provider qualifications.
315.12    (b) Beginning July 1, 2012, staff that provide direct contact, as defined in section
315.13245C.02, subdivision 11 , for services specified in the federally approved waiver plans
315.14must meet the requirements of chapter 245C prior to providing waiver services and as
315.15part of ongoing enrollment. Upon federal approval, this requirement must also apply to
315.16consumer-directed community supports.
315.17    (c) Beginning January 1, 2014, service owners and managerial officials overseeing
315.18the management or policies of services that provide direct contact as specified in the
315.19federally approved waiver plans must meet the requirements of chapter 245C prior to
315.20reenrollment or, for new providers, prior to initial enrollment if they have not already done
315.21so as a part of service licensure requirements.

315.22    Sec. 46. Minnesota Statutes 2012, section 256B.4912, subdivision 7, is amended to read:
315.23    Subd. 7. Applicant and license holder training. An applicant or license holder
315.24for the home and community-based waivers providing services to seniors and individuals
315.25with disabilities under sections 256B.0913, 256B.0915, 256B.092, and 256B.49 that is
315.26not enrolled as a Minnesota health care program home and community-based services
315.27waiver provider at the time of application must ensure that at least one controlling
315.28individual completes a onetime training on the requirements for providing home and
315.29community-based services from a qualified source as determined by the commissioner,
315.30before a provider is enrolled or license is issued. Within six months of enrollment, a newly
315.31enrolled home and community-based waiver service provider must ensure that at least one
315.32controlling individual has completed training on waiver and related program billing.

316.1    Sec. 47. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
316.2subdivision to read:
316.3    Subd. 8. Data on use of emergency use of manual restraint. Beginning July 1,
316.42013, facilities and services to be licensed under chapter 245D shall submit data regarding
316.5the use of emergency use of manual restraint as identified in section 245D.061 in a format
316.6and at a frequency identified by the commissioner.

316.7    Sec. 48. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
316.8subdivision to read:
316.9    Subd. 9. Definitions. (a) For the purposes of this section the following terms have
316.10the meanings given them.
316.11(b) "Controlling individual" means a public body, governmental agency, business
316.12entity, officer, owner, or managerial official whose responsibilities include the direction of
316.13the management or policies of a program.
316.14(c) "Managerial official" means an individual who has decision-making authority
316.15related to the operation of the program and responsibility for the ongoing management of
316.16or direction of the policies, services, or employees of the program.
316.17(d) "Owner" means an individual who has direct or indirect ownership interest in
316.18a corporation or partnership, or business association enrolling with the Department of
316.19Human Services as a provider of waiver services.

316.20    Sec. 49. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
316.21subdivision to read:
316.22    Subd. 10. Enrollment requirements. All home and community-based waiver
316.23providers must provide, at the time of enrollment and within 30 days of a request, in a
316.24format determined by the commissioner, information and documentation that includes, but
316.25is not limited to, the following:
316.26(1) proof of surety bond coverage in the amount of $50,000 or ten percent of the
316.27provider's payments from Medicaid in the previous calendar year, whichever is greater;
316.28(2) proof of fidelity bond coverage in the amount of $20,000; and
316.29(3) proof of liability insurance.

316.30    Sec. 50. Minnesota Statutes 2012, section 626.557, subdivision 9a, is amended to read:
316.31    Subd. 9a. Evaluation and referral of reports made to common entry point unit.
316.32    The common entry point must screen the reports of alleged or suspected maltreatment for
316.33immediate risk and make all necessary referrals as follows:
317.1    (1) if the common entry point determines that there is an immediate need for
317.2adult protective services, the common entry point agency shall immediately notify the
317.3appropriate county agency;
317.4    (2) if the report contains suspected criminal activity against a vulnerable adult, the
317.5common entry point shall immediately notify the appropriate law enforcement agency;
317.6    (3) the common entry point shall refer all reports of alleged or suspected
317.7maltreatment to the appropriate lead investigative agency as soon as possible, but in any
317.8event no longer than two working days; and
317.9    (4) if the report involves services licensed by the Department of Human Services
317.10and subject to chapter 245D, the common entry point shall refer the report to the county as
317.11the lead agency according to clause (3), but shall also notify the Department of Human
317.12Services of the report; and
317.13    (5) (4) if the report contains information about a suspicious death, the common
317.14entry point shall immediately notify the appropriate law enforcement agencies, the local
317.15medical examiner, and the ombudsman for mental health and developmental disabilities
317.16established under section 245.92. Law enforcement agencies shall coordinate with the
317.17local medical examiner and the ombudsman as provided by law.

317.18    Sec. 51. Minnesota Statutes 2012, section 626.5572, subdivision 13, is amended to read:
317.19    Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary
317.20administrative agency responsible for investigating reports made under section 626.557.
317.21(a) The Department of Health is the lead investigative agency for facilities or
317.22services licensed or required to be licensed as hospitals, home care providers, nursing
317.23homes, boarding care homes, hospice providers, residential facilities that are also federally
317.24certified as intermediate care facilities that serve people with developmental disabilities,
317.25or any other facility or service not listed in this subdivision that is licensed or required to
317.26be licensed by the Department of Health for the care of vulnerable adults. "Home care
317.27provider" has the meaning provided in section 144A.43, subdivision 4, and applies when
317.28care or services are delivered in the vulnerable adult's home, whether a private home or a
317.29housing with services establishment registered under chapter 144D, including those that
317.30offer assisted living services under chapter 144G.
317.31(b) Except as provided under paragraph (c), for services licensed according to
317.32chapter 245D, The Department of Human Services is the lead investigative agency for
317.33facilities or services licensed or required to be licensed as adult day care, adult foster care,
317.34programs for people with developmental disabilities, family adult day services, mental
317.35health programs, mental health clinics, chemical dependency programs, the Minnesota
318.1sex offender program, or any other facility or service not listed in this subdivision that is
318.2licensed or required to be licensed by the Department of Human Services.
318.3(c) The county social service agency or its designee is the lead investigative agency
318.4for all other reports, including, but not limited to, reports involving vulnerable adults
318.5receiving services from a personal care provider organization under section 256B.0659,
318.6or receiving home and community-based services licensed by the Department of Human
318.7Services and subject to chapter 245D.

318.8    Sec. 52. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
318.9AND COMMUNITY-BASED SERVICES.
318.10(a) The Department of Health Compliance Monitoring Division and the Department
318.11of Human Services Licensing Division shall jointly develop an integrated licensing system
318.12for providers of both home care services subject to licensure under Minnesota Statutes,
318.13chapter 144A, and for home and community-based services subject to licensure under
318.14Minnesota Statutes, chapter 245D. The integrated licensing system shall:
318.15(1) require only one license of any provider of services under Minnesota Statutes,
318.16sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
318.17(2) promote quality services that recognize a person's individual needs and protect
318.18the person's health, safety, rights, and well-being;
318.19(3) promote provider accountability through application requirements, compliance
318.20inspections, investigations, and enforcement actions;
318.21(4) reference other applicable requirements in existing state and federal laws,
318.22including the federal Affordable Care Act;
318.23(5) establish internal procedures to facilitate ongoing communications between the
318.24agencies, and with providers and services recipients about the regulatory activities;
318.25(6) create a link between the agency Web sites so that providers and the public can
318.26access the same information regardless of which Web site is accessed initially; and
318.27(7) collect data on identified outcome measures as necessary for the agencies to
318.28report to the Centers for Medicare and Medicaid Services.
318.29(b) The joint recommendations for legislative changes to implement the integrated
318.30licensing system are due to the legislature by February 15, 2014.
318.31(c) Before implementation of the integrated licensing system, providers licensed as
318.32home care providers under Minnesota Statutes, chapter 144A, may also provide home
318.33and community-based services subject to licensure under Minnesota Statutes, chapter
318.34245D, without obtaining a home and community-based services license under Minnesota
319.1Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
319.2apply to these providers:
319.3(1) the provider must comply with all requirements under Minnesota Statutes, chapter
319.4245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
319.5(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
319.6enforced by the Department of Health under the enforcement authority set forth in
319.7Minnesota Statutes, section 144A.475; and
319.8(3) the Department of Health will provide information to the Department of Human
319.9Services about each provider licensed under this section, including the provider's license
319.10application, licensing documents, inspections, information about complaints received, and
319.11investigations conducted for possible violations of Minnesota Statutes, chapter 245D.

319.12    Sec. 53. REPEALER.
319.13(a) Minnesota Statutes 2012, sections 245B.01; 245B.02; 245B.03; 245B.031;
319.14245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, and 7; 245B.055; 245B.06; 245B.07; and
319.15245B.08, are repealed effective January 1, 2014.
319.16(b) Minnesota Statutes 2012, section 245D.08, is repealed.


319.19    Section 1. Minnesota Statutes 2012, section 16C.10, subdivision 5, is amended to read:
319.20    Subd. 5. Specific purchases. The solicitation process described in this chapter is
319.21not required for acquisition of the following:
319.22(1) merchandise for resale purchased under policies determined by the commissioner;
319.23(2) farm and garden products which, as determined by the commissioner, may be
319.24purchased at the prevailing market price on the date of sale;
319.25(3) goods and services from the Minnesota correctional facilities;
319.26(4) goods and services from rehabilitation facilities and extended employment
319.27providers that are certified by the commissioner of employment and economic
319.28development, and day training and habilitation services licensed under sections 245B.01
319.29to 245B.08 chapter 245D;
319.30(5) goods and services for use by a community-based facility operated by the
319.31commissioner of human services;
319.32(6) goods purchased at auction or when submitting a sealed bid at auction provided
319.33that before authorizing such an action, the commissioner consult with the requesting
319.34agency to determine a fair and reasonable value for the goods considering factors
320.1including, but not limited to, costs associated with submitting a bid, travel, transportation,
320.2and storage. This fair and reasonable value must represent the limit of the state's bid;
320.3(7) utility services where no competition exists or where rates are fixed by law or
320.4ordinance; and
320.5(8) goods and services from Minnesota sex offender program facilities.
320.6EFFECTIVE DATE.This section is effective January 1, 2014.

320.7    Sec. 2. Minnesota Statutes 2012, section 16C.155, subdivision 1, is amended to read:
320.8    Subdivision 1. Service contracts. The commissioner of administration shall
320.9ensure that a portion of all contracts for janitorial services; document imaging;
320.10document shredding; and mailing, collating, and sorting services be awarded by the
320.11state to rehabilitation programs and extended employment providers that are certified
320.12by the commissioner of employment and economic development, and day training and
320.13habilitation services licensed under sections 245B.01 to 245B.08 chapter 245D. The
320.14amount of each contract awarded under this section may exceed the estimated fair market
320.15price as determined by the commissioner for the same goods and services by up to six
320.16percent. The aggregate value of the contracts awarded to eligible providers under this
320.17section in any given year must exceed 19 percent of the total value of all contracts for
320.18janitorial services; document imaging; document shredding; and mailing, collating, and
320.19sorting services entered into in the same year. For the 19 percent requirement to be
320.20applicable in any given year, the contract amounts proposed by eligible providers must be
320.21within six percent of the estimated fair market price for at least 19 percent of the contracts
320.22awarded for the corresponding service area.
320.23EFFECTIVE DATE.This section is effective January 1, 2014.

320.24    Sec. 3. Minnesota Statutes 2012, section 144D.01, subdivision 4, is amended to read:
320.25    Subd. 4. Housing with services establishment or establishment. (a) "Housing
320.26with services establishment" or "establishment" means:
320.27(1) an establishment providing sleeping accommodations to one or more adult
320.28residents, at least 80 percent of which are 55 years of age or older, and offering or
320.29providing, for a fee, one or more regularly scheduled health-related services or two or
320.30more regularly scheduled supportive services, whether offered or provided directly by the
320.31establishment or by another entity arranged for by the establishment; or
320.32(2) an establishment that registers under section 144D.025.
320.33(b) Housing with services establishment does not include:
321.1(1) a nursing home licensed under chapter 144A;
321.2(2) a hospital, certified boarding care home, or supervised living facility licensed
321.3under sections 144.50 to 144.56;
321.4(3) a board and lodging establishment licensed under chapter 157 and Minnesota
321.5Rules, parts 9520.0500 to 9520.0670, 9525.0215 to 9525.0355, 9525.0500 to 9525.0660,
321.6or 9530.4100 to 9530.4450, or under chapter 245B 245D;
321.7(4) a board and lodging establishment which serves as a shelter for battered women
321.8or other similar purpose;
321.9(5) a family adult foster care home licensed by the Department of Human Services;
321.10(6) private homes in which the residents are related by kinship, law, or affinity with
321.11the providers of services;
321.12(7) residential settings for persons with developmental disabilities in which the
321.13services are licensed under Minnesota Rules, parts 9525.2100 to 9525.2140, or applicable
321.14successor rules or laws;
321.15(8) a home-sharing arrangement such as when an elderly or disabled person or
321.16single-parent family makes lodging in a private residence available to another person
321.17in exchange for services or rent, or both;
321.18(9) a duly organized condominium, cooperative, common interest community, or
321.19owners' association of the foregoing where at least 80 percent of the units that comprise the
321.20condominium, cooperative, or common interest community are occupied by individuals
321.21who are the owners, members, or shareholders of the units; or
321.22(10) services for persons with developmental disabilities that are provided under
321.23a license according to Minnesota Rules, parts 9525.2000 to 9525.2140 in effect until
321.24January 1, 1998, or under chapter 245B 245D.
321.25EFFECTIVE DATE.This section is effective January 1, 2014.

321.26    Sec. 4. Minnesota Statutes 2012, section 174.30, subdivision 1, is amended to read:
321.27    Subdivision 1. Applicability. (a) The operating standards for special transportation
321.28service adopted under this section do not apply to special transportation provided by:
321.29(1) a common carrier operating on fixed routes and schedules;
321.30(2) a volunteer driver using a private automobile;
321.31(3) a school bus as defined in section 169.011, subdivision 71; or
321.32(4) an emergency ambulance regulated under chapter 144.
321.33(b) The operating standards adopted under this section only apply to providers
321.34of special transportation service who receive grants or other financial assistance from
321.35either the state or the federal government, or both, to provide or assist in providing that
322.1service; except that the operating standards adopted under this section do not apply
322.2to any nursing home licensed under section 144A.02, to any board and care facility
322.3licensed under section 144.50, or to any day training and habilitation services, day care,
322.4or group home facility licensed under sections 245A.01 to 245A.19 unless the facility or
322.5program provides transportation to nonresidents on a regular basis and the facility receives
322.6reimbursement, other than per diem payments, for that service under rules promulgated
322.7by the commissioner of human services.
322.8(c) Notwithstanding paragraph (b), the operating standards adopted under this
322.9section do not apply to any vendor of services licensed under chapter 245B 245D that
322.10provides transportation services to consumers or residents of other vendors licensed under
322.11chapter 245B 245D and transports 15 or fewer persons, including consumers or residents
322.12and the driver.
322.13EFFECTIVE DATE.This section is effective January 1, 2014.

322.14    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 1, is amended to read:
322.15    Subdivision 1. Scope. The terms used in this chapter and chapter 245B have the
322.16meanings given them in this section.
322.17EFFECTIVE DATE.This section is effective January 1, 2014.

322.18    Sec. 6. Minnesota Statutes 2012, section 245A.02, subdivision 9, is amended to read:
322.19    Subd. 9. License holder. "License holder" means an individual, corporation,
322.20partnership, voluntary association, or other organization that is legally responsible for the
322.21operation of the program, has been granted a license by the commissioner under this chapter
322.22or chapter 245B 245D and the rules of the commissioner, and is a controlling individual.
322.23EFFECTIVE DATE.This section is effective January 1, 2014.

322.24    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 9, is amended to read:
322.25    Subd. 9. Permitted services by an individual who is related. Notwithstanding
322.26subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
322.27person receiving supported living services may provide licensed services to that person if:
322.28(1) the person who receives supported living services received these services in a
322.29residential site on July 1, 2005;
322.30(2) the services under clause (1) were provided in a corporate foster care setting for
322.31adults and were funded by the developmental disabilities home and community-based
322.32services waiver defined in section 256B.092;
323.1(3) the individual who is related obtains and maintains both a license under chapter
323.2245B 245D and an adult foster care license under Minnesota Rules, parts 9555.5105
323.3to 9555.6265; and
323.4(4) the individual who is related is not the guardian of the person receiving supported
323.5living services.
323.6EFFECTIVE DATE.This section is effective January 1, 2014.

323.7    Sec. 8. Minnesota Statutes 2012, section 245A.04, subdivision 13, is amended to read:
323.8    Subd. 13. Funds and property; other requirements. (a) A license holder must
323.9ensure that persons served by the program retain the use and availability of personal funds
323.10or property unless restrictions are justified in the person's individual plan. This subdivision
323.11does not apply to programs governed by the provisions in section 245B.07, subdivision 10.
323.12(b) The license holder must ensure separation of funds of persons served by the
323.13program from funds of the license holder, the program, or program staff.
323.14(c) Whenever the license holder assists a person served by the program with the
323.15safekeeping of funds or other property, the license holder must:
323.16(1) immediately document receipt and disbursement of the person's funds or other
323.17property at the time of receipt or disbursement, including the person's signature, or the
323.18signature of the conservator or payee; and
323.19(2) return to the person upon the person's request, funds and property in the license
323.20holder's possession subject to restrictions in the person's treatment plan, as soon as
323.21possible, but no later than three working days after the date of request.
323.22(d) License holders and program staff must not:
323.23(1) borrow money from a person served by the program;
323.24(2) purchase personal items from a person served by the program;
323.25(3) sell merchandise or personal services to a person served by the program;
323.26(4) require a person served by the program to purchase items for which the license
323.27holder is eligible for reimbursement; or
323.28(5) use funds of persons served by the program to purchase items for which the
323.29facility is already receiving public or private payments.
323.30EFFECTIVE DATE.This section is effective January 1, 2014.

323.31    Sec. 9. Minnesota Statutes 2012, section 245A.07, subdivision 3, is amended to read:
323.32    Subd. 3. License suspension, revocation, or fine. (a) The commissioner may
323.33suspend or revoke a license, or impose a fine if:
324.1(1) a license holder fails to comply fully with applicable laws or rules;
324.2(2) a license holder, a controlling individual, or an individual living in the household
324.3where the licensed services are provided or is otherwise subject to a background study has
324.4a disqualification which has not been set aside under section 245C.22;
324.5(3) a license holder knowingly withholds relevant information from or gives false
324.6or misleading information to the commissioner in connection with an application for
324.7a license, in connection with the background study status of an individual, during an
324.8investigation, or regarding compliance with applicable laws or rules; or
324.9(4) after July 1, 2012, and upon request by the commissioner, a license holder fails
324.10to submit the information required of an applicant under section 245A.04, subdivision 1,
324.11paragraph (f) or (g).
324.12A license holder who has had a license suspended, revoked, or has been ordered
324.13to pay a fine must be given notice of the action by certified mail or personal service. If
324.14mailed, the notice must be mailed to the address shown on the application or the last
324.15known address of the license holder. The notice must state the reasons the license was
324.16suspended, revoked, or a fine was ordered.
324.17    (b) If the license was suspended or revoked, the notice must inform the license
324.18holder of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
324.191400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
324.20a license. The appeal of an order suspending or revoking a license must be made in writing
324.21by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
324.22the commissioner within ten calendar days after the license holder receives notice that the
324.23license has been suspended or revoked. If a request is made by personal service, it must be
324.24received by the commissioner within ten calendar days after the license holder received
324.25the order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits
324.26a timely appeal of an order suspending or revoking a license, the license holder may
324.27continue to operate the program as provided in section 245A.04, subdivision 7, paragraphs
324.28(g) and (h), until the commissioner issues a final order on the suspension or revocation.
324.29    (c)(1) If the license holder was ordered to pay a fine, the notice must inform the
324.30license holder of the responsibility for payment of fines and the right to a contested case
324.31hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal
324.32of an order to pay a fine must be made in writing by certified mail or personal service. If
324.33mailed, the appeal must be postmarked and sent to the commissioner within ten calendar
324.34days after the license holder receives notice that the fine has been ordered. If a request is
324.35made by personal service, it must be received by the commissioner within ten calendar
324.36days after the license holder received the order.
325.1    (2) The license holder shall pay the fines assessed on or before the payment date
325.2specified. If the license holder fails to fully comply with the order, the commissioner
325.3may issue a second fine or suspend the license until the license holder complies. If the
325.4license holder receives state funds, the state, county, or municipal agencies or departments
325.5responsible for administering the funds shall withhold payments and recover any payments
325.6made while the license is suspended for failure to pay a fine. A timely appeal shall stay
325.7payment of the fine until the commissioner issues a final order.
325.8    (3) A license holder shall promptly notify the commissioner of human services,
325.9in writing, when a violation specified in the order to forfeit a fine is corrected. If upon
325.10reinspection the commissioner determines that a violation has not been corrected as
325.11indicated by the order to forfeit a fine, the commissioner may issue a second fine. The
325.12commissioner shall notify the license holder by certified mail or personal service that a
325.13second fine has been assessed. The license holder may appeal the second fine as provided
325.14under this subdivision.
325.15    (4) Fines shall be assessed as follows: the license holder shall forfeit $1,000 for
325.16each determination of maltreatment of a child under section 626.556 or the maltreatment
325.17of a vulnerable adult under section 626.557 for which the license holder is determined
325.18responsible for the maltreatment under section 626.556, subdivision 10e, paragraph (i),
325.19or 626.557, subdivision 9c, paragraph (c); the license holder shall forfeit $200 for each
325.20occurrence of a violation of law or rule governing matters of health, safety, or supervision,
325.21including but not limited to the provision of adequate staff-to-child or adult ratios, and
325.22failure to comply with background study requirements under chapter 245C; and the license
325.23holder shall forfeit $100 for each occurrence of a violation of law or rule other than
325.24those subject to a $1,000 or $200 fine above. For purposes of this section, "occurrence"
325.25means each violation identified in the commissioner's fine order. Fines assessed against a
325.26license holder that holds a license to provide the residential-based habilitation home and
325.27community-based services, as defined under identified in section 245B.02, subdivision
325.2820 245D.03, subdivision 1, and a community residential setting or day services facility
325.29license to provide foster care under chapter 245D where the services are provided, may be
325.30assessed against both licenses for the same occurrence, but the combined amount of the
325.31fines shall not exceed the amount specified in this clause for that occurrence.
325.32    (5) When a fine has been assessed, the license holder may not avoid payment by
325.33closing, selling, or otherwise transferring the licensed program to a third party. In such an
325.34event, the license holder will be personally liable for payment. In the case of a corporation,
325.35each controlling individual is personally and jointly liable for payment.
326.1(d) Except for background study violations involving the failure to comply with an
326.2order to immediately remove an individual or an order to provide continuous, direct
326.3supervision, the commissioner shall not issue a fine under paragraph (c) relating to a
326.4background study violation to a license holder who self-corrects a background study
326.5violation before the commissioner discovers the violation. A license holder who has
326.6previously exercised the provisions of this paragraph to avoid a fine for a background
326.7study violation may not avoid a fine for a subsequent background study violation unless at
326.8least 365 days have passed since the license holder self-corrected the earlier background
326.9study violation.
326.10EFFECTIVE DATE.This section is effective January 1, 2014.

326.11    Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 19c, is amended to
326.12read:
326.13    Subd. 19c. Personal care. Medical assistance covers personal care assistance
326.14services provided by an individual who is qualified to provide the services according to
326.15subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
326.16plan, and supervised by a qualified professional.
326.17"Qualified professional" means a mental health professional as defined in section
326.18245.462, subdivision 18 , clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6);
326.19or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker
326.20as defined in sections 148E.010 and 148E.055, or a qualified developmental disabilities
326.21specialist under section 245B.07, subdivision 4 designated coordinator under section
326.22245D.081, subdivision 2. The qualified professional shall perform the duties required in
326.23section 256B.0659.
326.24EFFECTIVE DATE.This section is effective January 1, 2014.

326.25    Sec. 11. Minnesota Statutes 2012, section 256B.5011, subdivision 2, is amended to read:
326.26    Subd. 2. Contract provisions. (a) The service contract with each intermediate
326.27care facility must include provisions for:
326.28(1) modifying payments when significant changes occur in the needs of the
326.29consumers;
326.30(2) appropriate and necessary statistical information required by the commissioner;
326.31(3) annual aggregate facility financial information; and
326.32(4) additional requirements for intermediate care facilities not meeting the standards
326.33set forth in the service contract.
327.1(b) The commissioner of human services and the commissioner of health, in
327.2consultation with representatives from counties, advocacy organizations, and the provider
327.3community, shall review the consolidated standards under chapter 245B and the home and
327.4community-based services standards under chapter 245D and the supervised living facility
327.5rule under Minnesota Rules, chapter 4665, to determine what provisions in Minnesota
327.6Rules, chapter 4665, may be waived by the commissioner of health for intermediate care
327.7facilities in order to enable facilities to implement the performance measures in their
327.8contract and provide quality services to residents without a duplication of or increase in
327.9regulatory requirements.
327.10EFFECTIVE DATE.This section is effective January 1, 2014.

327.11    Sec. 12. Minnesota Statutes 2012, section 471.59, subdivision 1, is amended to read:
327.12    Subdivision 1. Agreement. Two or more governmental units, by agreement entered
327.13into through action of their governing bodies, may jointly or cooperatively exercise
327.14any power common to the contracting parties or any similar powers, including those
327.15which are the same except for the territorial limits within which they may be exercised.
327.16The agreement may provide for the exercise of such powers by one or more of the
327.17participating governmental units on behalf of the other participating units. The term
327.18"governmental unit" as used in this section includes every city, county, town, school
327.19district, independent nonprofit firefighting corporation, other political subdivision of
327.20this or another state, another state, federally recognized Indian tribe, the University
327.21of Minnesota, the Minnesota Historical Society, nonprofit hospitals licensed under
327.22sections 144.50 to 144.56, rehabilitation facilities and extended employment providers
327.23that are certified by the commissioner of employment and economic development, day
327.24training and habilitation services licensed under sections 245B.01 to 245B.08, day and
327.25supported employment services licensed under chapter 245D, and any agency of the state
327.26of Minnesota or the United States, and includes any instrumentality of a governmental
327.27unit. For the purpose of this section, an instrumentality of a governmental unit means an
327.28instrumentality having independent policy-making and appropriating authority.
327.29EFFECTIVE DATE.This section is effective January 1, 2014.

327.30    Sec. 13. Minnesota Statutes 2012, section 626.556, subdivision 2, is amended to read:
327.31    Subd. 2. Definitions. As used in this section, the following terms have the meanings
327.32given them unless the specific content indicates otherwise:
328.1    (a) "Family assessment" means a comprehensive assessment of child safety, risk
328.2of subsequent child maltreatment, and family strengths and needs that is applied to a
328.3child maltreatment report that does not allege substantial child endangerment. Family
328.4assessment does not include a determination as to whether child maltreatment occurred
328.5but does determine the need for services to address the safety of family members and the
328.6risk of subsequent maltreatment.
328.7    (b) "Investigation" means fact gathering related to the current safety of a child
328.8and the risk of subsequent maltreatment that determines whether child maltreatment
328.9occurred and whether child protective services are needed. An investigation must be used
328.10when reports involve substantial child endangerment, and for reports of maltreatment in
328.11facilities required to be licensed under chapter 245A or 245B; under sections 144.50 to
328.12144.58 and 241.021; in a school as defined in sections 120A.05, subdivisions 9, 11, and
328.1313, and 124D.10; or in a nonlicensed personal care provider association as defined in
328.14sections 256B.04, subdivision 16, and 256B.0625, subdivision 19a.
328.15    (c) "Substantial child endangerment" means a person responsible for a child's care,
328.16and in the case of sexual abuse includes a person who has a significant relationship to the
328.17child as defined in section 609.341, or a person in a position of authority as defined in
328.18section 609.341, who by act or omission commits or attempts to commit an act against a
328.19child under their care that constitutes any of the following:
328.20    (1) egregious harm as defined in section 260C.007, subdivision 14;
328.21    (2) sexual abuse as defined in paragraph (d);
328.22    (3) abandonment under section 260C.301, subdivision 2;
328.23    (4) neglect as defined in paragraph (f), clause (2), that substantially endangers the
328.24child's physical or mental health, including a growth delay, which may be referred to as
328.25failure to thrive, that has been diagnosed by a physician and is due to parental neglect;
328.26    (5) murder in the first, second, or third degree under section 609.185, 609.19, or
328.27609.195 ;
328.28    (6) manslaughter in the first or second degree under section 609.20 or 609.205;
328.29    (7) assault in the first, second, or third degree under section 609.221, 609.222, or
328.30609.223 ;
328.31    (8) solicitation, inducement, and promotion of prostitution under section 609.322;
328.32    (9) criminal sexual conduct under sections 609.342 to 609.3451;
328.33    (10) solicitation of children to engage in sexual conduct under section 609.352;
328.34    (11) malicious punishment or neglect or endangerment of a child under section
328.35609.377 or 609.378;
328.36    (12) use of a minor in sexual performance under section 617.246; or
329.1    (13) parental behavior, status, or condition which mandates that the county attorney
329.2file a termination of parental rights petition under section 260C.301, subdivision 3,
329.3paragraph (a).
329.4    (d) "Sexual abuse" means the subjection of a child by a person responsible for the
329.5child's care, by a person who has a significant relationship to the child, as defined in
329.6section 609.341, or by a person in a position of authority, as defined in section 609.341,
329.7subdivision 10, to any act which constitutes a violation of section 609.342 (criminal sexual
329.8conduct in the first degree), 609.343 (criminal sexual conduct in the second degree),
329.9609.344 (criminal sexual conduct in the third degree), 609.345 (criminal sexual conduct
329.10in the fourth degree), or 609.3451 (criminal sexual conduct in the fifth degree). Sexual
329.11abuse also includes any act which involves a minor which constitutes a violation of
329.12prostitution offenses under sections 609.321 to 609.324 or 617.246. Sexual abuse includes
329.13threatened sexual abuse which includes the status of a parent or household member
329.14who has committed a violation which requires registration as an offender under section
329.15243.166, subdivision 1b, paragraph (a) or (b), or required registration under section
329.16243.166, subdivision 1b, paragraph (a) or (b).
329.17    (e) "Person responsible for the child's care" means (1) an individual functioning
329.18within the family unit and having responsibilities for the care of the child such as a
329.19parent, guardian, or other person having similar care responsibilities, or (2) an individual
329.20functioning outside the family unit and having responsibilities for the care of the child
329.21such as a teacher, school administrator, other school employees or agents, or other lawful
329.22custodian of a child having either full-time or short-term care responsibilities including,
329.23but not limited to, day care, babysitting whether paid or unpaid, counseling, teaching,
329.24and coaching.
329.25    (f) "Neglect" means the commission or omission of any of the acts specified under
329.26clauses (1) to (9), other than by accidental means:
329.27    (1) failure by a person responsible for a child's care to supply a child with necessary
329.28food, clothing, shelter, health, medical, or other care required for the child's physical or
329.29mental health when reasonably able to do so;
329.30    (2) failure to protect a child from conditions or actions that seriously endanger the
329.31child's physical or mental health when reasonably able to do so, including a growth delay,
329.32which may be referred to as a failure to thrive, that has been diagnosed by a physician and
329.33is due to parental neglect;
329.34    (3) failure to provide for necessary supervision or child care arrangements
329.35appropriate for a child after considering factors as the child's age, mental ability, physical
330.1condition, length of absence, or environment, when the child is unable to care for the
330.2child's own basic needs or safety, or the basic needs or safety of another child in their care;
330.3    (4) failure to ensure that the child is educated as defined in sections 120A.22 and
330.4260C.163, subdivision 11 , which does not include a parent's refusal to provide the parent's
330.5child with sympathomimetic medications, consistent with section 125A.091, subdivision 5;
330.6    (5) nothing in this section shall be construed to mean that a child is neglected solely
330.7because the child's parent, guardian, or other person responsible for the child's care in
330.8good faith selects and depends upon spiritual means or prayer for treatment or care of
330.9disease or remedial care of the child in lieu of medical care; except that a parent, guardian,
330.10or caretaker, or a person mandated to report pursuant to subdivision 3, has a duty to report
330.11if a lack of medical care may cause serious danger to the child's health. This section does
330.12not impose upon persons, not otherwise legally responsible for providing a child with
330.13necessary food, clothing, shelter, education, or medical care, a duty to provide that care;
330.14    (6) prenatal exposure to a controlled substance, as defined in section 253B.02,
330.15subdivision 2, used by the mother for a nonmedical purpose, as evidenced by withdrawal
330.16symptoms in the child at birth, results of a toxicology test performed on the mother at
330.17delivery or the child at birth, medical effects or developmental delays during the child's
330.18first year of life that medically indicate prenatal exposure to a controlled substance, or the
330.19presence of a fetal alcohol spectrum disorder;
330.20    (7) "medical neglect" as defined in section 260C.007, subdivision 6, clause (5);
330.21    (8) chronic and severe use of alcohol or a controlled substance by a parent or
330.22person responsible for the care of the child that adversely affects the child's basic needs
330.23and safety; or
330.24    (9) emotional harm from a pattern of behavior which contributes to impaired
330.25emotional functioning of the child which may be demonstrated by a substantial and
330.26observable effect in the child's behavior, emotional response, or cognition that is not
330.27within the normal range for the child's age and stage of development, with due regard to
330.28the child's culture.
330.29    (g) "Physical abuse" means any physical injury, mental injury, or threatened injury,
330.30inflicted by a person responsible for the child's care on a child other than by accidental
330.31means, or any physical or mental injury that cannot reasonably be explained by the child's
330.32history of injuries, or any aversive or deprivation procedures, or regulated interventions,
330.33that have not been authorized under section 121A.67 or 245.825.
330.34    Abuse does not include reasonable and moderate physical discipline of a child
330.35administered by a parent or legal guardian which does not result in an injury. Abuse does
330.36not include the use of reasonable force by a teacher, principal, or school employee as
331.1allowed by section 121A.582. Actions which are not reasonable and moderate include,
331.2but are not limited to, any of the following that are done in anger or without regard to the
331.3safety of the child:
331.4    (1) throwing, kicking, burning, biting, or cutting a child;
331.5    (2) striking a child with a closed fist;
331.6    (3) shaking a child under age three;
331.7    (4) striking or other actions which result in any nonaccidental injury to a child
331.8under 18 months of age;
331.9    (5) unreasonable interference with a child's breathing;
331.10    (6) threatening a child with a weapon, as defined in section 609.02, subdivision 6;
331.11    (7) striking a child under age one on the face or head;
331.12    (8) purposely giving a child poison, alcohol, or dangerous, harmful, or controlled
331.13substances which were not prescribed for the child by a practitioner, in order to control or
331.14punish the child; or other substances that substantially affect the child's behavior, motor
331.15coordination, or judgment or that results in sickness or internal injury, or subjects the
331.16child to medical procedures that would be unnecessary if the child were not exposed
331.17to the substances;
331.18    (9) unreasonable physical confinement or restraint not permitted under section
331.19609.379 , including but not limited to tying, caging, or chaining; or
331.20    (10) in a school facility or school zone, an act by a person responsible for the child's
331.21care that is a violation under section 121A.58.
331.22    (h) "Report" means any report received by the local welfare agency, police
331.23department, county sheriff, or agency responsible for assessing or investigating
331.24maltreatment pursuant to this section.
331.25    (i) "Facility" means:
331.26    (1) a licensed or unlicensed day care facility, residential facility, agency, hospital,
331.27sanitarium, or other facility or institution required to be licensed under sections 144.50 to
331.28144.58 , 241.021, or 245A.01 to 245A.16, or chapter 245B 245D;
331.29    (2) a school as defined in sections 120A.05, subdivisions 9, 11, and 13; and
331.30124D.10 ; or
331.31    (3) a nonlicensed personal care provider organization as defined in sections 256B.04,
331.32subdivision 16, and 256B.0625, subdivision 19a.
331.33    (j) "Operator" means an operator or agency as defined in section 245A.02.
331.34    (k) "Commissioner" means the commissioner of human services.
332.1    (l) "Practice of social services," for the purposes of subdivision 3, includes but is
332.2not limited to employee assistance counseling and the provision of guardian ad litem and
332.3parenting time expeditor services.
332.4    (m) "Mental injury" means an injury to the psychological capacity or emotional
332.5stability of a child as evidenced by an observable or substantial impairment in the child's
332.6ability to function within a normal range of performance and behavior with due regard to
332.7the child's culture.
332.8    (n) "Threatened injury" means a statement, overt act, condition, or status that
332.9represents a substantial risk of physical or sexual abuse or mental injury. Threatened
332.10injury includes, but is not limited to, exposing a child to a person responsible for the
332.11child's care, as defined in paragraph (e), clause (1), who has:
332.12    (1) subjected a child to, or failed to protect a child from, an overt act or condition
332.13that constitutes egregious harm, as defined in section 260C.007, subdivision 14, or a
332.14similar law of another jurisdiction;
332.15    (2) been found to be palpably unfit under section 260C.301, paragraph (b), clause
332.16(4), or a similar law of another jurisdiction;
332.17    (3) committed an act that has resulted in an involuntary termination of parental rights
332.18under section 260C.301, or a similar law of another jurisdiction; or
332.19    (4) committed an act that has resulted in the involuntary transfer of permanent
332.20legal and physical custody of a child to a relative under Minnesota Statutes 2010, section
332.21260C.201, subdivision 11 , paragraph (d), clause (1), section 260C.515, subdivision 4, or a
332.22similar law of another jurisdiction.
332.23A child is the subject of a report of threatened injury when the responsible social
332.24services agency receives birth match data under paragraph (o) from the Department of
332.25Human Services.
332.26(o) Upon receiving data under section 144.225, subdivision 2b, contained in a
332.27birth record or recognition of parentage identifying a child who is subject to threatened
332.28injury under paragraph (n), the Department of Human Services shall send the data to the
332.29responsible social services agency. The data is known as "birth match" data. Unless the
332.30responsible social services agency has already begun an investigation or assessment of the
332.31report due to the birth of the child or execution of the recognition of parentage and the
332.32parent's previous history with child protection, the agency shall accept the birth match
332.33data as a report under this section. The agency may use either a family assessment or
332.34investigation to determine whether the child is safe. All of the provisions of this section
332.35apply. If the child is determined to be safe, the agency shall consult with the county
332.36attorney to determine the appropriateness of filing a petition alleging the child is in need
333.1of protection or services under section 260C.007, subdivision 6, clause (16), in order to
333.2deliver needed services. If the child is determined not to be safe, the agency and the county
333.3attorney shall take appropriate action as required under section 260C.301, subdivision 3.
333.4    (p) Persons who conduct assessments or investigations under this section shall take
333.5into account accepted child-rearing practices of the culture in which a child participates
333.6and accepted teacher discipline practices, which are not injurious to the child's health,
333.7welfare, and safety.
333.8    (q) "Accidental" means a sudden, not reasonably foreseeable, and unexpected
333.9occurrence or event which:
333.10    (1) is not likely to occur and could not have been prevented by exercise of due
333.11care; and
333.12    (2) if occurring while a child is receiving services from a facility, happens when the
333.13facility and the employee or person providing services in the facility are in compliance
333.14with the laws and rules relevant to the occurrence or event.
333.15(r) "Nonmaltreatment mistake" means:
333.16(1) at the time of the incident, the individual was performing duties identified in the
333.17center's child care program plan required under Minnesota Rules, part 9503.0045;
333.18(2) the individual has not been determined responsible for a similar incident that
333.19resulted in a finding of maltreatment for at least seven years;
333.20(3) the individual has not been determined to have committed a similar
333.21nonmaltreatment mistake under this paragraph for at least four years;
333.22(4) any injury to a child resulting from the incident, if treated, is treated only with
333.23remedies that are available over the counter, whether ordered by a medical professional or
333.24not; and
333.25(5) except for the period when the incident occurred, the facility and the individual
333.26providing services were both in compliance with all licensing requirements relevant to the
333.27incident.
333.28This definition only applies to child care centers licensed under Minnesota
333.29Rules, chapter 9503. If clauses (1) to (5) apply, rather than making a determination of
333.30substantiated maltreatment by the individual, the commissioner of human services shall
333.31determine that a nonmaltreatment mistake was made by the individual.
333.32EFFECTIVE DATE.This section is effective January 1, 2014.

333.33    Sec. 14. Minnesota Statutes 2012, section 626.556, subdivision 3, is amended to read:
333.34    Subd. 3. Persons mandated to report. (a) A person who knows or has reason
333.35to believe a child is being neglected or physically or sexually abused, as defined in
334.1subdivision 2, or has been neglected or physically or sexually abused within the preceding
334.2three years, shall immediately report the information to the local welfare agency, agency
334.3responsible for assessing or investigating the report, police department, or the county
334.4sheriff if the person is:
334.5    (1) a professional or professional's delegate who is engaged in the practice of
334.6the healing arts, social services, hospital administration, psychological or psychiatric
334.7treatment, child care, education, correctional supervision, probation and correctional
334.8services, or law enforcement; or
334.9    (2) employed as a member of the clergy and received the information while
334.10engaged in ministerial duties, provided that a member of the clergy is not required by
334.11this subdivision to report information that is otherwise privileged under section 595.02,
334.12subdivision 1 , paragraph (c).
334.13    The police department or the county sheriff, upon receiving a report, shall
334.14immediately notify the local welfare agency or agency responsible for assessing or
334.15investigating the report, orally and in writing. The local welfare agency, or agency
334.16responsible for assessing or investigating the report, upon receiving a report, shall
334.17immediately notify the local police department or the county sheriff orally and in writing.
334.18The county sheriff and the head of every local welfare agency, agency responsible
334.19for assessing or investigating reports, and police department shall each designate a
334.20person within their agency, department, or office who is responsible for ensuring that
334.21the notification duties of this paragraph and paragraph (b) are carried out. Nothing in
334.22this subdivision shall be construed to require more than one report from any institution,
334.23facility, school, or agency.
334.24    (b) Any person may voluntarily report to the local welfare agency, agency responsible
334.25for assessing or investigating the report, police department, or the county sheriff if the
334.26person knows, has reason to believe, or suspects a child is being or has been neglected or
334.27subjected to physical or sexual abuse. The police department or the county sheriff, upon
334.28receiving a report, shall immediately notify the local welfare agency or agency responsible
334.29for assessing or investigating the report, orally and in writing. The local welfare agency or
334.30agency responsible for assessing or investigating the report, upon receiving a report, shall
334.31immediately notify the local police department or the county sheriff orally and in writing.
334.32    (c) A person mandated to report physical or sexual child abuse or neglect occurring
334.33within a licensed facility shall report the information to the agency responsible for
334.34licensing the facility under sections 144.50 to 144.58; 241.021; 245A.01 to 245A.16; or
334.35chapter 245B 245D; or a nonlicensed personal care provider organization as defined in
334.36sections 256B.04, subdivision 16; and 256B.0625, subdivision 19. A health or corrections
335.1agency receiving a report may request the local welfare agency to provide assistance
335.2pursuant to subdivisions 10, 10a, and 10b. A board or other entity whose licensees
335.3perform work within a school facility, upon receiving a complaint of alleged maltreatment,
335.4shall provide information about the circumstances of the alleged maltreatment to the
335.5commissioner of education. Section 13.03, subdivision 4, applies to data received by the
335.6commissioner of education from a licensing entity.
335.7    (d) Any person mandated to report shall receive a summary of the disposition of
335.8any report made by that reporter, including whether the case has been opened for child
335.9protection or other services, or if a referral has been made to a community organization,
335.10unless release would be detrimental to the best interests of the child. Any person who is
335.11not mandated to report shall, upon request to the local welfare agency, receive a concise
335.12summary of the disposition of any report made by that reporter, unless release would be
335.13detrimental to the best interests of the child.
335.14    (e) For purposes of this section, "immediately" means as soon as possible but in
335.15no event longer than 24 hours.
335.16EFFECTIVE DATE.This section is effective January 1, 2014.

335.17    Sec. 15. Minnesota Statutes 2012, section 626.556, subdivision 10d, is amended to read:
335.18    Subd. 10d. Notification of neglect or abuse in facility. (a) When a report is
335.19received that alleges neglect, physical abuse, sexual abuse, or maltreatment of a child while
335.20in the care of a licensed or unlicensed day care facility, residential facility, agency, hospital,
335.21sanitarium, or other facility or institution required to be licensed according to sections
335.22144.50 to 144.58; 241.021; or 245A.01 to 245A.16; or chapter 245B 245D, or a school as
335.23defined in sections 120A.05, subdivisions 9, 11, and 13; and 124D.10; or a nonlicensed
335.24personal care provider organization as defined in section 256B.04, subdivision 16, and
335.25256B.0625, subdivision 19a , the commissioner of the agency responsible for assessing
335.26or investigating the report or local welfare agency investigating the report shall provide
335.27the following information to the parent, guardian, or legal custodian of a child alleged to
335.28have been neglected, physically abused, sexually abused, or the victim of maltreatment
335.29of a child in the facility: the name of the facility; the fact that a report alleging neglect,
335.30physical abuse, sexual abuse, or maltreatment of a child in the facility has been received;
335.31the nature of the alleged neglect, physical abuse, sexual abuse, or maltreatment of a child
335.32in the facility; that the agency is conducting an assessment or investigation; any protective
335.33or corrective measures being taken pending the outcome of the investigation; and that a
335.34written memorandum will be provided when the investigation is completed.
336.1(b) The commissioner of the agency responsible for assessing or investigating the
336.2report or local welfare agency may also provide the information in paragraph (a) to the
336.3parent, guardian, or legal custodian of any other child in the facility if the investigative
336.4agency knows or has reason to believe the alleged neglect, physical abuse, sexual
336.5abuse, or maltreatment of a child in the facility has occurred. In determining whether
336.6to exercise this authority, the commissioner of the agency responsible for assessing
336.7or investigating the report or local welfare agency shall consider the seriousness of the
336.8alleged neglect, physical abuse, sexual abuse, or maltreatment of a child in the facility; the
336.9number of children allegedly neglected, physically abused, sexually abused, or victims of
336.10maltreatment of a child in the facility; the number of alleged perpetrators; and the length
336.11of the investigation. The facility shall be notified whenever this discretion is exercised.
336.12(c) When the commissioner of the agency responsible for assessing or investigating
336.13the report or local welfare agency has completed its investigation, every parent, guardian,
336.14or legal custodian previously notified of the investigation by the commissioner or
336.15local welfare agency shall be provided with the following information in a written
336.16memorandum: the name of the facility investigated; the nature of the alleged neglect,
336.17physical abuse, sexual abuse, or maltreatment of a child in the facility; the investigator's
336.18name; a summary of the investigation findings; a statement whether maltreatment was
336.19found; and the protective or corrective measures that are being or will be taken. The
336.20memorandum shall be written in a manner that protects the identity of the reporter and
336.21the child and shall not contain the name, or to the extent possible, reveal the identity of
336.22the alleged perpetrator or of those interviewed during the investigation. If maltreatment
336.23is determined to exist, the commissioner or local welfare agency shall also provide the
336.24written memorandum to the parent, guardian, or legal custodian of each child in the facility
336.25who had contact with the individual responsible for the maltreatment. When the facility is
336.26the responsible party for maltreatment, the commissioner or local welfare agency shall also
336.27provide the written memorandum to the parent, guardian, or legal custodian of each child
336.28who received services in the population of the facility where the maltreatment occurred.
336.29This notification must be provided to the parent, guardian, or legal custodian of each child
336.30receiving services from the time the maltreatment occurred until either the individual
336.31responsible for maltreatment is no longer in contact with a child or children in the facility
336.32or the conclusion of the investigation. In the case of maltreatment within a school facility,
336.33as defined in sections 120A.05, subdivisions 9, 11, and 13, and 124D.10, the commissioner
336.34of education need not provide notification to parents, guardians, or legal custodians of
336.35each child in the facility, but shall, within ten days after the investigation is completed,
336.36provide written notification to the parent, guardian, or legal custodian of any student
337.1alleged to have been maltreated. The commissioner of education may notify the parent,
337.2guardian, or legal custodian of any student involved as a witness to alleged maltreatment.
337.3EFFECTIVE DATE.This section is effective January 1, 2014.

337.4    Sec. 16. REPEALER.
337.5Minnesota Statutes 2012, section 256B.49, subdivision 16a, is repealed effective
337.6January 1, 2014.


337.9    Section 1. Minnesota Statutes 2012, section 62A.65, subdivision 2, is amended to read:
337.10    Subd. 2. Guaranteed renewal. (a) No individual health plan may be offered, sold,
337.11issued, or renewed to a Minnesota resident unless the health plan provides that the plan
337.12is guaranteed renewable at a premium rate that does not take into account the claims
337.13experience or any change in the health status of any covered person that occurred after
337.14the initial issuance of the health plan to the person. The premium rate upon renewal
337.15must also otherwise comply with this section. A health carrier must not refuse to renew
337.16an individual health plan, except for nonpayment of premiums, fraud, or intentional
337.17 misrepresentation of a material fact.
337.18    (b) A health carrier may elect to discontinue health plan coverage of an individual in
337.19the individual market only, excluding a grandfathered plan as defined in section 62A.011,
337.20subdivision 1c, in one or more of the following situations:
337.21    (1) the health carrier is ceasing to offer individual health plan coverage in the
337.22individual market in accordance with sections 62A.65, subdivision 8, 62E.11, subdivision
337.239, and federal law;
337.24    (2) for network plans, the individual no longer resides, lives, or works in the
337.25service area of the health carrier, or the area for which the health carrier is authorized to
337.26do business, but only if coverage is terminated uniformly without regard to any health
337.27status-related factor of covered individuals; or
337.28    (3) a decision by the health carrier to discontinue offering a particular type of
337.29individual health plan if it meets the following requirements:
337.30    (i) provides notice in writing to each individual provided coverage of that type of
337.31health plan at least 90 days before the date coverage will be discontinued;
337.32    (ii) provides notice to the commissioner of commerce at least 30 business days
337.33before the issuer or health carrier gives notice to the individuals;
338.1    (iii) offers to each covered individual information about products currently offered
338.2that are closest in actuarial equivalence;
338.3    (iv) offers to each covered individual, on a guaranteed issue basis, the option to
338.4purchase any other individual health plan currently being offered by the health carrier or
338.5related health carrier for individuals in the market; and
338.6    (v) acts uniformly without regard to any health status-related factor of covered
338.7individuals or dependents of covered individuals who may become eligible for coverage.

338.8    Sec. 2. Minnesota Statutes 2012, section 62A.65, is amended by adding a subdivision
338.9to read:
338.10    Subd. 2a. Modification of plan. At the time of coverage renewal, an issuer or
338.11health carrier may modify the health plan, excluding a grandfathered plan as defined under
338.12section 62A.011, subdivision 1c, providing individual health plan coverage offered to
338.13individuals in the individual market, so long as the modification is consistent with state
338.14law and is effective on a uniform basis for individuals with that coverage.

338.15    Sec. 3. Minnesota Statutes 2012, section 119B.13, subdivision 7, is amended to read:
338.16    Subd. 7. Absent days. (a) Licensed child care providers and license-exempt centers
338.17must not be reimbursed for more than ten 25 full-day absent days per child, excluding
338.18holidays, in a fiscal year, or for more than ten consecutive full-day absent days. Legal
338.19nonlicensed family child care providers must not be reimbursed for absent days. If a child
338.20attends for part of the time authorized to be in care in a day, but is absent for part of the
338.21time authorized to be in care in that same day, the absent time must be reimbursed but
338.22the time must not count toward the ten absent day days limit. Child care providers must
338.23only be reimbursed for absent days if the provider has a written policy for child absences
338.24and charges all other families in care for similar absences.
338.25(b) Notwithstanding paragraph (a), children with documented medical conditions
338.26that cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
338.27full-day absent days limit. Absences due to a documented medical condition of a parent
338.28or sibling who lives in the same residence as the child receiving child care assistance
338.29do not count against the absent days limit in a fiscal year. Documentation of medical
338.30conditions must be on the forms and submitted according to the timelines established by
338.31the commissioner. A public health nurse or school nurse may verify the illness in lieu of
338.32a medical practitioner. If a provider sends a child home early due to a medical reason,
338.33including, but not limited to, fever or contagious illness, the child care center director or
338.34lead teacher may verify the illness in lieu of a medical practitioner.
339.1(b) (c) Notwithstanding paragraph (a), children in families may exceed the ten absent
339.2days limit if at least one parent: (1) is under the age of 21; (2) does not have a high school
339.3or general equivalency diploma; and (3) is a student in a school district or another similar
339.4program that provides or arranges for child care, parenting support, social services, career
339.5and employment supports, and academic support to achieve high school graduation, upon
339.6request of the program and approval of the county. If a child attends part of an authorized
339.7day, payment to the provider must be for the full amount of care authorized for that day.
339.8    (c) (d) Child care providers must be reimbursed for up to ten federal or state holidays
339.9or designated holidays per year when the provider charges all families for these days and the
339.10holiday or designated holiday falls on a day when the child is authorized to be in attendance.
339.11Parents may substitute other cultural or religious holidays for the ten recognized state and
339.12federal holidays. Holidays do not count toward the ten absent day days limit.
339.13    (d) (e) A family or child care provider must not be assessed an overpayment for an
339.14absent day payment unless (1) there was an error in the amount of care authorized for the
339.15family, (2) all of the allowed full-day absent payments for the child have been paid, or (3)
339.16the family or provider did not timely report a change as required under law.
339.17    (e) (f) The provider and family shall receive notification of the number of absent
339.18days used upon initial provider authorization for a family and ongoing notification of the
339.19number of absent days used as of the date of the notification.
339.20(g) For purposes of this subdivision, "absent days limit" means 25 full-day absent
339.21days per child, excluding holidays, in a fiscal year; and ten consecutive full-day absent days.

