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 home
1.6and community-based services; establishing payment methodologies for home
1.7and community-based services; adjusting nursing and ICF/DD facility rates;
1.8setting and modifying fees; modifying autism coverage; modifying assistance
1.9programs; requiring licensing of certain abortion facilities; requiring drug testing;
1.10making technical changes; requiring studies; requiring reports; appropriating
1.11money;amending Minnesota Statutes 2012, sections 16A.724, subdivisions
1.122, 3; 16C.10, subdivision 5; 16C.155, subdivision 1; 62A.65, subdivision
1.132, by adding a subdivision; 62J.692, subdivision 4; 62Q.19, subdivision 1;
1.14103I.005, by adding a subdivision; 103I.521; 119B.13, subdivision 7; 144.051,
1.15by adding subdivisions; 144.0724, subdivisions 4, 6; 144.123, subdivision 1;
1.16144.125, subdivision 1; 144.966, subdivisions 2, 3a; 144.98, subdivisions 3, 5,
1.17by adding subdivisions; 144.99, subdivision 4; 144A.351; 144A.43; 144A.44;
1.18144A.45; 144A.53, subdivision 2; 144D.01, subdivision 4; 145.986; 145C.01,
1.19subdivision 7; 148E.065, subdivision 4a; 149A.02, subdivisions 1a, 2, 3, 4, 5,
1.2016, 23, 27, 34, 35, 37, by adding subdivisions; 149A.03; 149A.65, by adding
1.21subdivisions; 149A.70, subdivisions 1, 2, 3, 5; 149A.71, subdivisions 2, 4;
1.22149A.72, subdivisions 3, 9, by adding a subdivision; 149A.73, subdivisions 1,
1.232, 4; 149A.74; 149A.91, subdivision 9; 149A.93, subdivisions 3, 6; 149A.94;
1.24149A.96, subdivision 9; 174.30, subdivision 1; 214.40, subdivision 1; 243.166,
1.25subdivisions 4b, 7; 245.4661, subdivisions 5, 6; 245.4682, subdivision 2;
1.26245A.02, subdivisions 1, 9, 10, 14; 245A.03, subdivisions 7, 8, 9; 245A.04,
1.27subdivision 13; 245A.042, subdivision 3; 245A.07, subdivisions 2a, 3; 245A.08,
1.28subdivision 2a; 245A.10; 245A.11, subdivisions 2a, 7, 7a, 7b, 8; 245A.1435;
1.29245A.144; 245A.1444; 245A.16, subdivision 1; 245A.40, subdivision 5;
1.30245A.50; 245C.04, by adding a subdivision; 245C.08, subdivision 1; 245D.02;
1.31245D.03; 245D.04; 245D.05; 245D.06; 245D.07; 245D.09; 245D.10; 246.18,
1.32subdivision 8, by adding a subdivision; 246.54; 254B.04, subdivision 1;
1.33254B.13; 256.01, subdivisions 2, 24, 34, by adding subdivisions; 256.9657,
1.34subdivisions 1, 2, 3a; 256.9685, subdivision 2; 256.969, subdivisions 3a, 29;
1.35256.975, subdivision 7, by adding subdivisions; 256.9754, subdivision 5, by
1.36adding subdivisions; 256B.02, by adding subdivisions; 256B.021, by adding
1.37subdivisions; 256B.04, subdivisions 18, 21, by adding a subdivision; 256B.055,
1.38subdivisions 3a, 6, 10, 14, 15, by adding a subdivision; 256B.056, subdivisions 1,
1.391c, 3, 4, as amended, 5c, 10, by adding a subdivision; 256B.057, subdivisions 1,
2.18, 10, by adding a subdivision; 256B.06, subdivision 4; 256B.0623, subdivision
2.22; 256B.0625, subdivisions 9, 13e, 19c, 31, 39, 48, 58, by adding subdivisions;
2.3256B.0631, subdivision 1; 256B.064, subdivisions 1a, 1b, 2; 256B.0659,
2.4subdivision 21; 256B.0755, subdivision 3; 256B.0756; 256B.0911, subdivisions
2.51, 1a, 3a, 4d, 6, 7, by adding a subdivision; 256B.0913, subdivision 4, by
2.6adding a subdivision; 256B.0915, subdivisions 3a, 5, by adding a subdivision;
2.7256B.0916, by adding a subdivision; 256B.0917, subdivisions 6, 13, by
2.8adding subdivisions; 256B.092, subdivisions 11, 12, by adding subdivisions;
2.9256B.0946; 256B.095; 256B.0951, subdivisions 1, 4; 256B.0952, subdivisions 1,
2.105; 256B.097, subdivisions 1, 3; 256B.431, subdivision 44; 256B.434, subdivision
2.114, by adding a subdivision; 256B.437, subdivision 6; 256B.439, subdivisions
2.121, 2, 3, 4, by adding a subdivision; 256B.441, subdivisions 13, 53; 256B.49,
2.13subdivisions 11a, 12, 14, 15, by adding subdivisions; 256B.4912, subdivisions
2.141, 2, 3, 7, by adding subdivisions; 256B.4913, subdivisions 5, 6, by adding a
2.15subdivision; 256B.492; 256B.493, subdivision 2; 256B.5011, subdivision 2;
2.16256B.5012, by adding subdivisions; 256B.69, subdivisions 5c, 31, by adding a
2.17subdivision; 256B.694; 256B.76, subdivisions 2, 4, by adding a subdivision;
2.18256B.761; 256B.764; 256B.766; 256D.024, by adding a subdivision; 256I.04,
2.19subdivision 3; 256I.05, subdivision 1e, by adding a subdivision; 256J.15, by
2.20adding a subdivision; 256J.26, subdivision 3, by adding a subdivision; 256J.35;
2.21256K.45; 256L.01, subdivisions 3a, 5, by adding subdivisions; 256L.02,
2.22subdivision 2, by adding subdivisions; 256L.03, subdivisions 1, 1a, 3, 5, 6, by
2.23adding a subdivision; 256L.04, subdivisions 1, 7, 8, 10, by adding subdivisions;
2.24256L.05, subdivisions 1, 2, 3; 256L.06, subdivision 3; 256L.07, subdivisions 1,
2.252, 3; 256L.09, subdivision 2; 256L.11, subdivision 6; 256L.15, subdivisions 1, 2;
2.26257.0755, subdivision 1; 260B.007, subdivisions 6, 16; 260C.007, subdivisions
2.276, 31; 270B.14, subdivision 1; 471.59, subdivision 1; 626.556, subdivisions 2, 3,
2.2810d; 626.557, subdivisions 4, 9, 9a, 9e; 626.5572, subdivision 13; Laws 1998,
2.29chapter 407, article 6, section 116; Laws 2011, First Special Session chapter 9,
2.30article 1, section 3; article 2, section 27; article 10, section 3, subdivision 3,
2.31as amended; proposing coding for new law in Minnesota Statutes, chapters 3;
2.3262A; 62D; 144; 144A; 145; 149A; 214; 245; 245A; 245D; 254B; 256; 256B;
2.33256L; repealing Minnesota Statutes 2012, sections 103I.005, subdivision 20;
2.34144.123, subdivision 2; 144A.46; 144A.461; 149A.025; 149A.20, subdivision
2.358; 149A.30, subdivision 2; 149A.40, subdivision 8; 149A.45, subdivision 6;
2.36149A.50, subdivision 6; 149A.51, subdivision 7; 149A.52, subdivision 5a;
2.37149A.53, subdivision 9; 245A.655; 245B.01; 245B.02; 245B.03; 245B.031;
2.38245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, 7; 245B.055; 245B.06; 245B.07;
2.39245B.08; 245D.08; 256B.055, subdivisions 3, 5, 10b; 256B.056, subdivision 5b;
2.40256B.057, subdivisions 1c, 2; 256B.0911, subdivisions 4a, 4b, 4c; 256B.0917,
2.41subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14; 256B.096, subdivisions 1, 2, 3, 4;
2.42256B.14, subdivision 3a; 256B.49, subdivision 16a; 256B.4913, subdivisions 1,
2.432, 3, 4; 256B.5012, subdivision 13; 256J.24, subdivision 6; 256K.45, subdivision
2.442; 256L.01, subdivision 4a; 256L.031; 256L.04, subdivisions 1b, 9, 10a;
2.45256L.05, subdivision 3b; 256L.07, subdivisions 5, 8, 9; 256L.11, subdivision 5;
2.46256L.12; 256L.17, subdivisions 1, 2, 3, 4, 5; 485.14; 609.093; Laws 2011, First
2.47Special Session chapter 9, article 7, section 54, as amended; Minnesota Rules,
2.48parts 4668.0002; 4668.0003; 4668.0005; 4668.0008; 4668.0012; 4668.0016;
2.494668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040; 4668.0050;
2.504668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100;
2.514668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160;
2.524668.0170; 4668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220;
2.534668.0230; 4668.0240; 4668.0800; 4668.0805; 4668.0810; 4668.0815;
2.544668.0820; 4668.0825; 4668.0830; 4668.0835; 4668.0840; 4668.0845;
2.554668.0855; 4668.0860; 4668.0865; 4668.0870; 4669.0001; 4669.0010;
2.564669.0020; 4669.0030; 4669.0040; 4669.0050.