339.22    Sec. 4. [214.075] HEALTH-RELATED LICENSING BOARDS; CRIMINAL
339.23BACKGROUND CHECKS.
339.24    Subdivision 1. Applications. (a) By January 1, 2018, each health-related licensing
339.25board, as defined in section 214.01, subdivision 2, shall require applicants for initial
339.26licensure, licensure by endorsement, or reinstatement or other relicensure after a lapse
339.27in licensure, as defined by the individual health-related licensing boards to submit to
339.28a criminal history records check of state data completed by the Bureau of Criminal
339.29Apprehension (BCA) and a national criminal history records check, including a search of
339.30the records of the Federal Bureau of Investigation (FBI).
339.31(b) An applicant must complete a criminal background check if more than one year
339.32has elapsed since the applicant last submitted a background check to the board.
339.33    Subd. 2. Investigations. If a health-related licensing board has reasonable cause
339.34to believe a licensee has been charged with or convicted of a crime in this or any other
339.35jurisdiction, the health-related licensing board may require the licensee to submit to a
340.1criminal history records check of state data completed by the BCA and a national criminal
340.2history records check, including a search of the records of the FBI.
340.3    Subd. 3. Consent form; fees; fingerprints. In order to effectuate the federal
340.4and state level, fingerprint-based criminal background check, the applicant or licensee
340.5must submit a completed criminal history records check consent form and a full set of
340.6fingerprints to the respective health-related licensing board or a designee in the manner
340.7and form specified by the board. The applicant or licensee is responsible for all fees
340.8associated with preparation of the fingerprints, the criminal records check consent form,
340.9and the criminal background check. The fees for the criminal records background check
340.10shall be set by the BCA and the FBI and are not refundable.
340.11    Subd. 4. Refusal to consent. (a) The health-related licensing boards shall not issue
340.12a license to any applicant who refuses to consent to a criminal background check or fails
340.13to submit fingerprints within 90 days after submission of an application for licensure. Any
340.14fees paid by the applicant to the board shall be forfeited if the applicant refuses to consent
340.15to the criminal background check or fails to submit the required fingerprints.
340.16(b) The failure of a licensee to submit to a criminal background check as provided in
340.17subdivision 3 is grounds for disciplinary action by the respective health licensing board.
340.18    Subd. 5. Submission of fingerprints to BCA. The health-related licensing board
340.19or designee shall submit applicant or licensee fingerprints to the BCA. The BCA shall
340.20perform a check for state criminal justice information and shall forward the applicant's
340.21or licensee's fingerprints to the FBI to perform a check for national criminal justice
340.22information regarding the applicant or licensee. The BCA shall report to the board the
340.23results of the state and national criminal justice information checks.
340.24    Subd. 6. Alternatives to fingerprint-based criminal background checks. The
340.25health-related licensing board may require an alternative method of criminal history
340.26checks for an applicant or licensee who has submitted at least three sets of fingerprints in
340.27accordance with this section that have been unreadable by the BCA or FBI.
340.28    Subd. 7. Opportunity to challenge accuracy of report. Prior to taking disciplinary
340.29action against an applicant or a licensee based on a criminal conviction, the health-related
340.30licensing board shall provide the applicant or licensee an opportunity to complete or
340.31challenge the accuracy of the criminal history information reported to the board. The
340.32applicant or licensee shall have 30 calendar days following notice from the board of the
340.33intent to deny licensure or take disciplinary action to request an opportunity to correct or
340.34complete the record prior to the board taking disciplinary action based on the information
340.35reported to the board. The board shall provide the applicant up to 180 days to challenge
340.36the accuracy or completeness of the report with the agency responsible for the record. This
341.1subdivision does not affect the right of the subject of the data to contest the accuracy or
341.2completeness under section 13.04, subdivision 4.
341.3    Subd. 8. Instructions to the board; plans. The health-related licensing boards, in
341.4collaboration with the commissioner of human services and the BCA, shall establish a
341.5plan for completing criminal background checks of all licensees who were licensed before
341.6the effective date requirement under subdivision 1. The plan must seek to minimize
341.7duplication of requirements for background checks of licensed health professionals. The
341.8plan for background checks of current licensees shall be developed no later than January
341.91, 2017, and may be contingent upon the implementation of a system by the BCA or FBI
341.10in which any new crimes that an applicant or licensee commits after an initial background
341.11check are flagged in the BCA's or FBI's database and reported back to the board. The plan
341.12shall include recommendations for any necessary statutory changes.

341.13    Sec. 5. Minnesota Statutes 2012, section 214.40, subdivision 1, is amended to read:
341.14    Subdivision 1. Definitions. (a) The definitions in this subdivision apply to this
341.15section.
341.16(b) "Administrative services unit" means the administrative services unit for the
341.17health-related licensing boards.
341.18(c) "Charitable organization" means a charitable organization within the meaning of
341.19section 501(c)(3) of the Internal Revenue Code that has as a purpose the sponsorship or
341.20support of programs designed to improve the quality, awareness, and availability of health
341.21care services and that serves as a funding mechanism for providing those services.
341.22(d) "Health care facility or organization" means a health care facility licensed under
341.23chapter 144 or 144A, or a charitable organization.
341.24(e) "Health care provider" means a physician licensed under chapter 147, physician
341.25assistant registered and practicing under chapter 147A, nurse licensed and registered to
341.26practice under chapter 148, or dentist or, dental hygienist, dental therapist, or advanced
341.27dental therapist licensed under chapter 150A.
341.28(f) "Health care services" means health promotion, health monitoring, health
341.29education, diagnosis, treatment, minor surgical procedures, the administration of local
341.30anesthesia for the stitching of wounds, and primary dental services, including preventive,
341.31diagnostic, restorative, and emergency treatment. Health care services do not include the
341.32administration of general anesthesia or surgical procedures other than minor surgical
341.33procedures.
341.34(g) "Medical professional liability insurance" means medical malpractice insurance
341.35as defined in section 62F.03.
342.1EFFECTIVE DATE.This section is effective the day following final enactment.

342.2    Sec. 6. Minnesota Statutes 2012, section 245A.07, subdivision 2a, is amended to read:
342.3    Subd. 2a. Immediate suspension expedited hearing. (a) Within five working days
342.4of receipt of the license holder's timely appeal, the commissioner shall request assignment
342.5of an administrative law judge. The request must include a proposed date, time, and place
342.6of a hearing. A hearing must be conducted by an administrative law judge within 30
342.7calendar days of the request for assignment, unless an extension is requested by either
342.8party and granted by the administrative law judge for good cause. The commissioner shall
342.9issue a notice of hearing by certified mail or personal service at least ten working days
342.10before the hearing. The scope of the hearing shall be limited solely to the issue of whether
342.11the temporary immediate suspension should remain in effect pending the commissioner's
342.12final order under section 245A.08, regarding a licensing sanction issued under subdivision
342.133 following the immediate suspension. The burden of proof in expedited hearings under
342.14this subdivision shall be limited to the commissioner's demonstration that reasonable
342.15cause exists to believe that the license holder's actions or failure to comply with applicable
342.16law or rule poses, or if the actions of other individuals or conditions in the program
342.17poses an imminent risk of harm to the health, safety, or rights of persons served by the
342.18program. "Reasonable cause" means there exist specific articulable facts or circumstances
342.19which provide the commissioner with a reasonable suspicion that there is an imminent
342.20risk of harm to the health, safety, or rights of persons served by the program. When the
342.21commissioner has determined there is reasonable cause to order the temporary immediate
342.22suspension of a license based on a violation of safe sleep requirements, as defined in
342.23section 245A.1435, the commissioner is not required to demonstrate that an infant died or
342.24was injured as a result of the safe sleep violations.
342.25    (b) The administrative law judge shall issue findings of fact, conclusions, and a
342.26recommendation within ten working days from the date of hearing. The parties shall have
342.27ten calendar days to submit exceptions to the administrative law judge's report. The
342.28record shall close at the end of the ten-day period for submission of exceptions. The
342.29commissioner's final order shall be issued within ten working days from the close of the
342.30record. Within 90 calendar days after a final order affirming an immediate suspension, the
342.31commissioner shall make a determination regarding whether a final licensing sanction
342.32shall be issued under subdivision 3. The license holder shall continue to be prohibited
342.33from operation of the program during this 90-day period.
342.34    (c) When the final order under paragraph (b) affirms an immediate suspension, and a
342.35final licensing sanction is issued under subdivision 3 and the license holder appeals that
343.1sanction, the license holder continues to be prohibited from operation of the program
343.2pending a final commissioner's order under section 245A.08, subdivision 5, regarding the
343.3final licensing sanction.

343.4    Sec. 7. Minnesota Statutes 2012, section 245A.1435, is amended to read:
343.5245A.1435 REDUCTION OF RISK OF SUDDEN UNEXPECTED INFANT
343.6DEATH SYNDROME IN LICENSED PROGRAMS.
343.7    (a) When a license holder is placing an infant to sleep, the license holder must
343.8place the infant on the infant's back, unless the license holder has documentation from
343.9the infant's parent physician directing an alternative sleeping position for the infant. The
343.10parent physician directive must be on a form approved by the commissioner and must
343.11include a statement that the parent or legal guardian has read the information provided by
343.12the Minnesota Sudden Infant Death Center, related to the risk of SIDS and the importance
343.13of placing an infant or child on its back to sleep to reduce the risk of SIDS. remain on file
343.14at the licensed location. An infant who independently rolls onto its stomach after being
343.15placed to sleep on its back may be allowed to remain sleeping on its stomach if the infant
343.16is at least six months of age or the license holder has a signed statement from the parent
343.17indicating that the infant regularly rolls over at home.
343.18(b) The license holder must place the infant in a crib directly on a firm mattress with
343.19a fitted crib sheet that fits tightly on the mattress and overlaps the mattress so it cannot be
343.20dislodged by pulling on the corner of the sheet. The license holder must not place pillows,
343.21quilts, comforters, sheepskin, pillow-like stuffed toys, or other soft products in the crib
343.22with the infant The license holder must place the infant in a crib directly on a firm mattress
343.23with a fitted sheet that is appropriate to the mattress size, that fits tightly on the mattress,
343.24and that overlaps the underside of the mattress so it cannot be dislodged by pulling on the
343.25corner of the sheet with reasonable effort. The license holder must not place anything in
343.26the crib with the infant except for the infant's pacifier. For the purposes of this section, a
343.27pacifier is defined as a synthetic nipple designed for infant sucking with nothing attached
343.28to it. The requirements of this section apply to license holders serving infants up to and
343.29including 12 months younger than one year of age. Licensed child care providers must
343.30meet the crib requirements under section 245A.146.
343.31(c) If an infant falls asleep before being placed in a crib, the license holder must
343.32move the infant to a crib as soon as practicable, and must keep the infant within sight of
343.33the license holder until the infant is placed in a crib. When an infant falls asleep while
343.34being held, the license holder must consider the supervision needs of other children in
343.35care when determining how long to hold the infant before placing the infant in a crib to
344.1sleep. The sleeping infant must not be in a position where the airway may be blocked or
344.2with anything covering the infant's face.
344.3(d) Placing a swaddled infant down to sleep in a licensed setting is not recommended
344.4for an infant of any age and is prohibited for any infant who has begun to roll over
344.5independently. However, with the written consent of a parent or guardian according to this
344.6paragraph, a license holder may place the infant who has not yet begun to roll over on its
344.7own down to sleep in a one-piece sleeper equipped with an attached system that fastens
344.8securely only across the upper torso, with no constriction of the hips or legs, to create a
344.9swaddle. Prior to any use of swaddling for sleep by a provider licensed under this chapter,
344.10the license holder must obtain informed written consent for the use of swaddling from the
344.11parent or guardian of the infant on a form provided by the commissioner and prepared in
344.12partnership with the Minnesota Sudden Infant Death Center.

344.13    Sec. 8. Minnesota Statutes 2012, section 245A.144, is amended to read:
344.14245A.144 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
344.15DEATH AND SHAKEN BABY SYNDROME ABUSIVE HEAD TRAUMA FOR
344.16CHILD FOSTER CARE PROVIDERS.
344.17    (a) Licensed child foster care providers that care for infants or children through five
344.18years of age must document that before staff persons and caregivers assist in the care
344.19of infants or children through five years of age, they are instructed on the standards in
344.20section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
344.21death syndrome and shaken baby syndrome for abusive head trauma from shaking infants
344.22and young children. This section does not apply to emergency relative placement under
344.23section 245A.035. The training on reducing the risk of sudden unexpected infant death
344.24syndrome and shaken baby syndrome abusive head trauma may be provided as:
344.25    (1) orientation training to child foster care providers, who care for infants or children
344.26through five years of age, under Minnesota Rules, part 2960.3070, subpart 1; or
344.27    (2) in-service training to child foster care providers, who care for infants or children
344.28through five years of age, under Minnesota Rules, part 2960.3070, subpart 2.
344.29    (b) Training required under this section must be at least one hour in length and must
344.30be completed at least once every five years. At a minimum, the training must address
344.31the risk factors related to sudden unexpected infant death syndrome and shaken baby
344.32syndrome abusive head trauma, means of reducing the risk of sudden unexpected infant
344.33death syndrome and shaken baby syndrome abusive head trauma, and license holder
344.34communication with parents regarding reducing the risk of sudden unexpected infant
344.35death syndrome and shaken baby syndrome abusive head trauma.
345.1    (c) Training for child foster care providers must be approved by the county or
345.2private licensing agency that is responsible for monitoring the child foster care provider
345.3under section 245A.16. The approved training fulfills, in part, training required under
345.4Minnesota Rules, part 2960.3070.

345.5    Sec. 9. Minnesota Statutes 2012, section 245A.1444, is amended to read:
345.6245A.1444 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
345.7DEATH SYNDROME AND SHAKEN BABY SYNDROME ABUSIVE HEAD
345.8TRAUMA BY OTHER PROGRAMS.
345.9    A licensed chemical dependency treatment program that serves clients with infants
345.10or children through five years of age, who sleep at the program and a licensed children's
345.11residential facility that serves infants or children through five years of age, must document
345.12that before program staff persons or volunteers assist in the care of infants or children
345.13through five years of age, they are instructed on the standards in section 245A.1435 and
345.14receive training on reducing the risk of sudden unexpected infant death syndrome and
345.15shaken baby syndrome abusive head trauma from shaking infants and young children. The
345.16training conducted under this section may be used to fulfill training requirements under
345.17Minnesota Rules, parts 2960.0100, subpart 3; and 9530.6490, subpart 4, item B.
345.18    This section does not apply to child care centers or family child care programs
345.19governed by sections 245A.40 and 245A.50.

345.20    Sec. 10. [245A.1446] FAMILY CHILD CARE DIAPERING AREA
345.21DISINFECTION.
345.22Notwithstanding Minnesota Rules, part 9502.0435, a family child care provider may
345.23disinfect the diaper changing surface with either a solution of at least two teaspoons
345.24of chlorine bleach to one quart of water or with a surface disinfectant that meets the
345.25following criteria:
345.26(1) the manufacturer's label or instructions state that the product is registered with
345.27the United States Environmental Protection Agency;
345.28(2) the manufacturer's label or instructions state that the disinfectant is effective
345.29against Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa;
345.30(3) the manufacturer's label or instructions state that the disinfectant is effective with
345.31a ten minute or less contact time;
345.32(4) the disinfectant is clearly labeled by the manufacturer with directions for mixing
345.33and use;
345.34(5) the disinfectant is used only in accordance with the manufacturer's directions; and
346.1(6) the product does not include triclosan or derivatives of triclosan.

346.2    Sec. 11. [245A.147] FAMILY CHILD CARE INFANT SLEEP SUPERVISION
346.3REQUIREMENTS.
346.4    Subdivision 1. In-person checks on infants. (a) License holders that serve infants
346.5are encouraged to monitor sleeping infants by conducting in-person checks on each infant
346.6in their care every 30 minutes.
346.7(b) Upon enrollment of an infant in a family child care program, the license holder is
346.8encouraged to conduct in-person checks on the sleeping infant every 15 minutes during
346.9the first four months of care.
346.10(c) When an infant has an upper respiratory infection, the license holder is
346.11encouraged to conduct in-person checks on the sleeping infant every 15 minutes
346.12throughout the hours of sleep.
346.13    Subd. 2. Use of audio or visual monitoring devices. In addition to conducting
346.14the in-person checks encouraged under subdivision 1, license holders serving infants are
346.15encouraged to use and maintain an audio or visual monitoring device to monitor each
346.16sleeping infant in care during all hours of sleep.

346.17    Sec. 12. [245A.152] CHILD CARE LICENSE HOLDER INSURANCE.
346.18(a) A license holder must provide a written notice to all parents or guardians of all
346.19children to be accepted for care prior to admission stating whether the license holder has
346.20liability insurance. This notice may be incorporated into and provided on the admission
346.21form used by the license holder.
346.22(b) If the license holder has liability insurance:
346.23(1) the license holder shall inform parents in writing that a current certificate of
346.24coverage for insurance is available for inspection to all parents or guardians of children
346.25receiving services and to all parents seeking services from the family child care program;
346.26(2) the notice must provide the parent or guardian with the date of expiration or
346.27next renewal of the policy; and
346.28(3) upon the expiration date of the policy, the license holder must provide a new
346.29written notice indicating whether the insurance policy has lapsed or whether the license
346.30holder has renewed the policy.
346.31If the policy was renewed, the license holder must provide the new expiration date of the
346.32policy in writing to the parents or guardians.
346.33(c) If the license holder does not have liability insurance, the license holder must
346.34provide an annual notice, on a form developed and made available by the commissioner,
347.1to the parents or guardians of children in care indicating that the license holder does not
347.2carry liability insurance.
347.3(d) The license holder must notify all parents and guardians in writing immediately
347.4of any change in insurance status.
347.5(e) The license holder must make available upon request the certificate of liability
347.6insurance to the parents of children in care, to the commissioner, and to county licensing
347.7agents.
347.8(f) The license holder must document, with the signature of the parent or guardian,
347.9that the parent or guardian received the notices required by this section.

347.10    Sec. 13. Minnesota Statutes 2012, section 245A.40, subdivision 5, is amended to read:
347.11    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome
347.12 abusive head trauma training. (a) License holders must document that before staff
347.13persons and volunteers care for infants, they are instructed on the standards in section
347.14245A.1435 and receive training on reducing the risk of sudden unexpected infant death
347.15syndrome. In addition, license holders must document that before staff persons care for
347.16infants or children under school age, they receive training on the risk of shaken baby
347.17syndrome abusive head trauma from shaking infants and young children. The training
347.18in this subdivision may be provided as orientation training under subdivision 1 and
347.19in-service training under subdivision 7.
347.20    (b) Sudden unexpected infant death syndrome reduction training required under
347.21this subdivision must be at least one-half hour in length and must be completed at least
347.22once every five years year. At a minimum, the training must address the risk factors
347.23related to sudden unexpected infant death syndrome, means of reducing the risk of sudden
347.24unexpected infant death syndrome in child care, and license holder communication with
347.25parents regarding reducing the risk of sudden unexpected infant death syndrome.
347.26    (c) Shaken baby syndrome Abusive head trauma training under this subdivision
347.27must be at least one-half hour in length and must be completed at least once every five
347.28years year. At a minimum, the training must address the risk factors related to shaken
347.29baby syndrome for shaking infants and young children, means to reduce the risk of shaken
347.30baby syndrome abusive head trauma in child care, and license holder communication with
347.31parents regarding reducing the risk of shaken baby syndrome abusive head trauma.
347.32(d) The commissioner shall make available for viewing a video presentation on the
347.33dangers associated with shaking infants and young children. The video presentation must
347.34be part of the orientation and annual in-service training of licensed child care center
347.35staff persons caring for children under school age. The commissioner shall provide to
348.1child care providers and interested individuals, at cost, copies of a video approved by the
348.2commissioner of health under section 144.574 on the dangers associated with shaking
348.3infants and young children.

348.4    Sec. 14. Minnesota Statutes 2012, section 245A.50, is amended to read:
348.5245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.
348.6    Subdivision 1. Initial training. (a) License holders, caregivers, and substitutes must
348.7comply with the training requirements in this section.
348.8    (b) Helpers who assist with care on a regular basis must complete six hours of
348.9training within one year after the date of initial employment.
348.10    Subd. 2. Child growth and development and behavior guidance training. (a) For
348.11purposes of family and group family child care, the license holder and each adult caregiver
348.12who provides care in the licensed setting for more than 30 days in any 12-month period
348.13shall complete and document at least two four hours of child growth and development
348.14and behavior guidance training within the first year of prior to initial licensure, and before
348.15caring for children. For purposes of this subdivision, "child growth and development
348.16training" means training in understanding how children acquire language and develop
348.17physically, cognitively, emotionally, and socially. "Behavior guidance training" means
348.18training in the understanding of the functions of child behavior and strategies for managing
348.19challenging situations. Child growth and development and behavior guidance training
348.20must be repeated annually. Training curriculum shall be developed or approved by the
348.21commissioner of human services by January 1, 2014.
348.22    (b) Notwithstanding paragraph (a), individuals are exempt from this requirement if
348.23they:
348.24    (1) have taken a three-credit course on early childhood development within the
348.25past five years;
348.26    (2) have received a baccalaureate or master's degree in early childhood education or
348.27school-age child care within the past five years;
348.28    (3) are licensed in Minnesota as a prekindergarten teacher, an early childhood
348.29educator, a kindergarten to grade 6 teacher with a prekindergarten specialty, an early
348.30childhood special education teacher, or an elementary teacher with a kindergarten
348.31endorsement; or
348.32    (4) have received a baccalaureate degree with a Montessori certificate within the
348.33past five years.
348.34    Subd. 3. First aid. (a) When children are present in a family child care home
348.35governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person
349.1must be present in the home who has been trained in first aid. The first aid training must
349.2have been provided by an individual approved to provide first aid instruction. First aid
349.3training may be less than eight hours and persons qualified to provide first aid training
349.4include individuals approved as first aid instructors. First aid training must be repeated
349.5every two years.
349.6    (b) A family child care provider is exempt from the first aid training requirements
349.7under this subdivision related to any substitute caregiver who provides less than 30 hours
349.8of care during any 12-month period.
349.9    (c) Video training reviewed and approved by the county licensing agency satisfies
349.10the training requirement of this subdivision.
349.11    Subd. 4. Cardiopulmonary resuscitation. (a) When children are present in a family
349.12child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least
349.13one staff person must be present in the home who has been trained in cardiopulmonary
349.14resuscitation (CPR) and in the treatment of obstructed airways that includes CPR
349.15techniques for infants and children. The CPR training must have been provided by an
349.16individual approved to provide CPR instruction, must be repeated at least once every three
349.17 two years, and must be documented in the staff person's records.
349.18    (b) A family child care provider is exempt from the CPR training requirement in
349.19this subdivision related to any substitute caregiver who provides less than 30 hours of
349.20care during any 12-month period.
349.21    (c) Video training reviewed and approved by the county licensing agency satisfies
349.22the training requirement of this subdivision. Persons providing CPR training must use
349.23CPR training that has been developed:
349.24    (1) by the American Heart Association or the American Red Cross and incorporates
349.25psychomotor skills to support the instruction; or
349.26    (2) using nationally recognized, evidence-based guidelines for CPR training and
349.27incorporates psychomotor skills to support the instruction.
349.28    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome
349.29 abusive head trauma training. (a) License holders must document that before staff
349.30persons, caregivers, and helpers assist in the care of infants, they are instructed on the
349.31standards in section 245A.1435 and receive training on reducing the risk of sudden
349.32unexpected infant death syndrome. In addition, license holders must document that before
349.33staff persons, caregivers, and helpers assist in the care of infants and children under
349.34school age, they receive training on reducing the risk of shaken baby syndrome abusive
349.35head trauma from shaking infants and young children. The training in this subdivision
350.1may be provided as initial training under subdivision 1 or ongoing annual training under
350.2subdivision 7.
350.3    (b) Sudden unexpected infant death syndrome reduction training required under this
350.4subdivision must be at least one-half hour in length and must be completed in person
350.5 at least once every five years two years. On the years when the license holder is not
350.6receiving the in-person training on sudden unexpected infant death reduction, the license
350.7holder must receive sudden unexpected infant death reduction training through a video
350.8of no more than one hour in length developed or approved by the commissioner. At a
350.9minimum, the training must address the risk factors related to sudden unexpected infant
350.10death syndrome, means of reducing the risk of sudden unexpected infant death syndrome
350.11 in child care, and license holder communication with parents regarding reducing the risk
350.12of sudden unexpected infant death syndrome.
350.13    (c) Shaken baby syndrome Abusive head trauma training required under this
350.14subdivision must be at least one-half hour in length and must be completed at least once
350.15every five years year. At a minimum, the training must address the risk factors related
350.16to shaken baby syndrome shaking infants and young children, means of reducing the
350.17risk of shaken baby syndrome abusive head trauma in child care, and license holder
350.18communication with parents regarding reducing the risk of shaken baby syndrome abusive
350.19head trauma.
350.20(d) Training for family and group family child care providers must be developed
350.21by the commissioner in conjunction with the Minnesota Sudden Infant Death Center
350.22and approved by the county licensing agency by the Minnesota Center for Professional
350.23Development.
350.24    (e) The commissioner shall make available for viewing by all licensed child care
350.25providers a video presentation on the dangers associated with shaking infants and young
350.26children. The video presentation shall be part of the initial and ongoing annual training of
350.27licensed child care providers, caregivers, and helpers caring for children under school age.
350.28The commissioner shall provide to child care providers and interested individuals, at cost,
350.29copies of a video approved by the commissioner of health under section 144.574 on the
350.30dangers associated with shaking infants and young children.
350.31    Subd. 6. Child passenger restraint systems; training requirement. (a) A license
350.32holder must comply with all seat belt and child passenger restraint system requirements
350.33under section 169.685.
350.34    (b) Family and group family child care programs licensed by the Department of
350.35Human Services that serve a child or children under nine years of age must document
350.36training that fulfills the requirements in this subdivision.
351.1    (1) Before a license holder, staff person, caregiver, or helper transports a child or
351.2children under age nine in a motor vehicle, the person placing the child or children in a
351.3passenger restraint must satisfactorily complete training on the proper use and installation
351.4of child restraint systems in motor vehicles. Training completed under this subdivision may
351.5be used to meet initial training under subdivision 1 or ongoing training under subdivision 7.
351.6    (2) Training required under this subdivision must be at least one hour in length,
351.7completed at initial training, and repeated at least once every five years. At a minimum,
351.8the training must address the proper use of child restraint systems based on the child's
351.9size, weight, and age, and the proper installation of a car seat or booster seat in the motor
351.10vehicle used by the license holder to transport the child or children.
351.11    (3) Training under this subdivision must be provided by individuals who are certified
351.12and approved by the Department of Public Safety, Office of Traffic Safety. License holders
351.13may obtain a list of certified and approved trainers through the Department of Public
351.14Safety Web site or by contacting the agency.
351.15    (c) Child care providers that only transport school-age children as defined in section
351.16245A.02, subdivision 19 , paragraph (f), in child care buses as defined in section 169.448,
351.17subdivision 1, paragraph (e), are exempt from this subdivision.
351.18    Subd. 7. Training requirements for family and group family child care. For
351.19purposes of family and group family child care, the license holder and each primary
351.20caregiver must complete eight 16 hours of ongoing training each year. For purposes
351.21of this subdivision, a primary caregiver is an adult caregiver who provides services in
351.22the licensed setting for more than 30 days in any 12-month period. Repeat of topical
351.23training requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
351.24requirement. Additional ongoing training subjects to meet the annual 16-hour training
351.25requirement must be selected from the following areas:
351.26    (1) "child growth and development training" has the meaning given in under
351.27 subdivision 2, paragraph (a);
351.28    (2) "learning environment and curriculum" includes, including training in
351.29establishing an environment and providing activities that provide learning experiences to
351.30meet each child's needs, capabilities, and interests;
351.31    (3) "assessment and planning for individual needs" includes, including training in
351.32observing and assessing what children know and can do in order to provide curriculum
351.33and instruction that addresses their developmental and learning needs, including children
351.34with special needs and bilingual children or children for whom English is not their
351.35primary language;
352.1    (4) "interactions with children" includes, including training in establishing
352.2supportive relationships with children, guiding them as individuals and as part of a group;
352.3    (5) "families and communities" includes, including training in working
352.4collaboratively with families and agencies or organizations to meet children's needs and to
352.5encourage the community's involvement;
352.6    (6) "health, safety, and nutrition" includes, including training in establishing and
352.7maintaining an environment that ensures children's health, safety, and nourishment,
352.8including child abuse, maltreatment, prevention, and reporting; home and fire safety; child
352.9injury prevention; communicable disease prevention and control; first aid; and CPR; and
352.10    (7) "program planning and evaluation" includes, including training in establishing,
352.11implementing, evaluating, and enhancing program operations.; and
352.12(8) behavior guidance, including training in the understanding of the functions of
352.13child behavior and strategies for managing behavior.
352.14    Subd. 8. Other required training requirements. (a) The training required of
352.15family and group family child care providers and staff must include training in the cultural
352.16dynamics of early childhood development and child care. The cultural dynamics and
352.17disabilities training and skills development of child care providers must be designed to
352.18achieve outcomes for providers of child care that include, but are not limited to:
352.19    (1) an understanding and support of the importance of culture and differences in
352.20ability in children's identity development;
352.21    (2) understanding the importance of awareness of cultural differences and
352.22similarities in working with children and their families;
352.23    (3) understanding and support of the needs of families and children with differences
352.24in ability;
352.25    (4) developing skills to help children develop unbiased attitudes about cultural
352.26differences and differences in ability;
352.27    (5) developing skills in culturally appropriate caregiving; and
352.28    (6) developing skills in appropriate caregiving for children of different abilities.
352.29    The commissioner shall approve the curriculum for cultural dynamics and disability
352.30training.
352.31    (b) The provider must meet the training requirement in section 245A.14, subdivision
352.3211 , paragraph (a), clause (4), to be eligible to allow a child cared for at the family child
352.33care or group family child care home to use the swimming pool located at the home.
352.34    Subd. 9. Supervising for safety; training requirement. Effective July 1, 2014,
352.35all family child care license holders and each adult caregiver who provides care in the
352.36licensed family child care home for more than 30 days in any 12-month period shall
353.1complete and document at least six hours of approved training on supervising for safety
353.2prior to initial licensure, and before caring for children. At least two hours of training
353.3on supervising for safety must be repeated annually. For purposes of this subdivision,
353.4"supervising for safety" includes supervision basics, supervision outdoors, equipment and
353.5materials, illness, injuries, and disaster preparedness. The commissioner shall develop
353.6the supervising for safety curriculum by January 1, 2014.
353.7    Subd. 10. Approved training. County licensing staff must accept training approved
353.8by the Minnesota Center for Professional Development, including:
353.9(1) face-to-face or classroom training;
353.10(2) online training; and
353.11(3) relationship-based professional development, such as mentoring, coaching,
353.12and consulting.

353.13    Sec. 15. Minnesota Statutes 2012, section 246.54, is amended to read:
353.14246.54 LIABILITY OF COUNTY; REIMBURSEMENT.
353.15    Subdivision 1. County portion for cost of care. (a) Except for chemical
353.16dependency services provided under sections 254B.01 to 254B.09, the client's county
353.17shall pay to the state of Minnesota a portion of the cost of care provided in a regional
353.18treatment center or a state nursing facility to a client legally settled in that county. A
353.19county's payment shall be made from the county's own sources of revenue and payments
353.20shall equal a percentage of the cost of care, as determined by the commissioner, for each
353.21day, or the portion thereof, that the client spends at a regional treatment center or a state
353.22nursing facility according to the following schedule:
353.23    (1) zero percent for the first 30 days;
353.24    (2) 20 percent for days 31 to 60; and
353.25    (3) 50 75 percent for any days over 60.
353.26    (b) The increase in the county portion for cost of care under paragraph (a), clause
353.27(3), shall be imposed when the treatment facility has determined that it is clinically
353.28appropriate for the client to be discharged.
353.29    (c) If payments received by the state under sections 246.50 to 246.53 exceed 80
353.30percent of the cost of care for days 31 to 60, or 50 25 percent for days over 60, the county
353.31shall be responsible for paying the state only the remaining amount. The county shall
353.32not be entitled to reimbursement from the client, the client's estate, or from the client's
353.33relatives, except as provided in section 246.53.
353.34    Subd. 2. Exceptions. (a) Subdivision 1 does not apply to services provided at the
353.35Minnesota Security Hospital or the Minnesota extended treatment options program. For
354.1services at these facilities the Minnesota Security Hospital, a county's payment shall be
354.2made from the county's own sources of revenue and payments shall be paid as follows:.
354.3Excluding the state-operated forensic transition service, payments to the state from the
354.4county shall equal ten percent of the cost of care, as determined by the commissioner, for
354.5each day, or the portion thereof, that the client spends at the facility. For the state-operated
354.6forensic transition service, payments to the state from the county shall equal 50 percent of
354.7the cost of care, as determined by the commissioner, for each day, or the portion thereof,
354.8that the client spends in the program. If payments received by the state under sections
354.9246.50 to 246.53 for services provided at the Minnesota Security Hospital, excluding the
354.10state-operated forensic transition service, exceed 90 percent of the cost of care, the county
354.11shall be responsible for paying the state only the remaining amount. If payments received
354.12by the state under sections 246.50 to 246.53 for the state-operated forensic transition service
354.13exceed 50 percent of the cost of care, the county shall be responsible for paying the state
354.14only the remaining amount. The county shall not be entitled to reimbursement from the
354.15client, the client's estate, or from the client's relatives, except as provided in section 246.53.
354.16    (b) Regardless of the facility to which the client is committed, subdivision 1 does
354.17not apply to the following individuals:
354.18    (1) clients who are committed as mentally ill and dangerous under section 253B.02,
354.19subdivision 17;
354.20    (2) (1) clients who are committed as sexual psychopathic personalities under section
354.21253B.02, subdivision 18b ; and
354.22    (3) (2) clients who are committed as sexually dangerous persons under section
354.23253B.02 , subdivision 18c.
354.24    For each of the individuals in clauses (1) to (3), the payment by the county to the state
354.25shall equal ten percent of the cost of care for each day as determined by the commissioner.

354.26    Sec. 16. [256.999] CULTURAL AND ETHNIC COMMUNITIES LEADERSHIP
354.27COUNCIL.
354.28    Subdivision 1. Establishment; purpose. There is hereby established the Cultural
354.29and Ethnic Communities Leadership Council for the Department of Human Services. The
354.30purpose of the council is to advise the commissioner of human services on reducing
354.31disparities that affect racial and ethnic groups.
354.32    Subd. 2. Members. (a) The council must consist of no fewer than 15 and no more
354.33than 25 members appointed by the commissioner of human services, in consultation with
354.34county, tribal, cultural, and ethnic communities; diverse program participants; and parent
354.35representatives from these communities. The commissioner shall direct the development
355.1of guidelines defining the membership of the council; setting out definitions; and
355.2developing duties of the commissioner, the council, and council members regarding racial
355.3and ethnic disparities reduction. The guidelines must be developed in consultation with:
355.4(1) the chairs of relevant committees; and
355.5(2) county, tribal, and cultural communities and program participants from these
355.6communities.
355.7(b) Members must be appointed to allow for representation of the following groups:
355.8(1) racial and ethnic minority groups;
355.9(2) tribal service providers;
355.10(3) culturally and linguistically specific advocacy groups and service providers;
355.11(4) human services program participants;
355.12(5) public and private institutions;
355.13(6) parents of human services program participants;
355.14(7) members of the faith community;
355.15(8) Department of Human Services employees;
355.16(9) chairs of relevant legislative committees; and
355.17(10) any other group the commissioner deems appropriate to facilitate the goals
355.18and duties of the council.
355.19(c) Each member of the council must be appointed to either a one-year or two-year
355.20term. The commissioner shall appoint one member as chair.
355.21(d) Notwithstanding section 15.059, members of the council shall receive no
355.22compensation for their services.
355.23    Subd. 3. Duties of commissioner. (a) The commissioner of human services or the
355.24commissioner's designee shall:
355.25(1) maintain the council established in this section;
355.26(2) supervise and coordinate policies for persons from racial, ethnic, cultural,
355.27linguistic, and tribal communities who experience disparities in access and outcomes;
355.28(3) identify human services rules or statutes affecting persons from racial, ethnic,
355.29cultural, linguistic, and tribal communities that may need to be revised;
355.30(4) investigate and implement cost-effective models of service delivery such as
355.31careful adaptation of clinically proven services that constitute one strategy for increasing
355.32the number of culturally relevant services available to currently underserved populations;
355.33(5) based on recommendations of the council, review identified department
355.34policies that maintain racial, ethnic, cultural, linguistic, and tribal disparities, and make
355.35adjustments to ensure those disparities are not perpetuated; and
356.1(6) based on recommendations of the council, submit legislation to reduce disparities
356.2affecting racial and ethnic groups, increase access to programs, and promote better
356.3outcomes.
356.4(b) The commissioner of human services or the commissioner's designee shall
356.5consult with the council and receive recommendations from the council when meeting
356.6the requirements of this section.
356.7    Subd. 4. Duties of council. The Cultural and Ethnic Communities Leadership
356.8Council shall:
356.9(1) recommend to the commissioner for review identified policies in the Department
356.10of Human Services that maintain racial, ethnic, cultural, linguistic, and tribal disparities;
356.11(2) identify issues regarding disparities by engaging diverse populations in human
356.12services programs;
356.13(3) engage in mutual learning essential for achieving human services parity and
356.14optimal wellness for service recipients;
356.15(4) raise awareness about human services disparities to the legislature and media;
356.16(5) provide technical assistance and consultation support to counties, private
356.17nonprofit agencies, and other service providers to build their capacity to provide equitable
356.18human services for persons from racial, ethnic, cultural, linguistic, and tribal communities
356.19who experience disparities in access and outcomes;
356.20(6) provide technical assistance to promote statewide development of culturally
356.21and linguistically appropriate, accessible, and cost-effective human services and related
356.22policies;
356.23(7) provide training and outreach to facilitate access to culturally and linguistically
356.24appropriate, accessible, and cost-effective human services to prevent disparities;
356.25(8) facilitate culturally appropriate and culturally sensitive admissions, continued
356.26services, discharges, and utilization review for human services agencies and institutions;
356.27(9) form work groups to help carry out the duties of the council that include, but are
356.28not limited to, persons who provide and receive services and representatives of advocacy
356.29groups, and provide the work groups with clear guidelines, standardized parameters, and
356.30tasks for the work groups to accomplish; and
356.31(10) promote information-sharing in the human services community and statewide.
356.32    Subd. 5. Duties of council members. The members of the council shall:
356.33(1) attend and participate in scheduled meetings and be prepared by reviewing
356.34meeting notes;
356.35(2) maintain open communication channels with respective constituencies;
357.1(3) identify and communicate issues and risks that could impact the timely
357.2completion of tasks;
357.3(4) collaborate on disparity reduction efforts;
357.4(5) communicate updates of the council's work progress and status on the
357.5Department of Human Services Web site; and
357.6(6) participate in any activities the council or chair deem appropriate and necessary
357.7to facilitate the goals and duties of the council.
357.8    Subd. 6. Expiration. Notwithstanding section 15.059, the council does not expire
357.9unless directed by the commissioner.

357.10    Sec. 17. Minnesota Statutes 2012, section 256I.04, subdivision 3, is amended to read:
357.11    Subd. 3. Moratorium on development of group residential housing beds. (a)
357.12County agencies shall not enter into agreements for new group residential housing beds
357.13with total rates in excess of the MSA equivalent rate except:
357.14(1) for group residential housing establishments licensed under Minnesota Rules,
357.15parts 9525.0215 to 9525.0355, provided the facility is needed to meet the census reduction
357.16targets for persons with developmental disabilities at regional treatment centers;
357.17(2) to ensure compliance with the federal Omnibus Budget Reconciliation Act
357.18alternative disposition plan requirements for inappropriately placed persons with
357.19developmental disabilities or mental illness;
357.20(3) up to 80 beds in a single, specialized facility located in Hennepin County that will
357.21provide housing for chronic inebriates who are repetitive users of detoxification centers
357.22and are refused placement in emergency shelters because of their state of intoxication,
357.23and planning for the specialized facility must have been initiated before July 1, 1991,
357.24in anticipation of receiving a grant from the Housing Finance Agency under section
357.25462A.05, subdivision 20a , paragraph (b);
357.26(4) notwithstanding the provisions of subdivision 2a, for up to 190 supportive
357.27housing units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a
357.28mental illness, a history of substance abuse, or human immunodeficiency virus or acquired
357.29immunodeficiency syndrome. For purposes of this section, "homeless adult" means a
357.30person who is living on the street or in a shelter or discharged from a regional treatment
357.31center, community hospital, or residential treatment program and has no appropriate
357.32housing available and lacks the resources and support necessary to access appropriate
357.33housing. At least 70 percent of the supportive housing units must serve homeless adults
357.34with mental illness, substance abuse problems, or human immunodeficiency virus or
357.35acquired immunodeficiency syndrome who are about to be or, within the previous six
358.1months, has been discharged from a regional treatment center, or a state-contracted
358.2psychiatric bed in a community hospital, or a residential mental health or chemical
358.3dependency treatment program. If a person meets the requirements of subdivision 1,
358.4paragraph (a), and receives a federal or state housing subsidy, the group residential housing
358.5rate for that person is limited to the supplementary rate under section 256I.05, subdivision
358.61a , and is determined by subtracting the amount of the person's countable income that
358.7exceeds the MSA equivalent rate from the group residential housing supplementary rate.
358.8A resident in a demonstration project site who no longer participates in the demonstration
358.9program shall retain eligibility for a group residential housing payment in an amount
358.10determined under section 256I.06, subdivision 8, using the MSA equivalent rate. Service
358.11funding under section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching
358.12funds are available and the services can be provided through a managed care entity. If
358.13federal matching funds are not available, then service funding will continue under section
358.14256I.05, subdivision 1a ;
358.15(5) for group residential housing beds in settings meeting the requirements of
358.16subdivision 2a, clauses (1) and (3), which are used exclusively for recipients receiving
358.17home and community-based waiver services under sections 256B.0915, 256B.092,
358.18subdivision 5 , 256B.093, and 256B.49, and who resided in a nursing facility for the six
358.19months immediately prior to the month of entry into the group residential housing setting.
358.20The group residential housing rate for these beds must be set so that the monthly group
358.21residential housing payment for an individual occupying the bed when combined with the
358.22nonfederal share of services delivered under the waiver for that person does not exceed the
358.23nonfederal share of the monthly medical assistance payment made for the person to the
358.24nursing facility in which the person resided prior to entry into the group residential housing
358.25establishment. The rate may not exceed the MSA equivalent rate plus $426.37 for any case;
358.26(6) for an additional two beds, resulting in a total of 32 beds, for a facility located in
358.27Hennepin County providing services for recovering and chemically dependent men that
358.28has had a group residential housing contract with the county and has been licensed as a
358.29board and lodge facility with special services since 1980;
358.30(7) for a group residential housing provider located in the city of St. Cloud, or a county
358.31contiguous to the city of St. Cloud, that operates a 40-bed facility, that received financing
358.32through the Minnesota Housing Finance Agency Ending Long-Term Homelessness
358.33Initiative and serves chemically dependent clientele, providing 24-hour-a-day supervision;
358.34(8) for a new 65-bed facility in Crow Wing County that will serve chemically
358.35dependent persons, operated by a group residential housing provider that currently
358.36operates a 304-bed facility in Minneapolis, and a 44-bed facility in Duluth;
359.1(9) for a group residential housing provider that operates two ten-bed facilities, one
359.2located in Hennepin County and one located in Ramsey County, that provide community
359.3support and 24-hour-a-day supervision to serve the mental health needs of individuals
359.4who have chronically lived unsheltered; and
359.5(10) for a group residential facility in Hennepin County with a capacity of up to 48
359.6beds that has been licensed since 1978 as a board and lodging facility and that until August
359.71, 2007, operated as a licensed chemical dependency treatment program.
359.8    (b) A county agency may enter into a group residential housing agreement for beds
359.9with rates in excess of the MSA equivalent rate in addition to those currently covered
359.10under a group residential housing agreement if the additional beds are only a replacement
359.11of beds with rates in excess of the MSA equivalent rate which have been made available
359.12due to closure of a setting, a change of licensure or certification which removes the beds
359.13from group residential housing payment, or as a result of the downsizing of a group
359.14residential housing setting. The transfer of available beds from one county to another can
359.15only occur by the agreement of both counties.
359.16(c) Effective July 1, 2013, 35 beds with rates in excess of the MSA-equivalent rate
359.17must be designated for youth victims of sex trafficking.

359.18    Sec. 18. Minnesota Statutes 2012, section 256I.05, subdivision 1e, is amended to read:
359.19    Subd. 1e. Supplementary rate for certain facilities. (a) Notwithstanding the
359.20provisions of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall
359.21negotiate a supplementary rate in addition to the rate specified in subdivision 1, not to
359.22exceed $700 per month, including any legislatively authorized inflationary adjustments,
359.23for a group residential housing provider that:
359.24(1) is located in Hennepin County and has had a group residential housing contract
359.25with the county since June 1996;
359.26(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a
359.2726-bed facility; and
359.28(3) serves a chemically dependent clientele, providing 24 hours per day supervision
359.29and limiting a resident's maximum length of stay to 13 months out of a consecutive
359.3024-month period.
359.31(b) Notwithstanding subdivisions 1a and 1c, a county agency shall negotiate a
359.32supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700
359.33per month, including any legislatively authorized inflationary adjustments, of a group
359.34residential provider that:
360.1(1) is located in St. Louis County and has had a group residential housing contract
360.2with the county since 2006;
360.3(2) operates a 62-bed facility; and
360.4(3) serves a chemically dependent adult male clientele, providing 24 hours per
360.5day supervision and limiting a resident's maximum length of stay to 13 months out of
360.6a consecutive 24-month period.
360.7(c) Notwithstanding subdivisions 1a and 1c, beginning July 1, 2013, a county agency
360.8shall negotiate a supplementary rate in addition to the rate specified in subdivision 1, not
360.9to exceed $700 per month, including any legislatively authorized inflationary adjustments,
360.10for the group residential provider described under paragraphs (a) and (b), not to exceed
360.11an additional 115 beds.

360.12    Sec. 19. Minnesota Statutes 2012, section 256J.35, is amended to read:
360.13256J.35 AMOUNT OF ASSISTANCE PAYMENT.
360.14Except as provided in paragraphs (a) to (c) (d), the amount of an assistance payment
360.15is equal to the difference between the MFIP standard of need or the Minnesota family
360.16wage level in section 256J.24 and countable income.
360.17(a) When MFIP eligibility exists for the month of application, the amount of the
360.18assistance payment for the month of application must be prorated from the date of
360.19application or the date all other eligibility factors are met for that applicant, whichever is
360.20later. This provision applies when an applicant loses at least one day of MFIP eligibility.
360.21(b) MFIP overpayments to an assistance unit must be recouped according to section
360.22256J.38, subdivision 4 .
360.23(c) An initial assistance payment must not be made to an applicant who is not
360.24eligible on the date payment is made.
360.25(d) MFIP assistance units whose housing costs exceed 50 percent of their monthly
360.26cash grant are eligible for an additional cash amount in the form of a housing assistance
360.27grant. The housing assistance grant must be equal to 50 percent of the difference between
360.28the assistance unit's cash grant and its housing costs, with a maximum housing assistance
360.29grant of $250 per month. MFIP assistance units must report their housing costs to the lead
360.30agency on the forms and according to the timelines established by the commissioner.
360.31EFFECTIVE DATE.This section is effective December 1, 2013.

360.32    Sec. 20. Minnesota Statutes 2012, section 256K.45, is amended to read:
360.33256K.45 RUNAWAY AND HOMELESS YOUTH ACT.
361.1    Subdivision 1. Mission. The mission of the Homeless Youth Act is to reduce
361.2the incidence of homelessness among youth by providing integrated and supportive
361.3services and housing to homeless youth, youth at risk of homelessness, and runaways.
361.4The commissioner shall establish a Homeless Youth Act fund and award grants to
361.5providers who are committed to serving homeless youth, to provide street and community
361.6outreach and drop-in programs, emergency shelter programs, and supportive housing and
361.7transitional living programs, consistent with the program descriptions in this act.
361.8    Subd. 1a. Definitions. (a) The definitions in this subdivision apply to this section.
361.9(b) "Commissioner" means the commissioner of human services.
361.10(c) "Homeless youth" means a person 21 years of age or younger who is
361.11unaccompanied by a parent or guardian and is without shelter where appropriate care and
361.12supervision are available, whose parent or legal guardian is unable or unwilling to provide
361.13shelter and care, or who lacks a fixed, regular, and adequate nighttime residence. The
361.14following are not fixed, regular, or adequate nighttime residences:
361.15(1) a supervised publicly or privately operated shelter designed to provide temporary
361.16living accommodations;
361.17(2) an institution or a publicly or privately operated shelter designed to provide
361.18temporary living accommodations;
361.19(3) transitional housing;
361.20(4) a temporary placement with a peer, friend, or family member that has not offered
361.21permanent residence, a residential lease, or temporary lodging for more than 30 days; or
361.22(5) a public or private place not designed for, nor ordinarily used as, a regular
361.23sleeping accommodation for human beings.
361.24Homeless youth does not include persons incarcerated or otherwise detained under
361.25federal or state law.
361.26(d) "Youth at risk of homelessness" means a person 21 years of age or younger
361.27whose status or circumstances indicate a significant danger of experiencing homelessness
361.28in the near future. Status or circumstances that indicate a significant danger may include:
361.29(1) youth exiting out-of-home placements; (2) youth who previously were homeless; (3)
361.30youth whose parents or primary caregivers are or were previously homeless; (4) youth
361.31who are exposed to abuse and neglect in their homes; (5) youth who experience conflict
361.32with parents due to chemical or alcohol dependency, mental health disabilities, or other
361.33disabilities; and (6) runaways.
361.34(e) "Runaway" means an unmarried child under the age of 18 years who is absent
361.35from the home of a parent or guardian or other lawful placement without the consent of
361.36the parent, guardian, or lawful custodian.
362.1    Subd. 2. Homeless and runaway youth report. The commissioner shall develop a
362.2report for homeless youth, youth at risk of homelessness, and runaways. The report shall
362.3include coordination of services as defined under subdivisions 3 to 5.
362.4    Subd. 3. Street and community outreach and drop-in program. Youth drop-in
362.5centers must provide walk-in access to crisis intervention and ongoing supportive services
362.6including one-to-one case management services on a self-referral basis. Street and
362.7community outreach programs must locate, contact, and provide information, referrals,
362.8and services to homeless youth, youth at risk of homelessness, and runaways. Information,
362.9referrals, and services provided may include, but are not limited to:
362.10(1) family reunification services;
362.11(2) conflict resolution or mediation counseling;
362.12(3) assistance in obtaining temporary emergency shelter;
362.13(4) assistance in obtaining food, clothing, medical care, or mental health counseling;
362.14(5) counseling regarding violence, prostitution sexual exploitation, substance abuse,
362.15sexually transmitted diseases, and pregnancy;
362.16(6) referrals to other agencies that provide support services to homeless youth,
362.17youth at risk of homelessness, and runaways;
362.18(7) assistance with education, employment, and independent living skills;
362.19(8) aftercare services;
362.20(9) specialized services for highly vulnerable runaways and homeless youth,
362.21including teen parents, emotionally disturbed and mentally ill youth, and sexually
362.22exploited youth; and
362.23(10) homelessness prevention.
362.24    Subd. 4. Emergency shelter program. (a) Emergency shelter programs must
362.25provide homeless youth and runaways with referral and walk-in access to emergency,
362.26short-term residential care. The program shall provide homeless youth and runaways with
362.27safe, dignified shelter, including private shower facilities, beds, and at least one meal each
362.28day; and shall assist a runaway and homeless youth with reunification with the family or
362.29legal guardian when required or appropriate.
362.30(b) The services provided at emergency shelters may include, but are not limited to:
362.31(1) family reunification services;
362.32(2) individual, family, and group counseling;
362.33(3) assistance obtaining clothing;
362.34(4) access to medical and dental care and mental health counseling;
362.35(5) education and employment services;
362.36(6) recreational activities;
363.1(7) advocacy and referral services;
363.2(8) independent living skills training;
363.3(9) aftercare and follow-up services;
363.4(10) transportation; and
363.5(11) homelessness prevention.
363.6    Subd. 5. Supportive housing and transitional living programs. Transitional
363.7living programs must help homeless youth and youth at risk of homelessness to find and
363.8maintain safe, dignified housing. The program may also provide rental assistance and
363.9related supportive services, or refer youth to other organizations or agencies that provide
363.10such services. Services provided may include, but are not limited to:
363.11(1) educational assessment and referrals to educational programs;
363.12(2) career planning, employment, work skill training, and independent living skills
363.13training;
363.14(3) job placement;
363.15(4) budgeting and money management;
363.16(5) assistance in securing housing appropriate to needs and income;
363.17(6) counseling regarding violence, prostitution sexual exploitation, substance abuse,
363.18sexually transmitted diseases, and pregnancy;
363.19(7) referral for medical services or chemical dependency treatment;
363.20(8) parenting skills;
363.21(9) self-sufficiency support services or life skill training;
363.22(10) aftercare and follow-up services; and
363.23(11) homelessness prevention.
363.24    Subd. 6. Funding. Any Funds appropriated for this section may be expended on
363.25programs described under subdivisions 3 to 5, technical assistance, and capacity building.
363.26Up to four percent of funds appropriated may be used for the purpose of monitoring and
363.27evaluating runaway and homeless youth programs receiving funding under this section.
363.28Funding shall be directed to meet the greatest need, with a significant share of the funding
363.29focused on homeless youth providers in greater Minnesota to meet the greatest need on
363.30a statewide basis. Programs funded under this section must submit demographic and
363.31outcome information to the commissioner. The commissioner must submit a report
363.32regarding program demographic and outcome information to the legislature upon request.

363.33    Sec. 21. Minnesota Statutes 2012, section 257.0755, subdivision 1, is amended to read:
363.34    Subdivision 1. Creation. One Each ombudsperson shall operate independently from
363.35but in collaboration with each of the following groups the community-specific board that
364.1appointed the ombudsperson under section 257.0768: the Indian Affairs Council, the
364.2Council on Affairs of Chicano/Latino people, the Council on Black Minnesotans, and
364.3the Council on Asian-Pacific Minnesotans.

364.4    Sec. 22. Minnesota Statutes 2012, section 260B.007, subdivision 6, is amended to read:
364.5    Subd. 6. Delinquent child. (a) Except as otherwise provided in paragraphs (b)
364.6and (c), "delinquent child" means a child:
364.7    (1) who has violated any state or local law, except as provided in section 260B.225,
364.8subdivision 1 , and except for juvenile offenders as described in subdivisions 16 to 18;
364.9    (2) who has violated a federal law or a law of another state and whose case has been
364.10referred to the juvenile court if the violation would be an act of delinquency if committed
364.11in this state or a crime or offense if committed by an adult;
364.12    (3) who has escaped from confinement to a state juvenile correctional facility after
364.13being committed to the custody of the commissioner of corrections; or
364.14    (4) who has escaped from confinement to a local juvenile correctional facility after
364.15being committed to the facility by the court.
364.16    (b) The term delinquent child does not include a child alleged to have committed
364.17murder in the first degree after becoming 16 years of age, but the term delinquent child
364.18does include a child alleged to have committed attempted murder in the first degree.
364.19    (c) The term delinquent child does not include a child under the age of 16 years
364.20 alleged to have engaged in conduct which would, if committed by an adult, violate any
364.21federal, state, or local law relating to being hired, offering to be hired, or agreeing to be
364.22hired by another individual to engage in sexual penetration or sexual conduct.
364.23EFFECTIVE DATE.This section is effective August 1, 2014, and applies to
364.24offenses committed on or after that date.

364.25    Sec. 23. Minnesota Statutes 2012, section 260B.007, subdivision 16, is amended to read:
364.26    Subd. 16. Juvenile petty offender; juvenile petty offense. (a) "Juvenile petty
364.27offense" includes a juvenile alcohol offense, a juvenile controlled substance offense,
364.28a violation of section 609.685, or a violation of a local ordinance, which by its terms
364.29prohibits conduct by a child under the age of 18 years which would be lawful conduct if
364.30committed by an adult.
364.31    (b) Except as otherwise provided in paragraph (c), "juvenile petty offense" also
364.32includes an offense that would be a misdemeanor if committed by an adult.
364.33    (c) "Juvenile petty offense" does not include any of the following:
365.1    (1) a misdemeanor-level violation of section 518B.01, 588.20, 609.224, 609.2242,
365.2609.324 , subdivision 2 or 3, 609.5632, 609.576, 609.66, 609.746, 609.748, 609.79,
365.3or 617.23;
365.4    (2) a major traffic offense or an adult court traffic offense, as described in section
365.5260B.225 ;
365.6    (3) a misdemeanor-level offense committed by a child whom the juvenile court
365.7previously has found to have committed a misdemeanor, gross misdemeanor, or felony
365.8offense; or
365.9    (4) a misdemeanor-level offense committed by a child whom the juvenile court
365.10has found to have committed a misdemeanor-level juvenile petty offense on two or
365.11more prior occasions, unless the county attorney designates the child on the petition
365.12as a juvenile petty offender notwithstanding this prior record. As used in this clause,
365.13"misdemeanor-level juvenile petty offense" includes a misdemeanor-level offense that
365.14would have been a juvenile petty offense if it had been committed on or after July 1, 1995.
365.15    (d) A child who commits a juvenile petty offense is a "juvenile petty offender." The
365.16term juvenile petty offender does not include a child under the age of 16 years alleged
365.17to have violated any law relating to being hired, offering to be hired, or agreeing to be
365.18hired by another individual to engage in sexual penetration or sexual conduct which, if
365.19committed by an adult, would be a misdemeanor.
365.20EFFECTIVE DATE.This section is effective August 1, 2014, and applies to
365.21offenses committed on or after that date.

365.22    Sec. 24. Minnesota Statutes 2012, section 260C.007, subdivision 6, is amended to read:
365.23    Subd. 6. Child in need of protection or services. "Child in need of protection or
365.24services" means a child who is in need of protection or services because the child:
365.25    (1) is abandoned or without parent, guardian, or custodian;
365.26    (2)(i) has been a victim of physical or sexual abuse as defined in section 626.556,
365.27subdivision 2, (ii) resides with or has resided with a victim of child abuse as defined in
365.28subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or
365.29would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or
365.30child abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment
365.31as defined in subdivision 15;
365.32    (3) is without necessary food, clothing, shelter, education, or other required care
365.33for the child's physical or mental health or morals because the child's parent, guardian,
365.34or custodian is unable or unwilling to provide that care;
366.1    (4) is without the special care made necessary by a physical, mental, or emotional
366.2condition because the child's parent, guardian, or custodian is unable or unwilling to
366.3provide that care;
366.4    (5) is medically neglected, which includes, but is not limited to, the withholding of
366.5medically indicated treatment from a disabled infant with a life-threatening condition. The
366.6term "withholding of medically indicated treatment" means the failure to respond to the
366.7infant's life-threatening conditions by providing treatment, including appropriate nutrition,
366.8hydration, and medication which, in the treating physician's or physicians' reasonable
366.9medical judgment, will be most likely to be effective in ameliorating or correcting all
366.10conditions, except that the term does not include the failure to provide treatment other
366.11than appropriate nutrition, hydration, or medication to an infant when, in the treating
366.12physician's or physicians' reasonable medical judgment:
366.13    (i) the infant is chronically and irreversibly comatose;
366.14    (ii) the provision of the treatment would merely prolong dying, not be effective in
366.15ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be
366.16futile in terms of the survival of the infant; or
366.17    (iii) the provision of the treatment would be virtually futile in terms of the survival
366.18of the infant and the treatment itself under the circumstances would be inhumane;
366.19    (6) is one whose parent, guardian, or other custodian for good cause desires to be
366.20relieved of the child's care and custody, including a child who entered foster care under a
366.21voluntary placement agreement between the parent and the responsible social services
366.22agency under section 260C.227;
366.23    (7) has been placed for adoption or care in violation of law;
366.24    (8) is without proper parental care because of the emotional, mental, or physical
366.25disability, or state of immaturity of the child's parent, guardian, or other custodian;
366.26    (9) is one whose behavior, condition, or environment is such as to be injurious or
366.27dangerous to the child or others. An injurious or dangerous environment may include, but
366.28is not limited to, the exposure of a child to criminal activity in the child's home;
366.29    (10) is experiencing growth delays, which may be referred to as failure to thrive, that
366.30have been diagnosed by a physician and are due to parental neglect;
366.31    (11) has engaged in prostitution as defined in section 609.321, subdivision 9 is a
366.32sexually exploited youth;
366.33    (12) has committed a delinquent act or a juvenile petty offense before becoming
366.34ten years old;
366.35    (13) is a runaway;
366.36    (14) is a habitual truant;
367.1    (15) has been found incompetent to proceed or has been found not guilty by reason
367.2of mental illness or mental deficiency in connection with a delinquency proceeding, a
367.3certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a
367.4proceeding involving a juvenile petty offense; or
367.5    (16) has a parent whose parental rights to one or more other children were
367.6involuntarily terminated or whose custodial rights to another child have been involuntarily
367.7transferred to a relative and there is a case plan prepared by the responsible social services
367.8agency documenting a compelling reason why filing the termination of parental rights
367.9petition under section 260C.301, subdivision 3, is not in the best interests of the child; or.
367.10    (17) is a sexually exploited youth.
367.11EFFECTIVE DATE.This section is effective August 1, 2014.

367.12    Sec. 25. Minnesota Statutes 2012, section 260C.007, subdivision 31, is amended to read:
367.13    Subd. 31. Sexually exploited youth. "Sexually exploited youth" means an
367.14individual who:
367.15    (1) is alleged to have engaged in conduct which would, if committed by an adult,
367.16violate any federal, state, or local law relating to being hired, offering to be hired, or
367.17agreeing to be hired by another individual to engage in sexual penetration or sexual conduct;
367.18    (2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
367.19609.3451 , 609.3453, 609.352, 617.246, or 617.247;
367.20    (3) is a victim of a crime described in United States Code, title 18, section 2260;
367.212421; 2422; 2423; 2425; 2425A; or 2256; or
367.22    (4) is a sex trafficking victim as defined in section 609.321, subdivision 7b.
367.23EFFECTIVE DATE.This section is effective the day following final enactment.

367.24    Sec. 26. Laws 1998, chapter 407, article 6, section 116, is amended to read:
367.25    Sec. 116. EBT TRANSACTION COSTS; APPROVAL FROM LEGISLATURE.
367.26    The commissioner of human services shall request and receive approval from the
367.27legislature before adjusting the payment to not subsidize retailers for electronic benefit
367.28transfer transaction costs Supplemental Nutrition Assistance Program transactions.
367.29EFFECTIVE DATE.This section is effective 30 days after the commissioner
367.30notifies retailers of the termination of their agreement with the state. The commissioner of
367.31human services must notify the revisor of statutes of that date.

368.1    Sec. 27. Laws 2011, First Special Session chapter 9, article 1, section 3, the effective
368.2date, is amended to read:
368.3EFFECTIVE DATE.This section is effective January 1, 2013 July 1, 2014.
368.4EFFECTIVE DATE.This section is effective retroactively from January 1, 2013.

368.5    Sec. 28. INCLUSION OF OTHER HEALTH-RELATED OCCUPATIONS TO
368.6CRIMINAL BACKGROUND CHECKS.
368.7(a) If the Department of Health is not reviewed by the Sunset Advisory Commission
368.8according to the schedule in Minnesota Statutes, section 3D.21, the commissioner
368.9of health, as the regulator for occupational therapy practitioners, speech-language
368.10pathologists, audiologists, and hearing instrument dispensers, shall require applicants
368.11for licensure or renewal to submit to a criminal history records check as required under
368.12Minnesota Statutes, section 214.075, for other health-related licensed occupations
368.13regulated by the health-related licensing boards.
368.14(b) Any statutory changes necessary to include the commissioner of health to
368.15Minnesota Statutes, section 214.075, shall be included in the plan required in Minnesota
368.16Statutes, section 214.075, subdivision 8.

368.17    Sec. 29. DIRECTION TO COMMISSIONERS; INCOME AND ASSET
368.18EXCLUSION.
368.19(a) The commissioner of human services shall not count conditional cash transfers
368.20made to families participating in a family independence demonstration as income or
368.21assets for purposes of determining or redetermining eligibility for child care assistance
368.22programs under Minnesota Statutes, chapter 119B; general assistance under Minnesota
368.23Statutes, chapter 256D; group residential housing under Minnesota Statutes, chapter 256I;
368.24the Minnesota family investment program, work benefit program, or diversionary work
368.25program under Minnesota Statutes, chapter 256J; or the MinnesotaCare program under
368.26Minnesota Statutes, chapter 256L, during the duration of the demonstration.
368.27(b) The commissioner of human services shall not count conditional cash transfers
368.28made to families participating in a family independence demonstration as income or assets
368.29for purposes of determining or redetermining eligibility for medical assistance under
368.30Minnesota Statutes, chapter 256B, and MinnesotaCare under Minnesota Statutes, chapter
368.31256L, except that for enrollees subject to a modified adjusted gross income calculation to
368.32determine eligibility, the conditional cash transfer payments shall be counted as income if
369.1they are included on the enrollee's federal tax return as income, or if the payments can be
369.2taken into account in the month of receipt as a lump sum payment.
369.3(c) The commissioner of the Minnesota Housing Finance Agency shall not count
369.4conditional cash transfers made to families participating in a family independence
369.5demonstration as income or assets for purposes of determining or redetermining eligibility
369.6for housing assistance programs under Minnesota Statutes, section 462A.201, during
369.7the duration of the demonstration.
369.8    (d) For the purposes of this section:
369.9(1) "conditional cash transfer" means a payment made to a participant in a family
369.10independence demonstration by a sponsoring organization to incent, support, or facilitate
369.11participation; and
369.12(2) "family independence demonstration" means an initiative sponsored or
369.13cosponsored by a governmental or nongovernmental organization, the goal of which is
369.14to facilitate individualized goal-setting and peer support for cohorts of no more than 12
369.15families each toward the development of financial and nonfinancial assets that enable the
369.16participating families to achieve financial independence.

369.17    Sec. 30. REDUCTION OF YOUTH HOMELESSNESS.
369.18(a) The Minnesota Interagency Council on Homelessness established under the
369.19authority of Minnesota Statutes, section 462A.29, as it updates its statewide plan to
369.20prevent and end homelessness, shall make recommendations on strategies to reduce the
369.21number of youth experiencing homelessness and to prevent homelessness for youth who
369.22are at risk of becoming homeless.
369.23(b) Recommended strategies must take into consideration, to the extent feasible,
369.24issues that contribute to or reduce youth homelessness including, but not limited to, mental
369.25health, chemical dependency, trafficking of youth for sex or other purposes, exiting foster
369.26care, and involvement in gangs. The recommended strategies must include supportive
369.27services as outlined in Minnesota Statutes, section 256K.45, subdivision 5.
369.28(c) The council shall provide an update on the status of its work by December 1,
369.292014, to the legislative committees with jurisdiction over housing, homelessness, and
369.30matters pertaining to youth. If the council determines legislative action is required to
369.31implement recommended strategies, the council shall submit proposals to the legislature at
369.32the earliest possible opportunity.

369.33    Sec. 31. REPEALER.
370.1(a) Minnesota Statutes 2012, sections 256J.24, subdivision 6; and 256K.45,
370.2subdivision 2, are repealed.
370.3(b) Minnesota Statutes 2012, section 609.093, is repealed.
370.4EFFECTIVE DATE.Paragraph (b) is effective the day following final enactment.


370.7    Section 1. Minnesota Statutes 2012, section 144.051, is amended by adding a
370.8subdivision to read:
370.9    Subd. 3. Data classification; private data. For providers regulated pursuant to
370.10sections 144A.43 to 144A.482, the following data collected, created, or maintained by the
370.11commissioner are classified as "private data" as defined in section 13.02, subdivision 12:
370.12(1) data submitted by or on behalf of applicants for licenses prior to issuance of
370.13the license;
370.14(2) the identity of complainants who have made reports concerning licensees or
370.15applicants unless the complainant consents to the disclosure;
370.16(3) the identity of individuals who provide information as part of surveys and
370.17investigations;
370.18(4) Social Security numbers; and
370.19(5) health record data.

370.20    Sec. 2. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
370.21to read:
370.22    Subd. 4. Data classification; public data. For providers regulated pursuant to
370.23sections 144A.43 to 144A.482, the following data collected, created, or maintained by the
370.24commissioner are classified as "public data" as defined in section 13.02, subdivision 15:
370.25(1) all application data on licensees, license numbers, license status;
370.26(2) licensing information about licenses previously held under this chapter;
370.27(3) correction orders, including information about compliance with the order and
370.28whether the fine was paid;
370.29(4) final enforcement actions pursuant to chapter 14;
370.30(5) orders for hearing, findings of fact and conclusions of law; and
370.31(6) when the licensee and department agree to resolve the matter without a hearing,
370.32the agreement and specific reasons for the agreement are public data.

371.1    Sec. 3. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
371.2to read:
371.3    Subd. 5. Data classification; confidential data. For providers regulated pursuant to
371.4sections 144A.43 to 144A.482, the following data collected, created, or maintained by
371.5the Department of Health are classified as "confidential data" as defined in section 13.02,
371.6subdivision 3: active investigative data relating to the investigation of potential violations
371.7of law by licensee including data from the survey process before the correction order is
371.8issued by the department.

371.9    Sec. 4. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
371.10to read:
371.11    Subd. 6. Release of private or confidential data. For providers regulated pursuant
371.12to sections 144A.43 to 144A.482, the department may release private or confidential
371.13data, except Social Security numbers, to the appropriate state, federal, or local agency
371.14and law enforcement office to enhance investigative or enforcement efforts or further
371.15public health protective process. Types of offices include, but are not limited to, Adult
371.16Protective Services, Office of the Ombudsmen for Long-Term Care and Office of the
371.17Ombudsmen for Mental Health and Developmental Disabilities, the health licensing
371.18boards, Department of Human Services, county or city attorney's offices, police, and local
371.19or county public health offices.

371.20    Sec. 5. Minnesota Statutes 2012, section 144A.43, is amended to read:
371.21144A.43 DEFINITIONS.
371.22    Subdivision 1. Applicability. The definitions in this section apply to sections
371.23144.699, subdivision 2 , and 144A.43 to 144A.47 144A.482.
371.24    Subd. 1a. Agent. "Agent" means the person upon whom all notices and orders shall
371.25be served and who is authorized to accept service of notices and orders on behalf of
371.26the home care provider.
371.27    Subd. 1b. Applicant. "Applicant" means an individual, organization, association,
371.28corporation, unit of government, or other entity that applies for a temporary license,
371.29license, or renewal of their home care provider license under section 144A.472.
371.30    Subd. 1c. Client. "Client" means a person to whom home care services are provided.
371.31    Subd. 1d. Client record. "Client record" means all records that document
371.32information about the home care services provided to the client by the home care provider.
371.33    Subd. 1e. Client representative. "Client representative" means a person who,
371.34because of the client's needs, makes decisions about the client's care on behalf of the
372.1client. A client representative may be a guardian, health care agent, family member, or
372.2other agent of the client. Nothing in this section expands or diminishes the rights of
372.3persons to act on behalf of clients under other law.
372.4    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.
372.5    Subd. 2a. Controlled substance. "Controlled substance" has the meaning given
372.6in section 152.01, subdivision 4.
372.7    Subd. 2b. Department. "Department" means the Minnesota Department of Health.
372.8    Subd. 2c. Dietary supplement. "Dietary supplement" means a product taken by
372.9mouth that contains a "dietary ingredient" intended to supplement the diet. Dietary
372.10ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and
372.11substances such as enzymes, organ tissue, glandulars, or metabolites.
372.12    Subd. 2d. Dietitian. "Dietitian" is a person licensed under sections 148.621 to
372.13148.633.
372.14    Subd. 2e. Dietetics or nutrition practice. "Dietetics or nutrition practice" is
372.15performed by a licensed dietician or licensed nutritionist and includes the activities of
372.16assessment, setting priorities and objectives, providing nutrition counseling, developing
372.17and implementing nutrition care services, and evaluating and maintaining appropriate
372.18standards of quality of nutrition care under sections 148.621 to 148.633.
372.19    Subd. 3. Home care service. "Home care service" means any of the following
372.20services when delivered in a place of residence to the home of a person whose illness,
372.21disability, or physical condition creates a need for the service:
372.22(1) nursing services, including the services of a home health aide;
372.23(2) personal care services not included under sections 148.171 to 148.285;
372.24(3) physical therapy;
372.25(4) speech therapy;
372.26(5) respiratory therapy;
372.27(6) occupational therapy;
372.28(7) nutritional services;
372.29(8) home management services when provided to a person who is unable to perform
372.30these activities due to illness, disability, or physical condition. Home management
372.31services include at least two of the following services: housekeeping, meal preparation,
372.32and shopping;
372.33(9) medical social services;
372.34(10) the provision of medical supplies and equipment when accompanied by the
372.35provision of a home care service; and
373.1(11) other similar medical services and health-related support services identified by
373.2the commissioner in rule.
373.3"Home care service" does not include the following activities conducted by the
373.4commissioner of health or a board of health as defined in section 145A.02, subdivision 2:
373.5communicable disease investigations or testing; administering or monitoring a prescribed
373.6therapy necessary to control or prevent a communicable disease; or the monitoring
373.7of an individual's compliance with a health directive as defined in section 144.4172,
373.8subdivision 6 .
373.9(1) assistive tasks provided by unlicensed personnel;
373.10(2) services provided by a registered nurse or licensed practical nurse, physical
373.11therapist, respiratory therapist, occupational therapist, speech-language pathologist,
373.12dietitian or nutritionist, or social worker;
373.13(3) medication and treatment management services; or
373.14(4) the provision of durable medical equipment services when provided with any of
373.15the home care services listed in clauses (1) to (3).
373.16    Subd. 3a. Hands-on-assistance. "Hands-on-assistance" means physical help by
373.17another person without which the client is not able to perform the activity.
373.18    Subd. 3b. Home. "Home" means the client's temporary or permanent place of
373.19residence.
373.20    Subd. 4. Home care provider. "Home care provider" means an individual,
373.21organization, association, corporation, unit of government, or other entity that is regularly
373.22engaged in the delivery of at least one home care service, directly or by contractual
373.23arrangement, of home care services in a client's home for a fee and who has a valid current
373.24temporary license or license issued under sections 144A.43 to 144A.482. At least one
373.25home care service must be provided directly, although additional home care services may
373.26be provided by contractual arrangements. "Home care provider" does not include:
373.27(1) any home care or nursing services conducted by and for the adherents of any
373.28recognized church or religious denomination for the purpose of providing care and
373.29services for those who depend upon spiritual means, through prayer alone, for healing;
373.30(2) an individual who only provides services to a relative;
373.31(3) an individual not connected with a home care provider who provides assistance
373.32with home management services or personal care needs if the assistance is provided
373.33primarily as a contribution and not as a business;
373.34(4) an individual not connected with a home care provider who shares housing with
373.35and provides primarily housekeeping or homemaking services to an elderly or disabled
373.36person in return for free or reduced-cost housing;
374.1(5) an individual or agency providing home-delivered meal services;
374.2(6) an agency providing senior companion services and other older American
374.3volunteer programs established under the Domestic Volunteer Service Act of 1973,
374.4Public Law 98-288;
374.5(7) an employee of a nursing home licensed under this chapter or an employee of a
374.6boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
374.7emergency calls from individuals residing in a residential setting that is attached to or
374.8located on property contiguous to the nursing home or boarding care home;
374.9(8) a member of a professional corporation organized under chapter 319B that does
374.10not regularly offer or provide home care services as defined in subdivision 3;
374.11(9) the following organizations established to provide medical or surgical services
374.12that do not regularly offer or provide home care services as defined in subdivision 3:
374.13a business trust organized under sections 318.01 to 318.04, a nonprofit corporation
374.14organized under chapter 317A, a partnership organized under chapter 323, or any other
374.15entity determined by the commissioner;
374.16(10) an individual or agency that provides medical supplies or durable medical
374.17equipment, except when the provision of supplies or equipment is accompanied by a
374.18home care service;
374.19(11) an individual licensed under chapter 147; or
374.20(12) an individual who provides home care services to a person with a developmental
374.21disability who lives in a place of residence with a family, foster family, or primary caregiver.
374.22    Subd. 5. Medication reminder. "Medication reminder" means providing a verbal
374.23or visual reminder to a client to take medication. This includes bringing the medication
374.24to the client and providing liquids or nutrition to accompany medication that a client is
374.25self-administering.
374.26    Subd. 6. License. "License" means a basic or comprehensive home care license
374.27issued by the commissioner to a home care provider.
374.28    Subd. 7. Licensed health professional. "Licensed health professional" means a
374.29person, other than a registered nurse or licensed practical nurse, who provides home care
374.30services within the scope of practice of the person's health occupation license, registration,
374.31or certification as regulated and who is licensed by the appropriate Minnesota state board
374.32or agency.
374.33    Subd. 8. Licensee. "Licensee" means a home care provider that is licensed under
374.34this chapter.
375.1    Subd. 9. Managerial official. "Managerial official" means an administrator,
375.2director, officer, trustee, or employee of a home care provider, however designated, who
375.3has the authority to establish or control business policy.
375.4    Subd. 10. Medication. "Medication" means a prescription or over-the-counter drug.
375.5For purposes of this chapter only, medication includes dietary supplements.
375.6    Subd. 11. Medication administration. "Medication administration" means
375.7performing a set of tasks to ensure a client takes medications, and includes the following:
375.8(1) checking the client's medication record;
375.9(2) preparing the medication as necessary;
375.10(3) administering the medication to the client;
375.11(4) documenting the administration or reason for not administering the medication;
375.12and
375.13(5) reporting to a nurse any concerns about the medication, the client, or the client's
375.14refusal to take the medication.
375.15    Subd. 12. Medication management. "Medication management" means the
375.16provision of any of the following medication-related services to a client:
375.17(1) performing medication setup;
375.18(2) administering medication;
375.19(3) storing and securing medications;
375.20(4) documenting medication activities;
375.21(5) verifying and monitoring effectiveness of systems to ensure safe handling and
375.22administration;
375.23(6) coordinating refills;
375.24(7) handling and implementing changes to prescriptions;
375.25(8) communicating with the pharmacy about the client's medications; and
375.26(9) coordinating and communicating with the prescriber.
375.27    Subd. 13. Medication setup. "Medication setup" means arranging medications by a
375.28nurse, pharmacy, or authorized prescriber for later administration by the client or by
375.29comprehensive home care staff.
375.30    Subd. 14. Nurse. "Nurse" means a person who is licensed under sections 148.171 to
375.31148.285.
375.32    Subd. 15. Occupational therapist. "Occupational therapist" means a person who is
375.33licensed under sections 148.6401 to 148.6450.
375.34    Subd. 16. Over-the-counter drug. "Over-the-counter drug" means a drug that is
375.35not required by federal law to bear the symbol "Rx only."
376.1    Subd. 17. Owner. "Owner" means a proprietor, general partner, limited partner who
376.2has five percent or more of equity interest in a limited partnership, a person who owns or
376.3controls voting stock in a corporation in an amount equal to or greater than five percent of
376.4the shares issued and outstanding, or a corporation that owns equity interest in a licensee
376.5or applicant for a license.
376.6    Subd. 18. Pharmacist. "Pharmacist" has the meaning given in section 151.01,
376.7subdivision 3.
376.8    Subd. 19. Physical therapist. "Physical therapist" means a person who is licensed
376.9under sections 148.65 to 148.78.
376.10    Subd. 20. Physician. "Physician" means a person who is licensed under chapter 147.
376.11    Subd. 21. Prescriber. "Prescriber" means a person who is authorized by sections
376.12148.235; 151.01, subdivision 23; and 151.37, to prescribe prescription drugs.
376.13    Subd. 22. Prescription. "Prescription" has the meaning given in section 151.01,
376.14subdivision 16.
376.15    Subd. 23. Regularly scheduled. "Regularly scheduled" means ordered or planned
376.16to be completed at predetermined times or according to a predetermined routine.
376.17    Subd. 24. Reminder. "Reminder" means providing a verbal or visual reminder
376.18to a client.
376.19    Subd. 25. Respiratory therapist. "Respiratory therapist" means a person who
376.20is licensed under chapter 147C.
376.21    Subd. 26. Revenues. "Revenues" means all money received by a licensee derived
376.22from the provision of home care services, including fees for services and appropriations
376.23of public money for home care services.
376.24    Subd. 27. Service plan. "Service plan" means the written plan between the client or
376.25client's representative and the temporary licensee or licensee about the services that will
376.26be provided to the client.
376.27    Subd. 28. Social worker. "Social worker" means a person who is licensed under
376.28chapter 148D or 148E.
376.29    Subd. 29. Speech language pathologist. "Speech language pathologist" has the
376.30meaning given in section 148.512.
376.31    Subd. 30. Standby assistance. "Standby assistance" means the presence of another
376.32person within arm's reach to minimize the risk of injury while performing daily activities
376.33through physical intervention or cuing.
376.34    Subd. 31. Substantial compliance. "Substantial compliance" means complying
376.35with the requirements in this chapter sufficiently to prevent unacceptable health or safety
376.36risks to the home care client.
377.1    Subd. 32. Survey. "Survey" means an inspection of a licensee or applicant for
377.2licensure for compliance with this chapter.
377.3    Subd. 33. Surveyor. "Surveyor" means a staff person of the department authorized
377.4to conduct surveys of home care providers and applicants.
377.5    Subd. 34. Temporary license. "Temporary license" means the initial basic or
377.6comprehensive home care license the department issues after approval of a complete
377.7written application and before the department completes the temporary license survey and
377.8determines that the temporary licensee is in substantial compliance.
377.9    Subd. 35. Treatment or therapy. "Treatment" or "therapy" means the provision
377.10of care, other than medications, ordered or prescribed by a licensed health professional
377.11provided to a client to cure, rehabilitate, or ease symptoms.
377.12    Subd. 36. Unit of government. "Unit of government" means every city, county,
377.13town, school district, other political subdivisions of the state, and any agency of the state
377.14or federal government, which includes any instrumentality of a unit of government.
377.15    Subd. 37. Unlicensed personnel. "Unlicensed personnel" are individuals not
377.16otherwise licensed or certified by a governmental health board or agency who provide
377.17home care services in the client's home.
377.18    Subd. 38. Verbal. "Verbal" means oral and not in writing.

377.19    Sec. 6. Minnesota Statutes 2012, section 144A.44, is amended to read:
377.20144A.44 HOME CARE BILL OF RIGHTS.
377.21    Subdivision 1. Statement of rights. A person who receives home care services
377.22has these rights:
377.23(1) the right to receive written information about rights in advance of before
377.24receiving care or during the initial evaluation visit before the initiation of treatment
377.25 services, including what to do if rights are violated;
377.26(2) the right to receive care and services according to a suitable and up-to-date plan,
377.27and subject to accepted health care, medical or nursing standards, to take an active part
377.28in creating and changing the plan developing, modifying, and evaluating care the plan
377.29 and services;
377.30(3) the right to be told in advance of before receiving care about the services that will
377.31be provided, the disciplines that will furnish care the type and disciplines of staff who will
377.32be providing the services, the frequency of visits proposed to be furnished, other choices
377.33that are available for addressing home care needs, and the consequences of these choices
377.34including the potential consequences of refusing these services;
378.1(4) the right to be told in advance of any change recommended changes by the
378.2provider in the service plan of care and to take an active part in any change decisions
378.3about changes to the service plan;
378.4(5) the right to refuse services or treatment;
378.5(6) the right to know, in advance before receiving services or during the initial
378.6visit, any limits to the services available from a home care provider, and the provider's
378.7grounds for a termination of services;
378.8(7) the right to know in advance of receiving care whether the services are covered
378.9by health insurance, medical assistance, or other health programs, the charges for services
378.10that will not be covered by Medicare, and the charges that the individual may have to pay;
378.11(8) (7) the right to know be told before services are initiated what the provider
378.12charges are for the services, no matter who will be paying the bill and if known to what
378.13extent payment may be expected from health insurance, public programs or other sources,
378.14and what charges the client may be responsible for paying;
378.15(9) (8) the right to know that there may be other services available in the community,
378.16including other home care services and providers, and to know where to go for find
378.17 information about these services;
378.18(10) (9) the right to choose freely among available providers and to change providers
378.19after services have begun, within the limits of health insurance, long-term care insurance,
378.20medical assistance, or other health programs;
378.21(11) (10) the right to have personal, financial, and medical information kept private,
378.22and to be advised of the provider's policies and procedures regarding disclosure of such
378.23information;
378.24(12) (11) the right to be allowed access to the client's own records and written
378.25information from those records in accordance with sections 144.291 to 144.298;
378.26(13) (12) the right to be served by people who are properly trained and competent
378.27to perform their duties;
378.28(14) (13) the right to be treated with courtesy and respect, and to have the patient's
378.29 client's property treated with respect;
378.30(15) (14) the right to be free from physical and verbal abuse, neglect, financial
378.31exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and
378.32the Maltreatment of Minors Act;
378.33(16) (15) the right to reasonable, advance notice of changes in services or charges,
378.34including;
378.35(16) the right to know the provider's reason for termination of services;
379.1(17) the right to at least ten days' advance notice of the termination of a service by a
379.2provider, except in cases where:
379.3(i) the recipient of services client engages in conduct that significantly alters the
379.4conditions of employment as specified in the employment contract between terms of
379.5the service plan with the home care provider and the individual providing home care
379.6services, or creates;
379.7(ii) the client, person who lives with the client, or others create an abusive or unsafe
379.8work environment for the individual person providing home care services; or
379.9(ii) (iii) an emergency for the informal caregiver or a significant change in the
379.10recipient's client's condition has resulted in service needs that exceed the current service
379.11provider agreement plan and that cannot be safely met by the home care provider;
379.12(17) (18) the right to a coordinated transfer when there will be a change in the
379.13provider of services;
379.14(18) (19) the right to voice grievances regarding treatment or care that is complain
379.15about services that are provided, or fails to be, furnished, or regarding fail to be provided,
379.16and the lack of courtesy or respect to the patient client or the patient's client's property;
379.17(19) (20) the right to know how to contact an individual associated with the home
379.18care provider who is responsible for handling problems and to have the home care provider
379.19investigate and attempt to resolve the grievance or complaint;
379.20(20) (21) the right to know the name and address of the state or county agency to
379.21contact for additional information or assistance; and
379.22(21) (22) the right to assert these rights personally, or have them asserted by
379.23the patient's family or guardian when the patient has been judged incompetent, client's
379.24representative or by anyone on behalf of the client, without retaliation.
379.25    Subd. 2. Interpretation and enforcement of rights. These rights are established
379.26for the benefit of persons clients who receive home care services. "Home care services"
379.27means home care services as defined in section 144A.43, subdivision 3, and unlicensed
379.28personal care assistance services, including services covered by medical assistance under
379.29section 256B.0625, subdivision 19a. All home care providers, including those exempted
379.30under section 144A.471, must comply with this section. The commissioner shall enforce
379.31this section and the home care bill of rights requirement against home care providers
379.32exempt from licensure in the same manner as for licensees. A home care provider may
379.33not request or require a person client to surrender any of these rights as a condition of
379.34receiving services. A guardian or conservator or, when there is no guardian or conservator,
379.35a designated person, may seek to enforce these rights. This statement of rights does not
379.36replace or diminish other rights and liberties that may exist relative to persons clients
380.1 receiving home care services, persons providing home care services, or providers licensed
380.2under Laws 1987, chapter 378. A copy of these rights must be provided to an individual
380.3at the time home care services, including personal care assistance services, are initiated.
380.4The copy shall also contain the address and phone number of the Office of Health Facility
380.5Complaints and the Office of Ombudsman for Long-Term Care and a brief statement
380.6describing how to file a complaint with these offices. Information about how to contact
380.7the Office of Ombudsman for Long-Term Care shall be included in notices of change in
380.8client fees and in notices where home care providers initiate transfer or discontinuation of
380.9services sections 144A.43 to 144A.482.

380.10    Sec. 7. Minnesota Statutes 2012, section 144A.45, is amended to read:
380.11144A.45 REGULATION OF HOME CARE SERVICES.
380.12    Subdivision 1. Rules Regulations. The commissioner shall adopt rules for the
380.13regulation of regulate home care providers pursuant to sections 144A.43 to 144A.47
380.14 144A.482. The rules regulations shall include the following:
380.15    (1) provisions to assure, to the extent possible, the health, safety and well-being,
380.16and appropriate treatment of persons who receive home care services while respecting
380.17clients' autonomy and choice;
380.18    (2) requirements that home care providers furnish the commissioner with specified
380.19information necessary to implement sections 144A.43 to 144A.47 144A.482;
380.20    (3) standards of training of home care provider personnel, which may vary according
380.21to the nature of the services provided or the health status of the consumer;
380.22(4) standards for provision of home care services;
380.23    (4) (5) standards for medication management which may vary according to the
380.24nature of the services provided, the setting in which the services are provided, or the
380.25status of the consumer. Medication management includes the central storage, handling,
380.26distribution, and administration of medications;
380.27    (5) (6) standards for supervision of home care services requiring supervision by a
380.28registered nurse or other appropriate health care professional which must occur on site
380.29at least every 62 days, or more frequently if indicated by a clinical assessment, and in
380.30accordance with sections 148.171 to 148.285 and rules adopted thereunder, except that a
380.31person performing home care aide tasks for a class B licensee providing paraprofessional
380.32services does not require nursing supervision;
380.33    (6) (7) standards for client evaluation or assessment which may vary according to
380.34the nature of the services provided or the status of the consumer;
381.1    (7) (8) requirements for the involvement of a consumer's physician client's health
381.2care provider, the documentation of physicians' health care providers' orders, if required,
381.3and the consumer's treatment client's service plan, and;
381.4(9) the maintenance of accurate, current clinical client records;
381.5    (8) (10) the establishment of different classes basic and comprehensive levels of
381.6licenses for different types of providers and different standards and requirements for
381.7different kinds of home care based on services provided; and
381.8    (9) operating procedures required to implement (11) provisions to enforce these
381.9regulations and the home care bill of rights.
381.10    Subd. 1a. Home care aide tasks. Notwithstanding the provisions of Minnesota
381.11Rules, part 4668.0110, subpart 1, item E, home care aide tasks also include assisting
381.12toileting, transfers, and ambulation if the client is ambulatory and if the client has no
381.13serious acute illness or infectious disease.
381.14    Subd. 1b. Home health aide qualifications. Notwithstanding the provisions of
381.15Minnesota Rules, part 4668.0100, subpart 5, a person may perform home health aide tasks
381.16if the person maintains current registration as a nursing assistant on the Minnesota nursing
381.17assistant registry. Maintaining current registration on the Minnesota nursing assistant
381.18registry satisfies the documentation requirements of Minnesota Rules, part 4668.0110,
381.19subpart 3.
381.20    Subd. 2. Regulatory functions. (a) The commissioner shall:
381.21(1) evaluate, monitor, and license, survey, and monitor without advance notice, home
381.22care providers in accordance with sections 144A.45 to 144A.47 144A.43 to 144A.482;
381.23(2) inspect the office and records of a provider during regular business hours without
381.24advance notice to the home care provider;
381.25(2) survey every temporary licensee within one year of the temporary license issuance
381.26date subject to the temporary licensee providing home care services to a client or clients;
381.27(3) survey all licensed home care providers on an interval that will promote the
381.28health and safety of clients;
381.29(3) (4) with the consent of the consumer client, visit the home where services are
381.30being provided;
381.31(4) (5) issue correction orders and assess civil penalties in accordance with section
381.32144.653, subdivisions 5 to 8 , for violations of sections 144A.43 to 144A.47 or the rules
381.33adopted under those sections 144A.482;
381.34(5) (6) take action as authorized in section 144A.46, subdivision 3 144A.475; and
381.35(6) (7) take other action reasonably required to accomplish the purposes of sections
381.36144A.43 to 144A.47 144A.482.
382.1(b) In the exercise of the authority granted in sections 144A.43 to 144A.47, the
382.2commissioner shall comply with the applicable requirements of section 144.122, the
382.3Government Data Practices Act, and the Administrative Procedure Act.
382.4    Subd. 4. Medicaid reimbursement. Notwithstanding the provisions of section
382.5256B.37 or state plan requirements to the contrary, certification by the federal Medicare
382.6program must not be a requirement of Medicaid payment for services delivered under
382.7section 144A.4605.
382.8    Subd. 5. Home care providers; services for Alzheimer's disease or related
382.9disorder. (a) If a home care provider licensed under section 144A.46 or 144A.4605 markets
382.10or otherwise promotes services for persons with Alzheimer's disease or related disorders,
382.11the facility's direct care staff and their supervisors must be trained in dementia care.
382.12(b) Areas of required training include:
382.13(1) an explanation of Alzheimer's disease and related disorders;
382.14(2) assistance with activities of daily living;
382.15(3) problem solving with challenging behaviors; and
382.16(4) communication skills.
382.17(c) The licensee shall provide to consumers in written or electronic form a
382.18description of the training program, the categories of employees trained, the frequency
382.19of training, and the basic topics covered.

382.20    Sec. 8. [144A.471] HOME CARE PROVIDER AND HOME CARE SERVICES.
382.21    Subdivision 1. License required. A home care provider may not open, operate,
382.22manage, conduct, maintain, or advertise itself as a home care provider or provide home
382.23care services in Minnesota without a temporary or current home care provider license
382.24issued by the commissioner of health.
382.25    Subd. 2. Determination of direct home care service. "Direct home care service"
382.26means a home care service provided to a client by the home care provider or its employees,
382.27and not by contract. Factors that must be considered in determining whether an individual
382.28or a business entity provides at least one home care service directly include, but are not
382.29limited to, whether the individual or business entity:
382.30    (1) has the right to control, and does control, the types of services provided;
382.31(2) has the right to control, and does control, when and how the services are provided;
382.32    (3) establishes the charges;
382.33(4) collects fees from the clients or receives payment from third-party payers on
382.34the clients' behalf;
383.1(5) pays individuals providing services compensation on an hourly, weekly, or
383.2similar basis;
383.3(6) treats the individuals providing services as employees for the purposes of payroll
383.4taxes and workers' compensation insurance; and
383.5(7) holds itself out as a provider of home care services or acts in a manner that
383.6leads clients or potential clients to believe that it is a home care provider providing home
383.7care services.
383.8    None of the factors listed in this subdivision is solely determinative.
383.9    Subd. 3. Determination of regularly engaged. "Regularly engaged" means
383.10providing, or offering to provide, home care services as a regular part of a business. The
383.11following factors must be considered by the commissioner in determining whether an
383.12individual or a business entity is regularly engaged in providing home care services:
383.13    (1) whether the individual or business entity states or otherwise promotes that the
383.14individual or business entity provides home care services;
383.15    (2) whether persons receiving home care services constitute a substantial part of the
383.16individual's or the business entity's clientele; and
383.17(3) whether the home care services provided are other than occasional or incidental
383.18to the provision of services other than home care services.
383.19    None of the factors listed in this subdivision is solely determinative.
383.20    Subd. 4. Penalties for operating without license. A person involved in the
383.21management, operation, or control of a home care provider that operates without an
383.22appropriate license is guilty of a misdemeanor. This section does not apply to a person
383.23who has no legal authority to affect or change decisions related to the management,
383.24operation, or control of a home care provider.
383.25    Subd. 5. Basic and comprehensive levels of licensure. An applicant seeking
383.26to become a home care provider must apply for either a basic or comprehensive home
383.27care license.
383.28    Subd. 6. Basic home care license provider. Home care services that can be
383.29provided with a basic home care license are assistive tasks provided by licensed or
383.30unlicensed personnel that include:
383.31(1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting,
383.32and bathing;
383.33(2) providing standby assistance;
383.34(3) providing verbal or visual reminders to the client to take regularly scheduled
383.35medication which includes bringing the client previously set-up medication, medication in
383.36original containers, or liquid or food to accompany the medication;
384.1(4) providing verbal or visual reminders to the client to perform regularly scheduled
384.2treatments and exercises;
384.3(5) preparing modified diets ordered by a licensed health professional; and
384.4(6) assisting with laundry, housekeeping, meal preparation, shopping, or other
384.5household chores and services if the provider is also providing at least one of the activities
384.6in clauses (1) to (5)
384.7    Subd. 7. Comprehensive home care license provider. Home care services that
384.8may be provided with a comprehensive home care license include any of the basic home
384.9care services listed in subdivision 6, and one or more of the following:
384.10(1) services of an advanced practice nurse, registered nurse, licensed practical
384.11nurse, physical therapist, respiratory therapist, occupational therapist, speech-language
384.12pathologist, dietician or nutritionist, or social worker;
384.13(2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a
384.14licensed health professional within the person's scope of practice;
384.15(3) medication management services;
384.16(4) hands-on assistance with transfers and mobility;
384.17(5) assisting clients with eating when the clients have complicating eating problems
384.18as identified in the client record or through an assessment such as difficulty swallowing,
384.19recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous
384.20instruments to be fed; or
384.21(6) providing other complex or specialty health care services.
384.22    Subd. 8. Exemptions from home care services licensure. (a) Except as otherwise
384.23provided in this chapter, home care services that are provided by the state, counties, or
384.24other units of government must be licensed under this chapter.
384.25(b) An exemption under this subdivision does not excuse the exempted individual or
384.26organization from complying with applicable provisions of the home care bill of rights
384.27in section 144A.44. The following individuals or organizations are exempt from the
384.28requirement to obtain a home care provider license:
384.29(1) an individual or organization that offers, provides, or arranges for personal care
384.30assistance services under the medical assistance program as authorized under sections
384.31256B.04, subdivision 16; 256B.0625, subdivision 19a; and 256B.0659;
384.32(2) a provider that is licensed by the commissioner of human services to provide
384.33semi-independent living services for persons with developmental disabilities under section
384.34252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020;
385.1(3) a provider that is licensed by the commissioner of human services to provide
385.2home and community-based services for persons with developmental disabilities under
385.3section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930;
385.4(4) an individual or organization that provides only home management services, if
385.5the individual or organization is registered under section 144A.482; or
385.6(5) an individual who is licensed in this state as a nurse, dietitian, social worker,
385.7occupational therapist, physical therapist, or speech-language pathologist who provides
385.8health care services in the home independently and not through any contractual or
385.9employment relationship with a home care provider or other organization.
385.10    Subd. 9. Exclusions from home care licensure. The following are excluded from
385.11home care licensure and are not required to provide the home care bill of rights:
385.12(1) an individual or business entity providing only coordination of home care that
385.13includes one or more of the following:
385.14(i) determination of whether a client needs home care services, or assisting a client
385.15in determining what services are needed;
385.16(ii) referral of clients to a home care provider;
385.17(iii) administration of payments for home care services; or
385.18(iv) administration of a health care home established under section 256B.0751;
385.19(2) an individual who is not an employee of a licensed home care provider if the
385.20individual:
385.21(i) only provides services as an independent contractor to one or more licensed
385.22home care providers;
385.23(ii) provides no services under direct agreements or contracts with clients; and
385.24(iii) is contractually bound to perform services in compliance with the contracting
385.25home care provider's policies and service plans;
385.26(3) a business that provides staff to home care providers, such as a temporary
385.27employment agency, if the business:
385.28(i) only provides staff under contract to licensed or exempt providers;
385.29(ii) provides no services under direct agreements with clients; and
385.30(iii) is contractually bound to perform services under the contracting home care
385.31provider's direction and supervision;
385.32(4) any home care services conducted by and for the adherents of any recognized
385.33church or religious denomination for its members through spiritual means, or by prayer
385.34for healing;
385.35(5) an individual who only provides home care services to a relative;
386.1(6) an individual not connected with a home care provider that provides assistance
386.2with basic home care needs if the assistance is provided primarily as a contribution and
386.3not as a business;
386.4(7) an individual not connected with a home care provider that shares housing with
386.5and provides primarily housekeeping or homemaking services to an elderly or disabled
386.6person in return for free or reduced-cost housing;
386.7(8) an individual or provider providing home-delivered meal services;
386.8(9) an individual providing senior companion services and other Older American
386.9Volunteer Programs (OAVP) established under the Domestic Volunteer Service Act of
386.101973, United States Code, title 42, chapter 66;
386.11(10) an employee of a nursing home licensed under this chapter or an employee of a
386.12boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
386.13emergency calls from individuals residing in a residential setting that is attached to or
386.14located on property contiguous to the nursing home or boarding care home;
386.15(11) a member of a professional corporation organized under chapter 319B that
386.16does not regularly offer or provide home care services as defined in section 144A.43,
386.17subdivision 3;
386.18(12) the following organizations established to provide medical or surgical services
386.19that do not regularly offer or provide home care services as defined in section 144A.43,
386.20subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit
386.21corporation organized under chapter 317A, a partnership organized under chapter 323, or
386.22any other entity determined by the commissioner;
386.23(13) an individual or agency that provides medical supplies or durable medical
386.24equipment, except when the provision of supplies or equipment is accompanied by a
386.25home care service;
386.26(14) a physician licensed under chapter 147;
386.27(15) an individual who provides home care services to a person with a developmental
386.28disability who lives in a place of residence with a family, foster family, or primary caregiver;
386.29(16) a business that only provides services that are primarily instructional and not
386.30medical services or health-related support services;
386.31(17) an individual who performs basic home care services for no more than 14 hours
386.32each calendar week to no more than one client;
386.33(18) an individual or business licensed as hospice as defined in sections 144A.75 to
386.34144A.755 who is not providing home care services independent of hospice service;
387.1(19) activities conducted by the commissioner of health or a board of health as
387.2defined in section 145A.02, subdivision 2, including communicable disease investigations
387.3or testing; or
387.4(20) administering or monitoring a prescribed therapy necessary to control or
387.5prevent a communicable disease, or the monitoring of an individual's compliance with a
387.6health directive as defined in section 144.4172, subdivision 6.

387.7    Sec. 9. [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION AND
387.8RENEWAL.
387.9    Subdivision 1. License applications. Each application for a home care provider
387.10license must include information sufficient to show that the applicant meets the
387.11requirements of licensure, including:
387.12    (1) the applicant's name, e-mail address, physical address, and mailing address,
387.13including the name of the county in which the applicant resides and has a principal
387.14place of business;
387.15(2) the initial license fee in the amount specified in subdivision 7;
387.16(3) e-mail address, physical address, mailing address, and telephone number of the
387.17principal administrative office;
387.18(4) e-mail address, physical address, mailing address, and telephone number of
387.19each branch office, if any;
387.20(5) names, e-mail and mailing addresses, and telephone numbers of all owners
387.21and managerial officials;
387.22(6) documentation of compliance with the background study requirements of section
387.23144A.476 for all persons involved in the management, operation, or control of the home
387.24care provider;
387.25(7) documentation of a background study as required by section 144.057 for any
387.26individual seeking employment, paid or volunteer, with the home care provider;
387.27(8) evidence of workers' compensation coverage as required by sections 176.181
387.28and 176.182;
387.29(9) documentation of liability coverage, if the provider has it;
387.30(10) identification of the license level the provider is seeking;
387.31(11) documentation that identifies the managerial official who is in charge of
387.32day-to-day operations and attestation that the person has reviewed and understands the
387.33home care provider regulations;
388.1(12) documentation that the applicant has designated one or more owners,
388.2managerial officials, or employees as an agent or agents, which shall not affect the legal
388.3responsibility of any other owner or managerial official under this chapter;
388.4(13) the signature of the officer or managing agent on behalf of an entity, corporation,
388.5association, or unit of government;
388.6(14) verification that the applicant has the following policies and procedures in place
388.7so that if a license is issued, the applicant will implement the policies and procedures
388.8and keep them current:
388.9    (i) requirements in sections 626.556, reporting of maltreatment of minors, and
388.10626.557, reporting of maltreatment of vulnerable adults;
388.11(ii) conducting and handling background studies on employees;
388.12(iii) orientation, training, and competency evaluations of home care staff, and a
388.13process for evaluating staff performance;
388.14(iv) handling complaints from clients, family members, or client representatives
388.15regarding staff or services provided by staff;
388.16(v) conducting initial evaluation of clients' needs and the providers' ability to provide
388.17those services;
388.18(vi) conducting initial and ongoing client evaluations and assessments and how
388.19changes in a client's condition are identified, managed, and communicated to staff and
388.20other health care providers as appropriate;
388.21(vii) orientation to and implementation of the home care client bill of rights;
388.22(viii) infection control practices;
388.23(ix) reminders for medications, treatments, or exercises, if provided; and
388.24(x) conducting appropriate screenings, or documentation of prior screenings, to
388.25show that staff are free of tuberculosis, consistent with current United States Centers for
388.26Disease Control standards; and
388.27(15) other information required by the department.
388.28    Subd. 2. Comprehensive home care license applications. In addition to the
388.29information and fee required in subdivision 1, applicants applying for a comprehensive
388.30home care license must also provide verification that the applicant has the following
388.31policies and procedures in place so that if a license is issued, the applicant will implement
388.32the policies and procedures in this subdivision and keep them current:
388.33(1) conducting initial and ongoing assessments of the client's needs by a registered
388.34nurse or appropriate licensed health professional, including how changes in the client's
388.35conditions are identified, managed, and communicated to staff and other health care
388.36providers, as appropriate;
389.1(2) ensuring that nurses and licensed health professionals have current and valid
389.2licenses to practice;
389.3(3) medication and treatment management;
389.4(4) delegation of home care tasks by registered nurses or licensed health professionals;
389.5(5) supervision of registered nurses and licensed health professionals; and
389.6(6) supervision of unlicensed personnel performing delegated home care tasks.
389.7    Subd. 3. License renewal. (a) Except as provided in section 144A.475, a license
389.8may be renewed for a period of one year if the licensee satisfies the following:
389.9(1) submits an application for renewal in the format provided by the commissioner
389.10at least 30 days before expiration of the license;
389.11(2) submits the renewal fee in the amount specified in subdivision 7;
389.12(3) has provided home care services within the past 12 months;
389.13(4) complies with sections 144A.43 to 144A.4799;
389.14(5) provides information sufficient to show that the applicant meets the requirements
389.15of licensure, including items required under subdivision 1;
389.16(6) provides verification that all policies under subdivision 1, are current; and
389.17(7) provides any other information deemed necessary by the commissioner.
389.18(b) A renewal applicant who holds a comprehensive home care license must also
389.19provide verification that policies listed under subdivision 2 are current.
389.20    Subd. 4. Multiple units. Multiple units or branches of a licensee must be separately
389.21licensed if the commissioner determines that the units cannot adequately share supervision
389.22and administration of services from the main office.
389.23    Subd. 5. Transfers prohibited; changes in ownership. Any home care license
389.24issued by the commissioner may not be transferred to another party. Before acquiring
389.25ownership of a home care provider business, a prospective applicant must apply for a
389.26new temporary license. A change of ownership is a transfer of operational control to
389.27a different business entity, and includes:
389.28(1) transfer of the business to a different or new corporation;
389.29(2) in the case of a partnership, the dissolution or termination of the partnership under
389.30chapter 323A, with the business continuing by a successor partnership or other entity;
389.31(3) relinquishment of control of the provider to another party, including to a contract
389.32management firm that is not under the control of the owner of the business' assets;
389.33(4) transfer of the business by a sole proprietor to another party or entity; or
389.34(5) in the case of a privately held corporation, the change in ownership or control of
389.3550 percent or more of the outstanding voting stock.
390.1    Subd. 6. Notification of changes of information. The temporary licensee or
390.2licensee shall notify the commissioner in writing within ten working days after any
390.3change in the information required in subdivision 1, except the information required in
390.4subdivision 1, clause (5), is required at the time of license renewal.
390.5    Subd. 7. Fees; application, change of ownership, and renewal. (a) An initial
390.6applicant seeking a temporary home care licensure must submit the following application
390.7fee to the commissioner along with a completed application:
390.8(1) basic home care provider, $2,100; or
390.9(2) comprehensive home care provider, $4,200.
390.10(b) A home care provider who is filing a change of ownership as required under
390.11subdivision 5 must submit the following application fee to the commissioner, along with
390.12the documentation required for the change of ownership:
390.13(1) basic home care provider, $2,100; or
390.14(2) comprehensive home care provider, $4,200.
390.15(c) A home care provider who is seeking to renew the provider's license shall pay a
390.16fee to the commissioner based on revenues derived from the provision of home care
390.17services during the calendar year prior to the year in which the application is submitted,
390.18according to the following schedule:
390.19License Renewal Fee

390.20	Provider Annual Revenue	Fee
390.21	greater than $1,500,000	$6,625
390.22 390.23	greater than $1,275,000 and no more than $1,500,000	$5,797
390.24 390.25	greater than $1,100,000 and no more than $1,275,000	$4,969
390.26 390.27	greater than $950,000 and no more than $1,100,000	$4,141
390.28 390.29	greater than $850,000 and no more than $950,000	$3,727
390.30 390.31	greater than $750,000 and no more than $850,000	$3,313
390.32 390.33	greater than $650,000 and no more than $750,000	$2,898
390.34 390.35	greater than $550,000 and no more than $650,000	$2,485
390.36 390.37	greater than $450,000 and no more than $550,000	$2,070
390.38 390.39	greater than $350,000 and no more than $450,000	$1,656
390.40 390.41	greater than $250,000 and no more than $350,000	$1,242
391.1 391.2	greater than $100,000 and no more than $250,000	$828
391.3	greater than $50,000 and no more than $100,000	$500
391.4	greater than $25,000 and no more than $50,000	$400
391.5	no more than $25,000	$200

391.6(d) If requested, the home care provider shall provide the commissioner information
391.7to verify the provider's annual revenues or other information as needed, including copies
391.8of documents submitted to the Department of Revenue.
391.9(e) At each annual renewal, a home care provider may elect to pay the highest
391.10renewal fee for its license category, and not provide annual revenue information to the
391.11commissioner.
391.12(f) A temporary license or license applicant, or temporary licensee or licensee that
391.13knowingly provides the commissioner incorrect revenue amounts for the purpose of
391.14paying a lower license fee, shall be subject to a civil penalty in the amount of double the
391.15fee the provider should have paid.
391.16(g) Fees and penalties collected under this section shall be deposited in the state
391.17treasury and credited to the special state government revenue fund.
391.18(h) The license renewal fee schedule in this subdivision is effective July 1, 2016.