2.57BE 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. INTENT.
42.15It is the intent of this act that Minnesota shall pursue market-based solutions to
42.16health care delivery reform in Minnesota. It is not the intent of this act to advance or
42.17implement policies leading to a single-payer system.

42.18    Sec. 62. REVISOR'S INSTRUCTION.
42.19The revisor shall remove cross-references to the sections repealed in this article
42.20wherever they appear in Minnesota Statutes and Minnesota Rules and make changes
42.21necessary to correct the punctuation, grammar, or structure of the remaining text and
42.22preserve its meaning.

42.23    Sec. 63. REPEALER.
42.24(a) Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.031; 256L.04,
42.25subdivisions 1b, 9, and 10a; 256L.05, subdivision 3b; 256L.07, subdivisions 5, 8, and 9;
42.26256L.11, subdivision 5; and 256L.17, subdivisions 1, 2, 3, 4, and 5, are repealed effective
42.27January 1, 2014.
42.28(b) Minnesota Statutes 2012, section 256L.12, is repealed effective January 1, 2015.
42.29(c) Minnesota Statutes 2012, sections 256B.055, subdivisions 3, 5, and 10b;
42.30256B.056, subdivision 5b; and 256B.057, subdivisions 1c and 2, are repealed effective
42.31January 1, 2014.


43.3    Section 1. Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:
43.4    Subd. 4. Resident assessment schedule. (a) A facility must conduct and
43.5electronically submit to the commissioner of health case mix assessments that conform
43.6with the assessment schedule defined by Code of Federal Regulations, title 42, section
43.7483.20, and published by the United States Department of Health and Human Services,
43.8Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
43.9Instrument User's Manual, version 3.0, and subsequent updates when issued by the
43.10Centers for Medicare and Medicaid Services. The commissioner of health may substitute
43.11successor manuals or question and answer documents published by the United States
43.12Department of Health and Human Services, Centers for Medicare and Medicaid Services,
43.13to replace or supplement the current version of the manual or document.
43.14(b) The assessments used to determine a case mix classification for reimbursement
43.15include the following:
43.16(1) a new admission assessment must be completed by day 14 following admission;
43.17(2) an annual assessment which must have an assessment reference date (ARD)
43.18within 366 days of the ARD of the last comprehensive assessment;
43.19(3) a significant change assessment must be completed within 14 days of the
43.20identification of a significant change; and
43.21(4) all quarterly assessments must have an assessment reference date (ARD) within
43.2292 days of the ARD of the previous assessment.
43.23(c) In addition to the assessments listed in paragraph (b), the assessments used to
43.24determine nursing facility level of care include the following:
43.25(1) preadmission screening completed under section 256B.0911, subdivision 4a, by a
43.26county, tribe, or managed care organization under contract with the Department of Human
43.27Services 256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line
43.28or other organization under contract with the Minnesota Board on Aging; and
43.29(2) a nursing facility level of care determination as provided for under section
43.30256B.0911, subdivision 4e, as part of a face-to-face long-term care consultation assessment
43.31completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
43.32managed care organization under contract with the Department of Human Services.

44.1    Sec. 2. Minnesota Statutes 2012, section 144A.351, is amended to read:
44.2144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS:
44.3REPORT AND STUDY REQUIRED.