391.19    Sec. 10. [144A.473] ISSUANCE OF TEMPORARY LICENSE AND LICENSE
391.20RENEWAL.
391.21    Subdivision 1. Temporary license and renewal of license. (a) The department
391.22shall review each application to determine the applicant's knowledge of and compliance
391.23with Minnesota home care regulations. Before granting a temporary license or renewing a
391.24license, the commissioner may further evaluate the applicant or licensee by requesting
391.25additional information or documentation or by conducting an on-site survey of the
391.26applicant to determine compliance with sections 144A.43 to 144A.482.
391.27(b) Within 14 calendar days after receiving an application for a license,
391.28the commissioner shall acknowledge receipt of the application in writing. The
391.29acknowledgment must indicate whether the application appears to be complete or whether
391.30additional information is required before the application will be considered complete.
391.31(c) Within 90 days after receiving a complete application, the commissioner shall
391.32issue a temporary license, renew the license, or deny the license.
391.33(d) The commissioner shall issue a license that contains the home care provider's
391.34name, address, license level, expiration date of the license, and unique license number. All
391.35licenses are valid for one year from the date of issuance.
392.1    Subd. 2. Temporary license. (a) For new license applicants, the commissioner
392.2shall issue a temporary license for either the basic or comprehensive home care level. A
392.3temporary license is effective for one year from the date of issuance. Temporary licensees
392.4must comply with sections 144A.43 to 144A.482.
392.5(b) During the temporary license year, the commissioner shall survey the temporary
392.6licensee after the commissioner is notified or has evidence that the temporary licensee
392.7is providing home care services.
392.8(c) Within five days of beginning the provision of services, the temporary
392.9licensee must notify the commissioner that it is serving clients. The notification to the
392.10commissioner may be mailed or e-mailed to the commissioner at the address provided by
392.11the commissioner. If the temporary licensee does not provide home care services during
392.12the temporary license year, then the temporary license expires at the end of the year and
392.13the applicant must reapply for a temporary home care license.
392.14(d) A temporary licensee may request a change in the level of licensure prior to
392.15being surveyed and granted a license by notifying the commissioner in writing and
392.16providing additional documentation or materials required to update or complete the
392.17changed temporary license application. The applicant must pay the difference between the
392.18application fees when changing from the basic to the comprehensive level of licensure.
392.19No refund will be made if the provider chooses to change the license application to the
392.20basic level.
392.21(e) If the temporary licensee notifies the commissioner that the licensee has clients
392.22within 45 days prior to the temporary license expiration, the commissioner may extend the
392.23temporary license for up to 60 days in order to allow the commissioner to complete the
392.24on-site survey required under this section and follow-up survey visits.
392.25    Subd. 3. Temporary licensee survey. (a) If the temporary licensee is in substantial
392.26compliance with the survey, the commissioner shall issue either a basic or comprehensive
392.27home care license. If the temporary licensee is not in substantial compliance with the
392.28survey, the commissioner shall not issue a basic or comprehensive license and there will
392.29be no contested hearing right under chapter 14.
392.30(b) If the temporary licensee whose basic or comprehensive license has been denied
392.31disagrees with the conclusions of the commissioner, then the licensee may request a
392.32reconsideration by the commissioner or commissioner's designee. The reconsideration
392.33request process will be conducted internally by the commissioner or commissioner's
392.34designee, and chapter 14 does not apply.
393.1(c) The temporary licensee requesting reconsideration must make the request in
393.2writing and must list and describe the reasons why the licensee disagrees with the decision
393.3to deny the basic or comprehensive home care license.
393.4(d) A temporary licensee whose license is denied must comply with the requirements
393.5for notification and transfer of clients in section 144A.475, subdivision 5.

393.6    Sec. 11. [144A.474] SURVEYS AND INVESTIGATIONS.
393.7    Subdivision 1. Surveys. The commissioner shall conduct surveys of each home
393.8care provider. By June 30, 2016, the commissioner shall conduct a survey of home care
393.9providers on a frequency of at least once every three years. Survey frequency may be
393.10based on the license level, the provider's compliance history, number of clients served,
393.11or other factors as determined by the department deemed necessary to ensure the health,
393.12safety, and welfare of clients and compliance with the law.
393.13    Subd. 2. Types of home care surveys. (a) "Initial full survey" is the survey
393.14conducted of a new temporary licensee after the department is notified or has evidence that
393.15the licensee is providing home care services to determine if the provider is in compliance
393.16with home care requirements. Initial surveys must be completed within 14 months after
393.17the department's issuance of a temporary basic or comprehensive license.
393.18(b) "Core survey" means periodic inspection of home care providers to determine
393.19ongoing compliance with the home care requirements, focusing on the essential health and
393.20safety requirements. Core surveys are available to licensed home care providers who have
393.21been licensed for three years and surveyed at least once in the past three years with the
393.22latest survey having no widespread violations beyond Level 1 as provided in subdivision
393.2311. Providers must also not have had any substantiated licensing complaints, substantiated
393.24complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
393.25Act, or an enforcement action as authorized in section 144A.475 in the past three years.
393.26(1) The core survey for basic license-level providers reviews compliance in the
393.27following areas:
393.28(i) reporting of maltreatment;
393.29(ii) orientation to and implementation of Home Care Client Bill of Rights;
393.30(iii) statement of home care services;
393.31(iv) initial evaluation of clients and initiation of services;
393.32(v) basic-license level client review and monitoring;
393.33(vi) service plan implementation and changes to the service plan;
393.34(vii) client complaint and investigative process;
393.35(viii) competency of unlicensed personnel; and
394.1(ix) infection control.
394.2(2) For comprehensive license-level providers, the core survey will include
394.3everything in the basic license-level core survey plus these areas:
394.4(i) delegation to unlicensed personnel;
394.5(ii) assessment, monitoring, and reassessment of clients; and
394.6(iii) medication, treatment, and therapy management.
394.7(c) "Full survey" means the periodic inspection of home care providers to determine
394.8ongoing compliance with the home care requirements that cover the core survey areas
394.9and all the legal requirements for home care providers. A full survey is conducted for all
394.10temporary licensees and for providers who do not meet the requirements needed for a core
394.11survey, and when a surveyor identifies unacceptable client health or safety risks during a
394.12core survey. A full survey will include all the tasks identified as part of the core survey
394.13and any additional review deemed necessary by the department, including additional
394.14observation, interviewing, or records review of additional clients and staff.
394.15(d) "Follow-up surveys" are conducted to determine if a home care provider has
394.16corrected deficient issues and systems identified during a core survey, full survey, or
394.17complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax,
394.18mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be
394.19concluded with an exit conference and written information provided on the process for
394.20requesting a reconsideration of the survey results.
394.21(e) Upon receiving information that a home care provider has violated or is currently
394.22violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
394.23investigate the complaint according to sections 144A.51 to 144A.54.
394.24    Subd. 3. Survey process. (a) The survey process for core surveys shall include the
394.25following as applicable to the particular licensee and setting surveyed:
394.26(1) presurvey review of pertinent documents and notification to the ombudsman
394.27for long-term care;
394.28(2) an entrance conference with available staff;
394.29(3) communication with managerial officials or the registered nurse in charge, if
394.30available, and ongoing communication with key staff throughout the survey regarding
394.31information needed by the surveyor, clarifications regarding home care requirements, and
394.32applicable standards of practice;
394.33(4) presentation of written contact information to the provider about the survey staff
394.34conducting the survey, the supervisor, and the process for requesting a reconsideration of
394.35the survey results;
395.1(5) a brief tour of a sample of the housing with services establishments in which the
395.2provider is providing home care services;
395.3(6) a sample selection of home care clients;
395.4(7) information-gathering through client and staff observations, client and staff
395.5interviews, and reviews of records, policies, procedures, practices, and other agency
395.6information;
395.7(8) interviews of clients' family members, if available, with clients' consent when the
395.8client can legally give consent;
395.9(9) except for complaint surveys conducted by the Office of Health Facilities
395.10Complaints, exit conference, with preliminary findings shared and discussed with the
395.11provider and written information provided on the process for requesting a reconsideration
395.12of the survey results; and
395.13(10) postsurvey analysis of findings and formulation of survey results, including
395.14correction orders when applicable.
395.15    Subd. 4. Scheduling surveys. Surveys and investigations shall be conducted
395.16without advance notice to home care providers. Surveyors may contact the home care
395.17provider on the day of a survey to arrange for someone to be available at the survey site.
395.18The contact does not constitute advance notice.
395.19    Subd. 5. Information provided by home care provider. The home care provider
395.20shall provide accurate and truthful information to the department during a survey,
395.21investigation, or other licensing activities.
395.22    Subd. 6. Providing client records. Upon request of a surveyor, home care providers
395.23shall provide a list of current and past clients or client representatives that includes
395.24addresses and telephone numbers and any other information requested about the services
395.25to clients within a reasonable period of time.
395.26    Subd. 7. Contacting and visiting clients. Surveyors may contact or visit a home
395.27care provider's clients to gather information without notice to the home care provider.
395.28Before visiting a client, a surveyor shall obtain the client's or client's representative's
395.29permission by telephone, mail, or in person. Surveyors shall inform all clients or client's
395.30representatives of their right to decline permission for a visit.
395.31    Subd. 8. Correction orders. (a) A correction order may be issued whenever the
395.32commissioner finds upon survey or during a complaint investigation that a home care
395.33provider, a managerial official, or an employee of the provider is not in compliance with
395.34sections 144A.43 to 144A.482. The correction order shall cite the specific statute and
395.35document areas of noncompliance and the time allowed for correction.
396.1(b) The commissioner shall mail copies of any correction order within 30 calendar
396.2days after exit survey to the last known address of the home care provider. A copy of each
396.3correction order and copies of any documentation supplied to the commissioner shall be
396.4kept on file by the home care provider, and public documents shall be made available for
396.5viewing by any person upon request. Copies may be kept electronically.
396.6(c) By the correction order date, the home care provider must document in the
396.7provider's records any action taken to comply with the correction order. The commissioner
396.8may request a copy of this documentation and the home care provider's action to respond
396.9to the correction order in future surveys, upon a complaint investigation, and as otherwise
396.10needed.
396.11    Subd. 9. Follow-up surveys. For providers that have Level 3 or Level 4 violations
396.12or any violations determined to be widespread, the department shall conduct a follow-up
396.13survey within 90 calendar days of the survey. When conducting a follow-up survey, the
396.14surveyor will focus on whether the previous violations have been corrected and may also
396.15address any new violations that are observed while evaluating the corrections that have
396.16been made. If a new violation is identified on a follow-up survey, no fine will be imposed
396.17unless it is not corrected on the next follow-up survey.
396.18    Subd. 10. Performance incentive. A licensee is eligible for a performance
396.19incentive if there are no violations identified in a core or full survey. The performance
396.20incentive is a ten percent discount on the licensee's next home care renewal license fee.
396.21    Subd. 11. Fines. (a) Fines and enforcement actions under this subdivision may be
396.22assessed based on the level and scope of the violations described in paragraph (c) as follows:
396.23(1) Level 1, no fines or enforcement;
396.24(2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
396.25mechanisms authorized in section 144A.475 for widespread violations;
396.26(3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
396.27mechanisms authorized in section 144A.475; and
396.28(4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the
396.29enforcement mechanisms authorized in section 144A.475.
396.30(b) Correction orders for violations are categorized by both level and scope as
396.31follows and fines will be assessed accordingly:
396.32(1) Level of violation:
396.33(i) Level 1. A violation that has no potential to cause more than a minimal impact on
396.34the client and does not affect health or safety.
397.1(ii) Level 2. A violation that did not harm the client's health or safety, but had the
397.2potential to have harmed a client's health or safety, but was not likely to cause serious
397.3injury, impairment, or death.
397.4(iii) Level 3. A violation that harmed a client's health or safety, not including serious
397.5injury, impairment, or death, or a violation that has the potential to lead to serious injury,
397.6impairment, or death.
397.7(iv) Level 4. A violation that results in serious injury, impairment, or death.
397.8(2) Scope of violation:
397.9(i) Isolated. When one or a limited number of clients are affected, or one or a limited
397.10number of staff are involved, or the situation has occurred only occasionally.
397.11(ii) Pattern. When more than a limited number of clients are affected, more than
397.12a limited number of staff are involved, or the situation has occurred repeatedly but is
397.13not found to be pervasive.
397.14(iii) Widespread. When problems are pervasive or represent a systemic failure that
397.15has affected or has the potential to affect a large portion or all of the clients.
397.16(c) If the commissioner finds that the applicant or a home care provider required
397.17to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the
397.18date specified in the correction order or conditional license resulting from a survey or
397.19complaint investigation, the commissioner may impose a fine. A notice of noncompliance
397.20with a correction order must be mailed to the applicant's or provider's last known address.
397.21The noncompliance notice must list the violations not corrected.
397.22(d) The license holder must pay the fines assessed on or before the payment date
397.23specified. If the license holder fails to fully comply with the order, the commissioner
397.24may issue a second fine or suspend the license until the license holder complies by
397.25paying the fine. A timely appeal shall stay payment of the fine until the commissioner
397.26issues a final order.
397.27(e) A license holder shall promptly notify the commissioner in writing when a
397.28violation specified in the order is corrected. If upon reinspection the commissioner
397.29determines that a violation has not been corrected as indicated by the order, the
397.30commissioner may issue a second fine. The commissioner shall notify the license holder by
397.31mail to the last known address in the licensing record that a second fine has been assessed.
397.32The license holder may appeal the second fine as provided under this subdivision.
397.33(f) A home care provider that has been assessed a fine under this subdivision has a
397.34right to a reconsideration or a hearing under this section and chapter 14.
398.1(g) When a fine has been assessed, the license holder may not avoid payment by
398.2closing, selling, or otherwise transferring the licensed program to a third party. In such an
398.3event, the license holder shall be liable for payment of the fine.
398.4(h) In addition to any fine imposed under this section, the commissioner may assess
398.5costs related to an investigation that results in a final order assessing a fine or other
398.6enforcement action authorized by this chapter.
398.7(i) Fines collected under this subdivision shall be deposited in the state government
398.8special revenue fund and credited to an account separate from the revenue collected under
398.9section 144A.472. Subject to an appropriation by the legislature, the revenue from the
398.10fines collected may be used by the commissioner for special projects to improve home care
398.11in Minnesota as recommended by the advisory council established in section 144A.4799.
398.12    Subd. 12. Reconsideration. The commissioner shall make available to home
398.13care providers a correction order reconsideration process. This process may be used
398.14to challenge the correction order issued, including the level and scope described in
398.15subdivision 9, and any fine assessed. During the correction order reconsideration request,
398.16the issuance for the correction orders under reconsideration are not stayed, but the
398.17department will post in formation on the Web site with the correction order that the
398.18licensee has requested a reconsideration required and that the review is pending.
398.19(a) A licensed home care provider may request from the commissioner, in writing,
398.20a correction order reconsideration regarding any correction order issued to the provider.
398.21The correction order reconsideration shall not be reviewed by any surveyor, investigator,
398.22or supervisor that participated in the writing or reviewing of the correction order being
398.23disputed. The correction order reconsiderations may be conducted in person by telephone,
398.24by another electronic form, or in writing, as determined by the commissioner. The
398.25commissioner shall respond in writing to the request from a home care provider for
398.26a correction order reconsideration within 60 days of the date the provider requests a
398.27reconsideration. The commissioner's response shall identify the commissioner's decision
398.28regarding each citation challenged by the home care provider.
398.29The findings of a correction order reconsideration process shall be one or more of
398.30the following:
398.31(1) Supported in full. The correction order is supported in full, with no deletion of
398.32findings to the citation.
398.33(2) Supported in substance. The correction order is supported, but one or more
398.34findings are deleted or modified without any change in the citation.
399.1(3) Correction order cited an incorrect home care licensing requirement. The
399.2correction order is amended by changing the correction order to the appropriate statutory
399.3reference.
399.4(4) Correction order was issued under an incorrect citation. The correction order is
399.5amended to be issued under the more appropriate correction order citation.
399.6(5) The correction order is rescinded.
399.7(6) Fine is amended. It is determined the fine assigned to the correction order was
399.8applied incorrectly.
399.9(7) The level or scope of the citation is modified based on the reconsideration.
399.10(b) If the correction order findings are changed by the commissioner, the
399.11commissioner shall update the correction order Web site accordingly.
399.12    Subd. 13. Home care surveyor training. Before conducting a home care survey,
399.13each home care surveyor must receive training on the following topics:
399.14(1) Minnesota home care licensure requirements;
399.15(2) Minnesota Home Care Client Bill of Rights;
399.16(3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
399.17(4) principles of documentation;
399.18(5) survey protocol and processes;
399.19(6) Offices of the Ombudsman roles;
399.20(7) Office of Health Facility Complaints;
399.21(8) Minnesota landlord-tenant and housing with services laws;
399.22(9) types of payors for home care services; and
399.23(10) Minnesota Nurse Practice Act for nurse surveyors.
399.24Materials used for this training will be posted on the department Web site. Requisite
399.25understanding of these topics will be reviewed as part of the quality improvement plan
399.26in section 28.

399.27    Sec. 12. [144A.475] ENFORCEMENT.
399.28    Subdivision 1. Conditions. (a) The commissioner may refuse to grant a temporary
399.29license, renew a license, suspend or revoke a license, or impose a conditional license if the
399.30home care provider or owner or managerial official of the home care provider:
399.31(1) is in violation of, or during the term of the license has violated, any of the
399.32requirements in sections 144A.471 to 144A.482;
399.33(2) permits, aids, or abets the commission of any illegal act in the provision of
399.34home care;
399.35(3) performs any act detrimental to the health, safety, and welfare of a client;
400.1(4) obtains the license by fraud or misrepresentation;
400.2(5) knowingly made or makes a false statement of a material fact in the application
400.3for a license or in any other record or report required by this chapter;
400.4(6) denies representatives of the department access to any part of the home care
400.5provider's books, records, files, or employees;
400.6(7) interferes with or impedes a representative of the department in contacting the
400.7home care provider's clients;
400.8(8) interferes with or impedes a representative of the department in the enforcement
400.9of this chapter or has failed to fully cooperate with an inspection, survey, or investigation
400.10by the department;
400.11(9) destroys or makes unavailable any records or other evidence relating to the home
400.12care provider's compliance with this chapter;
400.13(10) refuses to initiate a background study under section 144.057 or 245A.04;
400.14(11) fails to timely pay any fines assessed by the department;
400.15(12) violates any local, city, or township ordinance relating to home care services;
400.16(13) has repeated incidents of personnel performing services beyond their
400.17competency level; or
400.18(14) has operated beyond the scope of the home care provider's license level.
400.19    (b) A violation by a contractor providing the home care services of the home care
400.20provider is a violation by the home care provider.
400.21    Subd. 2. Terms to suspension or conditional license. A suspension or conditional
400.22license designation may include terms that must be completed or met before a suspension
400.23or conditional license designation is lifted. A conditional license designation may include
400.24restrictions or conditions that are imposed on the provider. Terms for a suspension or
400.25conditional license may include one or more of the following and the scope of each will be
400.26determined by the commissioner:
400.27(1) requiring a consultant to review, evaluate, and make recommended changes to
400.28the home care provider's practices and submit reports to the commissioner at the cost of
400.29the home care provider;
400.30(2) requiring supervision of the home care provider or staff practices at the cost
400.31of the home care provider by an unrelated person who has sufficient knowledge and
400.32qualifications to oversee the practices and who will submit reports to the commissioner;
400.33(3) requiring the home care provider or employees to obtain training at the cost of
400.34the home care provider;
400.35(4) requiring the home care provider to submit reports to the commissioner;
401.1(5) prohibiting the home care provider from taking any new clients for a period
401.2of time; or
401.3(6) any other action reasonably required to accomplish the purpose of this
401.4subdivision and section 144A.45, subdivision 2.
401.5    Subd. 3. Notice. Prior to any suspension, revocation, or refusal to renew a license,
401.6the home care provider shall be entitled to notice and a hearing as provided by sections
401.714.57 to 14.69. In addition to any other remedy provided by law, the commissioner may,
401.8without a prior contested case hearing, temporarily suspend a license or prohibit delivery
401.9of services by a provider for not more than 90 days if the commissioner determines that
401.10the health or safety of a consumer is in imminent danger, provided:
401.11(1) advance notice is given to the home care provider;
401.12(2) after notice, the home care provider fails to correct the problem;
401.13(3) the commissioner has reason to believe that other administrative remedies are not
401.14likely to be effective; and
401.15(4) there is an opportunity for a contested case hearing within the 90 days.
401.16    Subd. 4. Time limits for appeals. To appeal the assessment of civil penalties
401.17under section 144A.45, subdivision 2, clause (5), and an action against a license under
401.18this section, a provider must request a hearing no later than 15 days after the provider
401.19receives notice of the action.
401.20    Subd. 5. Plan required. (a) The process of suspending or revoking a license
401.21must include a plan for transferring affected clients to other providers by the home care
401.22provider, which will be monitored by the commissioner. Within three business days of
401.23being notified of the final revocation or suspension action, the home care provider shall
401.24provide the commissioner, the lead agencies as defined in section 256B.0911, and the
401.25ombudsman for long-term care with the following information:
401.26(1) a list of all clients, including full names and all contact information on file;
401.27(2) a list of each client's representative or emergency contact person, including full
401.28names and all contact information on file;
401.29(3) the location or current residence of each client;
401.30(4) the payor sources for each client, including payor source identification numbers;
401.31and
401.32(5) for each client, a copy of the client's service plan, and a list of the types of
401.33services being provided.
401.34(b) The revocation or suspension notification requirement is satisfied by mailing the
401.35notice to the address in the license record. The home care provider shall cooperate with
401.36the commissioner and the lead agencies during the process of transferring care of clients to
402.1qualified providers. Within three business days of being notified of the final revocation or
402.2suspension action, the home care provider must notify and disclose to each of the home
402.3care provider's clients, or the client's representative or emergency contact persons, that
402.4the commissioner is taking action against the home care provider's license by providing a
402.5copy of the revocation or suspension notice issued by the commissioner.
402.6    Subd. 6. Owners and managerial officials; refusal to grant license. (a) The
402.7owner and managerial officials of a home care provider whose Minnesota license has not
402.8been renewed or that has been revoked because of noncompliance with applicable laws or
402.9rules shall not be eligible to apply for nor will be granted a home care license, including
402.10other licenses under this chapter, or be given status as an enrolled personal care assistance
402.11provider agency or personal care assistant by the Department of Human Services under
402.12section 256B.0659 for five years following the effective date of the nonrenewal or
402.13revocation. If the owner and managerial officials already have enrollment status, their
402.14enrollment will be terminated by the Department of Human Services.
402.15(b) The commissioner shall not issue a license to a home care provider for five
402.16years following the effective date of license nonrenewal or revocation if the owner or
402.17managerial official, including any individual who was an owner or managerial official
402.18of another home care provider, had a Minnesota license that was not renewed or was
402.19revoked as described in paragraph (a).
402.20(c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall
402.21suspend or revoke, the license of any home care provider that includes any individual
402.22as an owner or managerial official who was an owner or managerial official of a home
402.23care provider whose Minnesota license was not renewed or was revoked as described in
402.24paragraph (a) for five years following the effective date of the nonrenewal or revocation.
402.25(d) The commissioner shall notify the home care provider 30 days in advance of
402.26the date of nonrenewal, suspension, or revocation of the license. Within ten days after
402.27the receipt of the notification, the home care provider may request, in writing, that the
402.28commissioner stay the nonrenewal, revocation, or suspension of the license. The home
402.29care provider shall specify the reasons for requesting the stay; the steps that will be taken
402.30to attain or maintain compliance with the licensure laws and regulations; any limits on the
402.31authority or responsibility of the owners or managerial officials whose actions resulted in
402.32the notice of nonrenewal, revocation, or suspension; and any other information to establish
402.33that the continuing affiliation with these individuals will not jeopardize client health, safety,
402.34or well-being. The commissioner shall determine whether the stay will be granted within
402.3530 days of receiving the provider's request. The commissioner may propose additional
402.36restrictions or limitations on the provider's license and require that the granting of the stay
403.1be contingent upon compliance with those provisions. The commissioner shall take into
403.2consideration the following factors when determining whether the stay should be granted:
403.3(1) the threat that continued involvement of the owners and managerial officials with
403.4the home care provider poses to client health, safety, and well-being;
403.5(2) the compliance history of the home care provider; and
403.6(3) the appropriateness of any limits suggested by the home care provider.
403.7    If the commissioner grants the stay, the order shall include any restrictions or
403.8limitation on the provider's license. The failure of the provider to comply with any
403.9restrictions or limitations shall result in the immediate removal of the stay and the
403.10commissioner shall take immediate action to suspend, revoke, or not renew the license.
403.11    Subd. 7. Request for hearing. A request for a hearing must be in writing and must:
403.12(1) be mailed or delivered to the department or the commissioner's designee;
403.13(2) contain a brief and plain statement describing every matter or issue contested; and
403.14(3) contain a brief and plain statement of any new matter that the applicant or home
403.15care provider believes constitutes a defense or mitigating factor.
403.16    Subd. 8. Informal conference. At any time, the applicant or home care provider
403.17and the commissioner may hold an informal conference to exchange information, clarify
403.18issues, or resolve issues.
403.19    Subd. 9. Injunctive relief. In addition to any other remedy provided by law, the
403.20commissioner may bring an action in district court to enjoin a person who is involved in
403.21the management, operation, or control of a home care provider or an employee of the
403.22home care provider from illegally engaging in activities regulated by sections 144A.43 to
403.23144A.482. The commissioner may bring an action under this subdivision in the district
403.24court in Ramsey County or in the district in which a home care provider is providing
403.25services. The court may grant a temporary restraining order in the proceeding if continued
403.26activity by the person who is involved in the management, operation, or control of a home
403.27care provider, or by an employee of the home care provider, would create an imminent
403.28risk of harm to a recipient of home care services.
403.29    Subd. 10. Subpoena. In matters pending before the commissioner under sections
403.30144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance
403.31of witnesses and the production of all necessary papers, books, records, documents, and
403.32other evidentiary material. If a person fails or refuses to comply with a subpoena or
403.33order of the commissioner to appear or testify regarding any matter about which the
403.34person may be lawfully questioned or to produce any papers, books, records, documents,
403.35or evidentiary materials in the matter to be heard, the commissioner may apply to the
403.36district court in any district, and the court shall order the person to comply with the
404.1commissioner's order or subpoena. The commissioner of health may administer oaths to
404.2witnesses or take their affirmation. Depositions may be taken in or outside the state in the
404.3manner provided by law for the taking of depositions in civil actions. A subpoena or other
404.4process or paper may be served on a named person anywhere in the state by an officer
404.5authorized to serve subpoenas in civil actions, with the same fees and mileage and in the
404.6same manner as prescribed by law for a process issued out of a district court. A person
404.7subpoenaed under this subdivision shall receive the same fees, mileage, and other costs
404.8that are paid in proceedings in district court.

404.9    Sec. 13. [144A.476] BACKGROUND STUDIES.
404.10    Subdivision 1. Prior criminal convictions; owner and managerial officials. (a)
404.11Before the commissioner issues a temporary license or renews a license, an owner or
404.12managerial official is required to complete a background study under section 144.057. No
404.13person may be involved in the management, operation, or control of a home care provider
404.14if the person has been disqualified under chapter 245C. If an individual is disqualified
404.15under section 144.057 or chapter 245C, the individual may request reconsideration of
404.16the disqualification. If the individual requests reconsideration and the commissioner
404.17sets aside or rescinds the disqualification, the individual is eligible to be involved in the
404.18management, operation, or control of the provider. If an individual has a disqualification
404.19under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's
404.20disqualification is barred from a set aside, and the individual must not be involved in the
404.21management, operation, or control of the provider.
404.22(b) For purposes of this section, owners of a home care provider subject to the
404.23background check requirement are those individuals whose ownership interest provides
404.24sufficient authority or control to affect or change decisions related to the operation of the
404.25home care provider. An owner includes a sole proprietor, a general partner, or any other
404.26individual whose individual ownership interest can affect the management and direction
404.27of the policies of the home care provider.
404.28(c) For the purposes of this section, managerial officials subject to the background
404.29check requirement are individuals who provide direct contact as defined in section 245C.02,
404.30subdivision 11, or individuals who have the responsibility for the ongoing management or
404.31direction of the policies, services, or employees of the home care provider. Data collected
404.32under this subdivision shall be classified as private data under section 13.02, subdivision 12.
404.33(d) The department shall not issue any license if the applicant or owner or managerial
404.34official has been unsuccessful in having a background study disqualification set aside
404.35under section 144.057 and chapter 245C; if the owner or managerial official, as an owner
405.1or managerial official of another home care provider, was substantially responsible for
405.2the other home care provider's failure to substantially comply with sections 144A.43 to
405.3144A.482; or if an owner that has ceased doing business, either individually or as an
405.4owner of a home care provider, was issued a correction order for failing to assist clients in
405.5violation of this chapter.
405.6    Subd. 2. Employees, contractors, and volunteers. (a) Employees, contractors,
405.7and volunteers of a home care provider are subject to the background study required by
405.8section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall
405.9be construed to prohibit a home care provider from requiring self-disclosure of criminal
405.10conviction information.
405.11(b) Termination of an employee in good faith reliance on information or records
405.12obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not
405.13subject the home care provider to civil liability or liability for unemployment benefits.

405.14    Sec. 14. [144A.477] COMPLIANCE.
405.15    Subdivision 1. Medicare-certified providers; coordination of surveys. If feasible,
405.16the commissioner shall survey licensees to determine compliance with this chapter at the
405.17same time as surveys for certification for Medicare if Medicare certification is based on
405.18compliance with the federal conditions of participation and on survey and enforcement
405.19by the Department of Health as agent for the United States Department of Health and
405.20Human Services.
405.21    Subd. 2. Medicare-certified providers; equivalent requirements. For home care
405.22providers licensed to provide comprehensive home care services that are also certified for
405.23participation in Medicare as a home health agency under Code of Federal Regulations,
405.24title 42, part 484, the following state licensure regulations are considered equivalent to
405.25the federal requirements:
405.26(1) quality management, section 144A.479, subdivision 3;
405.27(2) personnel records, section 144A.479, subdivision 7;
405.28(3) acceptance of clients, section 144A.4791, subdivision 4;
405.29(4) referrals, section 144A.4791, subdivision 5;
405.30(5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792,
405.31subdivisions 2 and 3;
405.32(6) individualized monitoring and reassessment, sections 144A.4791, subdivision
405.338, and 144A.4792, subdivisions 2 and 3;
405.34(7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792,
405.35subdivision 5, and 144A.4793, subdivision 3;
406.1(8) client complaint and investigation process, section 144A.4791, subdivision 11;
406.2(9) prescription orders, section 144A.4792, subdivisions 13 to 16;
406.3(10) client records, section 144A.4794, subdivisions 1 to 3;
406.4(11) qualifications for unlicensed personnel performing delegated tasks, section
406.5144A.4795;
406.6(12) training and competency staff, section 144A.4795;
406.7(13) training and competency for unlicensed personnel, section 144A.4795,
406.8subdivision 7;
406.9(14) delegation of home care services, section 144A.4795, subdivision 4;
406.10(15) availability of contact person, section 144A.4797, subdivision 1; and
406.11(16) supervision of staff, section 144A.4797, subdivisions 2 and 3.
406.12Violations of requirements in clauses (1) to (16) may lead to enforcement actions
406.13under section 144A.474.

406.14    Sec. 15. [144A.478] INNOVATION VARIANCE.
406.15    Subdivision 1. Definition. For purposes of this section, "innovation variance"
406.16means a specified alternative to a requirement of this chapter. An innovation variance
406.17may be granted to allow a home care provider to offer home care services of a type or
406.18in a manner that is innovative, will not impair the services provided, will not adversely
406.19affect the health, safety, or welfare of the clients, and is likely to improve the services
406.20provided. The innovative variance cannot change any of the client's rights under section
406.21144A.44, home care bill of rights.
406.22    Subd. 2. Conditions. The commissioner may impose conditions on the granting of
406.23an innovation variance that the commissioner considers necessary.
406.24    Subd. 3. Duration and renewal. The commissioner may limit the duration of any
406.25innovation variance and may renew a limited innovation variance.
406.26    Subd. 4. Applications; innovation variance. An application for innovation
406.27variance from the requirements of this chapter may be made at any time, must be made in
406.28writing to the commissioner, and must specify the following:
406.29(1) the statute or law from which the innovation variance is requested;
406.30(2) the time period for which the innovation variance is requested;
406.31(3) the specific alternative action that the licensee proposes;
406.32(4) the reasons for the request; and
406.33(5) justification that an innovation variance will not impair the services provided,
406.34will not adversely affect the health, safety, or welfare of clients, and is likely to improve
406.35the services provided.
407.1The commissioner may require additional information from the home care provider before
407.2acting on the request.
407.3    Subd. 5. Grants and denials. The commissioner shall grant or deny each request
407.4for an innovation variance in writing within 45 days of receipt of a complete request.
407.5Notice of a denial shall contain the reasons for the denial. The terms of a requested
407.6innovation variance may be modified upon agreement between the commissioner and
407.7the home care provider.
407.8    Subd. 6. Violation of innovation variances. A failure to comply with the terms of
407.9an innovation variance shall be deemed to be a violation of this chapter.
407.10    Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or
407.11deny renewal of an innovation variance if:
407.12(1) it is determined that the innovation variance is adversely affecting the health,
407.13safety, or welfare of the licensee's clients;
407.14(2) the home care provider has failed to comply with the terms of the innovation
407.15variance;
407.16(3) the home care provider notifies the commissioner in writing that it wishes to
407.17relinquish the innovation variance and be subject to the statute previously varied; or
407.18(4) the revocation or denial is required by a change in law.

407.19    Sec. 16. [144A.479] HOME CARE PROVIDER RESPONSIBILITIES;
407.20BUSINESS OPERATION.
407.21    Subdivision 1. Display of license. The original current license must be displayed
407.22in the home care providers' principal business office and copies must be displayed in
407.23any branch office. The home care provider must provide a copy of the license to any
407.24person who requests it.
407.25    Subd. 2. Advertising. Home care providers shall not use false, fraudulent,
407.26or misleading advertising in the marketing of services. For purposes of this section,
407.27advertising includes any verbal, written, or electronic means of communicating to
407.28potential clients about the availability, nature, or terms of home care services.
407.29    Subd. 3. Quality management. The home care provider shall engage in quality
407.30management appropriate to the size of the home care provider and relevant to the type
407.31of services the home care provider provides. The quality management activity means
407.32evaluating the quality of care by periodically reviewing client services, complaints made,
407.33and other issues that have occurred and determining whether changes in services, staffing,
407.34or other procedures need to be made in order to ensure safe and competent services to
407.35clients. Documentation about quality management activity must be available for two
408.1years. Information about quality management must be available to the commissioner at
408.2the time of the survey, investigation, or renewal.
408.3    Subd. 4. Provider restrictions. (a) This subdivision does not apply to licensees
408.4that are Minnesota counties or other units of government.
408.5(b) A home care provider or staff cannot accept powers-of-attorney from clients for
408.6any purpose, and may not accept appointments as guardians or conservators of clients.
408.7(c) A home care provider cannot serve as a client's representative.
408.8    Subd. 5. Handling of client's finances and property. (a) A home care provider
408.9may assist clients with household budgeting, including paying bills and purchasing
408.10household goods, but may not otherwise manage a client's property. A home care provider
408.11must provide a client with receipts for all transactions and purchases paid with the clients'
408.12funds. When receipts are not available, the transaction or purchase must be documented.
408.13A home care provider must maintain records of all such transactions.
408.14(b) A home care provider or staff may not borrow a client's funds or personal or
408.15real property, nor in any way convert a client's property to the home care provider's or
408.16staff's possession.
408.17(c) Nothing in this section precludes a home care provider or staff from accepting
408.18gifts of minimal value, or precludes the acceptance of donations or bequests made to a
408.19home care provider that are exempt from income tax under section 501(c) of the Internal
408.20Revenue Code of 1986.
408.21    Subd. 6. Reporting maltreatment of vulnerable adults and minors. (a) All
408.22home care providers must comply with requirements for the reporting of maltreatment
408.23of minors in section 626.556 and the requirements for the reporting of maltreatment
408.24of vulnerable adults in section 626.557. Home care providers must report suspected
408.25maltreatment of minors and vulnerable adults to the common entry point. Each home
408.26care provider must establish and implement a written procedure to ensure that all cases
408.27of suspected maltreatment are reported.
408.28(b) Each home care provider must develop and implement an individual abuse
408.29prevention plan for each vulnerable minor or adult for whom home care services are
408.30provided by a home care provider. The plan shall contain an individualized review or
408.31assessment of the person's susceptibility to abuse by another individual, including other
408.32vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors;
408.33and statements of the specific measures to be taken to minimize the risk of abuse to that
408.34person and other vulnerable adults or minors. For purposes of the abuse prevention plan,
408.35the term abuse includes self-abuse.
409.1    Subd. 7. Employee records. The home care provider must maintain current records
409.2of each paid employee, regularly scheduled volunteers providing home care services, and
409.3of each individual contractor providing home care services. The records must include
409.4the following information:
409.5(1) evidence of current professional licensure, registration, or certification, if
409.6licensure, registration, or certification is required by this statute, or other rules;
409.7(2) records of orientation, required annual training and infection control training,
409.8and competency evaluations;
409.9(3) current job description, including qualifications, responsibilities, and
409.10identification of staff providing supervision;
409.11(4) documentation of annual performance reviews which identify areas of
409.12improvement needed and training needs;
409.13(5) for individuals providing home care services, verification that required health
409.14screenings under section 144A.4798 have taken place and the dates of those screenings; and
409.15(6) documentation of the background study as required under section 144.057.
409.16Each employee record must be retained for at least three years after a paid employee,
409.17home care volunteer, or contractor ceases to be employed by or under contract with the
409.18home care provider. If a home care provider ceases operation, employee records must be
409.19maintained for three years.

409.20    Sec. 17. [144A.4791] HOME CARE PROVIDER RESPONSIBILITIES WITH
409.21RESPECT TO CLIENTS.
409.22    Subdivision 1. Home care bill of rights; notification to client. (a) The home
409.23care provider shall provide the client or the client's representative a written notice of the
409.24rights under section 144A.44 in a language that the client or the client's representative
409.25can understand before the initiation of services to that client. If a written version is not
409.26available, the home care bill of rights must be communicated to the client or client's
409.27representative in a language they can understand.
409.28(b) In addition to the text of the home care bill of rights in section 144A.44,
409.29subdivision 1, the notice shall also contain the following statement describing how to file
409.30a complaint with these offices.
409.31"If you have a complaint about the provider or the person providing your
409.32home care services, you may call, write, or visit the Office of Health Facility
409.33Complaints, Minnesota Department of Health. You may also contact the Office of
409.34Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health
409.35and Developmental Disabilities."
410.1The statement should include the telephone number, Web site address, e-mail
410.2address, mailing address, and street address of the Office of Health Facility Complaints at
410.3the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care,
410.4and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The
410.5statement should also include the home care provider's name, address, e-mail, telephone
410.6number, and name or title of the person at the provider to whom problems or complaints
410.7may be directed. It must also include a statement that the home care provider will not
410.8retaliate because of a complaint.
410.9(c) The home care provider shall obtain written acknowledgment of the client's
410.10receipt of the home care bill of rights or shall document why an acknowledgment cannot
410.11be obtained. The acknowledgment may be obtained from the client or the client's
410.12representative. Acknowledgment of receipt shall be retained in the client's record.
410.13    Subd. 2. Notice of services for dementia, Alzheimer's disease, or related
410.14disorders. The home care provider that provides services to clients with dementia shall
410.15provide in written or electronic form, to clients and families or other persons who request
410.16it, a description of the training program and related training it provides, including the
410.17categories of employees trained, the frequency of training, and the basic topics covered.
410.18This information satisfies the disclosure requirements in section 325F.72, subdivision
410.192, clause (4).
410.20    Subd. 3. Statement of home care services. Prior to the initiation of services,
410.21a home care provider must provide to the client or the client's representative a written
410.22statement which identifies if they have a basic or comprehensive home care license, the
410.23services they are authorized to provide, and which services they cannot provide under the
410.24scope of their license. The home care provider shall obtain written acknowledgment
410.25from the clients that they have provided the statement or must document why they could
410.26not obtain the acknowledgment.
410.27    Subd. 4. Acceptance of clients. No home care provider may accept a person as a
410.28client unless the home care provider has staff, sufficient in qualifications, competency,
410.29and numbers, to adequately provide the services agreed to in the service plan and that
410.30are within the provider's scope of practice.
410.31    Subd. 5. Referrals. If a home care provider reasonably believes that a client is in
410.32need of another medical or health service, including a licensed health professional, or
410.33social service provider, the home care provider shall:
410.34(1) determine the client's preferences with respect to obtaining the service; and
410.35(2) inform the client of resources available, if known, to assist the client in obtaining
410.36services.
411.1    Subd. 6. Initiation of services. When a provider initiates services and the
411.2individualized review or assessment required in subdivisions 7 and 8 has not been
411.3completed, the provider must complete a temporary plan and agreement with the client for
411.4services.
411.5    Subd. 7. Basic individualized client review and monitoring. (a) When services
411.6being provided are basic home care services, an individualized initial review of the client's
411.7needs and preferences must be conducted at the client's residence with the client or client's
411.8representative. This initial review must be completed within 30 days after the initiation of
411.9the home care services.
411.10(b) Client monitoring and review must be conducted as needed based on changes
411.11in the needs of the client and cannot exceed 90 days from the date of the last review.
411.12The monitoring and review may be conducted at the client's residence or through the
411.13utilization of telecommunication methods based on practice standards that meet the
411.14individual client's needs.
411.15    Subd. 8. Comprehensive assessment, monitoring, and reassessment. (a) When
411.16the services being provided are comprehensive home care services, an individualized
411.17initial assessment must be conducted in-person by a registered nurse. When the services
411.18are provided by other licensed health professionals, the assessment must be conducted by
411.19the appropriate health professional. This initial assessment must be completed within five
411.20days after initiation of home care services.
411.21(b) Client monitoring and reassessment must be conducted in the client's home no
411.22more than 14 days after initiation of services.
411.23(c) Ongoing client monitoring and reassessment must be conducted as needed based
411.24on changes in the needs of the client and cannot exceed 90 days from the last date of the
411.25assessment. The monitoring and reassessment may be conducted at the client's residence
411.26or through the utilization of telecommunication methods based on practice standards that
411.27meet the individual client's needs.
411.28    Subd. 9. Service plan, implementation, and revisions to service plan. (a) No later
411.29than 14 days after the initiation of services, a home care provider shall finalize a current
411.30written service plan.
411.31(b) The service plan and any revisions must include a signature or other
411.32authentication by the home care provider and by the client or the client's representative
411.33documenting agreement on the services to be provided. The service plan must be revised,
411.34if needed, based on client review or reassessment under subdivisions 7 and 8. The provider
411.35must provide information to the client about changes to the provider's fee for services and
411.36how to contact the Office of the Ombudsman for Long-Term Care.
412.1(c) The home care provider must implement and provide all services required by
412.2the current service plan.
412.3(d) The service plan and revised service plan must be entered into the client's record,
412.4including notice of a change in a client's fees when applicable.
412.5(e) Staff providing home care services must be informed of the current written
412.6service plan.
412.7(f) The service plan must include:
412.8(1) a description of the home care services to be provided, the fees for services, and
412.9the frequency of each service, according to the client's current review or assessment and
412.10client preferences;
412.11(2) the identification of the staff or categories of staff who will provide the services;
412.12(3) the schedule and methods of monitoring reviews or assessments of the client;
412.13(4) the frequency of sessions of supervision of staff and type of personnel who
412.14will supervise staff; and
412.15(5) a contingency plan that includes:
412.16(i) the action to be taken by the home care provider and by the client or client's
412.17representative if the scheduled service cannot be provided;
412.18(ii) information and method for a client or client's representative to contact the
412.19home care provider;
412.20(iii) names and contact information of persons the client wishes to have notified
412.21in an emergency or if there is a significant adverse change in the client's condition,
412.22including identification of and information as to who has authority to sign for the client in
412.23an emergency; and
412.24(iv) the circumstances in which emergency medical services are not to be summoned
412.25consistent with chapters 145B and 145C, and declarations made by the client under those
412.26chapters.
412.27    Subd. 10. Termination of service plan. (a) If a home care provider terminates a
412.28service plan with a client, and the client continues to need home care services, the home
412.29care provider shall provide the client and the client's representative, if any, with a written
412.30notice of termination which includes the following information:
412.31(1) the effective date of termination;
412.32(2) the reason for termination;
412.33(3) a list of known licensed home care providers in the client's immediate geographic
412.34area;
413.1(4) a statement that the home care provider will participate in a coordinated transfer
413.2of care of the client to another home care provider, health care provider, or caregiver, as
413.3required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
413.4(5) the name and contact information of a person employed by the home care
413.5provider with whom the client may discuss the notice of termination; and
413.6(6) if applicable, a statement that the notice of termination of home care services
413.7does not constitute notice of termination of the housing with services contract with a
413.8housing with services establishment.
413.9(b) When the home care provider voluntarily discontinues services to all clients, the
413.10home care provider must notify the commissioner, lead agencies, and the ombudsman for
413.11long-term care about its clients and comply with the requirements in this subdivision.
413.12    Subd. 11. Client complaint and investigative process. (a) The home care
413.13provider must have a written policy and system for receiving, investigating, reporting,
413.14and attempting to resolve complaints from its clients or clients' representatives. The
413.15policy should clearly identify the process by which clients may file a complaint or concern
413.16about home care services and an explicit statement that the home care provider will not
413.17discriminate or retaliate against a client for expressing concerns or complaints. A home
413.18care provider must have a process in place to conduct investigations of complaints made
413.19by the client or the client's representative about the services in the client's plan that are or
413.20are not being provided or other items covered in the client's home care bill of rights. This
413.21complaint system must provide reasonable accommodations for any special needs of the
413.22client or client's representative if requested.
413.23(b) The home care provider must document the complaint, name of the client,
413.24investigation, and resolution of each complaint filed. The home care provider must
413.25maintain a record of all activities regarding complaints received, including the date the
413.26complaint was received, and the home care provider's investigation and resolution of the
413.27complaint. This complaint record must be kept for each event for at least two years after
413.28the date of entry and must be available to the commissioner for review.
413.29(c) The required complaint system must provide for written notice to each client or
413.30client's representative that includes:
413.31(1) the client's right to complain to the home care provider about the services received;
413.32(2) the name or title of the person or persons with the home care provider to contact
413.33with complaints;
413.34(3) the method of submitting a complaint to the home care provider; and
413.35(4) a statement that the provider is prohibited against retaliation according to
413.36paragraph (d).
414.1(d) A home care provider must not take any action that negatively affects a client
414.2in retaliation for a complaint made or a concern expressed by the client or the client's
414.3representative.
414.4    Subd. 12. Disaster planning and emergency preparedness plan. The home care
414.5provider must have a written plan of action to facilitate the management of the client's care
414.6and services in response to a natural disaster, such as flood and storms, or other emergencies
414.7that may disrupt the home care provider's ability to provide care or services. The licensee
414.8must provide adequate orientation and training of staff on emergency preparedness.
414.9    Subd. 13. Request for discontinuation of life-sustaining treatment. (a) If a
414.10client, family member, or other caregiver of the client requests that an employee or other
414.11agent of the home care provider discontinue a life-sustaining treatment, the employee or
414.12agent receiving the request:
414.13(1) shall take no action to discontinue the treatment; and
414.14(2) shall promptly inform their supervisor or other agent of the home care provider
414.15of the client's request.
414.16(b) Upon being informed of a request for termination of treatment, the home care
414.17provider shall promptly:
414.18(1) inform the client that the request will be made known to the physician who
414.19ordered the client's treatment;
414.20(2) inform the physician of the client's request; and
414.21(3) work with the client and the client's physician to comply with the provisions of
414.22the Health Care Directive Act in chapter 145C.
414.23(c) This section does not require the home care provider to discontinue treatment,
414.24except as may be required by law or court order.
414.25(d) This section does not diminish the rights of clients to control their treatments,
414.26refuse services, or terminate their relationships with the home care provider.
414.27(e) This section shall be construed in a manner consistent with chapter 145B or
414.28145C, whichever applies, and declarations made by clients under those chapters.

414.29    Sec. 18. [144A.4792] MEDICATION MANAGEMENT.
414.30    Subdivision 1. Medication management services; comprehensive home care
414.31license. (a) This subdivision applies only to home care providers with a comprehensive
414.32home care license that provides medication management services to clients. Medication
414.33management services may not be provided by a home care provider that has a basic
414.34home care license.
415.1(b) A comprehensive home care provider who provides medication management
415.2services must develop, implement, and maintain current written medication management
415.3policies and procedures. The policies and procedures must be developed under the
415.4supervision and direction of a registered nurse, licensed health professional, or pharmacist
415.5consistent with current practice standards and guidelines.
415.6(c) The written policies and procedures must address requesting and receiving
415.7prescriptions for medications; preparing and giving medications; verifying that
415.8prescription drugs are administered as prescribed; documenting medication management
415.9activities; controlling and storing medications; monitoring and evaluating medication use;
415.10resolving medication errors; communicating with the prescriber, pharmacist, and client
415.11and client representative, if any; disposing of unused medications; and educating clients
415.12and client representatives about medications. When controlled substances are being
415.13managed, the policies and procedures must also identify how the provider will ensure
415.14security and accountability for the overall management, control, and disposition of those
415.15substances in compliance with state and federal regulations and with subdivision 22.
415.16    Subd. 2. Provision of medication management services. (a) For each client who
415.17requests medication management services, the comprehensive home care provider shall,
415.18prior to providing medication management services, have a registered nurse, licensed
415.19health professional, or authorized prescriber under section 151.37 conduct an assessment
415.20to determine what mediation management services will be provided and how the services
415.21will be provided. This assessment must be conducted face-to-face with the client. The
415.22assessment must include an identification and review of all medications the client is known
415.23to be taking. The review and identification must include indications for medications, side
415.24effects, contraindications, allergic or adverse reactions, and actions to address these issues.
415.25(b) The assessment must identify interventions needed in management of
415.26medications to prevent diversion of medication by the client or others who may have
415.27access to the medications. Diversion of medications means the misuse, theft, or illegal
415.28or improper disposition of medications.
415.29    Subd. 3. Individualized medication monitoring and reassessment. The
415.30comprehensive home care provider must monitor and reassess the client's medication
415.31management services as needed under subdivision 14 when the client presents with
415.32symptoms or other issues that may be medication-related and, at a minimum, annually.
415.33    Subd. 4. Client refusal. The home care provider must document in the client's
415.34record any refusal for an assessment for medication management by the client. The
415.35provider must discuss with the client the possible consequences of the client's refusal and
415.36document the discussion in the client's record.
416.1    Subd. 5. Individualized medication management plan. (a) For each client
416.2receiving medication management services, the comprehensive home care provider must
416.3prepare and include in the service plan a written statement of the medication management
416.4services that will be provided to the client. The provider must develop and maintain a
416.5current individualized medication management record for each client based on the client's
416.6assessment that must contain the following:
416.7(1) a statement describing the medication management services that will be provided;
416.8(2) a description of storage of medications based on the client's needs and
416.9preferences, risk of diversion, and consistent with the manufacturer's directions;
416.10(3) documentation of specific client instructions relating to the administration
416.11of medications;
416.12(4) identification of persons responsible for monitoring medication supplies and
416.13ensuring that medication refills are ordered on a timely basis;
416.14(5) identification of medication management tasks that may be delegated to
416.15unlicensed personnel;
416.16(6) procedures for staff notifying a registered nurse or appropriate licensed health
416.17professional when a problem arises with medication management services; and
416.18(7) any client-specific requirements relating to documenting medication
416.19administration, verifications that all medications are administered as prescribed, and
416.20monitoring of medication use to prevent possible complications or adverse reactions.
416.21(b) The medication management record must be current and updated when there are
416.22any changes.
416.23    Subd. 6. Administration of medication. Medications may be administered by a
416.24nurse, physician, or other licensed health practitioner authorized to administer medications
416.25or by unlicensed personnel who have been delegated medication administration tasks by
416.26a registered nurse.
416.27    Subd. 7. Delegation of medication administration. When administration of
416.28medications is delegated to unlicensed personnel, the comprehensive home care provider
416.29must ensure that the registered nurse has:
416.30(1) instructed the unlicensed personnel in the proper methods to administer the
416.31medications, and the unlicensed personnel has demonstrated ability to competently follow
416.32the procedures;
416.33(2) specified, in writing, specific instructions for each client and documented those
416.34instructions in the client's records; and
416.35(3) communicated with the unlicensed personnel about the individual needs of
416.36the client.
417.1    Subd. 8. Documentation of administration of medications. Each medication
417.2administered by comprehensive home care provider staff must be documented in the
417.3client's record. The documentation must include the signature and title of the person
417.4who administered the medication. The documentation must include the medication
417.5name, dosage, date and time administered, and method and route of administration. The
417.6staff must document the reason why medication administration was not completed as
417.7prescribed and document any follow-up procedures that were provided to meet the client's
417.8needs when medication was not administered as prescribed and in compliance with the
417.9client's medication management plan.
417.10    Subd. 9. Documentation of medication set up. Documentation of dates of
417.11medication set up, name of medication, quantity of dose, times to be administered, route
417.12of administration, and name of person completing medication set up must be done at
417.13time of set up.
417.14    Subd. 10. Medications management for clients who will be away from home. (a)
417.15A home care provider that is providing medication management services to the client and
417.16controls the client's access to the medications must develop and implement policies and
417.17procedures for giving accurate and current medications to clients for planned or unplanned
417.18times away from home according to the client's individualized medication management
417.19plan. The policy and procedures must state that:
417.20(1) for planned time away, the medications must be obtained from the pharmacy or
417.21set up by the registered nurse according to appropriate state and federal laws and nursing
417.22standards of practice;
417.23(2) for unplanned time away, when the pharmacy is not able to provide the
417.24medications, a licensed nurse or unlicensed personnel shall give the client or client's
417.25representative medications in amounts and dosages needed for the length of the anticipated
417.26absence, not to exceed 120 hours;
417.27(3) the client, or the client's representative, must be provided written information
417.28on medications, including any special instructions for administering or handling the
417.29medications, including controlled substances;
417.30(4) the medications must be placed in a medication container or containers
417.31appropriate to the provider's medication system and must be labeled with the client's name
417.32and the dates and times that the medications are scheduled; and
417.33(5) the client or client's representative must be provided in writing the home care
417.34provider's name and information on how to contact the home care provider.
417.35(b) For unplanned time away when the licensed nurse is not available, the registered
417.36nurse may delegate this task to unlicensed personnel if:
418.1(1) the registered nurse has trained the unlicensed staff and determined the
418.2unlicensed staff is competent to follow the procedures for giving medications to clients;
418.3(2) the registered nurse has developed written procedures for the unlicensed
418.4personnel, including any special instructions or procedures regarding controlled substances
418.5that are prescribed for the client. The procedures must address:
418.6(i) the type of container or containers to be used for the medications appropriate to
418.7the provider's medication system;
418.8(ii) how the container or containers must be labeled;
418.9(iii) the written information about the medications to be given to the client or client's
418.10representative;
418.11(iv) how the unlicensed staff will document in the client's record that medications
418.12have been given to the client or the client's representative, including documenting the date
418.13the medications were given to the client or the client's representative and who received the
418.14medications, the person who gave the medications to the client, the number of medications
418.15that were given to the client, and other required information;
418.16(v) how the registered nurse will be notified that medications have been given to
418.17the client or client's representative and whether the registered nurse needs to be contacted
418.18before the medications are given to the client or the client's representative; and
418.19(vi) a review by the registered nurse of the completion of this task to verify that this
418.20task was completed accurately by the unlicensed personnel.
418.21    Subd. 11. Prescribed and nonprescribed medication. The comprehensive home
418.22care provider must determine whether it will require a prescription for all medications it
418.23manages. The comprehensive home care provider must inform the client or the client's
418.24representative whether the comprehensive home care provider requires a prescription
418.25for all over-the-counter and dietary supplements before the comprehensive home care
418.26provider will agree to manage those medications.
418.27    Subd. 12. Medications; over-the-counter; dietary supplements not prescribed.
418.28A comprehensive home care provider providing medication management services for
418.29over-the-counter drugs or dietary supplements must retain those items in the original labeled
418.30container with directions for use prior to setting up for immediate or later administration.
418.31The provider must verify that the medications are up-to-date and stored as appropriate.
418.32    Subd. 13. Prescriptions. There must be a current written or electronically recorded
418.33prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed
418.34medications that the comprehensive home care provider is managing for the client.
419.1    Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least
419.2every 12 months or more frequently as indicated by the assessment in subdivision 2.
419.3Prescriptions for controlled substances must comply with chapter 152.
419.4    Subd. 15. Verbal prescription orders. Verbal prescription orders from an
419.5authorized prescriber must be received by a nurse or pharmacist. The order must be
419.6handled according to Minnesota Rules, part 6800.6200.
419.7    Subd. 16. Written or electronic prescription. When a written or electronic
419.8prescription is received, it must be communicated to the registered nurse in charge and
419.9recorded or placed in the client's record.
419.10    Subd. 17. Records confidential. A prescription or order received verbally, in
419.11writing, or electronically must be kept confidential according to sections 144.291 to
419.12144.298 and 144A.44.
419.13    Subd. 18. Medications provided by client or family members. When the
419.14comprehensive home care provider is aware of any medications or dietary supplements
419.15that are being used by the client and are not included in the assessment for medication
419.16management services, the staff must advise the registered nurse and document that in
419.17the client's record.
419.18    Subd. 19. Storage of drugs. A comprehensive home care provider providing
419.19storage of medications outside of the client's private living space must store all prescription
419.20drugs in securely locked and substantially constructed compartments according to the
419.21manufacturer's directions and permit only authorized personnel to have access.
419.22    Subd. 20. Prescription drugs. A prescription drug, prior to being set up for
419.23immediate or later administration, must be kept in the original container in which it was
419.24dispensed by the pharmacy bearing the original prescription label with legible information
419.25including the expiration or beyond-use date of a time-dated drug.
419.26    Subd. 21. Prohibitions. No prescription drug supply for one client may be used or
419.27saved for use by anyone other than the client.
419.28    Subd. 22. Disposition of drugs. (a) Any current medications being managed by the
419.29comprehensive home care provider must be given to the client or the client's representative
419.30when the client's service plan ends or medication management services are no longer part
419.31of the service plan. Medications that have been stored in the client's private living space
419.32for a client that is deceased or that have been discontinued or that have expired may be
419.33given to the client or the client's representative for disposal.
419.34(b) The comprehensive home care provider will dispose of any medications
419.35remaining with the comprehensive home care provider that are discontinued or expired or
420.1upon the termination of the service contract or the client's death according to state and
420.2federal regulations for disposition of drugs and controlled substances.
420.3(c) Upon disposition, the comprehensive home care provider must document in the
420.4client's record the disposition of the medications including the medication's name, strength,
420.5prescription number as applicable, quantity, to whom the medications were given, date of
420.6disposition, and names of staff and other individuals involved in the disposition.
420.7    Subd. 23. Loss or spillage. (a) Comprehensive home care providers providing
420.8medication management must develop and implement procedures for loss or spillage of all
420.9controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must
420.10require that when a spillage of a controlled substance occurs, a notation must be made
420.11in the client's record explaining the spillage and the actions taken. The notation must
420.12be signed by the person responsible for the spillage and include verification that any
420.13contaminated substance was disposed of according to state or federal regulations.
420.14(b) The procedures must require the comprehensive home care provider of
420.15medication management to investigate any known loss or unaccounted for prescription
420.16drugs and take appropriate action required under state or federal regulations and document
420.17the investigation in required records.

420.18    Sec. 19. [144A.4793] TREATMENT AND THERAPY MANAGEMENT
420.19SERVICES.
420.20    Subdivision 1. Providers with a comprehensive home care license. This section
420.21applies only to home care providers with a comprehensive home care license that provide
420.22treatment or therapy management services to clients. Treatment or therapy management
420.23services cannot be provided by a home care provider that has a basic home care license.
420.24    Subd. 2. Policies and procedures. (a) A comprehensive home care provider who
420.25provides treatment and therapy management services must develop, implement, and
420.26maintain up-to-date written treatment or therapy management policies and procedures.
420.27The policies and procedures must be developed under the supervision and direction of
420.28a registered nurse or appropriate licensed health professional consistent with current
420.29practice standards and guidelines.
420.30(b) The written policies and procedures must address requesting and receiving
420.31orders or prescriptions for treatments or therapies, providing the treatment or therapy,
420.32documenting of treatment or therapy activities, educating and communicating with clients
420.33about treatments or therapy they are receiving, monitoring and evaluating the treatment
420.34and therapy, and communicating with the prescriber.
421.1    Subd. 3. Individualized treatment or therapy management plan. For each
421.2client receiving management of ordered or prescribed treatments or therapy services, the
421.3comprehensive home care provider must prepare and include in the service plan a written
421.4statement of the treatment or therapy services that will be provided to the client. The
421.5provider must also develop and maintain a current individualized treatment and therapy
421.6management record for each client which must contain at least the following:
421.7(1) a statement of the type of services that will be provided;
421.8(2) documentation of specific client instructions relating to the treatments or therapy
421.9administration;
421.10(3) identification of treatment or therapy tasks that will be delegated to unlicensed
421.11personnel;
421.12(4) procedures for notifying a registered nurse or appropriate licensed health
421.13professional when a problem arises with treatments or therapy services; and
421.14(5) any client-specific requirements relating to documentation of treatment
421.15and therapy received, verification that all treatment and therapy was administered as
421.16prescribed, and monitoring of treatment or therapy to prevent possible complications or
421.17adverse reactions. The treatment or therapy management record must be current and
421.18updated when there are any changes.
421.19    Subd. 4. Administration of treatments and therapy. Ordered or prescribed
421.20treatments or therapies must be administered by a nurse, physician, or other licensed health
421.21professional authorized to perform the treatment or therapy, or may be delegated or assigned
421.22to unlicensed personnel by the licensed health professional according to the appropriate
421.23practice standards for delegation or assignment. When administration of a treatment or
421.24therapy is delegated or assigned to unlicensed personnel, the home care provider must
421.25ensure that the registered nurse or authorized licensed health professional has:
421.26(1) instructed the unlicensed personnel in the proper methods with respect to each
421.27client and has demonstrated their ability to competently follow the procedures;
421.28(2) specified, in writing, specific instructions for each client and documented those
421.29instructions in the client's record; and
421.30(3) communicated with the unlicensed personnel about the individual needs of
421.31the client.
421.32    Subd. 5. Documentation of administration of treatments and therapies. Each
421.33treatment or therapy administered by a comprehensive home care provider must be
421.34documented in the client's record. The documentation must include the signature and title
421.35of the person who administered the treatment or therapy and must include the date and
421.36time of administration. When treatment or therapies are not administered as ordered or
422.1prescribed, the provider must document the reason why it was not administered and any
422.2follow-up procedures that were provided to meet the client's needs.
422.3    Subd. 6. Orders or prescriptions. There must be an up-to-date written or
422.4electronically recorded order or prescription for all treatments and therapies. The order
422.5must contain the name of the client, description of the treatment or therapy to be provided,
422.6and the frequency and other information needed to administer the treatment or therapy.

422.7    Sec. 20. [144A.4794] CLIENT RECORD REQUIREMENTS.
422.8    Subdivision 1. Client record. (a) The home care provider must maintain records
422.9for each client for whom it is providing services. Entries in the client records must be
422.10current, legible, permanently recorded, dated, and authenticated with the name and title
422.11of the person making the entry.
422.12(b) Client records, whether written or electronic, must be protected against loss,
422.13tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable
422.14relevant federal and state laws. The home care provider shall establish and implement
422.15written procedures to control use, storage, and security of client's records and establish
422.16criteria for release of client information.
422.17(c) The home care provider may not disclose to any other person any personal,
422.18financial, medical, or other information about the client, except:
422.19(1) as may be required by law;
422.20(2) to employees or contractors of the home care provider, another home care
422.21provider, other health care practitioner or provider, or inpatient facility needing
422.22information in order to provide services to the client, but only such information that
422.23is necessary for the provision of services;
422.24(3) to persons authorized in writing by the client or the client's representative to
422.25receive the information, including third-party payers; and
422.26(4) to representatives of the commissioner authorized to survey or investigate home
422.27care providers under this chapter or federal laws.
422.28    Subd. 2. Access to records. The home care provider must ensure that the
422.29appropriate records are readily available to employees or contractors authorized to access
422.30the records. Client records must be maintained in a manner that allows for timely access,
422.31printing, or transmission of the records.
422.32    Subd. 3. Contents of client record. Contents of a client record include the
422.33following for each client:
422.34(1) identifying information, including the client's name, date of birth, address, and
422.35telephone number;
423.1(2) the name, address, and telephone number of an emergency contact, family
423.2members, client's representative, if any, or others as identified;
423.3(3) names, addresses, and telephone numbers of the client's health and medical
423.4service providers and other home care providers, if known;
423.5(4) health information, including medical history, allergies, and when the provider
423.6is managing medications, treatments or therapies that require documentation, and other
423.7relevant health records;
423.8(5) client's advance directives, if any;
423.9(6) the home care provider's current and previous assessments and service plans;
423.10(7) all records of communications pertinent to the client's home care services;
423.11(8) documentation of significant changes in the client's status and actions taken in
423.12response to the needs of the client including reporting to the appropriate supervisor or
423.13health care professional;
423.14(9) documentation of incidents involving the client and actions taken in response
423.15to the needs of the client including reporting to the appropriate supervisor or health
423.16care professional;
423.17(10) documentation that services have been provided as identified in the service plan;
423.18(11) documentation that the client has received and reviewed the home care bill
423.19of rights;
423.20(12) documentation that the client has been provided the statement of disclosure on
423.21limitations of services under section 144A.4791, subdivision 3;
423.22(13) documentation of complaints received and resolution;
423.23(14) discharge summary, including service termination notice and related
423.24documentation, when applicable; and
423.25(15) other documentation required under this chapter and relevant to the client's
423.26services or status.
423.27    Subd. 4. Transfer of client records. If a client transfers to another home care
423.28provider or other health care practitioner or provider, or is admitted to an inpatient facility,
423.29the home care provider, upon request of the client or the client's representative, shall take
423.30steps to ensure a coordinated transfer including sending a copy or summary of the client's
423.31record to the new home care provider, facility, or the client, as appropriate.
423.32    Subd. 5. Record retention. Following the client's discharge or termination of
423.33services, a home care provider must retain a client's record for at least five years, or as
423.34otherwise required by state or federal regulations. Arrangements must be made for secure
423.35storage and retrieval of client records if the home care provider ceases business.

424.1    Sec. 21. [144A.4795] HOME CARE PROVIDER RESPONSIBILITIES; STAFF.
424.2    Subdivision 1. Qualifications, training, and competency. All staff providing
424.3home care services must be trained and competent in the provision of home care services
424.4consistent with current practice standards appropriate to the client's needs.
424.5    Subd. 2. Licensed health professionals and nurses. (a) Licensed health
424.6professionals and nurses providing home care services as an employee of a licensed home
424.7care provider must possess current Minnesota license or registration to practice.
424.8(b) Licensed health professionals and registered nurses must be competent in
424.9assessing client needs, planning appropriate home care services to meet client needs,
424.10implementing services, and supervising staff if assigned.
424.11(c) Nothing in this section limits or expands the rights of nurses or licensed health
424.12professionals to provide services within the scope of their licenses or registrations, as
424.13provided by law.
424.14    Subd. 3. Unlicensed personnel. (a) Unlicensed personnel providing basic home
424.15care services must have:
424.16(1) successfully completed a training and competency evaluation appropriate to
424.17the services provided by the home care provider and the topics listed in subdivision 7,
424.18paragraph (b); or
424.19(2) demonstrated competency by satisfactorily completing a written or oral test on
424.20the tasks the unlicensed personnel will perform and in the topics listed in subdivision
424.217, paragraph (b); and successfully demonstrate competency of topics in subdivision 7,
424.22paragraph (b), clauses (5), (7), and (8), by a practical skills test.
424.23Unlicensed personnel providing home care services for a basic home care provider may
424.24not perform delegated nursing or therapy tasks.
424.25(b) Unlicensed personnel performing delegated nursing tasks for a comprehensive
424.26home care provider must:
424.27(1) have successfully completed training and demonstrated competency by
424.28successfully completing a written or oral test of the topics in subdivision 7, paragraphs (b)
424.29and (c), and a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5)
424.30and (7), and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform;
424.31(2) satisfy the current requirements of Medicare for training or competency of home
424.32health aides or nursing assistants, as provided by Code of Federal Regulations, title 42,
424.33section 483 or section 484.36; or
424.34(3) have, before April 19, 1993, completed a training course for nursing assistants
424.35that was approved by the commissioner.
425.1(c) Unlicensed personnel performing therapy or treatment tasks delegated or
425.2assigned by a licensed health professional must meet the requirements for delegated
425.3tasks in subdivision 4 and any other training or competency requirements within the
425.4licensed health professional scope of practice relating to delegation or assignment of tasks
425.5to unlicensed personnel.
425.6    Subd. 4. Delegation of home care tasks. A registered nurse or licensed health
425.7professional may delegate tasks only to staff that are competent and possess the knowledge
425.8and skills consistent with the complexity of the tasks and according to the appropriate
425.9Minnesota Practice Act. The comprehensive home care provider must establish and
425.10implement a system to communicate up-to-date information to the registered nurse or
425.11licensed health professional regarding the current available staff and their competency so
425.12the registered nurse or licensed health professional has sufficient information to determine
425.13the appropriateness of delegating tasks to meet individual client needs and preferences.
425.14    Subd. 5. Individual contractors. When a home care provider contracts with an
425.15individual contractor excluded from licensure under section 144A.471 to provide home
425.16care services, the contractor must meet the same requirements required by this section for
425.17personnel employed by the home care provider.
425.18    Subd. 6. Temporary staff. When a home care provider contracts with a temporary
425.19staffing agency excluded from licensure under section 144A.471, those individuals must
425.20meet the same requirements required by this section for personnel employed by the home
425.21care provider and shall be treated as if they are staff of the home care provider.
425.22    Subd. 7. Requirements for instructors, training content, and competency
425.23evaluations for unlicensed personnel. (a) Instructors and competency evaluators must
425.24meet the following requirements:
425.25(1) training and competency evaluations of unlicensed personnel providing basic
425.26home care services must be conducted by individuals with work experience and training in
425.27providing home care services listed in section 144A.471, subdivisions 6 and 7; and
425.28(2) training and competency evaluations of unlicensed personnel providing
425.29comprehensive home care services must be conducted by a registered nurse, or another
425.30instructor may provide training in conjunction with the registered nurse. If the home care
425.31provider is providing services by licensed health professionals only, then that specific
425.32training and competency evaluation may be conducted by the licensed health professionals
425.33as appropriate.
425.34(b) Training and competency evaluations for all unlicensed personnel must include
425.35the following:
425.36(1) documentation requirements for all services provided;
426.1(2) reports of changes in the client's condition to the supervisor designated by the
426.2home care provider;
426.3(3) basic infection control, including blood-borne pathogens;
426.4(4) maintenance of a clean and safe environment;
426.5(5) appropriate and safe techniques in personal hygiene and grooming, including:
426.6(i) hair care and bathing;
426.7(ii) care of teeth, gums, and oral prosthetic devices;
426.8(iii) care and use of hearing aids; and
426.9(iv) dressing and assisting with toileting;
426.10(6) training on the prevention of falls for providers working with the elderly or
426.11individuals at risk of falls;
426.12(7) standby assistance techniques and how to perform them;
426.13(8) medication, exercise, and treatment reminders;
426.14(9) basic nutrition, meal preparation, food safety, and assistance with eating;
426.15(10) preparation of modified diets as ordered by a licensed health professional;
426.16(11) communication skills that include preserving the dignity of the client and
426.17showing respect for the client and the client's preferences, cultural background, and family;
426.18(12) awareness of confidentiality and privacy;
426.19(13) understanding appropriate boundaries between staff and clients and the client's
426.20family;
426.21(14) procedures to utilize in handling various emergency situations; and
426.22(15) awareness of commonly used health technology equipment and assistive devices.
426.23(c) In addition to paragraph (b), training and competency evaluation for unlicensed
426.24personnel providing comprehensive home care services must include:
426.25(1) observation, reporting, and documenting of client status;
426.26(2) basic knowledge of body functioning and changes in body functioning, injuries,
426.27or other observed changes that must be reported to appropriate personnel;
426.28(3) reading and recording temperature, pulse, and respirations of the client;
426.29(4) recognizing physical, emotional, cognitive, and developmental needs of the client;
426.30(5) safe transfer techniques and ambulation;
426.31(6) range of motioning and positioning; and
426.32(7) administering medications or treatments as required.
426.33(d) When the registered nurse or licensed health professional delegates tasks, they
426.34must ensure that prior to the delegation the unlicensed personnel is trained in the proper
426.35methods to perform the tasks or procedures for each client and are able to demonstrate
426.36the ability to competently follow the procedures and perform the tasks. If an unlicensed
427.1personnel has not regularly performed the delegated home care task for a period of 24
427.2consecutive months, the unlicensed personnel must demonstrate competency in the task
427.3to the registered nurse or appropriate licensed health professional. The registered nurse
427.4or licensed health professional must document instructions for the delegated tasks in
427.5the client's record.

427.6    Sec. 22. [144A.4796] ORIENTATION AND ANNUAL TRAINING
427.7REQUIREMENTS.
427.8    Subdivision 1. Orientation of staff and supervisors to home care. All staff
427.9providing and supervising direct home care services must complete an orientation to home
427.10care licensing requirements and regulations before providing home care services to clients.
427.11The orientation may be incorporated into the training required under subdivision 6. The
427.12orientation need only be completed once for each staff person and is not transferable
427.13to another home care provider.
427.14    Subd. 2. Content. The orientation must contain the following topics:
427.15    (1) an overview of sections 144A.43 to 144A.4798;
427.16(2) introduction and review of all the provider's policies and procedures related to
427.17the provision of home care services;
427.18(3) handling of emergencies and use of emergency services;
427.19(4) compliance with and reporting the maltreatment of minors or vulnerable adults
427.20under sections 626.556 and 626.557;
427.21(5) home care bill of rights, under section 144A.44;
427.22(6) handling of clients' complaints; reporting of complaints and where to report
427.23complaints including information on the Office of Health Facility Complaints and the
427.24Common Entry Point;
427.25(7) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
427.26Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
427.27Ombudsman at the Department of Human Services, county managed care advocates,
427.28or other relevant advocacy services; and
427.29(8) review of the types of home care services the employee will be providing and
427.30the provider's scope of licensure.
427.31    Subd. 3. Verification and documentation of orientation. Each home care provider
427.32shall retain evidence in the employee record of each staff person having completed the
427.33orientation required by this section.
428.1    Subd. 4. Orientation to client. Staff providing home care services must be oriented
428.2specifically to each individual client and the services to be provided. This orientation may
428.3be provided in person, orally, in writing, or electronically.
428.4    Subd. 5. Training required relating to Alzheimer's disease and related disorders.
428.5For home care providers that provide services for persons with Alzheimer's or related
428.6disorders, all direct care staff and supervisors working with those clients must receive
428.7training that includes a current explanation of Alzheimer's disease and related disorders
428.8effective approaches to use to problem solve when working with a client's challenging
428.9behaviors, and how to communicate with clients who have Alzheimer's or related disorders.
428.10    Subd. 6. Required annual training. All staff that perform direct home care
428.11services must complete at least eight hours of annual training for each 12 months of
428.12employment. The training may be obtained from the home care provider or another source
428.13and must include topics relevant to the provision of home care services. The annual
428.14training must include:
428.15(1) training on reporting of maltreatment of minors under section 626.556 and
428.16maltreatment of vulnerable adults under section 626.557, whichever is applicable to the
428.17services provided;
428.18(2) review of the home care bill of rights in section 144A.44;
428.19(3) review of infection control techniques used in the home and implementation of
428.20infection control standards including a review of hand washing techniques; the need for
428.21and use of protective gloves, gowns, and masks; appropriate disposal of contaminated
428.22materials and equipment, such as dressings, needles, syringes, and razor blades;
428.23disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of
428.24communicable diseases; and
428.25(4) review of the provider's policies and procedures relating to the provision of home
428.26care services and how to implement those policies and procedures.
428.27    Subd. 7. Documentation. A home care provider must retain documentation in the
428.28employee records of the staff that have satisfied the orientation and training requirements
428.29of this section.

428.30    Sec. 23. [144A.4797] PROVISION OF SERVICES.
428.31    Subdivision 1. Availability of contact person to staff. (a) A home care provider
428.32with a basic home care license must have a person available to staff for consultation on
428.33items relating to the provision of services or about the client.
428.34(b) A home care provider with a comprehensive home care license must have a
428.35registered nurse available for consultation to staff performing delegated nursing tasks
429.1and must have an appropriate licensed health professional available if performing other
429.2delegated services such as therapies.
429.3(c) The appropriate contact person must be readily available either in person, by
429.4telephone, or by other means to the staff at times when the staff is providing services.
429.5    Subd. 2. Supervision of staff; basic home care services. (a) Staff who perform
429.6basic home care services must be supervised periodically where the services are being
429.7provided to verify that the work is being performed competently and to identify problems
429.8and solutions to address issues relating to the staff's ability to provide the services. The
429.9supervision of the unlicensed personnel must be done by staff of the home care provider
429.10having the authority, skills, and ability to provide the supervision of unlicensed personnel
429.11and who can implement changes as needed, and train staff.
429.12(b) Supervision includes direct observation of unlicensed personnel while they
429.13are providing the services and may also include indirect methods of gaining input such
429.14as gathering feedback from the client. Supervisory review of staff must be provided at a
429.15frequency based on the staff person's competency and performance.
429.16(c) For an individual who is licensed as a home care provider, this section does
429.17not apply.
429.18    Subd. 3. Supervision of staff providing delegated nursing or therapy home
429.19care tasks. (a) Staff who perform delegated nursing or therapy home care tasks must be
429.20supervised by an appropriate licensed health professional or a registered nurse periodically
429.21where the services are being provided to verify that the work is being performed
429.22competently and to identify problems and solutions related to the staff person's ability to
429.23perform the tasks. Supervision of staff performing medication or treatment administration
429.24shall be provided by a registered nurse or appropriate licensed health professional and
429.25must include observation of the staff administering the medication or treatment and the
429.26interaction with the client.
429.27(b) The direct supervision of staff performing delegated tasks must be provided
429.28within 30 days after the individual begins working for the home care provider and
429.29thereafter as needed based on performance. This requirement also applies to staff who
429.30have not performed delegated tasks for one year or longer.
429.31    Subd. 4. Documentation. A home care provider must retain documentation of
429.32supervision activities in the personnel records.
429.33    Subd. 5. Exemption. This section does not apply to an individual licensed under
429.34sections 144A.43 to 144A.4799.

429.35    Sec. 24. [144A.4798] EMPLOYEE HEALTH STATUS.
430.1    Subdivision 1. Tuberculosis (TB) prevention and control. A home care provider
430.2must establish and maintain a TB prevention and control program based on the most
430.3current guidelines issued by the Centers for Disease Control and Prevention (CDC).
430.4Components of a TB prevention and control program include screening all staff providing
430.5home care services, both paid and unpaid, at the time of hire for active TB disease and
430.6latent TB infection, and developing and implementing a written TB infection control plan.
430.7The commissioner shall make the most recent CDC standards available to home care
430.8providers on the department's Web site.
430.9    Subd. 2. Communicable diseases. A home care provider must follow
430.10current federal or state guidelines for prevention, control, and reporting of human
430.11immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other
430.12communicable diseases as defined in Minnesota Rules, part 4605.7040.

430.13    Sec. 25. [144A.4799] DEPARTMENT OF HEALTH LICENSED HOME CARE
430.14PROVIDER ADVISORY COUNCIL.
430.15    Subdivision 1. Membership. The commissioner of health shall appoint eight
430.16persons to a home care provider advisory council consisting of the following:
430.17(1) three public members as defined in section 214.02 who shall be either persons
430.18who are currently receiving home care services or have family members receiving home
430.19care services, or persons who have family members who have received home care services
430.20within five years of the application date;
430.21(2) three Minnesota home care licensees representing basic and comprehensive
430.22levels of licensure who may be a managerial official, an administrator, a supervising
430.23registered nurse, or an unlicensed personnel performing home care tasks;
430.24(3) one member representing the Minnesota Board of Nursing; and
430.25(4) one member representing the ombudsman for long-term care.
430.26    Subd. 2. Organizations and meetings. The advisory council shall be organized
430.27and administered under section 15.059 with per diems and costs paid within the limits of
430.28available appropriations. Meetings will be held quarterly and hosted by the department.
430.29Subcommittees may be developed as necessary by the commissioner. Advisory council
430.30meetings are subject to the Open Meeting Law under chapter 13D.
430.31    Subd. 3. Duties. At the commissioner's request, the advisory council shall provide
430.32advice regarding regulations of Department of Health licensed home care providers in
430.33this chapter such as:
430.34(1) advice to the commissioner regarding community standards for home care
430.35practices;
431.1(2) advice to the commissioner on enforcement of licensing standards and whether
431.2certain disciplinary actions are appropriate;
431.3(3) advice to the commissioner about ways of distributing information to licensees
431.4and consumers of home care;
431.5(4) advice to the commissioner about training standards;
431.6(5) identify emerging issues and opportunities in the home care field, including the
431.7use of technology in home and telehealth capabilities; and
431.8(6) perform other duties as directed by the commissioner.

431.9    Sec. 26. [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR
431.10NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.
431.11    Subdivision 1. Temporary home care licenses and changes of ownership. (a)
431.12Beginning January 1, 2014, all temporary license applicants must apply for either a
431.13temporary basic or comprehensive home care license.
431.14(b) Temporary home care temporary licenses issued beginning January 1, 2014,
431.15will be issued according to the provisions in sections 144A.43 to 144A.4799 and fees in
431.16section 144A.472 and will be required to comply with this chapter.
431.17(c) No temporary licenses or licenses will be accepted or issued between October 1,
431.182013, and December 31, 2013.
431.19(d) Beginning October 1, 2013, changes in ownership applications will require
431.20payment of the new fees listed in section 144A.472.
431.21    Subd. 2. Current home care licensees with licenses prior to July 1, 2013. (a)
431.22Beginning July 1, 2014, department licensed home care providers must apply for either
431.23the basic or comprehensive home care license on their regularly scheduled renewal date.
431.24(b) By June 30, 2015, all home care providers must either have a basic or
431.25comprehensive home care license or temporary license.
431.26    Subd. 3. Renewal application of home care licensure during transition period.
431.27Renewal of home care licenses issued beginning July 1, 2014, will be issued according to
431.28sections 144A.43 to 144A.4799 and, upon license renewal, providers must comply with
431.29sections 144A.43 to 144A.4799. Prior to renewal, providers must comply with the home
431.30care licensure law in effect on June 30, 2013.
431.31The fees charged for licenses renewed between July 1, 2014, and June 30, 2016,
431.32shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000
431.33increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
432.1For fiscal year 2014 only, the fees for providers with revenues greater than $25,000
432.2and no more than $100,000 will be $313 and for providers with revenues no more than
432.3$25,000 the fee will be $125.

432.4    Sec. 27. [144A.482] REGISTRATION OF HOME MANAGEMENT
432.5PROVIDERS.
432.6(a) For purposes of this section, a home management provider is an individual or
432.7organization that provides at least two of the following services: housekeeping, meal
432.8preparation, and shopping, to a person who is unable to perform these activities due to
432.9illness, disability, or physical condition.
432.10(b) A person or organization that provides only home management services may not
432.11operate in the state without a current certificate of registration issued by the commissioner
432.12of health. To obtain a certificate of registration, the person or organization must annually
432.13submit to the commissioner the name, mailing and physical address, e-mail address, and
432.14telephone number of the individual or organization and a signed statement declaring that
432.15the individual or organization is aware that the home care bill of rights applies to their
432.16clients and that the person or organization will comply with the home care bill of rights
432.17provisions contained in section 144A.44. An individual or organization applying for a
432.18certificate must also provide the name, business address, and telephone number of each of
432.19the individuals responsible for the management or direction of the organization.
432.20(c) The commissioner shall charge an annual registration fee of $20 for individuals
432.21and $50 for organizations. The registration fee shall be deposited in the state treasury and
432.22credited to the state government special revenue fund.
432.23(d) A home care provider that provides home management services and other home
432.24care services must be licensed, but licensure requirements other than the home care bill of
432.25rights do not apply to those employees or volunteers who provide only home management
432.26services to clients who do not receive any other home care services from the provider.
432.27A licensed home care provider need not be registered as a home management service
432.28provider, but must provide an orientation on the home care bill of rights to its employees
432.29or volunteers who provide home management services.
432.30(e) An individual who provides home management services under this section must,
432.31within 120 days after beginning to provide services, attend an orientation session approved
432.32by the commissioner that provides training on the home care bill of rights and an orientation
432.33on the aging process and the needs and concerns of elderly and disabled persons.
432.34(f) The commissioner may suspend or revoke a provider's certificate of registration
432.35or assess fines for violation of the home care bill of rights. Any fine assessed for a
433.1violation of the home care bill of rights by a provider registered under this section shall be
433.2in the amount established in the licensure rules for home care providers. As a condition
433.3of registration, a provider must cooperate fully with any investigation conducted by the
433.4commissioner, including providing specific information requested by the commissioner on
433.5clients served and the employees and volunteers who provide services. Fines collected
433.6under this paragraph shall be deposited in the state treasury and credited to the fund
433.7specified in the statute or rule in which the penalty was established.
433.8(g) The commissioner may use any of the powers granted in sections 144A.43 to
433.9144A.4799 to administer the registration system and enforce the home care bill of rights
433.10under this section.

433.11    Sec. 28. AGENCY QUALITY IMPROVEMENT PROGRAM.
433.12    Subdivision 1. Annual legislative report on home care licensing. The
433.13commissioner shall establish a quality improvement program for the home care survey
433.14and home care complaint investigation processes. The commissioner shall submit to the
433.15legislature an annual report, beginning October 1, 2015, and each October 1 thereafter.
433.16Each report will review the previous state fiscal year of home care licensing and regulatory
433.17activities. The report must include, but is not limited to, an analysis of:
433.18(1) the number of FTE's in the Division of Compliance Monitoring, including the
433.19Office of Health Facility Complaints units assigned to home care licensing, survey,
433.20investigation and enforcement process;
433.21(2) numbers of and descriptive information about licenses issued, complaints
433.22received and investigated, including allegations made and correction orders issued,
433.23surveys completed and timelines, and correction order reconsiderations and results;
433.24(3) descriptions of emerging trends in home care provision and areas of concern
433.25identified by the department in its regulation of home care providers;
433.26(4) information and data regarding performance improvement projects underway
433.27and planned by the commissioner in the area of home care surveys; and
433.28(5) work of the Department of Health Home Care Advisory Council.
433.29    Subd. 2. Study of correction order appeal process. Starting July 1, 2015, the
433.30commissioner shall study whether to add a correction order appeal process conducted by
433.31an independent reviewer such as an administrative law judge or other office and submit a
433.32report to the legislature by February 1, 2016. The commissioner shall review home care
433.33regulatory systems in other states as part of that study. The commissioner shall consult
433.34with the home care providers and representatives.

434.1    Sec. 29. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
434.2AND COMMUNITY-BASED SERVICES.
434.3(a) The Department of Health Compliance Monitoring Division and the Department
434.4of Human Services Licensing Division shall jointly develop an integrated licensing system
434.5for providers of both home care services subject to licensure under Minnesota Statutes,
434.6chapter 144A, and for home and community-based services subject to licensure under
434.7Minnesota Statutes, chapter 245D. The integrated licensing system shall:
434.8(1) require only one license of any provider of services under Minnesota Statutes,
434.9sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
434.10(2) promote quality services that recognize a person's individual needs and protect
434.11the person's health, safety, rights, and well-being;
434.12(3) promote provider accountability through application requirements, compliance
434.13inspections, investigations, and enforcement actions;
434.14(4) reference other applicable requirements in existing state and federal laws,
434.15including the federal Affordable Care Act;
434.16(5) establish internal procedures to facilitate ongoing communications between the
434.17agencies, and with providers and services recipients about the regulatory activities;
434.18(6) create a link between the agency Web sites so that providers and the public can
434.19access the same information regardless of which Web site is accessed initially; and
434.20(7) collect data on identified outcome measures as necessary for the agencies to
434.21report to the Centers for Medicare and Medicaid Services.
434.22(b) The joint recommendations for legislative changes to implement the integrated
434.23licensing system are due to the legislature by February 15, 2014.
434.24(c) Before implementation of the integrated licensing system, providers licensed as
434.25home care providers under Minnesota Statutes, chapter 144A, may also provide home
434.26and community-based services subject to licensure under Minnesota Statutes, chapter
434.27245D, without obtaining a home and community-based services license under Minnesota
434.28Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
434.29apply to these providers:
434.30(1) the provider must comply with all requirements under Minnesota Statutes, chapter
434.31245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
434.32(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
434.33enforced by the Department of Health under the enforcement authority set forth in
434.34Minnesota Statutes, section 144A.475; and
434.35(3) the Department of Health will provide information to the Department of Human
434.36Services about each provider licensed under this section, including the provider's license
435.1application, licensing documents, inspections, information about complaints received, and
435.2investigations conducted for possible violations of Minnesota Statutes, chapter 245D.

435.3    Sec. 30. REPEALER.
435.4(a) Minnesota Statutes 2012, sections 144A.46; and 144A.461, are repealed.
435.5(b) Minnesota Rules, parts 4668.0002; 4668.0003; 4668.0005; 4668.0008;
435.64668.0012; 4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040;
435.74668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100;
435.84668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160; 4668.0170;
435.94668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220; 4668.0230; 4668.0240;
435.104668.0800; 4668.0805; 4668.0810; 4668.0815; 4668.0820; 4668.0825; 4668.0830;
435.114668.0835; 4668.0840; 4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870;
435.124669.0001; 4669.0010; 4669.0020; 4669.0030; 4669.0040; and 4669.0050, are repealed.

435.13    Sec. 31. EFFECTIVE DATE.
435.14Sections 1 to 30 are effective the day following final enactment.


435.17    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 2, is amended to read:
435.18    Subd. 2. Transfers. (a) Notwithstanding section 295.581, to the extent available
435.19resources in the health care access fund exceed expenditures in that fund, effective for
435.20the biennium beginning July 1, 2007, the commissioner of management and budget shall
435.21transfer the excess funds from the health care access fund to the general fund on June 30
435.22of each year, provided that the amount transferred in any fiscal biennium shall not exceed
435.23$96,000,000. The purpose of this transfer is to meet the rate increase required under Laws
435.242003, First Special Session chapter 14, article 13C, section 2, subdivision 6.
435.25    (b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and,
435.26if necessary, the commissioner shall reduce these transfers from the health care access
435.27fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary,
435.28transfer sufficient funds from the general fund to the health care access fund to meet
435.29annual MinnesotaCare expenditures.
435.30(c) Notwithstanding section 295.581, to the extent available resources in the health
435.31care access fund exceed expenditures in that fund, effective for the biennium beginning
435.32July 1, 2013, the commissioner of management and budget shall transfer $1,000,000 each
435.33fiscal year from the health access fund to the medical education and research costs fund
436.1established under section 62J.692, for distribution under section 62J.692, subdivision 4,
436.2paragraph (b).

436.3    Sec. 2. [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
436.4    Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
436.5paragraphs (b) to (e) have the meanings given.
436.6    (b) "Autism spectrum disorders" means the conditions as determined by criteria
436.7set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental
436.8Disorders of the American Psychiatric Association.
436.9    (c) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
436.10    (d) "Medically necessary care" means health care services appropriate, in terms of
436.11type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
436.12testing and preventative services. Medically necessary care must be consistent with
436.13generally accepted practice parameters as determined by physicians and licensed
436.14psychologists who typically manage patients who have autism spectrum disorders.
436.15    (e) "Mental health professional" has the meaning given in section 245.4871,
436.16subdivision 27.
436.17    Subd. 2. Optional coverage required. (a) A health plan must provide:
436.18    (1) all health benefits related to the treatment of autism spectrum disorders required
436.19by the essential health benefits required under section 1302 of the Affordable Care Act;
436.20    (2) all health benefits required by this section or any other section of Minnesota
436.21Statutes as of December 31, 2012; and
436.22    (3) an offer of one or more options for the purchase of supplemental autism coverage
436.23for young children for children under age 18 for the diagnosis, evaluation, assessment,
436.24and medically necessary care of autism spectrum disorders, including but not limited to
436.25the following:
436.26    (i) early intensive behavioral and developmental therapy based in behavioral and
436.27developmental science, including but not limited to applied behavior analysis, intensive
436.28early intervention behavior therapy, intensive behavior intervention, and Lovaas therapy
436.29and developmental approaches;
436.30    (ii) neurodevelopmental and behavioral health treatments and management;
436.31    (iii) speech therapy;
436.32    (iv) occupational therapy;
436.33    (v) physical therapy; and
436.34    (vi) medications.
437.1    (b) The diagnosis, evaluation, and assessment must include an assessment of the
437.2child's developmental skills, functional behavior, needs, and capacities.
437.3    (c) The coverage option required under this section shall include treatment that is
437.4in accordance with an individualized treatment plan prescribed by the insured's treating
437.5physician or mental health professional.
437.6    (d) A health plan may not refuse to renew or reissue, or otherwise terminate or
437.7restrict, coverage of an individual solely because the individual is diagnosed with an
437.8autism spectrum disorder.
437.9    (e) A health plan may request an updated treatment plan only once every six months,
437.10unless the health plan and the treating physician or mental health professional agree that a
437.11more frequent review is necessary due to emerging circumstances.
437.12    (f) An independent progress evaluation conducted by a mental health professional
437.13with expertise and training in autism spectrum disorder and child development must
437.14be completed to determine if progress toward functional and generalizable gains, as
437.15determined in the treatment plan, is being made.
437.16    (g) A health plan may cap the dollar value of the supplemental coverage offered
437.17under this subdivision, but may not cap the value at less than $50,000 per calendar year
437.18per individual receiving a diagnosis of autism spectrum disorder.
437.19    Subd. 3. No effect on other law. Nothing in this section limits in any way the
437.20coverage required under section 62Q.47.
437.21    Subd. 4. State health care programs. This section does not affect benefits available
437.22under the medical assistance and MinnesotaCare programs and does not limit, restrict, or
437.23otherwise reduce coverage under these programs.
437.24EFFECTIVE DATE.This section is effective January 1, 2014, and sunsets effective
437.25December 31, 2015, and applies to coverage offered, issued, sold, renewed, or continued
437.26as defined in Minnesota Statutes, section 60A.02, subdivision 2a, on or after that date.

437.27    Sec. 3. [62D.0425] NET WORTH LIMIT.
437.28(a) Between July 1, 2013, and June 30, 2018, no health maintenance organization
437.29shall have a net worth of more than 25 percent of the sum of all expenses incurred during
437.30the most recent calendar year, except as provided in paragraph (b).
437.31(b) A health maintenance organization may have a net worth of more than 25 percent
437.32of the sum of all expenses incurred during the most recent calendar year if necessary to
437.33maintain capital reserves at the level of the product of 2.0 and its authorized control
437.34level risk-based capital, as required pursuant to sections 60A.50 to 60A.592 and 62D.04.
437.35Paragraphs (c) and (d) do not apply to health maintenance organizations permitted, under
438.1this paragraph, to have a net worth greater than 25 percent of the sum of all expenses
438.2incurred during the most recent calendar year.
438.3(c) By June 15, 2013, and annually thereafter until June 15, 2017, for a health
438.4maintenance organization that has a net worth of more than 25 percent of the sum of all
438.5expenses incurred during the most recent calendar year, the commissioner of health, in
438.6consultation with the commissioners of commerce and human services, shall determine:
438.7(1) capital reserves using the National Association of Insurance Commissioners
438.8definitions of admitted assets, which shall be used in clauses (2) to (5);
438.9(2) the proportion of capital reserves that are reasonably attributable to net
438.10underwriting gains in Minnesota public health care programs based on annual financial
438.11filings for calendar years 2003 through 2012;
438.12(3) the proportion of capital reserves that are reasonably attributable to investment
438.13gains associated with net underwriting gains in Minnesota public health care programs
438.14based on annual financial filings for calendar years 2003 through 2012;
438.15(4) any adjustments needed to clause (1) or (2) based on corporate reorganizations,
438.16since 2003; and
438.17(5) any adjustments needed to account for the impact of annual financial filings for
438.18calendar years 2013 through 2016.
438.19(d) A health maintenance organization that has a net worth of more than 25 percent
438.20of the sum of all expenses incurred during the most recent calendar year shall reduce its
438.21capital reserves as follows:
438.22(1) as determined by paragraph (c), the proportion of capital reserves that are greater
438.23than 25 percent of the sum of all expenses incurred during the most recent calendar
438.24year and that are reasonably attributable to net underwriting gains and investment gains
438.25associated with net underwriting gains in Minnesota public health care programs shall be
438.26spent down. The health maintenance organization shall place excess capital reserves in a
438.27special restricted account under the control of the health maintenance organization. The
438.28special restricted account may only be used to pay for a portion of the health maintenance
438.29organization's current public program enrollee premiums. The health maintenance
438.30organization shall spend no less than 50 percent of this special restricted account in any
438.31state fiscal year beginning on or after July 1, 2013; and
438.32(2) the proportion of capital reserves that are greater than 25 percent of the
438.33sum of all expenses incurred during the most recent calendar year and that are not
438.34reasonably attributable to net underwriting gains and investment gains associated with net
438.35underwriting gains in Minnesota public health care programs shall be spent down. The
438.36health maintenance organization shall place these excess capital reserves in a second
439.1special restricted account under the control of the health maintenance organization. The
439.2health maintenance organization may use this special restricted account to benefit current
439.3enrollees by moderating variation in premium increases, assisting enrollees in accessing
439.4new benefits, reducing health disparities, promoting health, wellness and preventive
439.5services, and improving care coordination. Prior to spending down excess reserves from
439.6this special revenue account, the health maintenance organization's spenddown plan must
439.7be approved by the commissioner of health. The health maintenance organization shall
439.8spend no less than 33 percent of this special restricted account in any state fiscal year
439.9beginning July 1, 2013.
439.10(e) The health maintenance organization must spend down all of the reserves placed
439.11in its special restricted accounts by July 1, 2018. All reserves placed in a special account
439.12must be spent according to paragraph (d), unless the reserves are necessary for the health
439.13maintenance organization to maintain capital reserves at the level of the product of 2.0 and
439.14its authorized control level risk-based capital, as required pursuant to sections 60A.50 to
439.1560A.592 and 62D.04, in which case the health maintenance organization may transfer funds
439.16out of its special restricted accounts in a manner approved by the commissioner of health.
439.17(f) The commissioner of health must approve all health maintenance organization
439.18expenditures for the acquisition of any asset that is not an admitted asset under National
439.19Association of Insurance Commissioners definitions. The commissioner shall disapprove
439.20any acquisition unless the health maintenance organization demonstrates that the
439.21acquisition is: (1) consistent with its long-standing business practices; or (2) more
439.22beneficial to enrollees than benefits to enrollees under paragraph (d).

439.23    Sec. 4. Minnesota Statutes 2012, section 62J.692, subdivision 4, is amended to read:
439.24    Subd. 4. Distribution of funds. (a) The commissioner shall annually distribute the
439.25available medical education funds to all qualifying applicants based on a distribution
439.26formula that reflects a summation of two factors:
439.27    (1) a public program volume factor, which is determined by the total volume of
439.28public program revenue received by each training site as a percentage of all public
439.29program revenue received by all training sites in the fund pool; and
439.30    (2) a supplemental public program volume factor, which is determined by providing
439.31a supplemental payment of 20 percent of each training site's grant to training sites whose
439.32public program revenue accounted for at least 0.98 percent of the total public program
439.33revenue received by all eligible training sites. Grants to training sites whose public
439.34program revenue accounted for less than 0.98 percent of the total public program revenue
440.1received by all eligible training sites shall be reduced by an amount equal to the total
440.2value of the supplemental payment.
440.3    Public program revenue for the distribution formula includes revenue from medical
440.4assistance, prepaid medical assistance, general assistance medical care, and prepaid
440.5general assistance medical care. Training sites that receive no public program revenue
440.6are ineligible for funds available under this subdivision. For purposes of determining
440.7training-site level grants to be distributed under paragraph (a), total statewide average
440.8costs per trainee for medical residents is based on audited clinical training costs per trainee
440.9in primary care clinical medical education programs for medical residents. Total statewide
440.10average costs per trainee for dental residents is based on audited clinical training costs
440.11per trainee in clinical medical education programs for dental students. Total statewide
440.12average costs per trainee for pharmacy residents is based on audited clinical training costs
440.13per trainee in clinical medical education programs for pharmacy students. Training sites
440.14whose training site level grant is less than $1,000, based on the formula described in this
440.15paragraph, are ineligible for funds available under this subdivision.
440.16    (b) Of available medical education funds, $1,000,000 shall be distributed each year
440.17for grants to family medicine residency programs located outside of the seven-county
440.18metropolitan area, as defined in section 473.121, subdivision 4, focused on eduction and
440.19training of family medicine physicians to serve communities outside the metropolitan area.
440.20To be eligible for a grant under this paragraph, a family medicine residency program must
440.21demonstrate that over the most recent three calendar years, at least 25 percent of its residents
440.22practice in Minnesota communities outside of the metropolitan area. Grant funds must be
440.23allocated proportionally based on the number of residents per eligible residency program.
440.24    (c) Funds distributed shall not be used to displace current funding appropriations
440.25from federal or state sources.
440.26    (c) (d) Funds shall be distributed to the sponsoring institutions indicating the amount
440.27to be distributed to each of the sponsor's clinical medical education programs based on
440.28the criteria in this subdivision and in accordance with the commissioner's approval letter.
440.29Each clinical medical education program must distribute funds allocated under paragraph
440.30(a) to the training sites as specified in the commissioner's approval letter. Sponsoring
440.31institutions, which are accredited through an organization recognized by the Department
440.32of Education or the Centers for Medicare and Medicaid Services, may contract directly
440.33with training sites to provide clinical training. To ensure the quality of clinical training,
440.34those accredited sponsoring institutions must:
440.35    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical
440.36training conducted at sites; and
441.1    (2) take necessary action if the contract requirements are not met. Action may include
441.2the withholding of payments under this section or the removal of students from the site.
441.3    (d) (e) Any funds not distributed in accordance with the commissioner's approval
441.4letter must be returned to the medical education and research fund within 30 days of
441.5receiving notice from the commissioner. The commissioner shall distribute returned funds
441.6to the appropriate training sites in accordance with the commissioner's approval letter.
441.7    (e) (f) A maximum of $150,000 of the funds dedicated to the commissioner
441.8under section 297F.10, subdivision 1, clause (2), may be used by the commissioner for
441.9administrative expenses associated with implementing this section.