44.4    Subdivision 1. Report requirements. The commissioners of health and human
44.5services, with the cooperation of counties and in consultation with stakeholders, including
44.6persons who need or are using long-term care services and supports, lead agencies,
44.7regional entities, senior, disability, and mental health organization representatives, service
44.8providers, and community members shall prepare a report to the legislature by August 15,
44.92013, and biennially thereafter, regarding the status of the full range of long-term care
44.10services and supports for the elderly and children and adults with disabilities and mental
44.11illnesses in Minnesota. The report shall address:
44.12    (1) demographics and need for long-term care services and supports in Minnesota;
44.13    (2) summary of county and regional reports on long-term care gaps, surpluses,
44.14imbalances, and corrective action plans;
44.15    (3) status of long-term care services and related mental health services, housing
44.16options, and supports by county and region including:
44.17    (i) changes in availability of the range of long-term care services and housing options;
44.18    (ii) access problems, including access to the least restrictive and most integrated
44.19services and settings, regarding long-term care services; and
44.20    (iii) comparative measures of long-term care services availability, including serving
44.21people in their home areas near family, and changes over time; and
44.22    (4) recommendations regarding goals for the future of long-term care services and
44.23supports, policy and fiscal changes, and resource development and transition needs.
44.24    Subd. 2. Critical access study. The commissioner shall conduct a onetime study to
44.25assess local capacity and availability of home and community-based services for older
44.26adults, people with disabilities, and people with mental illnesses. The study must assess
44.27critical access at the community level and identify potential strategies to build home and
44.28community-based service capacity in critical access areas. The report shall be submitted
44.29to the legislature no later than August 15, 2015.

44.30    Sec. 3. Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:
44.31    Subd. 4a. City, county, and state social workers. (a) Beginning July 1, 2016, the
44.32licensure of city, county, and state agency social workers is voluntary, except an individual
44.33who is newly employed by a city or state agency after July 1, 2016, must be licensed
44.34if the individual who provides social work services, as those services are defined in
45.1section 148E.010, subdivision 11, paragraph (b), is presented to the public by any title
45.2incorporating the words "social work" or "social worker."
45.3(b) City, county, and state agencies employing social workers and staff who are
45.4designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
45.5256.01, subdivision 24, are not required to employ licensed social workers.

45.6    Sec. 4. Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:
45.7    Subd. 2. Specific powers. Subject to the provisions of section 241.021, subdivision
45.82 , the commissioner of human services shall carry out the specific duties in paragraphs (a)
45.9through (cc) (dd):
45.10    (a) Administer and supervise all forms of public assistance provided for by state law
45.11and other welfare activities or services as are vested in the commissioner. Administration
45.12and supervision of human services activities or services includes, but is not limited to,
45.13assuring timely and accurate distribution of benefits, completeness of service, and quality
45.14program management. In addition to administering and supervising human services
45.15activities vested by law in the department, the commissioner shall have the authority to:
45.16    (1) require county agency participation in training and technical assistance programs
45.17to promote compliance with statutes, rules, federal laws, regulations, and policies
45.18governing human services;
45.19    (2) monitor, on an ongoing basis, the performance of county agencies in the
45.20operation and administration of human services, enforce compliance with statutes, rules,
45.21federal laws, regulations, and policies governing welfare services and promote excellence
45.22of administration and program operation;
45.23    (3) develop a quality control program or other monitoring program to review county
45.24performance and accuracy of benefit determinations;
45.25    (4) require county agencies to make an adjustment to the public assistance benefits
45.26issued to any individual consistent with federal law and regulation and state law and rule
45.27and to issue or recover benefits as appropriate;
45.28    (5) delay or deny payment of all or part of the state and federal share of benefits and
45.29administrative reimbursement according to the procedures set forth in section 256.017;
45.30    (6) make contracts with and grants to public and private agencies and organizations,
45.31both profit and nonprofit, and individuals, using appropriated funds; and
45.32    (7) enter into contractual agreements with federally recognized Indian tribes with
45.33a reservation in Minnesota to the extent necessary for the tribe to operate a federally
45.34approved family assistance program or any other program under the supervision of the
45.35commissioner. The commissioner shall consult with the affected county or counties in
46.1the contractual agreement negotiations, if the county or counties wish to be included,
46.2in order to avoid the duplication of county and tribal assistance program services. The
46.3commissioner may establish necessary accounts for the purposes of receiving and
46.4disbursing funds as necessary for the operation of the programs.
46.5    (b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
46.6regulation, and policy necessary to county agency administration of the programs.
46.7    (c) Administer and supervise all child welfare activities; promote the enforcement of
46.8laws protecting disabled, dependent, neglected and delinquent children, and children born
46.9to mothers who were not married to the children's fathers at the times of the conception
46.10nor at the births of the children; license and supervise child-caring and child-placing
46.11agencies and institutions; supervise the care of children in boarding and foster homes or
46.12in private institutions; and generally perform all functions relating to the field of child
46.13welfare now vested in the State Board of Control.
46.14    (d) Administer and supervise all noninstitutional service to disabled persons,
46.15including those who are visually impaired, hearing impaired, or physically impaired
46.16or otherwise disabled. The commissioner may provide and contract for the care and
46.17treatment of qualified indigent children in facilities other than those located and available
46.18at state hospitals when it is not feasible to provide the service in state hospitals.
46.19    (e) Assist and actively cooperate with other departments, agencies and institutions,
46.20local, state, and federal, by performing services in conformity with the purposes of Laws
46.211939, chapter 431.
46.22    (f) Act as the agent of and cooperate with the federal government in matters of
46.23mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
46.24431, including the administration of any federal funds granted to the state to aid in the
46.25performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
46.26and including the promulgation of rules making uniformly available medical care benefits
46.27to all recipients of public assistance, at such times as the federal government increases its
46.28participation in assistance expenditures for medical care to recipients of public assistance,
46.29the cost thereof to be borne in the same proportion as are grants of aid to said recipients.
46.30    (g) Establish and maintain any administrative units reasonably necessary for the
46.31performance of administrative functions common to all divisions of the department.
46.32    (h) Act as designated guardian of both the estate and the person of all the wards of
46.33the state of Minnesota, whether by operation of law or by an order of court, without any
46.34further act or proceeding whatever, except as to persons committed as developmentally
46.35disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
46.36recognized by the Secretary of the Interior whose interests would be best served by
47.1adoptive placement, the commissioner may contract with a licensed child-placing agency
47.2or a Minnesota tribal social services agency to provide adoption services. A contract
47.3with a licensed child-placing agency must be designed to supplement existing county
47.4efforts and may not replace existing county programs or tribal social services, unless the
47.5replacement is agreed to by the county board and the appropriate exclusive bargaining
47.6representative, tribal governing body, or the commissioner has evidence that child
47.7placements of the county continue to be substantially below that of other counties. Funds
47.8encumbered and obligated under an agreement for a specific child shall remain available
47.9until the terms of the agreement are fulfilled or the agreement is terminated.
47.10    (i) Act as coordinating referral and informational center on requests for service for
47.11newly arrived immigrants coming to Minnesota.
47.12    (j) The specific enumeration of powers and duties as hereinabove set forth shall in no
47.13way be construed to be a limitation upon the general transfer of powers herein contained.
47.14    (k) Establish county, regional, or statewide schedules of maximum fees and charges
47.15which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
47.16nursing home care and medicine and medical supplies under all programs of medical
47.17care provided by the state and for congregate living care under the income maintenance
47.18programs.
47.19    (l) Have the authority to conduct and administer experimental projects to test methods
47.20and procedures of administering assistance and services to recipients or potential recipients
47.21of public welfare. To carry out such experimental projects, it is further provided that the
47.22commissioner of human services is authorized to waive the enforcement of existing specific
47.23statutory program requirements, rules, and standards in one or more counties. The order
47.24establishing the waiver shall provide alternative methods and procedures of administration,
47.25shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and
47.26in no event shall the duration of a project exceed four years. It is further provided that no
47.27order establishing an experimental project as authorized by the provisions of this section
47.28shall become effective until the following conditions have been met:
47.29    (1) the secretary of health and human services of the United States has agreed, for
47.30the same project, to waive state plan requirements relative to statewide uniformity; and
47.31    (2) a comprehensive plan, including estimated project costs, shall be approved by
47.32the Legislative Advisory Commission and filed with the commissioner of administration.
47.33    (m) According to federal requirements, establish procedures to be followed by
47.34local welfare boards in creating citizen advisory committees, including procedures for
47.35selection of committee members.