441.10    Sec. 5. Minnesota Statutes 2012, section 62Q.19, subdivision 1, is amended to read:
441.11    Subdivision 1. Designation. (a) The commissioner shall designate essential
441.12community providers. The criteria for essential community provider designation shall be
441.13the following:
441.14(1) a demonstrated ability to integrate applicable supportive and stabilizing services
441.15with medical care for uninsured persons and high-risk and special needs populations,
441.16underserved, and other special needs populations; and
441.17(2) a commitment to serve low-income and underserved populations by meeting the
441.18following requirements:
441.19(i) has nonprofit status in accordance with chapter 317A;
441.20(ii) has tax-exempt status in accordance with the Internal Revenue Service Code,
441.21section 501(c)(3);
441.22(iii) charges for services on a sliding fee schedule based on current poverty income
441.23guidelines; and
441.24(iv) does not restrict access or services because of a client's financial limitation;
441.25(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
441.26hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
441.27government, an Indian health service unit, or a community health board as defined in
441.28chapter 145A;
441.29(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
441.30bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
441.31conditions;
441.32(5) a sole community hospital. For these rural hospitals, the essential community
441.33provider designation applies to all health services provided, including both inpatient and
441.34outpatient services. For purposes of this section, "sole community hospital" means a
441.35rural hospital that:
442.1(i) is eligible to be classified as a sole community hospital according to Code
442.2of Federal Regulations, title 42, section 412.92, or is located in a community with a
442.3population of less than 5,000 and located more than 25 miles from a like hospital currently
442.4providing acute short-term services;
442.5(ii) has experienced net operating income losses in two of the previous three
442.6most recent consecutive hospital fiscal years for which audited financial information is
442.7available; and
442.8(iii) consists of 40 or fewer licensed beds; or
442.9(6) a birth center licensed under section 144.615.; or
442.10(7) a hospital, and its affiliated specialty clinics, whose inpatients are predominantly
442.11under 21 years of age and that meets the following criteria:
442.12(i) provides intensive specialty pediatric services that are routinely provided in
442.13only four or fewer hospitals in the state; and
442.14(ii) serves children from at least one-half of the counties in the state.
442.15(b) Prior to designation, the commissioner shall publish the names of all applicants
442.16in the State Register. The public shall have 30 days from the date of publication to submit
442.17written comments to the commissioner on the application. No designation shall be made
442.18by the commissioner until the 30-day period has expired.
442.19(c) The commissioner may designate an eligible provider as an essential community
442.20provider for all the services offered by that provider or for specific services designated by
442.21the commissioner.
442.22(d) For the purpose of this subdivision, supportive and stabilizing services include at
442.23a minimum, transportation, child care, cultural, and linguistic services where appropriate.

442.24    Sec. 6. Minnesota Statutes 2012, section 103I.005, is amended by adding a subdivision
442.25to read:
442.26    Subd. 1a. Bored geothermal heat exchanger. "Bored geothermal heat exchanger"
442.27means an earth-coupled heating or cooling device consisting of a sealed closed-loop
442.28piping system installed in a boring in the ground to transfer heat to or from the surrounding
442.29earth with no discharge.

442.30    Sec. 7. Minnesota Statutes 2012, section 103I.521, is amended to read:
442.31103I.521 FEES DEPOSITED WITH COMMISSIONER OF MANAGEMENT
442.32AND BUDGET.
443.1Unless otherwise specified, fees collected for licenses or registration by the
443.2commissioner under this chapter shall be deposited in the state treasury and credited to
443.3the state government special revenue fund.

443.4    Sec. 8. Minnesota Statutes 2012, section 144.0724, subdivision 6, is amended to read:
443.5    Subd. 6. Penalties for late or nonsubmission. A facility that fails to complete or
443.6submit an assessment for a RUG-III or RUG-IV classification within seven days of the
443.7time requirements in subdivisions 4 and 5 is subject to a reduced rate for that resident.
443.8The reduced rate shall be the lowest rate for that facility. The reduced rate is effective on
443.9the day of admission for new admission assessments or on the day that the assessment
443.10was due for all other assessments and continues in effect until the first day of the month
443.11following the date of submission of the resident's assessment. If loss of revenue due to
443.12penalties incurred by a facility for any period of 92 days are equal to or greater than 1.0
443.13percent of the total operating costs on the facility's most recent annual statistical and cost
443.14report, a facility may apply to the commissioner of human services for a reduction in
443.15the total penalty amount. The commissioner of human services in consultation with the
443.16commissioner of health may, at the sole discretion of the commissioner of human services,
443.17limit the penalty for residents covered by medical assistance to 15 days.

443.18    Sec. 9. Minnesota Statutes 2012, section 144.123, subdivision 1, is amended to read:
443.19    Subdivision 1. Who must pay. Except for the limitation contained in this section,
443.20the commissioner of health shall charge a handling fee may enter into a contractual
443.21agreement to recover costs incurred for analysis for diagnostic purposes for each specimen
443.22submitted to the Department of Health for analysis for diagnostic purposes by any hospital,
443.23private laboratory, private clinic, or physician. No fee shall be charged to any entity which
443.24receives direct or indirect financial assistance from state or federal funds administered by
443.25the Department of Health, including any public health department, nonprofit community
443.26clinic, sexually transmitted disease clinic, or similar entity. No fee will be charged The
443.27commissioner shall not charge for any biological materials submitted to the Department
443.28of Health as a requirement of Minnesota Rules, part 4605.7040, or for those biological
443.29materials requested by the department to gather information for disease prevention or
443.30control purposes. The commissioner of health may establish other exceptions to the
443.31handling fee as may be necessary to protect the public's health. All fees collected pursuant
443.32to this section shall be deposited in the state treasury and credited to the state government
443.33special revenue fund. Funds generated in a contractual agreement made pursuant to this
443.34section shall be deposited in a special account and are appropriated to the commissioner
444.1for purposes of providing the services specified in the contracts. All such contractual
444.2agreements shall be processed in accordance with the provisions of chapter 16C.
444.3EFFECTIVE DATE.This section is effective July 1, 2014.

444.4    Sec. 10. Minnesota Statutes 2012, section 144.125, subdivision 1, is amended to read:
444.5    Subdivision 1. Duty to perform testing. (a) It is the duty of (1) the administrative
444.6officer or other person in charge of each institution caring for infants 28 days or less
444.7of age, (2) the person required in pursuance of the provisions of section 144.215, to
444.8register the birth of a child, or (3) the nurse midwife or midwife in attendance at the
444.9birth, to arrange to have administered to every infant or child in its care tests for heritable
444.10and congenital disorders according to subdivision 2 and rules prescribed by the state
444.11commissioner of health.
444.12    (b) Testing and the, recording and of test results, reporting of test results, and
444.13follow-up of infants with heritable congenital disorders, including hearing loss detected
444.14through the early hearing detection and intervention program in section 144.966, shall be
444.15performed at the times and in the manner prescribed by the commissioner of health. The
444.16commissioner shall charge a fee so that the total of fees collected will approximate the
444.17costs of conducting the tests and implementing and maintaining a system to follow-up
444.18infants with heritable or congenital disorders, including hearing loss detected through the
444.19early hearing detection and intervention program under section 144.966.
444.20    (c) The fee is $101 per specimen. Effective July 1, 2010, the fee shall be increased
444.21to $106 to support the newborn screening program, including tests administered under
444.22this section and section 144.966, shall be $145 per specimen. The increased fee amount
444.23shall be deposited in the general fund. Costs associated with capital expenditures and
444.24the development of new procedures may be prorated over a three-year period when
444.25calculating the amount of the fees. This fee amount shall be deposited in the state treasury
444.26and credited to the state government special revenue fund.
444.27(d) The fee to offset the cost of the support services provided under section 144.966,
444.28subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury
444.29and credited to the general fund.

444.30    Sec. 11. [144.1251] NEWBORN SCREENING FOR CRITICAL CONGENITAL
444.31HEART DISEASE (CCHD).
444.32    Subdivision 1. Required testing and reporting. Each licensed hospital or
444.33state-licensed birthing center or facility that provides maternity and newborn care services
444.34shall provide screening for congenital heart disease to all newborns prior to discharge
445.1using pulse oximetry screening. This screening should occur before discharge from the
445.2nursery, after the infant turns 24 hours of age. If discharge prior to 24 hours after birth
445.3occurs, screening should occur as close as possible to the time of discharge. Results of this
445.4screening must be reported to the Department of Health.
445.5For premature infants (less than 36 weeks of gestation) and infants admitted to a
445.6higher-level nursery (special care or intensive care), pulse oximetry should be performed
445.7when medically appropriate, but always prior to discharge.
445.8    Subd. 2. Implementation. The Department of Health shall:
445.9(1) communicate the screening protocol requirements;
445.10(2) make information and forms available to the persons with a duty to perform
445.11testing and reporting, health care providers, parents of newborns, and the public on
445.12screening and parental options;
445.13(3) provide training to ensure compliance with and appropriate implementation of
445.14the screening;
445.15(4) establish the mechanism for the required data collection and reporting of
445.16screening and follow-up diagnostic results to the Department of Health according to the
445.17Department of Health's recommendations;
445.18(5) coordinate the implementation of universal standardized screening;
445.19(6) act as a resource for providers as the screening program is implemented, and in
445.20consultation with the Advisory Committee on Heritable and Congenital Disorders, develop
445.21and implement policies for early medical and developmental intervention services and
445.22long-term follow-up services for children and their families identified with a CCHD; and
445.23(7) comply with sections 144.125 to 144.128.

445.24    Sec. 12. [144.492] DEFINITIONS.
445.25    Subdivision 1. Applicability. For the purposes of sections 144.492 to 144.494, the
445.26terms defined in this section have the meanings given them.
445.27    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.
445.28    Subd. 3. Stroke. "Stroke" means the sudden death of brain cells in a localized
445.29area due to inadequate blood flow.

445.30    Sec. 13. [144.493] CRITERIA.
445.31    Subdivision 1. Comprehensive stroke center. A hospital meets the criteria for a
445.32comprehensive stroke center if the hospital has been certified as a comprehensive stroke
445.33center by the joint commission or another nationally recognized accreditation entity.
446.1    Subd. 2. Primary stroke center. A hospital meets the criteria for a primary stroke
446.2center if the hospital has been certified as a primary stroke center by the joint commission
446.3or another nationally recognized accreditation entity.
446.4    Subd. 3. Acute stroke ready hospital. A hospital meets the criteria for an acute
446.5stroke ready hospital if the hospital has the following elements of an acute stroke ready
446.6hospital:
446.7(1) an acute stroke team available and/or on-call 24 hours a days, seven days a week;
446.8(2) written stroke protocols, including triage, stabilization of vital functions, initial
446.9diagnostic tests, and use of medications;
446.10(3) a written plan and letter of cooperation with emergency medical services regarding
446.11triage and communication that are consistent with regional patient care procedures;
446.12(4) emergency department personnel who are trained in diagnosing and treating
446.13acute stroke;
446.14(5) the capacity to complete basic laboratory tests, electrocardiograms, and chest
446.15x-rays 24 hours a day, seven days a week;
446.16(6) the capacity to perform and interpret brain injury imaging studies 24 hours a
446.17days, seven days a week;
446.18(7) written protocols that detail available emergent therapies and reflect current
446.19treatment guidelines, which include performance measures and are revised at least annually;
446.20(8) a neurosurgery coverage plan, call schedule, and a triage and transportation plan;
446.21(9) transfer protocols and agreements for stroke patients; and
446.22(10) a designated medical director with experience and expertise in acute stroke care.

446.23    Sec. 14. [144.494] DESIGNATING STROKE CENTERS AND STROKE
446.24HOSPITALS.
446.25    Subdivision 1. Naming privileges. Unless it has been designated as a stroke center
446.26or stroke hospital pursuant to section 144.493, no hospital shall use the term "stroke
446.27center" or "stroke hospital" in its name or its advertising or shall otherwise indicate it
446.28has stroke treatment capabilities.
446.29    Subd. 2. Designation. A hospital that voluntarily meets the criteria for a
446.30comprehensive stroke center, primary stroke center, or acute stroke ready hospital may
446.31apply to the commissioner for designation, and upon the commissioner's review and
446.32approval of the application, shall be designated as a comprehensive stroke center, a
446.33primary stroke center, or an acute stroke ready hospital for a three-year period. If a hospital
446.34loses its certification as a comprehensive stroke center or primary stroke center from
446.35the joint commission or other nationally recognized accreditation entity, its Minnesota
447.1designation will be immediately withdrawn. Prior to the expiration of the three-year
447.2designation, a hospital seeking to remain part of the voluntary acute stroke system may
447.3reapply to the commissioner for designation.

447.4    Sec. 15. [144.554] HEALTH FACILITIES CONSTRUCTION PLAN
447.5SUBMITTAL AND FEES.
447.6For hospitals, nursing homes, boarding care homes, residential hospices, supervised
447.7living facilities, freestanding outpatient surgical centers, and end-stage renal disease
447.8facilities, the commissioner shall collect a fee for the review and approval of architectural,
447.9mechanical, and electrical plans and specifications submitted before construction begins
447.10for each project relative to construction of new buildings, additions to existing buildings,
447.11or for remodeling or alterations of existing buildings. All fees collected in this section
447.12shall be deposited in the state treasury and credited to the state government special revenue
447.13fund. Fees must be paid at the time of submission of final plans for review and are not
447.14refundable. The fee is calculated as follows:

447.15	Construction project total estimated cost	Fee
447.16	$0 - $10,000	$30
447.17	$10,001 - $50,000	$150
447.18	$50,001 - $100,000	$300
447.19	$100,001 - $150,000	$450
447.20	$150,001 - $200,000	$600
447.21	$200,001 - $250,000	$750
447.22	$250,001 - $300,000	$900
447.23	$300,001 - $350,000	$1,050
447.24	$350,001 - $400,000	$1,200
447.25	$400,001 - $450,000	$1,350
447.26	$450,001 - $500,000	$1,500
447.27	$500,001 - $550,000	$1,650
447.28	$550,001 - $600,000	$1,800
447.29	$600,001 - $650,000	$1,950
447.30	$650,001 - $700,000	$2,100
447.31	$700,001 - $750,000	$2,250
447.32	$750,001 - $800,000	$2,400
447.33	$800,001 - $850,000	$2,550
447.34	$850,001 - $900,000	$2,700
447.35	$900,001 - $950,000	$2,850
447.36	$950,001 - $1,000,000	$3,000
447.37	$1,000,001 - $1,050,000	$3,150
447.38	$1,050,001 - $1,100,000	$3,300
447.39	$1,100,001 - $1,150,000	$3,450
448.1	$1,150,001 - $1,200,000	$3,600
448.2	$1,200,001 - $1,250,000	$3,750
448.3	$1,250,001 - $1,300,000	$3,900
448.4	$1,300,001 - $1,350,000	$4,050
448.5	$1,350,001 - $1,400,000	$4,200
448.6	$1,400,001 - $1,450,000	$4,350
448.7	$1,450,001 - $1,500,000	$4,500
448.8	$1,500,001 and over	$4,800

448.9    Sec. 16. Minnesota Statutes 2012, section 144.966, subdivision 2, is amended to read:
448.10    Subd. 2. Newborn Hearing Screening Advisory Committee. (a) The
448.11commissioner of health shall establish a Newborn Hearing Screening Advisory Committee
448.12to advise and assist the Department of Health and the Department of Education in:
448.13    (1) developing protocols and timelines for screening, rescreening, and diagnostic
448.14audiological assessment and early medical, audiological, and educational intervention
448.15services for children who are deaf or hard-of-hearing;
448.16    (2) designing protocols for tracking children from birth through age three that may
448.17have passed newborn screening but are at risk for delayed or late onset of permanent
448.18hearing loss;
448.19    (3) designing a technical assistance program to support facilities implementing the
448.20screening program and facilities conducting rescreening and diagnostic audiological
448.21assessment;
448.22    (4) designing implementation and evaluation of a system of follow-up and tracking;
448.23and
448.24    (5) evaluating program outcomes to increase effectiveness and efficiency and ensure
448.25culturally appropriate services for children with a confirmed hearing loss and their families.
448.26    (b) The commissioner of health shall appoint at least one member from each of the
448.27following groups with no less than two of the members being deaf or hard-of-hearing:
448.28    (1) a representative from a consumer organization representing culturally deaf
448.29persons;
448.30    (2) a parent with a child with hearing loss representing a parent organization;
448.31    (3) a consumer from an organization representing oral communication options;
448.32    (4) a consumer from an organization representing cued speech communication
448.33options;
448.34    (5) an audiologist who has experience in evaluation and intervention of infants
448.35and young children;
449.1    (6) a speech-language pathologist who has experience in evaluation and intervention
449.2of infants and young children;
449.3    (7) two primary care providers who have experience in the care of infants and young
449.4children, one of which shall be a pediatrician;
449.5    (8) a representative from the early hearing detection intervention teams;
449.6    (9) a representative from the Department of Education resource center for the deaf
449.7and hard-of-hearing or the representative's designee;
449.8    (10) a representative of the Commission of Deaf, DeafBlind and Hard-of-Hearing
449.9Minnesotans;
449.10    (11) a representative from the Department of Human Services Deaf and
449.11Hard-of-Hearing Services Division;
449.12    (12) one or more of the Part C coordinators from the Department of Education, the
449.13Department of Health, or the Department of Human Services or the department's designees;
449.14    (13) the Department of Health early hearing detection and intervention coordinators;
449.15    (14) two birth hospital representatives from one rural and one urban hospital;
449.16    (15) a pediatric geneticist;
449.17    (16) an otolaryngologist;
449.18    (17) a representative from the Newborn Screening Advisory Committee under
449.19this subdivision; and
449.20    (18) a representative of the Department of Education regional low-incidence
449.21facilitators.
449.22The commissioner must complete the appointments required under this subdivision by
449.23September 1, 2007.
449.24    (c) The Department of Health member shall chair the first meeting of the committee.
449.25At the first meeting, the committee shall elect a chair from its membership. The committee
449.26shall meet at the call of the chair, at least four times a year. The committee shall adopt
449.27written bylaws to govern its activities. The Department of Health shall provide technical
449.28and administrative support services as required by the committee. These services shall
449.29include technical support from individuals qualified to administer infant hearing screening,
449.30rescreening, and diagnostic audiological assessments.
449.31    Members of the committee shall receive no compensation for their service, but
449.32shall be reimbursed as provided in section 15.059 for expenses incurred as a result of
449.33their duties as members of the committee.
449.34    (d) This subdivision expires June 30, 2013 2019.

449.35    Sec. 17. Minnesota Statutes 2012, section 144.966, subdivision 3a, is amended to read:
450.1    Subd. 3a. Support services to families. The commissioner shall contract with a
450.2nonprofit organization to provide support and assistance to families with children who are
450.3deaf or have a hearing loss. The family support provided must include:
450.4    (1) direct hearing loss specific parent-to-parent assistance and unbiased information
450.5on communication, educational, and medical options, preferably provided by a program
450.6that is part of a national organization; and
450.7    (2) individualized deaf or hard of hearing mentors who provide education, including
450.8instruction in American Sign Language.
450.9The commissioner shall give preference to a nonprofit organization that has the ability to
450.10provide these services throughout the state.

450.11    Sec. 18. Minnesota Statutes 2012, section 144.98, subdivision 3, is amended to read:
450.12    Subd. 3. Annual fees. (a) An application for accreditation under subdivision 6 must
450.13be accompanied by the annual fees specified in this subdivision. The annual fees include:
450.14(1) base accreditation fee, $1,500 $600;
450.15(2) sample preparation techniques fee, $200 per technique;
450.16(3) an administrative fee for laboratories located outside this state, $3,750 $2,000; and
450.17(4) test category fees.
450.18(b) For the programs in subdivision 3a, the commissioner may accredit laboratories
450.19for fields of testing under the categories listed in clauses (1) to (10) upon completion of
450.20the application requirements provided by subdivision 6 and receipt of the fees for each
450.21category under each program that accreditation is requested. The categories offered and
450.22related fees include:
450.23(1) microbiology, $450 $200;
450.24(2) inorganics, $450 $200;
450.25(3) metals, $1,000 $500;
450.26(4) volatile organics, $1,300 $1,000;
450.27(5) other organics, $1,300 $1,000;
450.28(6) radiochemistry, $1,500 $750;
450.29(7) emerging contaminants, $1,500 $1,000;
450.30(8) agricultural contaminants, $1,250 $1,000;
450.31(9) toxicity (bioassay), $1,000 $500; and
450.32(10) physical characterization, $250.
450.33(c) The total annual fee includes the base fee, the sample preparation techniques
450.34fees, the test category fees per program, and, when applicable, an administrative fee for
450.35out-of-state laboratories.
451.1EFFECTIVE DATE.This section is effective the day following final enactment.

451.2    Sec. 19. Minnesota Statutes 2012, section 144.98, subdivision 5, is amended to read:
451.3    Subd. 5. State government special revenue fund. Fees collected by the
451.4commissioner under this section must be deposited in the state treasury and credited to
451.5the state government special revenue fund.
451.6EFFECTIVE DATE.This section is effective the day following final enactment.

451.7    Sec. 20. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
451.8to read:
451.9    Subd. 10. Establishing a selection committee. (a) The commissioner shall
451.10establish a selection committee for the purpose of recommending approval of qualified
451.11laboratory assessors and assessment bodies. Committee members shall demonstrate
451.12competence in assessment practices. The committee shall initially consist of seven
451.13members appointed by the commissioner as follows:
451.14(1) one member from a municipal laboratory accredited by the commissioner;
451.15(2) one member from an industrial treatment laboratory accredited by the
451.16commissioner;
451.17(3) one member from a commercial laboratory located in this state and accredited by
451.18the commissioner;
451.19(4) one member from a commercial laboratory located outside the state and
451.20accredited by the commissioner;
451.21(5) one member from a nongovernmental client of environmental laboratories;
451.22(6) one member from a professional organization with a demonstrated interest in
451.23environmental laboratory data and accreditation; and
451.24(7) one employee of the laboratory accreditation program administered by the
451.25department.
451.26(b) Committee appointments begin on January 1 and end on December 31 of the
451.27same year.
451.28(c) The commissioner shall appoint persons to fill vacant committee positions,
451.29expand the total number of appointed positions, or change the designated positions upon
451.30the advice of the committee.
451.31(d) The commissioner shall rescind the appointment of a selection committee
451.32member for sufficient cause as the commissioner determines, such as:
451.33(1) neglect of duty;
451.34(2) failure to notify the commissioner of a real or perceived conflict of interest;
452.1(3) nonconformance with committee procedures;
452.2(4) failure to demonstrate competence in assessment practices; or
452.3(5) official misconduct.
452.4(e) Members of the selection committee shall be compensated according to the
452.5provisions in section 15.059, subdivision 3.

452.6    Sec. 21. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
452.7to read:
452.8    Subd. 11. Activities of the selection committee. (a) The selection committee
452.9will determine assessor and assessment body application requirements, the frequency
452.10of application submittal, and the application review schedule. The commissioner shall
452.11publish the application requirements and procedures on the accreditation program Web site.
452.12(b) In its selection process, the committee shall ensure its application requirements
452.13and review process:
452.14(1) meet the standards implemented in subdivision 2a;
452.15(2) ensure assessors have demonstrated competence in technical disciplines offered
452.16for accreditation by the commissioner; and
452.17(3) consider any history of repeated nonconformance or complaints regarding
452.18assessors or assessment bodies.
452.19(c) The selection committee shall consider an application received from qualified
452.20applicants and shall supply a list of recommended assessors and assessment bodies to
452.21the commissioner of health no later than 90 days after the commissioner notifies the
452.22committee of the need for review of applications.

452.23    Sec. 22. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
452.24to read:
452.25    Subd. 12. Commissioner approval of assessors and scheduling of assessments.
452.26(a) The commissioner shall approve assessors who:
452.27(1) are employed by the commissioner for the purpose of accrediting laboratories
452.28and demonstrate competence in assessment practices for environmental laboratories; or
452.29(2) are employed by a state or federal agency with established agreements for
452.30mutual assistance or recognition with the commissioner and demonstrate competence in
452.31assessment practices for environmental laboratories.
452.32(b) The commissioner may approve other assessors or assessment bodies who are
452.33recommended by the selection committee according to subdivision 11, paragraph (c). The
453.1commissioner shall publish the list of assessors and assessment bodies approved from the
453.2recommendations.
453.3(c) The commissioner shall rescind approval for an assessor or assessment body for
453.4sufficient cause as the commissioner determines, such as:
453.5(1) failure to meet the minimum qualifications for performing assessments;
453.6(2) lack of availability;
453.7(3) nonconformance with the applicable laws, rules, standards, policies, and
453.8procedures;
453.9(4) misrepresentation of application information regarding qualifications and
453.10training; or
453.11(5) excessive cost to perform the assessment activities.

453.12    Sec. 23. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
453.13to read:
453.14    Subd. 13. Laboratory requirements for assessor selection and scheduling
453.15assessments. (a) A laboratory accredited or seeking accreditation that requires an
453.16assessment by the commissioner must select an assessor, group of assessors, or an
453.17assessment body from the published list specified in subdivision 12, paragraph (b). An
453.18accredited laboratory must complete an assessment and make all corrective actions at least
453.19once every 24 months. Unless the commissioner grants interim accreditation, a laboratory
453.20seeking accreditation must complete an assessment and make all corrective actions
453.21prior to, but no earlier than, 18 months prior to the date the application is submitted to
453.22the commissioner.
453.23(b) A laboratory shall not select the same assessor more than twice in succession
453.24for assessments of the same facility unless the laboratory receives written approval
453.25from the commissioner for the selection. The laboratory must supply a written request
453.26to the commissioner for approval and must justify the reason for the request and provide
453.27the alternate options considered.
453.28(c) A laboratory must select assessors appropriate to the size and scope of the
453.29laboratory's application or existing accreditation.
453.30(d) A laboratory must enter into its own contract for direct payment of the assessors
453.31or assessment body. The contract must authorize the assessor, assessment body, or
453.32subcontractors to release all records to the commissioner regarding the assessment activity,
453.33when the assessment is performed in compliance with this statute.
453.34(e) A laboratory must agree to permit other assessors as selected by the commissioner
453.35to participate in the assessment activities.
454.1(f) If the laboratory determines no approved assessor is available to perform
454.2the assessment, the laboratory must notify the commissioner in writing and provide a
454.3justification for the determination. If the commissioner confirms no approved assessor
454.4is available, the commissioner may designate an alternate assessor from those approved
454.5in subdivision 12, paragraph (a), or the commissioner may delay the assessment until
454.6an assessor is available. If an approved alternate assessor performs the assessment, the
454.7commissioner may collect fees equivalent to the cost of performing the assessment
454.8activities.
454.9(g) Fees collected under this section are deposited in a special account and are
454.10annually appropriated to the commissioner for the purpose of performing assessment
454.11activities.
454.12EFFECTIVE DATE.This section is effective the day following final enactment.

454.13    Sec. 24. Minnesota Statutes 2012, section 144.99, subdivision 4, is amended to read:
454.14    Subd. 4. Administrative penalty orders. (a) The commissioner may issue an
454.15order requiring violations to be corrected and administratively assessing monetary
454.16penalties for violations of the statutes, rules, and other actions listed in subdivision 1. The
454.17procedures in section 144.991 must be followed when issuing administrative penalty
454.18orders. Except in the case of repeated or serious violations, the penalty assessed in the
454.19order must be forgiven if the person who is subject to the order demonstrates in writing
454.20to the commissioner before the 31st day after receiving the order that the person has
454.21corrected the violation or has developed a corrective plan acceptable to the commissioner.
454.22The maximum amount of an administrative penalty order is $10,000 for each violator for
454.23all violations by that violator identified in an inspection or review of compliance.
454.24(b) Notwithstanding paragraph (a), the commissioner may issue to a large public
454.25water supply, serving a population of more than 10,000 persons, an administrative penalty
454.26order imposing a penalty of at least $1,000 per day per violation, not to exceed $10,000
454.27for each violation of sections 144.381 to 144.385 and rules adopted thereunder.
454.28(c) Notwithstanding paragraph (a), the commissioner may issue to a certified lead
454.29firm or person performing regulated lead work, an administrative penalty order imposing a
454.30penalty of at least $5,000 per violation per day, not to exceed $10,000 for each violation of
454.31sections 144.9501 to 144.9512 and rules adopted thereunder. All revenue collected from
454.32monetary penalties in this section shall be deposited in the state treasury and credited to
454.33the state government special revenue fund.

454.34    Sec. 25. Minnesota Statutes 2012, section 144A.53, subdivision 2, is amended to read:
455.1    Subd. 2. Complaints. The director may receive a complaint from any source
455.2concerning an action of an administrative agency, a health care provider, a home care
455.3provider, a residential care home, or a health facility. The director may require a
455.4complainant to pursue other remedies or channels of complaint open to the complainant
455.5before accepting or investigating the complaint. Investigators are required to interview
455.6at least one family member of the vulnerable adult identified in the complaint. If the
455.7vulnerable adult is directing the vulnerable adult's own care and does not want the
455.8investigator to contact the family, this information shall be documented in the investigative
455.9file.
455.10The director shall keep written records of all complaints and any action upon
455.11them. After completing an investigation of a complaint, the director shall inform the
455.12complainant, the administrative agency having jurisdiction over the subject matter, the
455.13health care provider, the home care provider, the residential care home, and the health
455.14facility of the action taken. Complainants must be provided a copy of the public report
455.15upon completion of the investigation.

455.16    Sec. 26. [145.4716] SAFE HARBOR FOR SEXUALLY EXPLOITED YOUTH.
455.17    Subdivision 1. Director. The commissioner of health shall establish a position for a
455.18director of child sex trafficking prevention.
455.19    Subd. 2. Duties of director. The director of child sex trafficking prevention is
455.20responsible for the following:
455.21    (1) developing and providing comprehensive training on sexual exploitation of
455.22youth for social service professionals, medical professionals, public health workers, and
455.23criminal justice professionals;
455.24    (2) collecting, organizing, maintaining, and disseminating information on sexual
455.25exploitation and services across the state, including maintaining a list of resources on the
455.26Department of Health Web site;
455.27    (3) monitoring and applying for federal funding for antitrafficking efforts that may
455.28benefit victims in the state;
455.29    (4) managing grant programs established under this act;
455.30    (5) identifying best practices in serving sexually exploited youth, as defined in
455.31section 260C.007, subdivision 31;
455.32    (6) providing oversight of and technical support to regional navigators pursuant to
455.33section 145.4717;
455.34    (7) conducting a comprehensive evaluation of the statewide program for safe harbor
455.35of sexually exploited youth; and
456.1    (8) developing a policy, consistent with the requirements of chapter 13, for sharing
456.2data related to sexually exploited youth, as defined in section 260C.007, subdivision 31,
456.3among regional navigators and community-based advocates.

456.4    Sec. 27. [145.4717] REGIONAL NAVIGATOR GRANTS.
456.5    The commissioner of health, through its director of child sex trafficking prevention,
456.6established in section 145.4716, shall provide grants to regional navigators serving six
456.7regions of the state to be determined by the commissioner. Each regional navigator must
456.8develop and annually submit a work plan to the director of child sex trafficking prevention.
456.9The work plans must include, but are not limited to, the following information:
456.10    (1) a needs statement specific to the region, including an examination of the
456.11population at risk;
456.12    (2) regional resources available to sexually exploited youth, as defined in section
456.13260C.007, subdivision 31;
456.14    (3) grant goals and measurable outcomes; and
456.15    (4) grant activities including timelines.

456.16    Sec. 28. [145.4718] PROGRAM EVALUATION.
456.17    (a) The director of child sex trafficking prevention, established under section
456.18145.4716, must conduct, or contract for, comprehensive evaluation of the statewide
456.19program for safe harbor for sexually exploited youth. The first evaluation must be
456.20completed by June 30, 2015, and must be submitted to the commissioner of health by
456.21September 1, 2015, and every two years thereafter. The evaluation must consider whether
456.22the program is reaching intended victims and whether support services are available,
456.23accessible, and adequate for sexually exploited youth, as defined in section 260C.007,
456.24subdivision 31.
456.25    (b) In conducting the evaluation, the director of child sex trafficking prevention must
456.26consider evaluation of outcomes, including whether the program increases identification
456.27of sexually exploited youth, coordination of investigations, access to services and housing
456.28available for sexually exploited youth, and improved effectiveness of services. The
456.29evaluation must also include examination of the ways in which penalties under section
456.30609.3241 are assessed, collected, and distributed to ensure funding for investigation,
456.31prosecution, and victim services to combat sexual exploitation of youth.

456.32    Sec. 29. Minnesota Statutes 2012, section 145.986, is amended to read:
456.33145.986 STATEWIDE HEALTH IMPROVEMENT PROGRAM.
457.1    Subdivision 1. Grants to local communities Purpose. The purpose of the statewide
457.2health improvement program is to:
457.3(1) address the top three leading preventable causes of illness, preventable health
457.4costs, and death: tobacco use and exposure, poor diet, and lack of regular physical activity;
457.5(2) promote the development, availability, and use of evidence-based, community
457.6level, comprehensive strategies to create healthy communities; and
457.7(3) measure the impact of the evidence-based, community health improvement
457.8practices which over time work to contain health care costs and reduce chronic diseases.
457.9    Subd. 1a. Grants to local communities. (a) Beginning July 1, 2009 2013,
457.10the commissioner of health shall award competitive grants to all community health
457.11boards established pursuant to section 145A.09 and tribal governments to convene,
457.12coordinate, and implement evidence-based strategies targeted at reducing the percentage
457.13of Minnesotans who are obese or overweight and to reduce the use of tobacco.
457.14    (b) Grantee activities shall:
457.15    (1) be based on scientific evidence;
457.16    (2) be based on community input;
457.17    (3) address behavior change at the individual, community, and systems levels;
457.18    (4) occur in community, school, worksite, and health care settings; and
457.19    (5) be focused on policy, systems, and environmental changes that support healthy
457.20behaviors.; and
457.21(6) address the health disparities and inequities that exist in the grantee's community.
457.22    (c) To receive a grant under this section, community health boards and tribal
457.23governments must submit proposals to the commissioner. A local match of ten percent
457.24of the total funding allocation is required. This local match may include funds donated
457.25by community partners.
457.26    (d) In order to receive a grant, community health boards and tribal governments
457.27must submit a health improvement plan to the commissioner of health for approval. The
457.28commissioner may require the plan to identify a community leadership team, community
457.29partners, and a community action plan that includes an assessment of area strengths and
457.30needs, proposed action strategies, technical assistance needs, and a staffing plan.
457.31    (e) The grant recipient must implement the health improvement plan, evaluate the
457.32effectiveness of the interventions strategies, and modify or discontinue interventions
457.33 strategies found to be ineffective.
457.34    (f) By January 15, 2011, the commissioner of health shall recommend whether any
457.35funding should be distributed to community health boards and tribal governments based
457.36on health disparities demonstrated in the populations served.
458.1    (g) (f) Grant recipients shall report their activities and their progress toward the
458.2outcomes established under subdivision 2 to the commissioner in a format and at a time
458.3specified by the commissioner.
458.4    (h) (g) All grant recipients shall be held accountable for making progress toward
458.5the measurable outcomes established in subdivision 2. The commissioner shall require a
458.6corrective action plan and may reduce the funding level of grant recipients that do not
458.7make adequate progress toward the measurable outcomes.
458.8    Subd. 2. Outcomes. (a) The commissioner shall set measurable outcomes to meet
458.9the goals specified in subdivision 1, and annually review the progress of grant recipients
458.10in meeting the outcomes.
458.11    (b) The commissioner shall measure current public health status, using existing
458.12measures and data collection systems when available, to determine baseline data against
458.13which progress shall be monitored.
458.14    Subd. 3. Technical assistance and oversight. (a) The commissioner shall provide
458.15content expertise, technical expertise, and training to grant recipients and advice on
458.16evidence-based strategies, including those based on populations and types of communities
458.17served. The commissioner shall ensure that the statewide health improvement program
458.18meets the outcomes established under subdivision 2 by conducting a comprehensive
458.19statewide evaluation and assisting grant recipients to modify or discontinue interventions
458.20found to be ineffective.
458.21    (b) In carrying out its responsibilities for administration, technical assistance, and
458.22oversight, the commissioner may contract out its responsibilities within the limits of the
458.23administrative budget given for those purposes.
458.24    Subd. 4. Evaluation. (a) Using the outcome measures established in subdivision
458.253, the commissioner shall conduct a biennial an evaluation of the statewide health
458.26improvement program funded under this section. Grant recipients shall cooperate with
458.27the commissioner in the evaluation and provide the commissioner with the information
458.28necessary to conduct the evaluation.
458.29(b) Grant recipients will collect, monitor, and submit to the Department of Health
458.30baseline and annual data, and provide information to improve the quality and impact of
458.31community health improvement strategies.
458.32    Subd. 5. Report. The commissioner shall submit a biennial report to the legislature
458.33on the statewide health improvement program funded under this section. These reports
458.34must include information on grant recipients, activities that were conducted using grant
458.35funds, evaluation data, and outcome measures, if available. In addition, the commissioner
458.36shall provide recommendations on future areas of focus for health improvement. These
459.1reports are due by January 15 of every other year, beginning in 2010. In the report due
459.2on January 15, 2010, the commissioner shall include recommendations on a sustainable
459.3funding source for the statewide health improvement program other than the health care
459.4access fund.
459.5    Subd. 6. Supplantation of existing funds. Community health boards and tribal
459.6governments must use funds received under this section to develop new programs, expand
459.7current programs that work to reduce the percentage of Minnesotans who are obese or
459.8overweight or who use tobacco, or replace discontinued state or federal funds previously
459.9used to reduce the percentage of Minnesotans who are obese or overweight or who use
459.10tobacco. Funds must not be used to supplant current state or local funding to community
459.11health boards or tribal governments used to reduce the percentage of Minnesotans who are
459.12obese or overweight or to reduce tobacco use.

459.13    Sec. 30. Minnesota Statutes 2012, section 149A.02, subdivision 1a, is amended to read:
459.14    Subd. 1a. Alkaline hydrolysis. "Alkaline hydrolysis" means the reduction of a dead
459.15human body to essential elements through exposure to a combination of heat and alkaline
459.16hydrolysis and the repositioning or movement of the body during the process to facilitate
459.17reduction, a water-based dissolution process using alkaline chemicals, heat, agitation, and
459.18pressure to accelerate natural decomposition; the processing of the hydrolyzed remains
459.19after removal from the alkaline hydrolysis chamber, vessel; placement of the processed
459.20remains in a hydrolyzed remains container,; and release of the hydrolyzed remains to an
459.21appropriate party. Alkaline hydrolysis is a form of final disposition.

459.22    Sec. 31. Minnesota Statutes 2012, section 149A.02, is amended by adding a
459.23subdivision to read:
459.24    Subd. 1b. Alkaline hydrolysis container. "Alkaline hydrolysis container" means a
459.25hydrolyzable or biodegradable closed container or pouch resistant to leakage of bodily
459.26fluids that encases the body and into which a dead human body is placed prior to insertion
459.27into an alkaline hydrolysis vessel. Alkaline hydrolysis containers may be hydrolyzable or
459.28biodegradable alternative containers or caskets.

459.29    Sec. 32. Minnesota Statutes 2012, section 149A.02, is amended by adding a
459.30subdivision to read:
459.31    Subd. 1c. Alkaline hydrolysis facility. "Alkaline hydrolysis facility" means a
459.32building or structure containing one or more alkaline hydrolysis vessels for the alkaline
459.33hydrolysis of dead human bodies.

460.1    Sec. 33. Minnesota Statutes 2012, section 149A.02, is amended by adding a
460.2subdivision to read:
460.3    Subd. 1d. Alkaline hydrolysis vessel. "Alkaline hydrolysis vessel" means the
460.4container in which the alkaline hydrolysis of a dead human body is performed.

460.5    Sec. 34. Minnesota Statutes 2012, section 149A.02, subdivision 2, is amended to read:
460.6    Subd. 2. Alternative container. "Alternative container" means a nonmetal
460.7receptacle or enclosure, without ornamentation or a fixed interior lining, which is designed
460.8for the encasement of dead human bodies and is made of hydrolyzable or biodegradable
460.9materials, corrugated cardboard, fiberboard, pressed-wood, or other like materials.

460.10    Sec. 35. Minnesota Statutes 2012, section 149A.02, subdivision 3, is amended to read:
460.11    Subd. 3. Arrangements for disposition. "Arrangements for disposition" means
460.12any action normally taken by a funeral provider in anticipation of or preparation for the
460.13entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.

460.14    Sec. 36. Minnesota Statutes 2012, section 149A.02, subdivision 4, is amended to read:
460.15    Subd. 4. Cash advance item. "Cash advance item" means any item of service
460.16or merchandise described to a purchaser as a "cash advance," "accommodation," "cash
460.17disbursement," or similar term. A cash advance item is also any item obtained from a
460.18third party and paid for by the funeral provider on the purchaser's behalf. Cash advance
460.19items include, but are not limited to, cemetery, alkaline hydrolysis, or crematory services,
460.20pallbearers, public transportation, clergy honoraria, flowers, musicians or singers, obituary
460.21notices, gratuities, and death records.

460.22    Sec. 37. Minnesota Statutes 2012, section 149A.02, subdivision 5, is amended to read:
460.23    Subd. 5. Casket. "Casket" means a rigid container which is designed for the
460.24encasement of a dead human body and is usually constructed of hydrolyzable or
460.25biodegradable materials, wood, metal, fiberglass, plastic, or like material, and ornamented
460.26and lined with fabric.

460.27    Sec. 38. Minnesota Statutes 2012, section 149A.02, is amended by adding a
460.28subdivision to read:
460.29    Subd. 12a. Crypt. "Crypt" means a space in a mausoleum of sufficient size, used or
460.30intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.

461.1    Sec. 39. Minnesota Statutes 2012, section 149A.02, is amended by adding a
461.2subdivision to read:
461.3    Subd. 12b. Direct alkaline hydrolysis. "Direct alkaline hydrolysis" means a
461.4final disposition of a dead human body by alkaline hydrolysis, without formal viewing,
461.5visitation, or ceremony with the body present.

461.6    Sec. 40. Minnesota Statutes 2012, section 149A.02, subdivision 16, is amended to read:
461.7    Subd. 16. Final disposition. "Final disposition" means the acts leading to and the
461.8entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.

461.9    Sec. 41. Minnesota Statutes 2012, section 149A.02, subdivision 23, is amended to read:
461.10    Subd. 23. Funeral services. "Funeral services" means any services which may
461.11be used to: (1) care for and prepare dead human bodies for burial, alkaline hydrolysis,
461.12cremation, or other final disposition; and (2) arrange, supervise, or conduct the funeral
461.13ceremony or the final disposition of dead human bodies.

461.14    Sec. 42. Minnesota Statutes 2012, section 149A.02, is amended by adding a
461.15subdivision to read:
461.16    Subd. 24b. Hydrolyzed remains. "Hydrolyzed remains" means the remains of a
461.17dead human body following the alkaline hydrolysis process. Hydrolyzed remains does not
461.18include pacemakers, prostheses, or similar foreign materials.

461.19    Sec. 43. Minnesota Statutes 2012, section 149A.02, is amended by adding a
461.20subdivision to read:
461.21    Subd. 24c. Hydrolyzed remains container. "Hydrolyzed remains container" means
461.22a receptacle in which hydrolyzed remains are placed. For purposes of this chapter, a
461.23hydrolyzed remains container is interchangeable with "urn" or similar keepsake storage
461.24jewelry.

461.25    Sec. 44. Minnesota Statutes 2012, section 149A.02, is amended by adding a
461.26subdivision to read:
461.27    Subd. 26a. Inurnment. "Inurnment" means placing hydrolyzed or cremated remains
461.28in a hydrolyzed or cremated remains container suitable for placement, burial, or shipment.

461.29    Sec. 45. Minnesota Statutes 2012, section 149A.02, subdivision 27, is amended to read:
462.1    Subd. 27. Licensee. "Licensee" means any person or entity that has been issued
462.2a license to practice mortuary science, to operate a funeral establishment, to operate an
462.3alkaline hydrolysis facility, or to operate a crematory by the Minnesota commissioner
462.4of health.

462.5    Sec. 46. Minnesota Statutes 2012, section 149A.02, is amended by adding a
462.6subdivision to read:
462.7    Subd. 30a. Niche. "Niche" means a space in a columbarium used, or intended to be
462.8used, for the placement of hydrolyzed or cremated remains.

462.9    Sec. 47. Minnesota Statutes 2012, section 149A.02, is amended by adding a
462.10subdivision to read:
462.11    Subd. 32a. Placement. "Placement" means the placing of a container holding
462.12hydrolyzed or cremated remains in a crypt, vault, or niche.

462.13    Sec. 48. Minnesota Statutes 2012, section 149A.02, subdivision 34, is amended to read:
462.14    Subd. 34. Preparation of the body. "Preparation of the body" means placement of
462.15the body into an appropriate cremation or alkaline hydrolysis container, embalming of
462.16the body or such items of care as washing, disinfecting, shaving, positioning of features,
462.17restorative procedures, application of cosmetics, dressing, and casketing.

462.18    Sec. 49. Minnesota Statutes 2012, section 149A.02, subdivision 35, is amended to read:
462.19    Subd. 35. Processing. "Processing" means the removal of foreign objects, drying or
462.20cooling, and the reduction of the hydrolyzed or cremated remains by mechanical means
462.21including, but not limited to, grinding, crushing, or pulverizing, to a granulated appearance
462.22appropriate for final disposition.

462.23    Sec. 50. Minnesota Statutes 2012, section 149A.02, subdivision 37, is amended to read:
462.24    Subd. 37. Public transportation. "Public transportation" means all manner of
462.25transportation via common carrier available to the general public including airlines, buses,
462.26railroads, and ships. For purposes of this chapter, a livery service providing transportation
462.27to private funeral establishments, alkaline hydrolysis facilities, or crematories is not public
462.28transportation.

462.29    Sec. 51. Minnesota Statutes 2012, section 149A.02, is amended by adding a
462.30subdivision to read:
463.1    Subd. 37c. Scattering. "Scattering" means the authorized dispersal of hydrolyzed
463.2or cremated remains in a defined area of a dedicated cemetery or in areas where no local
463.3prohibition exists provided that the hydrolyzed or cremated remains are not distinguishable
463.4to the public, are not in a container, and that the person who has control over disposition
463.5of the hydrolyzed or cremated remains has obtained written permission of the property
463.6owner or governing agency to scatter on the property.

463.7    Sec. 52. Minnesota Statutes 2012, section 149A.02, is amended by adding a
463.8subdivision to read:
463.9    Subd. 41. Vault. "Vault" means a space in a mausoleum of sufficient size, used or
463.10intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.
463.11Vault may also mean a sealed and lined casket enclosure.

463.12    Sec. 53. Minnesota Statutes 2012, section 149A.03, is amended to read:
463.13149A.03 DUTIES OF COMMISSIONER.
463.14    The commissioner shall:
463.15    (1) enforce all laws and adopt and enforce rules relating to the:
463.16    (i) removal, preparation, transportation, arrangements for disposition, and final
463.17disposition of dead human bodies;
463.18    (ii) licensure and professional conduct of funeral directors, morticians, interns,
463.19practicum students, and clinical students;
463.20    (iii) licensing and operation of a funeral establishment; and
463.21(iv) licensing and operation of an alkaline hydrolysis facility; and
463.22    (iv) (v) licensing and operation of a crematory;
463.23    (2) provide copies of the requirements for licensure and permits to all applicants;
463.24    (3) administer examinations and issue licenses and permits to qualified persons
463.25and other legal entities;
463.26    (4) maintain a record of the name and location of all current licensees and interns;
463.27    (5) perform periodic compliance reviews and premise inspections of licensees;
463.28    (6) accept and investigate complaints relating to conduct governed by this chapter;
463.29    (7) maintain a record of all current preneed arrangement trust accounts;
463.30    (8) maintain a schedule of application, examination, permit, and licensure fees,
463.31initial and renewal, sufficient to cover all necessary operating expenses;
463.32    (9) educate the public about the existence and content of the laws and rules for
463.33mortuary science licensing and the removal, preparation, transportation, arrangements
464.1for disposition, and final disposition of dead human bodies to enable consumers to file
464.2complaints against licensees and others who may have violated those laws or rules;
464.3    (10) evaluate the laws, rules, and procedures regulating the practice of mortuary
464.4science in order to refine the standards for licensing and to improve the regulatory and
464.5enforcement methods used; and
464.6    (11) initiate proceedings to address and remedy deficiencies and inconsistencies in
464.7the laws, rules, or procedures governing the practice of mortuary science and the removal,
464.8preparation, transportation, arrangements for disposition, and final disposition of dead
464.9human bodies.

464.10    Sec. 54. [149A.54] LICENSE TO OPERATE AN ALKALINE HYDROLYSIS
464.11FACILITY.
464.12    Subdivision 1. License requirement. Except as provided in section 149A.01,
464.13subdivision 3, a place or premise shall not be maintained, managed, or operated which
464.14is devoted to or used in the holding and alkaline hydrolysis of a dead human body
464.15without possessing a valid license to operate an alkaline hydrolysis facility issued by the
464.16commissioner of health.
464.17    Subd. 2. Requirements for an alkaline hydrolysis facility. (a) An alkaline
464.18hydrolysis facility licensed under this section must consist of:
464.19(1) a building or structure that complies with applicable local and state building
464.20codes, zoning laws and ordinances, wastewater management and environmental standards,
464.21containing one or more alkaline hydrolysis vessels for the alkaline hydrolysis of dead
464.22human bodies;
464.23(2) a method approved by the commissioner of health to dry the hydrolyzed remains
464.24and which is located within the licensed facility;
464.25(3) a means approved by the commissioner of health for refrigeration of dead human
464.26bodies awaiting alkaline hydrolysis;
464.27(4) an appropriate means of processing hydrolyzed remains to a granulated
464.28appearance appropriate for final disposition; and
464.29(5) an appropriate holding facility for dead human bodies awaiting alkaline
464.30hydrolysis.
464.31(b) An alkaline hydrolysis facility licensed under this section may also contain a
464.32display room for funeral goods.
464.33    Subd. 3. Application procedure; documentation; initial inspection. An
464.34application to license and operate an alkaline hydrolysis facility shall be submitted to the
464.35commissioner of health. A completed application includes:
465.1(1) a completed application form, as provided by the commissioner;
465.2(2) proof of business form and ownership;
465.3(3) proof of liability insurance coverage or other financial documentation, as
465.4determined by the commissioner, that demonstrates the applicant's ability to respond in
465.5damages for liability arising from the ownership, maintenance management, or operation
465.6of an alkaline hydrolysis facility; and
465.7(4) copies of wastewater and other environmental regulatory permits and
465.8environmental regulatory licenses necessary to conduct operations.
465.9Upon receipt of the application and appropriate fee, the commissioner shall review and
465.10verify all information. Upon completion of the verification process and resolution of any
465.11deficiencies in the application information, the commissioner shall conduct an initial
465.12inspection of the premises to be licensed. After the inspection and resolution of any
465.13deficiencies found and any reinspections as may be necessary, the commissioner shall
465.14make a determination, based on all the information available, to grant or deny licensure. If
465.15the commissioner's determination is to grant the license, the applicant shall be notified and
465.16the license shall issue and remain valid for a period prescribed on the license, but not to
465.17exceed one calendar year from the date of issuance of the license. If the commissioner's
465.18determination is to deny the license, the commissioner must notify the applicant in writing
465.19of the denial and provide the specific reason for denial.
465.20    Subd. 4. Nontransferability of license. A license to operate an alkaline hydrolysis
465.21facility is not assignable or transferable and shall not be valid for any entity other than the
465.22one named. Each license issued to operate an alkaline hydrolysis facility is valid only for the
465.23location identified on the license. A 50 percent or more change in ownership or location of
465.24the alkaline hydrolysis facility automatically terminates the license. Separate licenses shall
465.25be required of two or more persons or other legal entities operating from the same location.
465.26    Subd. 5. Display of license. Each license to operate an alkaline hydrolysis
465.27facility must be conspicuously displayed in the alkaline hydrolysis facility at all times.
465.28Conspicuous display means in a location where a member of the general public within the
465.29alkaline hydrolysis facility will be able to observe and read the license.
465.30    Subd. 6. Period of licensure. All licenses to operate an alkaline hydrolysis facility
465.31issued by the commissioner are valid for a period of one calendar year beginning on July 1
465.32and ending on June 30, regardless of the date of issuance.
465.33    Subd. 7. Reporting changes in license information. Any change of license
465.34information must be reported to the commissioner, on forms provided by the
465.35commissioner, no later than 30 calendar days after the change occurs. Failure to report
465.36changes is grounds for disciplinary action.
466.1    Subd. 8. Notification to the commissioner. If the licensee is operating under a
466.2wastewater or an environmental permit or license that is subsequently revoked, denied,
466.3or terminated, the licensee shall notify the commissioner.
466.4    Subd. 9. Application information. All information submitted to the commissioner
466.5for a license to operate an alkaline hydrolysis facility is classified as licensing data under
466.6section 13.41, subdivision 5.