48.1    (n) Allocate federal fiscal disallowances or sanctions which are based on quality
48.2control error rates for the aid to families with dependent children program formerly
48.3codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
48.4following manner:
48.5    (1) one-half of the total amount of the disallowance shall be borne by the county
48.6boards responsible for administering the programs. For the medical assistance and the
48.7AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
48.8shared by each county board in the same proportion as that county's expenditures for the
48.9sanctioned program are to the total of all counties' expenditures for the AFDC program
48.10formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
48.11food stamp program, sanctions shall be shared by each county board, with 50 percent of
48.12the sanction being distributed to each county in the same proportion as that county's
48.13administrative costs for food stamps are to the total of all food stamp administrative costs
48.14for all counties, and 50 percent of the sanctions being distributed to each county in the
48.15same proportion as that county's value of food stamp benefits issued are to the total of
48.16all benefits issued for all counties. Each county shall pay its share of the disallowance
48.17to the state of Minnesota. When a county fails to pay the amount due hereunder, the
48.18commissioner may deduct the amount from reimbursement otherwise due the county, or
48.19the attorney general, upon the request of the commissioner, may institute civil action
48.20to recover the amount due; and
48.21    (2) notwithstanding the provisions of clause (1), if the disallowance results from
48.22knowing noncompliance by one or more counties with a specific program instruction, and
48.23that knowing noncompliance is a matter of official county board record, the commissioner
48.24may require payment or recover from the county or counties, in the manner prescribed in
48.25clause (1), an amount equal to the portion of the total disallowance which resulted from the
48.26noncompliance, and may distribute the balance of the disallowance according to clause (1).
48.27    (o) Develop and implement special projects that maximize reimbursements and
48.28result in the recovery of money to the state. For the purpose of recovering state money,
48.29the commissioner may enter into contracts with third parties. Any recoveries that result
48.30from projects or contracts entered into under this paragraph shall be deposited in the
48.31state treasury and credited to a special account until the balance in the account reaches
48.32$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
48.33transferred and credited to the general fund. All money in the account is appropriated to
48.34the commissioner for the purposes of this paragraph.
48.35    (p) Have the authority to make direct payments to facilities providing shelter
48.36to women and their children according to section 256D.05, subdivision 3. Upon
49.1the written request of a shelter facility that has been denied payments under section
49.2256D.05, subdivision 3 , the commissioner shall review all relevant evidence and make
49.3a determination within 30 days of the request for review regarding issuance of direct
49.4payments to the shelter facility. Failure to act within 30 days shall be considered a
49.5determination not to issue direct payments.
49.6    (q) Have the authority to establish and enforce the following county reporting
49.7requirements:
49.8    (1) the commissioner shall establish fiscal and statistical reporting requirements
49.9necessary to account for the expenditure of funds allocated to counties for human
49.10services programs. When establishing financial and statistical reporting requirements, the
49.11commissioner shall evaluate all reports, in consultation with the counties, to determine if
49.12the reports can be simplified or the number of reports can be reduced;
49.13    (2) the county board shall submit monthly or quarterly reports to the department
49.14as required by the commissioner. Monthly reports are due no later than 15 working days
49.15after the end of the month. Quarterly reports are due no later than 30 calendar days after
49.16the end of the quarter, unless the commissioner determines that the deadline must be
49.17shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
49.18or risking a loss of federal funding. Only reports that are complete, legible, and in the
49.19required format shall be accepted by the commissioner;
49.20    (3) if the required reports are not received by the deadlines established in clause (2),
49.21the commissioner may delay payments and withhold funds from the county board until
49.22the next reporting period. When the report is needed to account for the use of federal
49.23funds and the late report results in a reduction in federal funding, the commissioner shall
49.24withhold from the county boards with late reports an amount equal to the reduction in
49.25federal funding until full federal funding is received;
49.26    (4) a county board that submits reports that are late, illegible, incomplete, or not
49.27in the required format for two out of three consecutive reporting periods is considered
49.28noncompliant. When a county board is found to be noncompliant, the commissioner
49.29shall notify the county board of the reason the county board is considered noncompliant
49.30and request that the county board develop a corrective action plan stating how the
49.31county board plans to correct the problem. The corrective action plan must be submitted
49.32to the commissioner within 45 days after the date the county board received notice
49.33of noncompliance;
49.34    (5) the final deadline for fiscal reports or amendments to fiscal reports is one year
49.35after the date the report was originally due. If the commissioner does not receive a report
49.36by the final deadline, the county board forfeits the funding associated with the report for
50.1that reporting period and the county board must repay any funds associated with the
50.2report received for that reporting period;
50.3    (6) the commissioner may not delay payments, withhold funds, or require repayment
50.4under clause (3) or (5) if the county demonstrates that the commissioner failed to
50.5provide appropriate forms, guidelines, and technical assistance to enable the county to
50.6comply with the requirements. If the county board disagrees with an action taken by the
50.7commissioner under clause (3) or (5), the county board may appeal the action according
50.8to sections 14.57 to 14.69; and
50.9    (7) counties subject to withholding of funds under clause (3) or forfeiture or
50.10repayment of funds under clause (5) shall not reduce or withhold benefits or services to
50.11clients to cover costs incurred due to actions taken by the commissioner under clause
50.12(3) or (5).
50.13    (r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
50.14federal fiscal disallowances or sanctions are based on a statewide random sample in direct
50.15proportion to each county's claim for that period.
50.16    (s) Be responsible for ensuring the detection, prevention, investigation, and
50.17resolution of fraudulent activities or behavior by applicants, recipients, and other
50.18participants in the human services programs administered by the department.
50.19    (t) Require county agencies to identify overpayments, establish claims, and utilize
50.20all available and cost-beneficial methodologies to collect and recover these overpayments
50.21in the human services programs administered by the department.
50.22    (u) Have the authority to administer a drug rebate program for drugs purchased
50.23pursuant to the prescription drug program established under section 256.955 after the
50.24beneficiary's satisfaction of any deductible established in the program. The commissioner
50.25shall require a rebate agreement from all manufacturers of covered drugs as defined in
50.26section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
50.27or after July 1, 2002, must include rebates for individuals covered under the prescription
50.28drug program who are under 65 years of age. For each drug, the amount of the rebate shall
50.29be equal to the rebate as defined for purposes of the federal rebate program in United
50.30States Code, title 42, section 1396r-8. The manufacturers must provide full payment
50.31within 30 days of receipt of the state invoice for the rebate within the terms and conditions
50.32used for the federal rebate program established pursuant to section 1927 of title XIX of
50.33the Social Security Act. The manufacturers must provide the commissioner with any
50.34information necessary to verify the rebate determined per drug. The rebate program shall
50.35utilize the terms and conditions used for the federal rebate program established pursuant to
50.36section 1927 of title XIX of the Social Security Act.
51.1    (v) Have the authority to administer the federal drug rebate program for drugs
51.2purchased under the medical assistance program as allowed by section 1927 of title XIX
51.3of the Social Security Act and according to the terms and conditions of section 1927.
51.4Rebates shall be collected for all drugs that have been dispensed or administered in an
51.5outpatient setting and that are from manufacturers who have signed a rebate agreement
51.6with the United States Department of Health and Human Services.
51.7    (w) Have the authority to administer a supplemental drug rebate program for drugs
51.8purchased under the medical assistance program. The commissioner may enter into
51.9supplemental rebate contracts with pharmaceutical manufacturers and may require prior
51.10authorization for drugs that are from manufacturers that have not signed a supplemental
51.11rebate contract. Prior authorization of drugs shall be subject to the provisions of section
51.12256B.0625, subdivision 13 .
51.13    (x) Operate the department's communication systems account established in Laws
51.141993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
51.15communication costs necessary for the operation of the programs the commissioner
51.16supervises. A communications account may also be established for each regional
51.17treatment center which operates communications systems. Each account must be used
51.18to manage shared communication costs necessary for the operations of the programs the
51.19commissioner supervises. The commissioner may distribute the costs of operating and
51.20maintaining communication systems to participants in a manner that reflects actual usage.
51.21Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
51.22other costs as determined by the commissioner. Nonprofit organizations and state, county,
51.23and local government agencies involved in the operation of programs the commissioner
51.24supervises may participate in the use of the department's communications technology and
51.25share in the cost of operation. The commissioner may accept on behalf of the state any
51.26gift, bequest, devise or personal property of any kind, or money tendered to the state for
51.27any lawful purpose pertaining to the communication activities of the department. Any
51.28money received for this purpose must be deposited in the department's communication
51.29systems accounts. Money collected by the commissioner for the use of communication
51.30systems must be deposited in the state communication systems account and is appropriated
51.31to the commissioner for purposes of this section.