466.7    Sec. 55. [149A.55] RENEWAL OF LICENSE TO OPERATE AN ALKALINE
466.8HYDROLYSIS FACILITY.
466.9    Subdivision 1. Renewal required. All licenses to operate an alkaline hydrolysis
466.10facility issued by the commissioner expire on June 30 following the date of issuance of the
466.11license and must be renewed to remain valid.
466.12    Subd. 2. Renewal procedure and documentation. Licensees who wish to renew
466.13their licenses must submit to the commissioner a completed renewal application no later
466.14than June 30 following the date the license was issued. A completed renewal application
466.15includes:
466.16(1) a completed renewal application form, as provided by the commissioner; and
466.17(2) proof of liability insurance coverage or other financial documentation, as
466.18determined by the commissioner, that demonstrates the applicant's ability to respond in
466.19damages for liability arising from the ownership, maintenance, management, or operation
466.20of an alkaline hydrolysis facility.
466.21Upon receipt of the completed renewal application, the commissioner shall review and
466.22verify the information. Upon completion of the verification process and resolution of
466.23any deficiencies in the renewal application information, the commissioner shall make a
466.24determination, based on all the information available, to reissue or refuse to reissue the
466.25license. If the commissioner's determination is to reissue the license, the applicant shall
466.26be notified and the license shall issue and remain valid for a period prescribed on the
466.27license, but not to exceed one calendar year from the date of issuance of the license. If
466.28the commissioner's determination is to refuse to reissue the license, section 149A.09,
466.29subdivision 2, applies.
466.30    Subd. 3. Penalty for late filing. Renewal applications received after the expiration
466.31date of a license will result in the assessment of a late filing penalty. The late filing penalty
466.32must be paid before the reissuance of the license and received by the commissioner no
466.33later than 31 calendar days after the expiration date of the license.
466.34    Subd. 4. Lapse of license. Licenses to operate alkaline hydrolysis facilities
466.35shall automatically lapse when a completed renewal application is not received by the
467.1commissioner within 31 calendar days after the expiration date of a license, or a late
467.2filing penalty assessed under subdivision 3 is not received by the commissioner within 31
467.3calendar days after the expiration of a license.
467.4    Subd. 5. Effect of lapse of license. Upon the lapse of a license, the person to whom
467.5the license was issued is no longer licensed to operate an alkaline hydrolysis facility in
467.6Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed
467.7license holder from operating an alkaline hydrolysis facility in Minnesota and may pursue
467.8any additional lawful remedies as justified by the case.
467.9    Subd. 6. Restoration of lapsed license. The commissioner may restore a lapsed
467.10license upon receipt and review of a completed renewal application, receipt of the late
467.11filing penalty, and reinspection of the premises, provided that the receipt is made within
467.12one calendar year from the expiration date of the lapsed license and the cease and desist
467.13order issued by the commissioner has not been violated. If a lapsed license is not restored
467.14within one calendar year from the expiration date of the lapsed license, the holder of the
467.15lapsed license cannot be relicensed until the requirements in section 149A.54 are met.
467.16    Subd. 7. Reporting changes in license information. Any change of license
467.17information must be reported to the commissioner, on forms provided by the
467.18commissioner, no later than 30 calendar days after the change occurs. Failure to report
467.19changes is grounds for disciplinary action.
467.20    Subd. 8. Application information. All information submitted to the commissioner
467.21by an applicant for renewal of licensure to operate an alkaline hydrolysis facility is
467.22classified as licensing data under section 13.41, subdivision 5.

467.23    Sec. 56. Minnesota Statutes 2012, section 149A.65, is amended by adding a
467.24subdivision to read:
467.25    Subd. 6. Alkaline hydrolysis facilities. The initial and renewal fee for an alkaline
467.26hydrolysis facility is $300. The late fee charge for a license renewal is $25.

467.27    Sec. 57. Minnesota Statutes 2012, section 149A.65, is amended by adding a
467.28subdivision to read:
467.29    Subd. 7. State government special revenue fund. Fees collected by the
467.30commissioner under this section must be deposited in the state treasury and credited to
467.31the state government special revenue fund.

467.32    Sec. 58. Minnesota Statutes 2012, section 149A.70, subdivision 1, is amended to read:
468.1    Subdivision 1. Use of titles. Only a person holding a valid license to practice
468.2mortuary science issued by the commissioner may use the title of mortician, funeral
468.3director, or any other title implying that the licensee is engaged in the business or practice
468.4of mortuary science. Only the holder of a valid license to operate an alkaline hydrolysis
468.5facility issued by the commissioner may use the title of alkaline hydrolysis facility, water
468.6cremation, water-reduction, biocremation, green-cremation, resomation, dissolution, or
468.7any other title, word, or term implying that the licensee operates an alkaline hydrolysis
468.8facility. Only the holder of a valid license to operate a funeral establishment issued by the
468.9commissioner may use the title of funeral home, funeral chapel, funeral service, or any
468.10other title, word, or term implying that the licensee is engaged in the business or practice
468.11of mortuary science. Only the holder of a valid license to operate a crematory issued by
468.12the commissioner may use the title of crematory, crematorium, green-cremation, or any
468.13other title, word, or term implying that the licensee operates a crematory or crematorium.

468.14    Sec. 59. Minnesota Statutes 2012, section 149A.70, subdivision 2, is amended to read:
468.15    Subd. 2. Business location. A funeral establishment, alkaline hydrolysis facility, or
468.16crematory shall not do business in a location that is not licensed as a funeral establishment,
468.17alkaline hydrolysis facility, or crematory and shall not advertise a service that is available
468.18from an unlicensed location.

468.19    Sec. 60. Minnesota Statutes 2012, section 149A.70, subdivision 3, is amended to read:
468.20    Subd. 3. Advertising. No licensee, clinical student, practicum student, or intern
468.21shall publish or disseminate false, misleading, or deceptive advertising. False, misleading,
468.22or deceptive advertising includes, but is not limited to:
468.23    (1) identifying, by using the names or pictures of, persons who are not licensed to
468.24practice mortuary science in a way that leads the public to believe that those persons will
468.25provide mortuary science services;
468.26    (2) using any name other than the names under which the funeral establishment,
468.27alkaline hydrolysis facility, or crematory is known to or licensed by the commissioner;
468.28    (3) using a surname not directly, actively, or presently associated with a licensed
468.29funeral establishment, alkaline hydrolysis facility, or crematory, unless the surname had
468.30been previously and continuously used by the licensed funeral establishment, alkaline
468.31hydrolysis facility, or crematory; and
468.32    (4) using a founding or establishing date or total years of service not directly or
468.33continuously related to a name under which the funeral establishment, alkaline hydrolysis
468.34facility, or crematory is currently or was previously licensed.
469.1    Any advertising or other printed material that contains the names or pictures of
469.2persons affiliated with a funeral establishment, alkaline hydrolysis facility, or crematory
469.3shall state the position held by the persons and shall identify each person who is licensed
469.4or unlicensed under this chapter.

469.5    Sec. 61. Minnesota Statutes 2012, section 149A.70, subdivision 5, is amended to read:
469.6    Subd. 5. Reimbursement prohibited. No licensee, clinical student, practicum
469.7student, or intern shall offer, solicit, or accept a commission, fee, bonus, rebate, or other
469.8reimbursement in consideration for recommending or causing a dead human body to
469.9be disposed of by a specific body donation program, funeral establishment, alkaline
469.10hydrolysis facility, crematory, mausoleum, or cemetery.

469.11    Sec. 62. Minnesota Statutes 2012, section 149A.71, subdivision 2, is amended to read:
469.12    Subd. 2. Preventive requirements. (a) To prevent unfair or deceptive acts or
469.13practices, the requirements of this subdivision must be met.
469.14    (b) Funeral providers must tell persons who ask by telephone about the funeral
469.15provider's offerings or prices any accurate information from the price lists described in
469.16paragraphs (c) to (e) and any other readily available information that reasonably answers
469.17the questions asked.
469.18    (c) Funeral providers must make available for viewing to people who inquire in
469.19person about the offerings or prices of funeral goods or burial site goods, separate printed
469.20or typewritten price lists using a ten-point font or larger. Each funeral provider must have a
469.21separate price list for each of the following types of goods that are sold or offered for sale:
469.22    (1) caskets;
469.23    (2) alternative containers;
469.24    (3) outer burial containers;
469.25(4) alkaline hydrolysis containers;
469.26    (4) (5) cremation containers;
469.27(6) hydrolyzed remains containers;
469.28    (5) (7) cremated remains containers;
469.29    (6) (8) markers; and
469.30    (7) (9) headstones.
469.31    (d) Each separate price list must contain the name of the funeral provider's place
469.32of business, address, and telephone number and a caption describing the list as a price
469.33list for one of the types of funeral goods or burial site goods described in paragraph (c),
469.34clauses (1) to (7) (9). The funeral provider must offer the list upon beginning discussion
470.1of, but in any event before showing, the specific funeral goods or burial site goods and
470.2must provide a photocopy of the price list, for retention, if so asked by the consumer. The
470.3list must contain, at least, the retail prices of all the specific funeral goods and burial site
470.4goods offered which do not require special ordering, enough information to identify each,
470.5and the effective date for the price list. However, funeral providers are not required to
470.6make a specific price list available if the funeral providers place the information required
470.7by this paragraph on the general price list described in paragraph (e).
470.8    (e) Funeral providers must give a printed price list, for retention, to persons who
470.9inquire in person about the funeral goods, funeral services, burial site goods, or burial site
470.10services or prices offered by the funeral provider. The funeral provider must give the list
470.11upon beginning discussion of either the prices of or the overall type of funeral service or
470.12disposition or specific funeral goods, funeral services, burial site goods, or burial site
470.13services offered by the provider. This requirement applies whether the discussion takes
470.14place in the funeral establishment or elsewhere. However, when the deceased is removed
470.15for transportation to the funeral establishment, an in-person request for authorization to
470.16embalm does not, by itself, trigger the requirement to offer the general price list. If the
470.17provider, in making an in-person request for authorization to embalm, discloses that
470.18embalming is not required by law except in certain special cases, the provider is not
470.19required to offer the general price list. Any other discussion during that time about prices
470.20or the selection of funeral goods, funeral services, burial site goods, or burial site services
470.21triggers the requirement to give the consumer a general price list. The general price list
470.22must contain the following information:
470.23    (1) the name, address, and telephone number of the funeral provider's place of
470.24business;
470.25    (2) a caption describing the list as a "general price list";
470.26    (3) the effective date for the price list;
470.27    (4) the retail prices, in any order, expressed either as a flat fee or as the prices per
470.28hour, mile, or other unit of computation, and other information described as follows:
470.29    (i) forwarding of remains to another funeral establishment, together with a list of
470.30the services provided for any quoted price;
470.31    (ii) receiving remains from another funeral establishment, together with a list of
470.32the services provided for any quoted price;
470.33    (iii) separate prices for each alkaline hydrolysis or cremation offered by the funeral
470.34provider, with the price including an alternative container or alkaline hydrolysis or
470.35cremation container, any alkaline hydrolysis or crematory charges, and a description of the
471.1services and container included in the price, where applicable, and the price of alkaline
471.2hydrolysis or cremation where the purchaser provides the container;
471.3    (iv) separate prices for each immediate burial offered by the funeral provider,
471.4including a casket or alternative container, and a description of the services and container
471.5included in that price, and the price of immediate burial where the purchaser provides the
471.6casket or alternative container;
471.7    (v) transfer of remains to the funeral establishment or other location;
471.8    (vi) embalming;
471.9    (vii) other preparation of the body;
471.10    (viii) use of facilities, equipment, or staff for viewing;
471.11    (ix) use of facilities, equipment, or staff for funeral ceremony;
471.12    (x) use of facilities, equipment, or staff for memorial service;
471.13    (xi) use of equipment or staff for graveside service;
471.14    (xii) hearse or funeral coach;
471.15    (xiii) limousine; and
471.16    (xiv) separate prices for all cemetery-specific goods and services, including all goods
471.17and services associated with interment and burial site goods and services and excluding
471.18markers and headstones;
471.19    (5) the price range for the caskets offered by the funeral provider, together with the
471.20statement "A complete price list will be provided at the funeral establishment or casket
471.21sale location." or the prices of individual caskets, as disclosed in the manner described
471.22in paragraphs (c) and (d);
471.23    (6) the price range for the alternative containers offered by the funeral provider,
471.24together with the statement "A complete price list will be provided at the funeral
471.25establishment or alternative container sale location." or the prices of individual alternative
471.26containers, as disclosed in the manner described in paragraphs (c) and (d);
471.27    (7) the price range for the outer burial containers offered by the funeral provider,
471.28together with the statement "A complete price list will be provided at the funeral
471.29establishment or outer burial container sale location." or the prices of individual outer
471.30burial containers, as disclosed in the manner described in paragraphs (c) and (d);
471.31(8) the price range for the alkaline hydrolysis container offered by the funeral
471.32provider, together with the statement: "A complete price list will be provided at the funeral
471.33establishment or alkaline hydrolysis container sale location.", or the prices of individual
471.34alkaline hydrolysis containers, as disclosed in the manner described in paragraphs (c)
471.35and (d);
472.1(9) the price range for the hydrolyzed remains container offered by the funeral
472.2provider, together with the statement: "A complete price list will be provided at the
472.3funeral establishment or hydrolyzed remains container sale location.", or the prices
472.4of individual hydrolyzed remains container, as disclosed in the manner described in
472.5paragraphs (c) and (d);
472.6    (8) (10) the price range for the cremation containers offered by the funeral provider,
472.7together with the statement "A complete price list will be provided at the funeral
472.8establishment or cremation container sale location." or the prices of individual cremation
472.9containers and cremated remains containers, as disclosed in the manner described in
472.10paragraphs (c) and (d);
472.11    (9) (11) the price range for the cremated remains containers offered by the funeral
472.12provider, together with the statement, "A complete price list will be provided at the funeral
472.13establishment or cremation cremated remains container sale location," or the prices of
472.14individual cremation containers as disclosed in the manner described in paragraphs (c)
472.15and (d);
472.16    (10) (12) the price for the basic services of funeral provider and staff, together with a
472.17list of the principal basic services provided for any quoted price and, if the charge cannot
472.18be declined by the purchaser, the statement "This fee for our basic services will be added
472.19to the total cost of the funeral arrangements you select. (This fee is already included in
472.20our charges for alkaline hydrolysis, direct cremations, immediate burials, and forwarding
472.21or receiving remains.)" If the charge cannot be declined by the purchaser, the quoted
472.22price shall include all charges for the recovery of unallocated funeral provider overhead,
472.23and funeral providers may include in the required disclosure the phrase "and overhead"
472.24after the word "services." This services fee is the only funeral provider fee for services,
472.25facilities, or unallocated overhead permitted by this subdivision to be nondeclinable,
472.26unless otherwise required by law;
472.27    (11) (13) the price range for the markers and headstones offered by the funeral
472.28provider, together with the statement "A complete price list will be provided at the funeral
472.29establishment or marker or headstone sale location." or the prices of individual markers
472.30and headstones, as disclosed in the manner described in paragraphs (c) and (d); and
472.31    (12) (14) any package priced funerals offered must be listed in addition to and
472.32following the information required in paragraph (e) and must clearly state the funeral
472.33goods and services being offered, the price being charged for those goods and services,
472.34and the discounted savings.
472.35    (f) Funeral providers must give an itemized written statement, for retention, to each
472.36consumer who arranges an at-need funeral or other disposition of human remains at the
473.1conclusion of the discussion of the arrangements. The itemized written statement must be
473.2signed by the consumer selecting the goods and services as required in section 149A.80.
473.3If the statement is provided by a funeral establishment, the statement must be signed by
473.4the licensed funeral director or mortician planning the arrangements. If the statement is
473.5provided by any other funeral provider, the statement must be signed by an authorized
473.6agent of the funeral provider. The statement must list the funeral goods, funeral services,
473.7burial site goods, or burial site services selected by that consumer and the prices to be paid
473.8for each item, specifically itemized cash advance items (these prices must be given to the
473.9extent then known or reasonably ascertainable if the prices are not known or reasonably
473.10ascertainable, a good faith estimate shall be given and a written statement of the actual
473.11charges shall be provided before the final bill is paid), and the total cost of goods and
473.12services selected. At the conclusion of an at-need arrangement, the funeral provider is
473.13required to give the consumer a copy of the signed itemized written contract that must
473.14contain the information required in this paragraph.
473.15    (g) Upon receiving actual notice of the death of an individual with whom a funeral
473.16provider has entered a preneed funeral agreement, the funeral provider must provide
473.17a copy of all preneed funeral agreement documents to the person who controls final
473.18disposition of the human remains or to the designee of the person controlling disposition.
473.19The person controlling final disposition shall be provided with these documents at the time
473.20of the person's first in-person contact with the funeral provider, if the first contact occurs
473.21in person at a funeral establishment, alkaline hydrolysis facility, crematory, or other place
473.22of business of the funeral provider. If the contact occurs by other means or at another
473.23location, the documents must be provided within 24 hours of the first contact.

473.24    Sec. 63. Minnesota Statutes 2012, section 149A.71, subdivision 4, is amended to read:
473.25    Subd. 4. Casket, alternate container, alkaline hydrolysis containers, and
473.26cremation container sales; records; required disclosures. Any funeral provider who
473.27sells or offers to sell a casket, alternate container, alkaline hydrolysis container, hydrolyzed
473.28remains container, or cremation container, or cremated remains container to the public
473.29must maintain a record of each sale that includes the name of the purchaser, the purchaser's
473.30mailing address, the name of the decedent, the date of the decedent's death, and the place
473.31of death. These records shall be open to inspection by the regulatory agency. Any funeral
473.32provider selling a casket, alternate container, or cremation container to the public, and not
473.33having charge of the final disposition of the dead human body, shall provide a copy of the
473.34statutes and rules controlling the removal, preparation, transportation, arrangements for
473.35disposition, and final disposition of a dead human body. This subdivision does not apply to
474.1morticians, funeral directors, funeral establishments, crematories, or wholesale distributors
474.2of caskets, alternate containers, alkaline hydrolysis containers, or cremation containers.

474.3    Sec. 64. Minnesota Statutes 2012, section 149A.72, subdivision 3, is amended to read:
474.4    Subd. 3. Casket for alkaline hydrolysis or cremation provisions; deceptive acts
474.5or practices. In selling or offering to sell funeral goods or funeral services to the public, it
474.6is a deceptive act or practice for a funeral provider to represent that a casket is required for
474.7alkaline hydrolysis or cremations by state or local law or otherwise.

474.8    Sec. 65. Minnesota Statutes 2012, section 149A.72, is amended by adding a
474.9subdivision to read:
474.10    Subd. 3a. Casket for alkaline hydrolysis provision; preventive measures. To
474.11prevent deceptive acts or practices, funeral providers must place the following disclosure
474.12in immediate conjunction with the prices shown for alkaline hydrolysis: "Minnesota
474.13law does not require you to purchase a casket for alkaline hydrolysis. If you want to
474.14arrange for alkaline hydrolysis, you can use an alkaline hydrolysis container. An alkaline
474.15hydrolysis container is a hydrolyzable or biodegradable closed container or pouch resistant
474.16to leakage of bodily fluids that encases the body and into which a dead human body is
474.17placed prior to insertion into an alkaline hydrolysis vessel. The containers we provide
474.18are (specify containers provided)." This disclosure is required only if the funeral provider
474.19arranges alkaline hydrolysis.

474.20    Sec. 66. Minnesota Statutes 2012, section 149A.72, subdivision 9, is amended to read:
474.21    Subd. 9. Deceptive acts or practices. In selling or offering to sell funeral goods,
474.22funeral services, burial site goods, or burial site services to the public, it is a deceptive act
474.23or practice for a funeral provider to represent that federal, state, or local laws, or particular
474.24cemeteries, alkaline hydrolysis facilities, or crematories, require the purchase of any funeral
474.25goods, funeral services, burial site goods, or burial site services when that is not the case.

474.26    Sec. 67. Minnesota Statutes 2012, section 149A.73, subdivision 1, is amended to read:
474.27    Subdivision 1. Casket for alkaline hydrolysis or cremation provisions; deceptive
474.28acts or practices. In selling or offering to sell funeral goods, funeral services, burial site
474.29goods, or burial site services to the public, it is a deceptive act or practice for a funeral
474.30provider to require that a casket be purchased for alkaline hydrolysis or cremation.

474.31    Sec. 68. Minnesota Statutes 2012, section 149A.73, subdivision 2, is amended to read:
475.1    Subd. 2. Casket for alkaline hydrolysis or cremation; preventive requirements.
475.2To prevent unfair or deceptive acts or practices, if funeral providers arrange for alkaline
475.3hydrolysis or cremations, they must make a an alkaline hydrolysis container or cremation
475.4container available for alkaline hydrolysis or cremations.

475.5    Sec. 69. Minnesota Statutes 2012, section 149A.73, subdivision 4, is amended to read:
475.6    Subd. 4. Required purchases of funeral goods or services; preventive
475.7requirements. To prevent unfair or deceptive acts or practices, funeral providers must
475.8place the following disclosure in the general price list, immediately above the prices
475.9required by section 149A.71, subdivision 2, paragraph (e), clauses (4) to (10): "The goods
475.10and services shown below are those we can provide to our customers. You may choose
475.11only the items you desire. If legal or other requirements mean that you must buy any items
475.12you did not specifically ask for, we will explain the reason in writing on the statement we
475.13provide describing the funeral goods, funeral services, burial site goods, and burial site
475.14services you selected." However, if the charge for "services of funeral director and staff"
475.15cannot be declined by the purchaser, the statement shall include the sentence "However,
475.16any funeral arrangements you select will include a charge for our basic services." between
475.17the second and third sentences of the sentences specified in this subdivision. The statement
475.18may include the phrase "and overhead" after the word "services" if the fee includes a
475.19charge for the recovery of unallocated funeral overhead. If the funeral provider does
475.20not include this disclosure statement, then the following disclosure statement must be
475.21placed in the statement of funeral goods, funeral services, burial site goods, and burial site
475.22services selected, as described in section 149A.71, subdivision 2, paragraph (f): "Charges
475.23are only for those items that you selected or that are required. If we are required by law or
475.24by a cemetery, alkaline hydrolysis facility, or crematory to use any items, we will explain
475.25the reasons in writing below." A funeral provider is not in violation of this subdivision by
475.26failing to comply with a request for a combination of goods or services which would be
475.27impossible, impractical, or excessively burdensome to provide.

475.28    Sec. 70. Minnesota Statutes 2012, section 149A.74, is amended to read:
475.29149A.74 FUNERAL SERVICES PROVIDED WITHOUT PRIOR APPROVAL.
475.30    Subdivision 1. Services provided without prior approval; deceptive acts or
475.31practices. In selling or offering to sell funeral goods or funeral services to the public, it
475.32is a deceptive act or practice for any funeral provider to embalm a dead human body
475.33unless state or local law or regulation requires embalming in the particular circumstances
475.34regardless of any funeral choice which might be made, or prior approval for embalming
476.1has been obtained from an individual legally authorized to make such a decision. In
476.2seeking approval to embalm, the funeral provider must disclose that embalming is not
476.3required by law except in certain circumstances; that a fee will be charged if a funeral
476.4is selected which requires embalming, such as a funeral with viewing; and that no
476.5embalming fee will be charged if the family selects a service which does not require
476.6embalming, such as direct alkaline hydrolysis, direct cremation, or immediate burial.
476.7    Subd. 2. Services provided without prior approval; preventive requirement.
476.8To prevent unfair or deceptive acts or practices, funeral providers must include on
476.9the itemized statement of funeral goods or services, as described in section 149A.71,
476.10subdivision 2 , paragraph (f), the statement "If you selected a funeral that may require
476.11embalming, such as a funeral with viewing, you may have to pay for embalming. You do
476.12not have to pay for embalming you did not approve if you selected arrangements such
476.13as direct alkaline hydrolysis, direct cremation, or immediate burial. If we charged for
476.14embalming, we will explain why below."

476.15    Sec. 71. Minnesota Statutes 2012, section 149A.91, subdivision 9, is amended to read:
476.16    Subd. 9. Embalmed Bodies awaiting final disposition. All embalmed bodies
476.17awaiting final disposition shall be kept in an appropriate holding facility or preparation
476.18and embalming room. The holding facility must be secure from access by anyone except
476.19the authorized personnel of the funeral establishment, preserve the dignity and integrity of
476.20the body, and protect the health and safety of the personnel of the funeral establishment.

476.21    Sec. 72. Minnesota Statutes 2012, section 149A.93, subdivision 3, is amended to read:
476.22    Subd. 3. Disposition permit. A disposition permit is required before a body can
476.23be buried, entombed, alkaline hydrolyzed, or cremated. No disposition permit shall be
476.24issued until a fact of death record has been completed and filed with the local or state
476.25registrar of vital statistics.

476.26    Sec. 73. Minnesota Statutes 2012, section 149A.93, subdivision 6, is amended to read:
476.27    Subd. 6. Conveyances permitted for transportation. A dead human body may be
476.28transported by means of private vehicle or private aircraft, provided that the body must be
476.29encased in an appropriate container, that meets the following standards:
476.30    (1) promotes respect for and preserves the dignity of the dead human body;
476.31    (2) shields the body from being viewed from outside of the conveyance;
477.1    (3) has ample enclosed area to accommodate a cot, stretcher, rigid tray, casket,
477.2alternative container, alkaline hydrolysis container, or cremation container in a horizontal
477.3position;
477.4    (4) is designed to permit loading and unloading of the body without excessive tilting
477.5of the cot, stretcher, rigid tray, casket, alternative container, alkaline hydrolysis container,
477.6 or cremation container; and
477.7    (5) if used for the transportation of more than one dead human body at one time,
477.8the vehicle must be designed so that a body or container does not rest directly on top of
477.9another body or container and that each body or container is secured to prevent the body
477.10or container from excessive movement within the conveyance.
477.11    A vehicle that is a dignified conveyance and was specified for use by the deceased
477.12or by the family of the deceased may be used to transport the body to the place of final
477.13disposition.

477.14    Sec. 74. Minnesota Statutes 2012, section 149A.94, is amended to read:
477.15149A.94 FINAL DISPOSITION.
477.16    Subdivision 1. Generally. Every dead human body lying within the state, except
477.17unclaimed bodies delivered for dissection by the medical examiner, those delivered for
477.18anatomical study pursuant to section 149A.81, subdivision 2, or lawfully carried through
477.19the state for the purpose of disposition elsewhere; and the remains of any dead human
477.20body after dissection or anatomical study, shall be decently buried, or entombed in a
477.21public or private cemetery, alkaline hydrolyzed or cremated, within a reasonable time
477.22after death. Where final disposition of a body will not be accomplished within 72 hours
477.23following death or release of the body by a competent authority with jurisdiction over the
477.24body, the body must be properly embalmed, refrigerated, or packed with dry ice. A body
477.25may not be kept in refrigeration for a period exceeding six calendar days, or packed in dry
477.26ice for a period that exceeds four calendar days, from the time of death or release of the
477.27body from the coroner or medical examiner.
477.28    Subd. 3. Permit required. No dead human body shall be buried, entombed, or
477.29cremated without a disposition permit. The disposition permit must be filed with the person
477.30in charge of the place of final disposition. Where a dead human body will be transported out
477.31of this state for final disposition, the body must be accompanied by a certificate of removal.
477.32    Subd. 4. Alkaline hydrolysis or cremation. Inurnment of alkaline hydrolyzed or
477.33cremated remains and release to an appropriate party is considered final disposition and no
477.34further permits or authorizations are required for transportation, interment, entombment, or
477.35placement of the cremated remains, except as provided in section 149A.95, subdivision 16.

478.1    Sec. 75. [149A.941] ALKALINE HYDROLYSIS FACILITIES AND ALKALINE
478.2HYDROLYSIS.
478.3    Subdivision 1. License required. A dead human body may only be hydrolyzed in
478.4this state at an alkaline hydrolysis facility licensed by the commissioner of health.
478.5    Subd. 2. General requirements. Any building to be used as an alkaline hydrolysis
478.6facility must comply with all applicable local and state building codes, zoning laws and
478.7ordinances, wastewater management regulations, and environmental statutes, rules, and
478.8standards. An alkaline hydrolysis facility must have, on site, a purpose built human
478.9alkaline hydrolysis system approved by the commissioner of health, a system approved by
478.10the commissioner of health for drying the hydrolyzed remains, a motorized mechanical
478.11device approved by the commissioner of health for processing hydrolyzed remains and
478.12must have in the building a holding facility approved by the commissioner of health for
478.13the retention of dead human bodies awaiting alkaline hydrolysis. The holding facility
478.14must be secure from access by anyone except the authorized personnel of the alkaline
478.15hydrolysis facility, preserve the dignity of the remains, and protect the health and safety of
478.16the alkaline hydrolysis facility personnel.
478.17    Subd. 3. Lighting and ventilation. The room where the alkaline hydrolysis vessel
478.18is located and the room where the chemical storage takes place shall be properly lit and
478.19ventilated with an exhaust fan that provides at least 12 air changes per hour.
478.20    Subd. 4. Plumbing connections. All plumbing fixtures, water supply lines,
478.21plumbing vents, and waste drains shall be properly vented and connected pursuant to the
478.22Minnesota Plumbing Code. The alkaline hydrolysis facility shall be equipped with a
478.23functional sink with hot and cold running water.
478.24    Subd. 5. Flooring, walls, ceiling, doors, and windows. The room where the
478.25alkaline hydrolysis vessel is located and the room where the chemical storage takes place
478.26shall have nonporous flooring, so that a sanitary condition is provided. The walls and
478.27ceiling of the room where the alkaline hydrolysis vessel is located and the room where
478.28the chemical storage takes place shall run from floor to ceiling and be covered with tile,
478.29or by plaster or sheetrock painted with washable paint or other appropriate material so
478.30that a sanitary condition is provided. The doors, walls, ceiling, and windows shall be
478.31constructed to prevent odors from entering any other part of the building. All windows
478.32or other openings to the outside must be screened and all windows must be treated in a
478.33manner that prevents viewing into the room where the alkaline hydrolysis vessel is located
478.34and the room where the chemical storage takes place. A viewing window for authorized
478.35family members or their designees is not a violation of this subdivision.
479.1    Subd. 6. Equipment and supplies. The alkaline hydrolysis facility must have a
479.2functional emergency eye wash and quick drench shower.
479.3    Subd. 7. Access and privacy. (a) The room where the alkaline hydrolysis vessel is
479.4located and the room where the chemical storage takes place must be private and have no
479.5general passageway through it. The room shall, at all times, be secure from the entrance of
479.6unauthorized persons. Authorized persons are:
479.7(1) licensed morticians;
479.8(2) registered interns or students as described in section 149A.91, subdivision 6;
479.9(3) public officials or representatives in the discharge of their official duties;
479.10(4) trained alkaline hydrolysis facility operators; and
479.11(5) the person(s) with the right to control the dead human body as defined in section
479.12149A.80, subdivision 2, and their designees.
479.13    (b) Each door allowing ingress or egress shall carry a sign that indicates that the
479.14room is private and access is limited. All authorized persons who are present in or enter
479.15the room where the alkaline hydrolysis vessel is located while a body is being prepared for
479.16final disposition must be attired according to all applicable state and federal regulations
479.17regarding the control of infectious disease and occupational and workplace health and
479.18safety.
479.19    Subd. 8. Sanitary conditions and permitted use. The room where the alkaline
479.20hydrolysis vessel is located and the room where the chemical storage takes place and all
479.21fixtures, equipment, instruments, receptacles, clothing, and other appliances or supplies
479.22stored or used in the room must be maintained in a clean and sanitary condition at all times.
479.23    Subd. 9. Boiler use. When a boiler is required by the manufacturer of the alkaline
479.24hydrolysis vessel for its operation, all state and local regulations for that boiler must be
479.25followed.
479.26    Subd. 10. Occupational and workplace safety. All applicable provisions of state
479.27and federal regulations regarding exposure to workplace hazards and accidents shall be
479.28followed in order to protect the health and safety of all authorized persons at the alkaline
479.29hydrolysis facility.
479.30    Subd. 11. Licensed personnel. A licensed alkaline hydrolysis facility must employ
479.31a licensed mortician to carry out the process of alkaline hydrolysis of a dead human body.
479.32It is the duty of the licensed alkaline hydrolysis facility to provide proper procedures for
479.33all personnel, and the licensed alkaline hydrolysis facility shall be strictly accountable for
479.34compliance with this chapter and other applicable state and federal regulations regarding
479.35occupational and workplace health and safety.
480.1    Subd. 12. Authorization to hydrolyze required. No alkaline hydrolysis facility
480.2shall hydrolyze or cause to be hydrolyzed any dead human body or identifiable body part
480.3without receiving written authorization to do so from the person or persons who have the
480.4legal right to control disposition as described in section 149A.80 or the person's legal
480.5designee. The written authorization must include:
480.6(1) the name of the deceased and the date of death of the deceased;
480.7(2) a statement authorizing the alkaline hydrolysis facility to hydrolyze the body;
480.8(3) the name, address, telephone number, relationship to the deceased, and signature
480.9of the person or persons with legal right to control final disposition or a legal designee;
480.10(4) directions for the disposition of any nonhydrolyzed materials or items recovered
480.11from the alkaline hydrolysis vessel;
480.12(5) acknowledgment that the hydrolyzed remains will be dried and mechanically
480.13reduced to a granulated appearance and placed in an appropriate container and
480.14authorization to place any hydrolyzed remains that a selected urn or container will not
480.15accommodate into a temporary container;
480.16(6) acknowledgment that, even with the exercise of reasonable care, it is not possible
480.17to recover all particles of the hydrolyzed remains and that some particles may inadvertently
480.18become commingled with particles of other hydrolyzed remains that remain in the alkaline
480.19hydrolysis vessel or other mechanical devices used to process the hydrolyzed remains;
480.20(7) directions for the ultimate disposition of the hydrolyzed remains; and
480.21(8) a statement that includes, but is not limited to, the following information:
480.22"During the alkaline hydrolysis process, chemical dissolution using heat, water, and an
480.23alkaline solution is used to chemically break down the human tissue and the hydrolyzable
480.24alkaline hydrolysis container. After the process is complete, the liquid effluent solution
480.25contains the chemical by-products of the alkaline hydrolysis process except for the
480.26deceased's bone fragments. The solution is cooled and released according to local
480.27environmental regulations. A water rinse is applied to the hydrolyzed remains which are
480.28then dried and processed to facilitate inurnment or scattering."
480.29    Subd. 13. Limitation of liability. A licensed alkaline hydrolysis facility acting in
480.30good faith, with reasonable reliance upon an authorization to hydrolyze, pursuant to an
480.31authorization to hydrolyze and in an otherwise lawful manner, shall be held harmless from
480.32civil liability and criminal prosecution for any actions taken by the alkaline hydrolysis
480.33facility.
480.34    Subd. 14. Acceptance of delivery of body. (a) No dead human body shall be
480.35accepted for final disposition by alkaline hydrolysis unless:
480.36(1) encased in an appropriate alkaline hydrolysis container;
481.1(2) accompanied by a disposition permit issued pursuant to section 149A.93,
481.2subdivision 3, including a photocopy of the completed death record or a signed release
481.3authorizing alkaline hydrolysis of the body received from the coroner or medical
481.4examiner; and
481.5(3) accompanied by an alkaline hydrolysis authorization that complies with
481.6subdivision 12.
481.7    (b) An alkaline hydrolysis facility shall refuse to accept delivery of an alkaline
481.8hydrolysis container where there is:
481.9(1) evidence of leakage of fluids from the alkaline hydrolysis container;
481.10(2) a known dispute concerning hydrolysis of the body delivered;
481.11(3) a reasonable basis for questioning any of the representations made on the written
481.12authorization to hydrolyze; or
481.13(4) any other lawful reason.
481.14    Subd. 15. Bodies awaiting hydrolysis. A dead human body must be hydrolyzed
481.15within 24 hours of the alkaline hydrolysis facility accepting legal and physical custody of
481.16the body.
481.17    Subd. 16. Handling of alkaline hydrolysis containers for dead human bodies.
481.18All alkaline hydrolysis facility employees handling alkaline hydrolysis containers for
481.19dead human bodies shall use universal precautions and otherwise exercise all reasonable
481.20precautions to minimize the risk of transmitting any communicable disease from the body.
481.21No dead human body shall be removed from the container in which it is delivered.
481.22    Subd. 17. Identification of body. All licensed alkaline hydrolysis facilities shall
481.23develop, implement, and maintain an identification procedure whereby dead human
481.24bodies can be identified from the time the alkaline hydrolysis facility accepts delivery
481.25of the remains until the hydrolyzed remains are released to an authorized party. After
481.26hydrolyzation, an identifying disk, tab, or other permanent label shall be placed within the
481.27hydrolyzed remains container before the hydrolyzed remains are released from the alkaline
481.28hydrolysis facility. Each identification disk, tab, or label shall have a number that shall
481.29be recorded on all paperwork regarding the decedent. This procedure shall be designed
481.30to reasonably ensure that the proper body is hydrolyzed and that the hydrolyzed remains
481.31are returned to the appropriate party. Loss of all or part of the hydrolyzed remains or the
481.32inability to individually identify the hydrolyzed remains is a violation of this subdivision.
481.33    Subd. 18. Alkaline hydrolysis vessel for human remains. A licensed alkaline
481.34hydrolysis facility shall knowingly hydrolyze only dead human bodies or human remains
481.35in an alkaline hydrolysis vessel, along with the alkaline hydrolysis container used for
481.36infectious disease control.
482.1    Subd. 19. Alkaline hydrolysis procedures; privacy. The final disposition of
482.2dead human bodies by alkaline hydrolysis shall be done in privacy. Unless there is
482.3written authorization from the person with the legal right to control the disposition,
482.4only authorized alkaline hydrolysis facility personnel shall be permitted in the alkaline
482.5hydrolysis area while any dead human body is in the alkaline hydrolysis area awaiting
482.6alkaline hydrolysis, in the alkaline hydrolysis vessel, being removed from the alkaline
482.7hydrolysis vessel, or being processed and placed in a hydrolyzed remains container.
482.8    Subd. 20. Alkaline hydrolysis procedures; commingling of hydrolyzed remains
482.9prohibited. Except with the express written permission of the person with the legal right
482.10to control the disposition, no alkaline hydrolysis facility shall hydrolyze more than one
482.11dead human body at the same time and in the same alkaline hydrolysis vessel, or introduce
482.12a second dead human body into an alkaline hydrolysis vessel until reasonable efforts have
482.13been employed to remove all fragments of the preceding hydrolyzed remains, or hydrolyze
482.14a dead human body and other human remains at the same time and in the same alkaline
482.15hydrolysis vessel. This section does not apply where commingling of human remains
482.16during alkaline hydrolysis is otherwise provided by law. The fact that there is incidental
482.17and unavoidable residue in the alkaline hydrolysis vessel used in a prior hydrolyzation is
482.18not a violation of this subdivision.
482.19    Subd. 21. Alkaline hydrolysis procedures; removal from alkaline hydrolysis
482.20vessel. Upon completion of the alkaline hydrolysis process, reasonable efforts shall be
482.21made to remove from the alkaline hydrolysis vessel all of the recoverable hydrolyzed
482.22remains and nonhydrolyzed materials or items. Further, all reasonable efforts shall be
482.23made to separate and recover the nonhydrolyzed materials or items from the hydrolyzed
482.24human remains and dispose of these materials in a lawful manner, by the alkaline
482.25hydrolysis facility. The hydrolyzed human remains shall be placed in an appropriate
482.26container to be transported to the processing area.
482.27    Subd. 22. Drying device or mechanical processor procedures; commingling of
482.28hydrolyzed remains prohibited. Except with the express written permission of the
482.29person with the legal right to control the final disposition or otherwise provided by
482.30law, no alkaline hydrolysis facility shall dry or mechanically process the hydrolyzed
482.31human remains of more than one body at a time in the same drying device or mechanical
482.32processor, or introduce the hydrolyzed human remains of a second body into a drying
482.33device or mechanical processor until processing of any preceding hydrolyzed human
482.34remains has been terminated and reasonable efforts have been employed to remove all
482.35fragments of the preceding hydrolyzed remains. The fact that there is incidental and
483.1unavoidable residue in the drying device, the mechanical processor, or any container used
483.2in a prior alkaline hydrolysis process, is not a violation of this provision.
483.3    Subd. 23. Alkaline hydrolysis procedures; processing hydrolyzed remains. The
483.4hydrolyzed human remains shall be dried and then reduced by a motorized mechanical
483.5device to a granulated appearance appropriate for final disposition and placed in an
483.6alkaline hydrolysis remains container along with the appropriate identifying disk, tab,
483.7or permanent label. Processing must take place within the licensed alkaline hydrolysis
483.8facility. Dental gold, silver or amalgam, jewelry, or mementos, to the extent that they
483.9can be identified, may be removed prior to processing the hydrolyzed remains, only by
483.10staff licensed or registered by the commissioner of health; however, any dental gold and
483.11silver, jewelry, or mementos that are removed shall be returned to the hydrolyzed remains
483.12container unless otherwise directed by the person or persons having the right to control the
483.13final disposition. Every person who removes or possesses dental gold or silver, jewelry,
483.14or mementos from any hydrolyzed remains without specific written permission of the
483.15person or persons having the right to control those remains is guilty of a misdemeanor.
483.16The fact that residue and any unavoidable dental gold or dental silver, or other precious
483.17metals remain in the alkaline hydrolysis vessel or other equipment or any container used
483.18in a prior hydrolysis is not a violation of this section.
483.19    Subd. 24. Alkaline hydrolysis procedures; container of insufficient capacity.
483.20If a hydrolyzed remains container is of insufficient capacity to accommodate all
483.21hydrolyzed remains of a given dead human body, subject to directives provided in the
483.22written authorization to hydrolyze, the alkaline hydrolysis facility shall place the excess
483.23hydrolyzed remains in a secondary alkaline hydrolysis remains container and attach the
483.24second container, in a manner so as not to be easily detached through incidental contact, to
483.25the primary alkaline hydrolysis remains container. The secondary container shall contain a
483.26duplicate of the identification disk, tab, or permanent label that was placed in the primary
483.27container and all paperwork regarding the given body shall include a notation that the
483.28hydrolyzed remains were placed in two containers. Keepsake jewelry or similar miniature
483.29hydrolyzed remains containers are not subject to the requirements of this subdivision.
483.30    Subd. 25. Disposition procedures; commingling of hydrolyzed remains
483.31prohibited. No hydrolyzed remains shall be disposed of or scattered in a manner or in
483.32a location where the hydrolyzed remains are commingled with those of another person
483.33without the express written permission of the person with the legal right to control
483.34disposition or as otherwise provided by law. This subdivision does not apply to the
483.35scattering or burial of hydrolyzed remains at sea or in a body of water from individual
483.36containers, to the scattering or burial of hydrolyzed remains in a dedicated cemetery, to
484.1the disposal in a dedicated cemetery of accumulated residue removed from an alkaline
484.2hydrolysis vessel or other alkaline hydrolysis equipment, to the inurnment of members
484.3of the same family in a common container designed for the hydrolyzed remains of more
484.4than one body, or to the inurnment in a container or interment in a space that has been
484.5previously designated, at the time of sale or purchase, as being intended for the inurnment
484.6or interment of the hydrolyzed remains of more than one person.
484.7    Subd. 26. Alkaline hydrolysis procedures; disposition of accumulated residue.
484.8Every alkaline hydrolysis facility shall provide for the removal and disposition in a
484.9dedicated cemetery of any accumulated residue from any alkaline hydrolysis vessel,
484.10drying device, mechanical processor, container, or other equipment used in alkaline
484.11hydrolysis. Disposition of accumulated residue shall be according to the regulations of the
484.12dedicated cemetery and any applicable local ordinances.
484.13    Subd. 27. Alkaline hydrolysis procedures; release of hydrolyzed remains.
484.14Following completion of the hydrolyzation, the inurned hydrolyzed remains shall be
484.15released according to the instructions given on the written authorization to hydrolyze. If
484.16the hydrolyzed remains are to be shipped, they must be securely packaged and transported
484.17by a method which has an internal tracing system available and which provides for a
484.18receipt signed by the person accepting delivery. Where there is a dispute over release
484.19or disposition of the hydrolyzed remains, an alkaline hydrolysis facility may deposit
484.20the hydrolyzed remains with a court of competent jurisdiction pending resolution of the
484.21dispute or retain the hydrolyzed remains until the person with the legal right to control
484.22disposition presents satisfactory indication that the dispute is resolved.
484.23    Subd. 28. Unclaimed hydrolyzed remains. If, after 30 calendar days following
484.24the inurnment, the hydrolyzed remains are not claimed or disposed of according to the
484.25written authorization to hydrolyze, the alkaline hydrolysis facility or funeral establishment
484.26may give written notice, by certified mail, to the person with the legal right to control
484.27the final disposition or a legal designee, that the hydrolyzed remains are unclaimed and
484.28requesting further release directions. Should the hydrolyzed remains be unclaimed 120
484.29calendar days following the mailing of the written notification, the alkaline hydrolysis
484.30facility or funeral establishment may dispose of the hydrolyzed remains in any lawful
484.31manner deemed appropriate.
484.32    Subd. 29. Required records. Every alkaline hydrolysis facility shall create and
484.33maintain on its premises or other business location in Minnesota an accurate record of
484.34every hydrolyzation provided. The record shall include all of the following information
484.35for each hydrolyzation:
485.1(1) the name of the person or funeral establishment delivering the body for alkaline
485.2hydrolysis;
485.3(2) the name of the deceased and the identification number assigned to the body;
485.4(3) the date of acceptance of delivery;
485.5(4) the names of the alkaline hydrolysis vessel, drying device, and mechanical
485.6processor operator;
485.7(5) the time and date that the body was placed in and removed from the alkaline
485.8hydrolysis vessel;
485.9(6) the time and date that processing and inurnment of the hydrolyzed remains
485.10was completed;
485.11(7) the time, date, and manner of release of the hydrolyzed remains;
485.12(8) the name and address of the person who signed the authorization to hydrolyze;
485.13(9) all supporting documentation, including any transit or disposition permits, a
485.14photocopy of the death record, and the authorization to hydrolyze; and
485.15(10) the type of alkaline hydrolysis container.
485.16    Subd. 30. Retention of records. Records required under subdivision 29 shall be
485.17maintained for a period of three calendar years after the release of the hydrolyzed remains.
485.18Following this period and subject to any other laws requiring retention of records, the
485.19alkaline hydrolysis facility may then place the records in storage or reduce them to
485.20microfilm, microfiche, laser disc, or any other method that can produce an accurate
485.21reproduction of the original record, for retention for a period of ten calendar years from
485.22the date of release of the hydrolyzed remains. At the end of this period and subject to any
485.23other laws requiring retention of records, the alkaline hydrolysis facility may destroy
485.24the records by shredding, incineration, or any other manner that protects the privacy of
485.25the individuals identified.

485.26    Sec. 76. Minnesota Statutes 2012, section 149A.96, subdivision 9, is amended to read:
485.27    Subd. 9. Hydrolyzed and cremated remains. Subject to section 149A.95,
485.28subdivision 16 , inurnment of the hydrolyzed or cremated remains and release to an
485.29appropriate party is considered final disposition and no further permits or authorizations
485.30are required for disinterment, transportation, or placement of the hydrolyzed or cremated
485.31remains.

485.32    Sec. 77. Laws 2011, First Special Session chapter 9, article 2, section 27, is amended to
485.33read:
485.34    Sec. 27. MINNESOTA TASK FORCE ON PREMATURITY.
486.1    Subdivision 1. Establishment. The Minnesota Task Force on Prematurity is
486.2established to evaluate and make recommendations on methods for reducing prematurity
486.3and improving premature infant health care in the state.
486.4    Subd. 2. Membership; meetings; staff. (a) The task force shall be composed of at
486.5least the following members, who serve at the pleasure of their appointing authority:
486.6(1) 15 representatives of the Minnesota Prematurity Coalition including, but not
486.7limited to, health care providers who treat pregnant women or neonates, organizations
486.8focused on preterm births, early childhood education and development professionals, and
486.9families affected by prematurity;
486.10(2) one representative appointed by the commissioner of human services;
486.11(3) two representatives appointed by the commissioner of health;
486.12(4) one representative appointed by the commissioner of education;
486.13(5) two members of the house of representatives, one appointed by the speaker of
486.14the house and one appointed by the minority leader; and
486.15(6) two members of the senate, appointed according to the rules of the senate.
486.16(b) Members of the task force serve without compensation or payment of expenses.
486.17(c) The commissioner of health must convene the first meeting of the Minnesota
486.18Task Force on Prematurity by July 31, 2011. The task force must continue to meet at
486.19least quarterly. Staffing and technical assistance shall be provided by the Minnesota
486.20Perinatal Coalition.
486.21    Subd. 3. Duties. The task force must report the current state of prematurity in
486.22Minnesota and develop recommendations on strategies for reducing prematurity and
486.23improving premature infant health care in the state by considering the following:
486.24(1) promoting adherence to standards of care for premature infants born less than 37
486.25weeks gestational age, including recommendations to improve utilization of appropriate
486.26 hospital discharge and follow-up care procedures;
486.27(2) coordination of information among appropriate professional and advocacy
486.28organizations on measures to improve health care for infants born prematurely;
486.29(3) identification and centralization of available resources to improve access and
486.30awareness for caregivers of premature infants; and
486.31(4) development and dissemination of evidence-based practices through networking
486.32and educational opportunities;
486.33(5) a review of relevant evidence-based research regarding the causes and effects of
486.34premature births in Minnesota;
486.35(6) a review of relevant evidence-based research regarding premature infant health
486.36care, including methods for improving quality of and access to care for premature infants;
487.1(7) (4) a review of the potential improvements in health status related to the use of
487.2health care homes to provide and coordinate pregnancy-related services; and.
487.3(8) identification of gaps in public reporting measures and possible effects of these
487.4measures on prematurity rates.
487.5    Subd. 4. Report; expiration. (a) By November 30, 2011 January 15, 2015, the
487.6task force must submit a final report to the chairs and ranking minority members of
487.7the legislative policy committees on health and human services on the current state of
487.8prematurity in Minnesota to the chairs of the legislative policy committees on health and
487.9human services, including any recommendations to reduce premature births and improve
487.10premature infant health in the state.
487.11(b) By January 15, 2013, the task force must report its final recommendations,
487.12including any draft legislation necessary for implementation, to the chairs of the legislative
487.13policy committees on health and human services.
487.14(c) (b) This task force expires on January 31, 2013 2015, or upon submission of the
487.15final report required in paragraph (b) (a), whichever is earlier.

487.16    Sec. 78. FUNERAL ESTABLISHMENTS; BRANCH LOCATIONS.
487.17The commissioner of health shall review the statutory requirements for preparation
487.18and embalming rooms and develop legislation with input from stakeholders that provides
487.19appropriate health and safety protection for funeral home locations where deceased bodies
487.20are present but are branch locations associated through a majority ownership of a licensed
487.21funeral establishment that meets the requirements of Minnesota Statutes, sections 149A.50
487.22and 149A.92, subdivisions 2 to 10. The review shall include consideration of distance
487.23between the main location and branch and other health and safety issues.

487.24    Sec. 79. STAFFING PLAN DISCLOSURE ACT.
487.25    Subdivision 1. Definitions. (a) For the purposes of this section, the following terms
487.26have the meanings given.
487.27(b) "Core staffing plan" means the projected number of full-time equivalent
487.28nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit.
487.29(c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses,
487.30and other health care workers, which may include but is not limited to nursing assistants,
487.31nursing aides, patient care technicians, and patient care assistants, who perform
487.32nonmanagerial direct patient care functions for more than 50 percent of their scheduled
487.33hours on a given patient care unit.
488.1(d) "Inpatient care unit" means a designated inpatient area for assigning patients and
488.2staff for which a distinct staffing plan exists and that operates 24 hours per day, seven days
488.3per week in a hospital setting. Inpatient care unit does not include any hospital-based
488.4clinic, long-term care facility, or outpatient hospital department.
488.5(e) "Staffing hours per patient day" means the number of full-time equivalent
488.6nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
488.7divided by the expected average number of patients upon which such assignments are based.
488.8(f) "Patient acuity tool" means a system for measuring an individual patient's need
488.9for nursing care. This includes utilizing a professional registered nursing assessment of
488.10patient condition to assess staffing need.
488.11    Subd. 2. Hospital staffing report. (a) The chief nursing executive or nursing
488.12designee of every reporting hospital in Minnesota under section 144.50 will develop a
488.13core staffing plan for each patient care unit.
488.14(b) Core staffing plans shall specify the full-time equivalent for each patient care
488.15unit for each 24-hour period.
488.16(c) Prior to submitting the core staffing plan, as required in subdivision 3,
488.17hospitals shall consult with representatives of the hospital medical staff, managerial and
488.18nonmanagerial care staff, and other relevant hospital personnel about the core staffing plan
488.19and the expected average number of patients upon which the staffing plan is based.
488.20    Subd. 3. Standard electronic reporting developed. (a) Hospitals must submit
488.21the core staffing plans to the Minnesota Hospital Association by January 1, 2014. The
488.22Minnesota Hospital Association shall include each reporting hospital's core staffing plan on
488.23the Minnesota Hospital Association's Minnesota Hospital Quality Report Web site by April
488.241, 2014. Any substantial changes to the core staffing plan shall be updated within 30 days.
488.25(b) The Minnesota Hospital Association shall include on its Web site for each
488.26reporting hospital on a quarterly basis the actual direct patient care hours per patient and
488.27per unit. Hospitals must submit the direct patient care report to the Minnesota Hospital
488.28Association by July 1, 2014, and quarterly thereafter.

488.29    Sec. 80. STUDY; NURSE STAFFING LEVELS AND PATIENT OUTCOMES.
488.30The Department of Health shall convene a work group to study the correlation
488.31between nurse staffing levels and patient outcomes. This report shall be presented to the
488.32chairs and ranking minority members of the health and human services committees in the
488.33house of representatives and the senate by January 15, 2015.

488.34    Sec. 81. TRAUMA CENTERS.
489.1The commissioner of health, through the Office of Rural Health and Primary Care,
489.2and in consultation with the commissioner of human services, shall study the 24-hour
489.3costs of maintaining a level of readiness in hospitals designated as trauma centers under
489.4Minnesota Statutes, section 144.605, and shall present recommendations to the legislature,
489.5by December 15, 2013, on a state public programs level of readiness payment modifier
489.6for hospitals designated as trauma centers.

489.7    Sec. 82. HEALTH EQUITY REPORT.
489.8By February 1, 2014, the commissioner of health, in consultation with local public
489.9health, health care, and community partners, must submit a report to the chairs and ranking
489.10minority members of the committees with jurisdiction over health policy and finance, on a
489.11plan for advancing health equity in Minnesota. The report must include the following:
489.12(1) assessment of health disparities that exist in the state and how these disparities
489.13relate to health equity;
489.14(2) identification of policies, processes, and systems that contribute to health
489.15inequity in the state;
489.16(3) recommendations for changes to policies, processes and systems within the
489.17Department of Health that would increase the department's leadership in addressing health
489.18inequities;
489.19(4) identification of best practices for local public health, health care, and community
489.20partners to provide culturally responsive services and advance health equity; and
489.21(5) recommendations for strategies for the use of data to document and monitor
489.22existing health inequities and to evaluate effectiveness of policies, processes, systems,
489.23and environmental changes that will advance health equity.

489.24    Sec. 83. ELIMINATING HEALTH DISPARITIES GRANTS; ORGANIZATIONS
489.25WITH LIMITED FISCAL CAPACITY.
489.26For grants awarded from the general fund under Minnesota Statutes, section 145.928,
489.27during the fiscal years ending June 30, 2013, and June 30, 2014, the commissioner
489.28of health may provide working capital advanced to grantees determined during the
489.29application process to have limited financial capacity, in accordance with Office of Grant
489.30Management Policies.

489.31    Sec. 84. ASSESSMENT OF QUALITY METRICS FOR MEASURING THE
489.32SCREENING, DIAGNOSIS, AND TREATMENT OF YOUNG CHILDREN WITH
489.33AUTISM SPECTRUM DISORDER.
490.1    As part of the annual review and ongoing development of quality measures under
490.2Minnesota Statutes, section 62U.02, the commissioner of health shall assess the medical
490.3evidence and feasibility of adding a set of quality metrics for measuring the screening,
490.4diagnosis, and treatment of young children with autism spectrum disorder.

490.5    Sec. 85. REVISOR'S INSTRUCTION.
490.6The revisor shall substitute the term "vertical heat exchangers" or "vertical
490.7heat exchanger" with "bored geothermal heat exchangers" or "bored geothermal heat
490.8exchanger" wherever it appears in Minnesota Statutes, sections 103I.005, subdivisions
490.92 and 12; 103I.101, subdivisions 2 and 5; 103I.105; 103I.205, subdivision 4; 103I.208,
490.10subdivision 2; 103I.501; 103I.531, subdivision 5; and 103I.641, subdivisions 1, 2, and 3.

490.11    Sec. 86. REPEALER.
490.12(a) Minnesota Statutes 2012, sections 103I.005, subdivision 20; 149A.025; 149A.20,
490.13subdivision 8; 149A.30, subdivision 2; 149A.40, subdivision 8; 149A.45, subdivision 6;
490.14149A.50, subdivision 6; 149A.51, subdivision 7; 149A.52, subdivision 5a; 149A.53,
490.15subdivision 9; and 485.14, are repealed.
490.16(b) Minnesota Statutes 2012, section 144.123, subdivision 2, is repealed effective
490.17July 1, 2014.

490.20 490.21

Section 1. COMMISSIONER OF HUMAN SERVICES

490.22

Subdivision 1.Total Appropriation

$

(161,031,000)

490.23	Appropriations by Fund
490.24		2013
490.25	General Fund	(158,668,000)
490.26	Health Care Access	(7,179,000)
490.27	TANF	4,816,000

490.28	Subd. 2.Forecasted Programs
490.29	(a) MFIP/DWP Grants

490.30	Appropriations by Fund
490.31	General Fund	(8,211,000)
490.32	TANF	4,399,000

490.33

(b) MFIP Child Care Assistance Grants

10,113,000

491.1

(c) General Assistance Grants

3,230,000

491.2

(d) Minnesota Supplemental Aid Grants

(1,008,000)

491.3

(e) Group Residential Housing Grants

(5,423,000)

491.4

(f) MinnesotaCare Grants

(7,179,000)

491.5This appropriation is from the health care
491.6access fund.

491.7

(g) Medical Assistance Grants

(159,733,000)

491.8

(h) Alternative Care Grants

-0-

491.9

(i) CD Entitlement Grants

2,364,000

491.10

Subd. 3.Technical Activities

417,000

491.11This appropriation is from the TANF fund.

491.12    Sec. 2. EFFECTIVE DATE.
491.13Section 1 is effective the day following final enactment.

491.16

Section 1. SUMMARY OF APPROPRIATIONS.

491.17The amounts shown in this section summarize direct appropriations, by fund, made
491.18in this article.

491.19			2014		2015		Total
491.20	General	$	5,643,757,000	$	5,877,152,000	$	11,520,909,000
491.21 491.22	State Government Special Revenue		69,619,000		74,135,000		143,754,000
491.23	Health Care Access		664,087,000		432,345,000		1,096,433,000
491.24	Federal TANF		269,628,000		266,526,000		536,154,000
491.25	Lottery Prize Fund		1,667,000		1,668,000		3,335,000
491.26	Total	$	6,648,757,000	$	6,651,827,000	$	13,300,584,000

491.27

Sec. 2. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

491.28The sums shown in the columns marked "Appropriations" are appropriated to the
491.29agencies and for the purposes specified in this article. The appropriations are from the
491.30general fund, or another named fund, and are available for the fiscal years indicated
491.31for each purpose. The figures "2014" and "2015" used in this article mean that the
492.1appropriations listed under them are available for the fiscal year ending June 30, 2014, or
492.2June 30, 2015, respectively. "The first year" is fiscal year 2014. "The second year" is fiscal
492.3year 2015. "The biennium" is fiscal years 2014 and 2015.

492.4				APPROPRIATIONS
492.5				Available for the Year
492.6				Ending June 30
492.7					2014		2015

492.8 492.9

Sec. 3. COMMISSIONER OF HUMAN SERVICES

492.10

Subdivision 1.Total Appropriation

$

6,454,078,000

$

6,455,116,000

492.11	Appropriations by Fund
492.12		2014	2015
492.13	General	5,558,235,000	5,796,754,000
492.14 492.15	State Government Special Revenue	4,099,000	6,332,000
492.16	Health Care Access	631,807,000	395,628,000
492.17	Federal TANF	257,915,000	254,813,000
492.18	Lottery Prize Fund	1,667,000	1,668,000

492.19Receipts for Systems Projects.
492.20Appropriations and federal receipts for
492.21information systems projects for MAXIS,
492.22PRISM, MMIS, and SSIS must be deposited
492.23in the state system account authorized
492.24in Minnesota Statutes, section 256.014.
492.25Money appropriated for computer projects
492.26approved by the commissioner of Minnesota
492.27information technology services, funded
492.28by the legislature, and approved by the
492.29commissioner of management and budget,
492.30may be transferred from one project to
492.31another and from development to operations
492.32as the commissioner of human services
492.33considers necessary. Any unexpended
492.34balance in the appropriation for these
492.35projects does not cancel but is available for
492.36ongoing development and operations.
493.1Nonfederal Share Transfers. The
493.2nonfederal share of activities for which
493.3federal administrative reimbursement is
493.4appropriated to the commissioner may be
493.5transferred to the special revenue fund.
493.6ARRA Supplemental Nutrition Assistance
493.7Benefit Increases. The funds provided for
493.8food support benefit increases under the
493.9Supplemental Nutrition Assistance Program
493.10provisions of the American Recovery and
493.11Reinvestment Act (ARRA) of 2009 must be
493.12used for benefit increases beginning July 1,
493.132009.
493.14Supplemental Nutrition Assistance
493.15Program Employment and Training.
493.16(1) Notwithstanding Minnesota Statutes,
493.17sections 256D.051, subdivisions 1a, 6b,
493.18and 6c, and 256J.626, federal Supplemental
493.19Nutrition Assistance employment and
493.20training funds received as reimbursement of
493.21MFIP consolidated fund grant expenditures
493.22for diversionary work program participants
493.23and child care assistance program
493.24expenditures must be deposited in the general
493.25fund. The amount of funds must be limited to
493.26$4,900,000 per year in fiscal years 2014 and
493.272015, and to $4,400,000 per year in fiscal
493.28years 2016 and 2017, contingent on approval
493.29by the federal Food and Nutrition Service.
493.30(2) Consistent with the receipt of the federal
493.31funds, the commissioner may adjust the
493.32level of working family credit expenditures
493.33claimed as TANF maintenance of effort.
493.34Notwithstanding any contrary provision in
493.35this article, this rider expires June 30, 2017.
494.1TANF Maintenance of Effort. (a) In order
494.2to meet the basic maintenance of effort
494.3(MOE) requirements of the TANF block grant
494.4specified under Code of Federal Regulations,
494.5title 45, section 263.1, the commissioner may
494.6only report nonfederal money expended for
494.7allowable activities listed in the following
494.8clauses as TANF/MOE expenditures:
494.9(1) MFIP cash, diversionary work program,
494.10and food assistance benefits under Minnesota
494.11Statutes, chapter 256J;
494.12(2) the child care assistance programs
494.13under Minnesota Statutes, sections 119B.03
494.14and 119B.05, and county child care
494.15administrative costs under Minnesota
494.16Statutes, section 119B.15;
494.17(3) state and county MFIP administrative
494.18costs under Minnesota Statutes, chapters
494.19256J and 256K;
494.20(4) state, county, and tribal MFIP
494.21employment services under Minnesota
494.22Statutes, chapters 256J and 256K;
494.23(5) expenditures made on behalf of legal
494.24noncitizen MFIP recipients who qualify for
494.25the MinnesotaCare program under Minnesota
494.26Statutes, chapter 256L;
494.27(6) qualifying working family credit
494.28expenditures under Minnesota Statutes,
494.29section 290.0671;
494.30(7) qualifying Minnesota education credit
494.31expenditures under Minnesota Statutes,
494.32section 290.0674; and
494.33(8) qualifying Head Start expenditures under
494.34Minnesota Statutes, section 119A.50.
495.1(b) The commissioner shall ensure that
495.2sufficient qualified nonfederal expenditures
495.3are made each year to meet the state's
495.4TANF/MOE requirements. For the activities
495.5listed in paragraph (a), clauses (2) to
495.6(8), the commissioner may only report
495.7expenditures that are excluded from the
495.8definition of assistance under Code of
495.9Federal Regulations, title 45, section 260.31.
495.10(c) For fiscal years beginning with state fiscal
495.11year 2003, the commissioner shall ensure
495.12that the maintenance of effort used by the
495.13commissioner of management and budget
495.14for the February and November forecasts
495.15required under Minnesota Statutes, section
495.1616A.103, contains expenditures under
495.17paragraph (a), clause (1), equal to at least 16
495.18percent of the total required under Code of
495.19Federal Regulations, title 45, section 263.1.
495.20(d) The requirement in Minnesota Statutes,
495.21section 256.011, subdivision 3, that federal
495.22grants or aids secured or obtained under that
495.23subdivision be used to reduce any direct
495.24appropriations provided by law, do not apply
495.25if the grants or aids are federal TANF funds.
495.26(e) For the federal fiscal years beginning on
495.27or after October 1, 2007, the commissioner
495.28may not claim an amount of TANF/MOE in
495.29excess of the 75 percent standard in Code
495.30of Federal Regulations, title 45, section
495.31263.1(a)(2), except:
495.32(1) to the extent necessary to meet the 80
495.33percent standard under Code of Federal
495.34Regulations, title 45, section 263.1(a)(1),
495.35if it is determined by the commissioner
496.1that the state will not meet the TANF work
496.2participation target rate for the current year;
496.3(2) to provide any additional amounts
496.4under Code of Federal Regulations, title 45,
496.5section 264.5, that relate to replacement of
496.6TANF funds due to the operation of TANF
496.7penalties; and
496.8(3) to provide any additional amounts that
496.9may contribute to avoiding or reducing
496.10TANF work participation penalties through
496.11the operation of the excess MOE provisions
496.12of Code of Federal Regulations, title 45,
496.13section 261.43(a)(2).
496.14For the purposes of clauses (1) to (3),
496.15the commissioner may supplement the
496.16MOE claim with working family credit
496.17expenditures or other qualified expenditures
496.18to the extent such expenditures are otherwise
496.19available after considering the expenditures
496.20allowed in this subdivision and subdivisions
496.212 and 3.
496.22(f) Notwithstanding any contrary provision
496.23in this article, paragraphs (a) to (e) expire
496.24June 30, 2017.
496.25Working Family Credit Expenditures
496.26as TANF/MOE. The commissioner may
496.27claim as TANF maintenance of effort up to
496.28$6,707,000 per year of working family credit
496.29expenditures in each fiscal year.

496.30 496.31

Subd. 2.Working Family Credit to be Claimed for TANF/MOE

496.32The commissioner may count the following
496.33amounts of working family credit
496.34expenditures as TANF/MOE:
496.35(1) fiscal year 2014, $43,576,000; and
497.1(2) fiscal year 2015, $43,548,000.

497.2 497.3

Subd. 3.TANF Transfer to Federal Child Care and Development Fund

497.4(a) The following TANF fund amounts
497.5are appropriated to the commissioner for
497.6purposes of MFIP/transition year child care
497.7assistance under Minnesota Statutes, section
497.8119B.05:
497.9(1) fiscal year 2014; $14,020,000; and
497.10(2) fiscal year 2015, $14,020,000.
497.11(b) The commissioner shall authorize the
497.12transfer of sufficient TANF funds to the
497.13federal child care and development fund to
497.14meet this appropriation and shall ensure that
497.15all transferred funds are expended according
497.16to federal child care and development fund
497.17regulations.

497.18

Subd. 4.Central Office

497.19The amounts that may be spent from this
497.20appropriation for each purpose are as follows:

497.21

(a) Operations

497.22	Appropriations by Fund
497.23	General	88,410,000	89,985,000
497.24 497.25	State Government Special Revenue	3,974,000	6,207,000
497.26	Health Care Access	13,252,000	13,154,000
497.27	Federal TANF	117,000	100,000

497.28Return on Taxpayer Investment
497.29Implementation Study. $100,000 is
497.30appropriated in fiscal year 2014 from the
497.31general fund to the commissioner of human
497.32services for transfer to the commissioner
497.33of management and budget to develop
497.34recommendations for implementing a return
497.35on taxpayer investment (ROTI) methodology
498.1and practice related to human services and
498.2corrections programs administered and
498.3funded by state and county government.
498.4The scope of the study shall include
498.5assessments of ROTI initiatives in other
498.6states, design implications for Minnesota,
498.7and identification of one or more Minnesota
498.8institutions of higher education capable of
498.9providing rigorous and consistent nonpartisan
498.10institutional support for ROTI. The scope of
498.11the study shall also include recommendations
498.12on methods to evaluate the value of prepaid
498.13medical assistance services (PMAP)
498.14versus other ways of delivering public
498.15health care programs. The commissioner
498.16shall consult with representatives of other
498.17state agencies, counties, legislative staff,
498.18Minnesota institutions of higher education,
498.19and other stakeholders in developing
498.20recommendations. The commissioner shall
498.21report findings and recommendations to the
498.22governor and legislature by November 30,
498.232013.
498.24DHS Receipt Center Accounting. The
498.25commissioner is authorized to transfer
498.26appropriations to, and account for DHS
498.27receipt center operations in, the special
498.28revenue fund.
498.29Administrative Recovery; Set-Aside. The
498.30commissioner may invoice local entities
498.31through the SWIFT accounting system as an
498.32alternative means to recover the actual cost
498.33of administering the following provisions:
498.34(1) Minnesota Statutes, section 125A.744,
498.35subdivision 3;
499.1(2) Minnesota Statutes, section 245.495,
499.2paragraph (b);
499.3(3) Minnesota Statutes, section 256B.0625,
499.4subdivision 20, paragraph (k);
499.5(4) Minnesota Statutes, section 256B.0924,
499.6subdivision 6, paragraph (g);
499.7(5) Minnesota Statutes, section 256B.0945,
499.8subdivision 4, paragraph (d); and
499.9(6) Minnesota Statutes, section 256F.10,
499.10subdivision 6, paragraph (b).
499.11Systems Modernization. The following
499.12amounts are appropriated for transfer to
499.13the state systems account authorized in
499.14Minnesota Statutes, section 256.014:
499.15(1) $1,825,000 in fiscal year 2014 and
499.16$2,502,000 in fiscal year 2015 is for the
499.17state share of Medicaid-allocated costs of
499.18the health insurance exchange information
499.19technology and operational structure. The
499.20funding base is $3,222,000 in fiscal year 2016
499.21and $3,037,000 in fiscal year 2017 but shall
499.22not be included in the base thereafter; and
499.23(2) Any unexpended balance from
499.24the contingent system modernization
499.25appropriation in article 15 must be
499.26transferred from the Department of Human
499.27Services state systems account to the Office
499.28of Enterprise Technology when the Office
499.29of Enterprise Technology has negotiated a
499.30federally approved internal service fund rates
499.31and billing process with sufficient internal
499.32accounting controls to properly maximize
499.33federal reimbursement to Minnesota for
500.1human services system modernization
500.2projects, but not later than June 30, 2015.
500.3Base Adjustment. The general fund base
500.4is increased by $6,099,000 in fiscal year
500.52016 and $1,185,000 in fiscal year 2017.
500.6The health access fund base is decreased by
500.7$551,000 in fiscal years 2016 and 2017.

500.8

(b) Children and Families

500.9	Appropriations by Fund
500.10	General	7,626,000	7,634,000
500.11	Federal TANF	2,282,000	2,282,000

500.12Financial Institution Data Match and
500.13Payment of Fees. The commissioner is
500.14authorized to allocate up to $310,000 each
500.15year in fiscal years 2014 and 2015 from the
500.16PRISM special revenue account to make
500.17payments to financial institutions in exchange
500.18for performing data matches between account
500.19information held by financial institutions
500.20and the public authority's database of child
500.21support obligors as authorized by Minnesota
500.22Statutes, section 13B.06, subdivision 7.
500.23Base Adjustment. The general fund base is
500.24decreased by $300,000 in fiscal years 2016
500.25and 2017, and the federal TANF fund base is
500.26increased by $300,000 in fiscal years 2016
500.27and 2017.

500.28

(c) Health Care

500.29	Appropriations by Fund
500.30	General	13,924,000	13,795,000
500.31	Health Care Access	26,599,000	30,306,000

500.32Base Adjustment. The health care access
500.33fund base is increased by $8,177,000 in fiscal
500.34year 2016 and by $6,712,000 in fiscal year
500.352017.
501.1Medical assistance costs for inmates. The
501.2commissioner of corrections, for fiscal years
501.32014 through 2017, shall transfer to the
501.4commissioner of human services an amount
501.5equal to the state share of medical assistance
501.6costs related to implementation of Minnesota
501.7Statutes, section 256B.055, subdivision 14,
501.8paragraph (c).

501.9

(d) Continuing Care

501.10	Appropriations by Fund
501.11	General	18,734,000	19,272,000
501.12 501.13	State Government Special Revenue	125,000	125,000

501.14Base Adjustment. The general fund base is
501.15increased by $3,324,000 in fiscal year 2016
501.16and by $3,324,000 in fiscal year 2017.

501.17

(e) Chemical and Mental Health

501.18	Appropriations by Fund
501.19	General	4,480,000	4,300,000
501.20	Lottery Prize Fund	159,000	160,000

501.21

Subd. 5.Forecasted Programs

501.22The amounts that may be spent from this
501.23appropriation for each purpose are as follows:

501.24

(a) MFIP/DWP

501.25	Appropriations by Fund
501.26	General	72,583,000	74,634,000
501.27	Federal TANF	83,104,000	80,510,000

501.28

(b) MFIP Child Care Assistance

59,662,000

59,393,000

501.29Notwithstanding Minnesota Statutes, section
501.30256J.021, TANF funds may be used to pay for
501.31any additional costs related to repeal of the
501.32MFIP family cap for individuals identified
501.33under Minnesota Statutes, section 256J.021.

501.34

(c) General Assistance

54,787,000

56,068,000

502.1General Assistance Standard. The
502.2commissioner shall set the monthly standard
502.3of assistance for general assistance units
502.4consisting of an adult recipient who is
502.5childless and unmarried or living apart
502.6from parents or a legal guardian at $203.
502.7The commissioner may reduce this amount
502.8according to Laws 1997, chapter 85, article
502.93, section 54.
502.10Emergency General Assistance. The
502.11amount appropriated for emergency general
502.12assistance funds is limited to no more
502.13than $6,729,812 in fiscal year 2014 and
502.14$6,729,812 in fiscal year 2015. Funds
502.15to counties shall be allocated by the
502.16commissioner using the allocation method in
502.17Minnesota Statutes, section 256D.06.

502.18

(d) MN Supplemental Assistance

38,646,000

39,821,000

502.19

(e) Group Residential Housing

140,447,000

149,984,000

502.20

(f) MinnesotaCare

502.21

Health Care Access

296,282,000

226,619,000

502.22

(g) Medical Assistance

502.23	Appropriations by Fund
502.24	General	4,371,808,000	4,595,789,000
502.25	Health Care Access	292,697,000	123,386,000

502.26The Departments of Human Services and
502.27Management and Budget shall identify
502.28general fund medical assistance populations
502.29costing $240,426,000 for fiscal year 2016
502.30and $218,557,000 for fiscal year 2017 and
502.31transfer those costs to the HCAF. The base for
502.32these costs shall be counted in the health care
502.33access fund for fiscal years 2016 and 2017.
503.1Newborn Screening. $121,000 in fiscal
503.2year 2014 and $141,000 in fiscal year 2015
503.3are appropriated from the general fund, and
503.4$10,000 in fiscal year 2014 and $13,000 in
503.5fiscal year 2015 are appropriated from the
503.6health care access fund to the commissioner
503.7of human services for the hospital
503.8reimbursement increase in Minnesota
503.9Statutes, section 256.969, subdivision 29.
503.10The base for this appropriation in fiscal year
503.112016 is $14,000.
503.12Transfer. $704,000 in fiscal year 2014 and
503.13$2,090,000 in fiscal year 2015 is transferred
503.14from the health care access fund to the
503.15general fund to provide increases in dental
503.16payment rates under Minnesota Statutes,
503.17section 256B.76, subdivision 2, paragraph (j).

503.18

(h) Alternative Care

47,197,000

45,084,000

503.19Alternative Care Transfer. Any money
503.20allocated to the alternative care program that
503.21is not spent for the purposes indicated does
503.22not cancel but shall be transferred to the
503.23medical assistance account.

503.24

(i) CD Treatment Fund

81,440,000

74,875,000

503.25Balance Transfer. The commissioner must
503.26transfer $18,188,000 from the consolidated
503.27chemical dependency treatment fund to the
503.28general fund by September 30, 2013.

503.29

Subd. 6.Grant Programs

503.30The amounts that may be spent from this
503.31appropriation for each purpose are as follows:

503.32

(a) Support Services Grants

504.1	Appropriations by Fund
504.2	General	8,715,000	8,715,000
504.3	Federal TANF	91,832,000	90,952,000

504.4MFIP Housing Assistance Grants. MFIP
504.5housing assistance grants under Minnesota
504.6Statutes, section 256J.35, paragraph (d),
504.7must be paid out of support services grants
504.8under this paragraph.
504.9Base Adjustment. The general fund base is
504.10decreased by $4,618,000 in fiscal years 2016
504.11and 2017. The TANF fund base is increased
504.12by $1,700,000 in fiscal years 2016 and 2017.

504.13 504.14

(b) Basic Sliding Fee Child Care Assistance Grants

38,356,000

38,681,000

504.15Base Adjustment. The general fund base is
504.16increased by $1,278,000 in fiscal year 2016
504.17and by $1,349,000 in fiscal year 2017.

504.18

(c) Child Care Development Grants

1,487,000

1,487,000

504.19

(d) Child Support Enforcement Grants

50,000

50,000

504.20Federal Child Support Demonstration
504.21Grants. Federal administrative
504.22reimbursement resulting from the federal
504.23child support grant expenditures authorized
504.24under United States Code, title 42, section
504.251315, is appropriated to the commissioner
504.26for this activity.

504.27

(e) Children's Services Grants

504.28	Appropriations by Fund
504.29	General	47,438,000	47,801,000
504.30	Federal TANF	140,000	140,000

504.31Adoption Assistance and Relative Custody
504.32Assistance. The commissioner may transfer
504.33unencumbered appropriation balances for
504.34adoption assistance and relative custody
505.1assistance between fiscal years and between
505.2programs.
505.3Privatized Adoption Grants. Federal
505.4reimbursement for privatized adoption grant
505.5and foster care recruitment grant expenditures
505.6is appropriated to the commissioner for
505.7adoption grants and foster care and adoption
505.8administrative purposes.
505.9Adoption Assistance Incentive Grants.
505.10Federal funds available during fiscal years
505.112014 and 2015 for adoption incentive grants
505.12are appropriated to the commissioner for
505.13these purposes.
505.14Base Adjustment. The general fund base is
505.15increased by $5,139,000 in fiscal year 2016
505.16and by $9,155,000 in fiscal year 2017.

505.17

(f) Child and Community Service Grants

53,301,000

53,301,000

505.18

(g) Child and Economic Support Grants

16,597,000

16,598,000

505.19Minnesota Food Assistance Program.
505.20Unexpended funds for the Minnesota food
505.21assistance program for fiscal year 2014 do
505.22not cancel but are available for this purpose
505.23in fiscal year 2015.
505.24Family Assets for Independence. $250,000
505.25each year is for the Family Assets for
505.26Independence Minnesota program. This
505.27appropriation is available in either year of the
505.28biennium and may be transferred between
505.29fiscal years. This appropriation is added to
505.30the base.
505.31Food Shelf Programs. $25,000 each year
505.32from the general fund is for food shelf
505.33programs under Minnesota Statutes, section
505.34256E.34. This appropriation is onetime.
506.1Notwithstanding Minnesota Statutes, section
506.2256E.34, subdivision 4, no portion of this
506.3appropriation may be used by Hunger
506.4Solutions for its administrative expenses,
506.5including but not limited to rent and salaries.

506.6

(h) Health Care Grants

506.7	Appropriations by Fund
506.8	General	90,000	90,000
506.9	Health Care Access	2,228,000	1,413,000

506.10Premium Subsidy. $....... is appropriated
506.11from the general fund in fiscal years 2014
506.12and 2015 to the commissioner of human
506.13services for the purpose of providing a
506.14premium subsidy to families purchasing
506.15supplemental autism coverage for young
506.16children on the private market if a family has
506.17an income below 400 percent of the federal
506.18poverty level. The commissioner may utilize
506.19the existing eligibility and enrollment system
506.20described in Minnesota Statutes, section
506.21252.27, to determine a family's eligibility
506.22for subsidies under this section. This
506.23appropriation is available until expended and
506.24does not become part of the base.
506.25Base Adjustment. The health care access
506.26fund is decreased by $1,223,000 in fiscal
506.27years 2016 and 2017.

506.28

(i) Aging and Adult Services Grants

18,556,000

19,422,000

506.29Community Service Development Grants
506.30and Community Services Grants. Of
506.31this appropriation, $1,025,000 each year is
506.32for community service development grants
506.33and $1,165,000 each year is for community
506.34services grants.

506.35

(j) Deaf and Hard-of-Hearing Grants

1,767,000

1,767,000

507.1

(k) Disabilities Grants

17,984,000

17,861,000

507.2$180,000 each year from the general fund is
507.3for a grant to the Minnesota Organization
507.4on Fetal Alcohol Syndrome (MOFAS) to
507.5support nonprofit Fetal Alcohol Spectrum
507.6Disorders (FASD) outreach prevention
507.7programs in Olmsted County. This is a
507.8onetime appropriation.
507.9Base Adjustment. The general fund base
507.10is increased by $502,000 in fiscal year 2016
507.11and by $676,000 in fiscal year 2017.

507.12

(l) Adult Mental Health Grants

507.13	Appropriations by Fund
507.14	General	71,257,000	69,588,000
507.15	Health Care Access	750,000	750,000
507.16	Lottery Prize	1,508,000	1,508,000

507.17Funding Usage. Up to 75 percent of a fiscal
507.18year's appropriations for adult mental health
507.19grants may be used to fund allocations in that
507.20portion of the fiscal year ending December
507.2131.
507.22Base Adjustment. The general fund base is
507.23decreased by $4,461,000 in fiscal years 2016
507.24and 2017.
507.25Mental Health Pilot Project. $230,000
507.26each year is for a grant to the Zumbro
507.27Valley Mental Health Center. The grant
507.28shall be used to implement a pilot project
507.29to test an integrated behavioral health care
507.30coordination model. The grant recipient must
507.31report measurable outcomes and savings
507.32to the commissioner of human services
507.33by January 15, 2016. This is a onetime
507.34appropriation.
508.1High-risk adults. $100,000 in fiscal year
508.22014 and $100,000 in fiscal year 2015 are
508.3appropriated from the general fund to the
508.4commissioner of human services for a grant
508.5to the nonprofit organization selected to
508.6administer the demonstration project for
508.7high-risk adults under Laws 2007, chapter
508.854, article 1, section 19, in order to complete
508.9the project. This is a onetime appropriation.

508.10

(m) Child Mental Health Grants

17,599,000

19,988,000

508.11Funding Usage. Up to 75 percent of a fiscal
508.12year's appropriation for child mental health
508.13grants may be used to fund allocations in that
508.14portion of the fiscal year ending December
508.1531.

508.16

(n) CD Treatment Support Grants

1,516,000

1,516,000

508.17Base Adjustment. The general fund base is
508.18decreased by $300,000 in fiscal years 2016
508.19and 2017.

508.20

Subd. 7.State-Operated Services

186,744,000

188,183,000

508.21Transfer Authority Related to
508.22State-Operated Services. Money
508.23appropriated for state-operated services
508.24may be transferred between fiscal years
508.25of the biennium with the approval of the
508.26commissioner of management and budget.
508.27The amounts that may be spent from the
508.28appropriation for each purpose are as follows:

508.29

(a) SOS Mental Health

116,598,000

117,467,000

508.30Dedicated Receipts Available. Of the
508.31revenue received under Minnesota Statutes,
508.32section 246.18, subdivision 8, paragraph
508.33(a), $1,000,000 each year is available for
508.34the purposes of paragraph (b), clause (1),
509.1of that subdivision, $1,000,000 each year
509.2is available to transfer to the adult mental
509.3health budget activity for the purposes of
509.4paragraph (b), clause (2), of that subdivision,
509.5and up to $2,713,000 each year is available
509.6for the purposes of paragraph (b), clause (3),
509.7of that subdivision.

509.8

(b) SOS MN Security Hospital

70,146,000

70,715,000

509.9

Subd. 8.Sex Offender Program

77,341,000

80,895,000

509.10Transfer Authority Related to Minnesota
509.11Sex Offender Program. Money
509.12appropriated for the Minnesota sex offender
509.13program may be transferred between fiscal
509.14years of the biennium with the approval of the
509.15commissioner of management and budget.

509.16

Subd. 9.Technical Activities

80,440,000

80,829,000

509.17This appropriation is from the federal TANF
509.18fund.
509.19Base Adjustment. The federal TANF fund
509.20base is decreased by $22,000 in fiscal year
509.212016 and by $49,000 in fiscal year 2017.

509.22

Subd. 10.Transfer.

509.23The commissioner of management and
509.24budget must transfer $65,000,000 in fiscal
509.25year 2014 from the general fund to the health
509.26care access fund. This is a onetime transfer.

509.27

Sec. 4. COMMISSIONER OF HEALTH

509.28

Subdivision 1.Total Appropriation

$

172,440,000

$

173,946,000

509.29	Appropriations by Fund
509.30		2014	2015
509.31	General	80,151,000	75,001,000
509.32 509.33	State Government Special Revenue	48,296,000	50,515,000
510.1	Health Care Access	32,280,000	36,717,000
510.2	Federal TANF	11,713,000	11,713,000

510.3The amounts that may be spent for each
510.4purpose are specified in the following
510.5subdivisions.

510.6

Subd. 2.Health Improvement

510.7	Appropriations by Fund
510.8	General	53,475,000	48,260,000
510.9 510.10	State Government Special Revenue	1,040,000	1,047,000
510.11	Health Care Access	21,725,000	26,731,000
510.12	Federal TANF	11,713,000	11,713,000

510.13Notwithstanding the cancellation requirement
510.14in Minnesota Statutes, section 256J.02,
510.15subdivision 6, TANF funds awarded under
510.16Minnesota Statutes, section 145.928, during
510.17fiscal year 2013 to grantees determined
510.18during the application process to have limited
510.19financial capacity, are available until June
510.2030, 2014.
510.21Statewide Health Improvement Program.
510.22(a) $20,000,000 in fiscal year 2014 and
510.23$25,000,000 in fiscal year 2015 is from the
510.24Health Care Access fund for the Statewide
510.25Health Improvement Program (SHIP) for
510.26grants to all local community health boards
510.27and tribal governments. Funds appropriated
510.28under this paragraph are available until
510.29expended. Public health agencies in their
510.30third cycle of SHIP funding shall incorporate
510.31activities targeted to addressing populations
510.32with health disparities or persons with
510.33disabilities.
510.34(b) Of the appropriated amount, $500,000
510.35in fiscal year 2015 shall be distributed as
511.1two-year pilot grants focused on improving
511.2health and reducing health care costs in
511.3populations over age 60. Grants shall be
511.4awarded by February 1, 2014, to five county
511.5public health agencies, multicounty public
511.6health agency partnerships, or county/city
511.7public health agency partnerships to initiate
511.8evidence-based strategies for improving
511.9the physical activity levels of citizens over
511.10age 60 with a goal of improving health and
511.11reducing health care costs. Partnerships with
511.12community education, health providers, or
511.13other local institutions shall be encouraged
511.14to establish ongoing outreach and sustainable
511.15programming.
511.16(c) Pilot project funds shall be distributed
511.17based on a $30,000 base with a per senior
511.18add-on based on the population to be served
511.19and shall include urban, suburban, regional
511.20center, and rural counties. Each grant shall
511.21serve an area with a minimum population
511.22base of persons over age 60 and shall target
511.23those seniors most at risk of high health costs
511.24due to a sedentary lifestyle, chronic disease,
511.25or other risk factors. Up to 8 percent of the
511.26above appropriation is available for creating
511.27a library of evidence-based programs that
511.28improve health and reduce health care costs,
511.29outcome-based reporting, and administration.
511.30The planning for the pilots shall engage
511.31local public health officials, other health
511.32promotion organizations and Board of Aging
511.33staff, and explore the potential future use of
511.34Title III Older American Act funds and other
511.35nonstate funding.
512.1(d) No more than 16 percent of the SHIP
512.2budget may be used for administration,
512.3technical assistance, and state-level
512.4evaluation costs.
512.5Statewide Cancer Surveillance System.
512.6 Of the general fund appropriation, $350,000
512.7in fiscal year 2014 and $350,000 in fiscal
512.8year 2015 are appropriated to develop and
512.9implement a new cancer reporting system
512.10under Minnesota Statutes, sections 144.671
512.11to 144.69. Any information technology
512.12development or support costs necessary
512.13for the cancer surveillance system must
512.14be incorporated into the agency's service
512.15level agreement and paid to the Office of
512.16Enterprise Technology.
512.17Eliminating Reproductive Health
512.18Disparities. To the extent funds are
512.19available for fiscal years 2014 and 2015
512.20for grants provided pursuant to Minnesota
512.21Statutes, section 145.928, the commissioner
512.22may provide a grant to a Somali-based
512.23organization located in Minnesota to
512.24develop a reproductive health strategic
512.25plan to eliminate reproductive health
512.26disparities for Somali women. The plan shall
512.27develop initiatives to provide educational
512.28and information resources to health care
512.29providers, community organizations, and
512.30Somali women to ensure effective interaction
512.31with Somali culture and western medicine
512.32and the delivery of appropriate health care
512.33services, and the achievement of better health
512.34outcomes for Somali women. The plan must
512.35engage health care providers, the Somali
512.36community, and Somali health-centered
513.1organizations. The commissioner shall
513.2submit a report to the chairs and ranking
513.3minority members of the senate and house
513.4committees with jurisdiction over health
513.5policy on the strategic plan developed under
513.6this grant for eliminating reproductive health
513.7disparities for Somali women. The report
513.8must be submitted by February 15, 2014.
513.9TANF Appropriations. (1) $1,156,000 of
513.10the TANF funds is appropriated each year of
513.11the biennium to the commissioner for family
513.12planning grants under Minnesota Statutes,
513.13section 145.925.
513.14(2) $3,579,000 of the TANF funds is
513.15appropriated each year of the biennium to
513.16the commissioner for home visiting and
513.17nutritional services listed under Minnesota
513.18Statutes, section 145.882, subdivision 7,
513.19clauses (6) and (7). Funds must be distributed
513.20to community health boards according to
513.21Minnesota Statutes, section 145A.131,
513.22subdivision 1.
513.23(3) $2,000,000 of the TANF funds is
513.24appropriated each year of the biennium to
513.25the commissioner for decreasing racial and
513.26ethnic disparities in infant mortality rates
513.27under Minnesota Statutes, section 145.928,
513.28subdivision 7.
513.29(4) $4,978,000 of the TANF funds is
513.30appropriated each year of the biennium to the
513.31commissioner for the family home visiting
513.32grant program according to Minnesota
513.33Statutes, section 145A.17. $4,000,000 of the
513.34funding must be distributed to community
513.35health boards according to Minnesota
514.1Statutes, section 145A.131, subdivision 1.
514.2$978,000 of the funding must be distributed
514.3to tribal governments based on Minnesota
514.4Statutes, section 145A.14, subdivision 2a.
514.5(5) The commissioner may use up to 6.23
514.6percent of the funds appropriated each fiscal
514.7year to conduct the ongoing evaluations
514.8required under Minnesota Statutes, section
514.9145A.17, subdivision 7, and training and
514.10technical assistance as required under
514.11Minnesota Statutes, section 145A.17,
514.12subdivisions 4 and 5.
514.13TANF Carryforward. Any unexpended
514.14balance of the TANF appropriation in the
514.15first year of the biennium does not cancel but
514.16is available for the second year.

514.17

Subd. 3.Policy Quality and Compliance

514.18	Appropriations by Fund
514.19	General	9,400,000	9,409,000
514.20 514.21	State Government Special Revenue	14,481,000	16,548,000
514.22	Health Care Access	10,555,000	9,986,000

514.23Base Level Adjustment. The state
514.24government special revenue fund base shall
514.25be reduced by $2,000 in fiscal year 2017. The
514.26health care access base shall be increased by
514.27$600,000 in fiscal year 2015.

514.28

Subd. 4.Health Protection

514.29	Appropriations by Fund
514.30	General	9,503,000	9,558,000
514.31 514.32	State Government Special Revenue	32,775,000	32,920,000

514.33Infectious Disease Laboratory. Of the
514.34general fund appropriation, $200,000 in
514.35fiscal year 2014 and $200,000 in fiscal year
514.362015 are appropriated to the commissioner
515.1to monitor infectious disease trends and
515.2investigate infectious disease outbreaks.
515.3Surveillance for Elevated Blood Lead
515.4Levels. Of the general fund appropriation,
515.5$100,000 in fiscal year 2014 and $100,000
515.6in fiscal year 2015 are appropriated to the
515.7commissioner for the blood lead surveillance
515.8system under Minnesota Statutes, section
515.9144.9502.
515.10Newborn Screening. (a) $365,000 in fiscal
515.11year 2014 and $349,000 in fiscal year 2015
515.12are appropriated for the purpose of providing
515.13support services to families as required
515.14under Minnesota Statutes, section 144.966,
515.15subdivision 3a.
515.16(b) $164,000 in fiscal year 2014 and
515.17$156,000 in fiscal year 2015 are appropriated
515.18for home-based education in American Sign
515.19Language for families with children who
515.20are deaf or have hearing loss, as required
515.21under Minnesota Statutes, section 144.966,
515.22subdivision 3a.
515.23Sexual Violence Prevention. Within
515.24available appropriations, by January 15,
515.252015, the commissioner must report to the
515.26legislature on its activities to prevent sexual
515.27violence, including activities to promote
515.28coordination of existing state programs and
515.29services to achieve maximum impact on
515.30addressing the root causes of sexual violence.
515.31Safe Harbor for Sexually Exploited
515.32Youth. (a) $1,000,000 in fiscal year 2014
515.33and $1,000,000 in fiscal year 2015 are
515.34for supportive service grants for the safe
515.35harbor for sexually exploited youth program,
516.1under Minnesota Statutes, section 145.4716,
516.2including advocacy services, civil legal
516.3services, health care services, mental and
516.4chemical health services, education and
516.5employment services, aftercare and relapse
516.6prevention, and family reunification services.
516.7This appropriation shall be added to the base.
516.8(b) $381,000 in fiscal year 2014 and
516.9$381,000 in fiscal year 2015 are for
516.10grants to six regional navigators under
516.11Minnesota Statutes, section 145.4717. This
516.12appropriation shall be added to the base.
516.13(c) $82,500 in fiscal year 2014 and $82,500
516.14in fiscal year 2015 are for the director of
516.15child sex trafficking prevention position.
516.16This appropriation shall be added to the base.
516.17(d) $72,900 in fiscal year 2015 is for
516.18program evaluation required under
516.19Minnesota Statutes, section 145.4718. This
516.20appropriation shall be added to the base.
516.21Base Level Adjustment. The state
516.22government special revenue base is increased
516.23by $6,000 in fiscal year 2016 and by $27,000
516.24in fiscal year 2017.

516.25

Subd. 5.Administrative Support Services

7,773,000

7,774,000

516.26Regional Support for Local Public Health
516.27Departments. $350,000 in fiscal year
516.282014 and $350,000 in fiscal year 2015
516.29are appropriated to the commissioner for
516.30regional staff who provide specialized
516.31expertise to local public health departments.

516.32

Sec. 5. HEALTH-RELATED BOARDS

516.33

Subdivision 1.Total Appropriation

$

17,224,000

$

17,288,000

517.1This appropriation is from the state
517.2government special revenue fund. The
517.3amounts that may be spent for each purpose
517.4are specified in the following subdivisions.

517.5

Subd. 2.Board of Chiropractic Examiners

473,000

477,000

517.6

Subd. 3.Board of Dentistry

1,835,000

1,850,000

517.7Health Professional Services Program. Of
517.8this appropriation, $704,000 in fiscal year
517.92014 and $704,000 in fiscal year 2015 from
517.10the state government special revenue fund are
517.11for the health professional services program.

517.12 517.13

Subd. 4.Board of Dietetic and Nutrition Practice

112,000

112,000

517.14 517.15

Subd. 5.Board of Marriage and Family Therapy

169,000

170,000

517.16

Subd. 6.Board of Medical Practice

3,883,000

3,900,000

517.17

Subd. 7.Board of Nursing

3,664,000

3,692,000

517.18 517.19

Subd. 8.Board of Nursing Home Administrators

1,630,000

1,586,000

517.20Administrative Services Unit - Operating
517.21Costs. Of this appropriation, $676,000
517.22in fiscal year 2014 and $626,000 in
517.23fiscal year 2015 are for operating costs
517.24of the administrative services unit. The
517.25administrative services unit may receive
517.26and expend reimbursements for services
517.27performed by other agencies.
517.28Administrative Services Unit - Volunteer
517.29Health Care Provider Program. Of this
517.30appropriation, $150,000 in fiscal year 2014
517.31and $150,000 in fiscal year 2015 are to pay
517.32for medical professional liability coverage
517.33required under Minnesota Statutes, section
517.34214.40.
518.1Administrative Services Unit - Contested
518.2Cases and Other Legal Proceedings. Of
518.3this appropriation, $200,000 in fiscal year
518.42014 and $200,000 in fiscal year 2015 are
518.5for costs of contested case hearings and other
518.6unanticipated costs of legal proceedings
518.7involving health-related boards funded
518.8under this section. Upon certification of a
518.9health-related board to the administrative
518.10services unit that the costs will be incurred
518.11and that there is insufficient money available
518.12to pay for the costs out of money currently
518.13available to that board, the administrative
518.14services unit is authorized to transfer money
518.15from this appropriation to the board for
518.16payment of those costs with the approval
518.17of the commissioner of management and
518.18budget. This appropriation does not cancel.
518.19Any unencumbered and unspent balances
518.20remain available for these expenditures in
518.21subsequent fiscal years.
518.22Criminal Background Checks. $390,000
518.23each year from the state government special
518.24revenue fund is for the Administrative
518.25Support Services Unit for the implementation
518.26of a criminal background check program.

518.27

Subd. 9.Board of Optometry

108,000

108,000

518.28

Subd. 10.Board of Pharmacy

2,362,000

2,380,000

518.29Prescription Electronic Reporting. Of
518.30this appropriation, $356,000 in fiscal year
518.312014 and $356,000 in fiscal year 2015 from
518.32the state government special revenue fund
518.33are to the board to operate the prescription
518.34electronic reporting system in Minnesota
518.35Statutes, section 152.126.

519.1

Subd. 11.Board of Physical Therapy

348,000

351,000

519.2

Subd. 12.Board of Podiatry

76,000

77,000

519.3

Subd. 13.Board of Psychology

853,000

861,000

519.4

Subd. 14.Board of Social Work

1,061,000

1,069,000

519.5

Subd. 15.Board of Veterinary Medicine

232,000

234,000

519.6 519.7

Subd. 16.Board of Behavioral Health and Therapy

418,000

421,000

519.8 519.9

Sec. 6. EMERGENCY MEDICAL SERVICES REGULATORY BOARD

$

2,749,000

$

2,756,000

519.10Regional Grants. $585,000 in fiscal year
519.112014 and $585,000 in fiscal year 2015 are
519.12for regional emergency medical services
519.13programs, to be distributed equally to the
519.14eight emergency medical service regions.
519.15Cooper/Sams Volunteer Ambulance
519.16Program. $700,000 in fiscal year 2014 and
519.17$700,000 in fiscal year 2015 are for the
519.18Cooper/Sams volunteer ambulance program
519.19under Minnesota Statutes, section 144E.40.
519.20(a) Of this amount, $611,000 in fiscal year
519.212014 and $611,000 in fiscal year 2015
519.22are for the ambulance service personnel
519.23longevity award and incentive program under
519.24Minnesota Statutes, section 144E.40.
519.25(b) Of this amount, $89,000 in fiscal year
519.262014 and $89,000 in fiscal year 2015 are
519.27for the operations of the ambulance service
519.28personnel longevity award and incentive
519.29program under Minnesota Statutes, section
519.30144E.40.
519.31Ambulance Training Grant. $361,000 in
519.32fiscal year 2014 and $361,000 in fiscal year
519.332015 are for training grants.
520.1EMSRB Board Operations. $1,095,000 in
520.2fiscal year 2014 and $1,095,000 in fiscal year
520.32015 are for operations.

520.4

Sec. 7. COUNCIL ON DISABILITY

$

618,000

$

622,000

520.5 520.6 520.7

Sec. 8. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES

$

1,668,000

$

1,680,000

520.8

Sec. 9. OMBUDSPERSON FOR FAMILIES

$

336,000

$

339,000

520.9    Sec. 10. Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:
520.10    Subd. 34. Federal administrative reimbursement dedicated. Federal
520.11administrative reimbursement resulting from the following activities is appropriated to the
520.12commissioner for the designated purposes:
520.13(1) reimbursement for the Minnesota senior health options project; and
520.14(2) reimbursement related to prior authorization and inpatient admission certification
520.15by a professional review organization. A portion of these funds must be used for activities
520.16to decrease unnecessary pharmaceutical costs in medical assistance.; and
520.17(3) reimbursement resulting from the federal child support grant expenditures
520.18authorized under United States Code, title 42, section 1315.

520.19    Sec. 11. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
520.20to read:
520.21    Subd. 35. Federal reimbursement for privatized adoption grants. Federal
520.22reimbursement for privatized adoption grant and foster care recruitment grant expenditures
520.23is appropriated to the commissioner for adoption grants and foster care and adoption
520.24administrative purposes.

520.25    Sec. 12. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
520.26to read:
520.27    Subd. 36. DHS receipt center accounting. The commissioner may transfer
520.28appropriations to, and account for DHS receipt center operations in, the special revenue
520.29fund.

520.30    Sec. 13. TRANSFERS.
521.1    Subdivision 1. Grants. The commissioner of human services, with the approval of
521.2the commissioner of management and budget, may transfer unencumbered appropriation
521.3balances for the biennium ending June 30, 2015, within fiscal years among the MFIP,
521.4general assistance, general assistance medical care under Minnesota Statutes 2009
521.5Supplement, section 256D.03, subdivision 3, medical assistance, MinnesotaCare, MFIP
521.6child care assistance under Minnesota Statutes, section 119B.05, Minnesota supplemental
521.7aid, group residential housing programs, the entitlement portion of the chemical
521.8dependency consolidated treatment fund, and between fiscal years of the biennium. The
521.9commissioner shall inform the chairs and ranking minority members of the senate Health
521.10and Human Services Finance Division and the house of representatives Health and Human
521.11Services Finance Committee quarterly about transfers made under this provision.
521.12    Subd. 2. Administration. Positions, salary money, and nonsalary administrative
521.13money may be transferred within the Departments of Human Services and Health as the
521.14commissioners consider necessary, with the advance approval of the commissioner of
521.15management and budget. The commissioner shall inform the chairs and ranking minority
521.16members of the senate Health and Human Services Finance Division and the house of
521.17representatives Health and Human Services Finance Committee quarterly about transfers
521.18made under this provision.

521.19    Sec. 14. INDIRECT COSTS NOT TO FUND PROGRAMS.
521.20The commissioners of health and human services shall not use indirect cost
521.21allocations to pay for the operational costs of any program for which they are responsible.

521.22    Sec. 15. EXPIRATION OF UNCODIFIED LANGUAGE.
521.23All uncodified language contained in this article expires on June 30, 2015, unless a
521.24different expiration date is explicit.

521.25    Sec. 16. EFFECTIVE DATE.
521.26This article is effective July 1, 2013, unless a different effective date is specified.

521.29

Section 1. HUMAN SERVICES APPROPRIATIONS.

521.30The sums shown in the columns marked "Appropriations" are added to or, if shown
521.31in parentheses, subtracted from the appropriations in article 14 to the agencies and for the
521.32purposes specified in this article. The appropriations are from the general fund or other
522.1named fund and are available for the fiscal years indicated for each purpose. The figures
522.2"2014" and "2015" used in this article mean that the addition to or subtraction from the
522.3appropriation listed under them is available for the fiscal year ending June 30, 2014, or
522.4June 30, 2015, respectively. Supplemental appropriations and reductions to appropriations
522.5for the fiscal year ending June 30, 2014, are effective the day following final enactment
522.6unless a different effective date is explicit.

522.7				APPROPRIATIONS
522.8				Available for the Year
522.9				Ending June 30
522.10					2014		2015

522.11 522.12

Sec. 2. COMMISSIONER OF HUMAN SERVICES

522.13

Subdivision 1.Total Appropriation

$

1,906,000

$

2,047,000

522.14	Appropriations by Fund
522.15		2014	2015
522.16	General	1,906,000	2,047,000

522.17Reform 2020 Contingency. The
522.18appropriation from the general fund may
522.19be adjusted as provided in article 2, section
522.2049, in order to implement Reform 2020 and
522.21systems modernization.

522.22

Subd. 2.Central Office Operations

522.23

(a) Operations

3,384,000

14,506,000

522.24Systems Modernization Transfer. If
522.25contingent funding is fully or partially
522.26disbursed as provided in article 2, section 49,
522.27and transferred to the state systems account,
522.28the unexpended balance of that appropriation
522.29must be transferred to the Office of Enterprise
522.30Technology in accordance with clause (2)
522.31of the systems modernization provision in
522.32article 14. Contingent funding under this
522.33provision must not exceed $16,992,000 for
522.34the biennium.

522.35

(b) Children and Families

109,000

206,000

523.1

(c) Health Care

100,000

100,000

523.2

(d) Continuing Care

5,236,000

5,541,000

523.3

Subd. 3.Forecasted Programs

523.4

(a) Group Residential Housing

(1,166,000)

(8,602,000)

523.5

(b) Medical Assistance

(3,770,000)

(10,086,000)

523.6

(c) Alternative Care

(6,981,000)

(4,394,000)

523.7

Subd. 4.Grant Programs

523.8

(a) Child and Community Services Grants

3,000,000

3,000,000

523.9

(b) Aging and Adult Services Grants

1,430,000

1,237,000

523.10

(c) Disability Grants

564,000

539,000