51.32    (y) Receive any federal matching money that is made available through the medical
51.33assistance program for the consumer satisfaction survey. Any federal money received for
51.34the survey is appropriated to the commissioner for this purpose. The commissioner may
51.35expend the federal money received for the consumer satisfaction survey in either year of
51.36the biennium.
52.1    (z) Designate community information and referral call centers and incorporate
52.2cost reimbursement claims from the designated community information and referral
52.3call centers into the federal cost reimbursement claiming processes of the department
52.4according to federal law, rule, and regulations. Existing information and referral centers
52.5provided by Greater Twin Cities United Way or existing call centers for which Greater
52.6Twin Cities United Way has legal authority to represent, shall be included in these
52.7designations upon review by the commissioner and assurance that these services are
52.8accredited and in compliance with national standards. Any reimbursement is appropriated
52.9to the commissioner and all designated information and referral centers shall receive
52.10payments according to normal department schedules established by the commissioner
52.11upon final approval of allocation methodologies from the United States Department of
52.12Health and Human Services Division of Cost Allocation or other appropriate authorities.
52.13    (aa) Develop recommended standards for foster care homes that address the
52.14components of specialized therapeutic services to be provided by foster care homes with
52.15those services.
52.16    (bb) Authorize the method of payment to or from the department as part of the
52.17human services programs administered by the department. This authorization includes the
52.18receipt or disbursement of funds held by the department in a fiduciary capacity as part of
52.19the human services programs administered by the department.
52.20    (cc) Have the authority to administer a drug rebate program for drugs purchased for
52.21persons eligible for general assistance medical care under section 256D.03, subdivision 3.
52.22For manufacturers that agree to participate in the general assistance medical care rebate
52.23program, the commissioner shall enter into a rebate agreement for covered drugs as
52.24defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
52.25rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
52.26United States Code, title 42, section 1396r-8. The manufacturers must provide payment
52.27within the terms and conditions used for the federal rebate program established under
52.28section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
52.29the terms and conditions used for the federal rebate program established under section
52.301927 of title XIX of the Social Security Act.
52.31    Effective January 1, 2006, drug coverage under general assistance medical care shall
52.32be limited to those prescription drugs that:
52.33    (1) are covered under the medical assistance program as described in section
52.34256B.0625, subdivisions 13 and 13d ; and
52.35    (2) are provided by manufacturers that have fully executed general assistance
52.36medical care rebate agreements with the commissioner and comply with such agreements.
53.1Prescription drug coverage under general assistance medical care shall conform to
53.2coverage under the medical assistance program according to section 256B.0625,
53.3subdivisions 13 to 13g .
53.4    The rebate revenues collected under the drug rebate program are deposited in the
53.5general fund.
53.6(dd) Designate the agencies that operate the Senior LinkAge Line under section
53.7256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state
53.8of Minnesota Aging and the Disability Resource Centers under United States Code, title
53.942, section 3001, the Older Americans Act Amendments of 2006 and incorporate cost
53.10reimbursement claims from the designated centers into the federal cost reimbursement
53.11claiming processes of the department according to federal law, rule, and regulations. Any
53.12reimbursement must be appropriated to the commissioner and all Aging and Disability
53.13Resource Center designated agencies shall receive payments of grant funding that supports
53.14the activity and generates the federal financial participation according to Board on Aging
53.15administrative granting mechanisms.

53.16    Sec. 5. Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:
53.17    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability
53.18Linkage Line, to who shall serve people with disabilities as the designated Aging and
53.19Disability Resource Center under United States Code, title 42, section 3001, the Older
53.20Americans Act Amendments of 2006 in partnership with the Senior LinkAge Line and
53.21shall serve as Minnesota's neutral access point for statewide disability information and
53.22assistance and must be available during business hours through a statewide toll-free
53.23number and the internet. The Disability Linkage Line shall:
53.24(1) deliver information and assistance based on national and state standards;
53.25    (2) provide information about state and federal eligibility requirements, benefits,
53.26and service options;
53.27(3) provide benefits and options counseling;
53.28    (4) make referrals to appropriate support entities;
53.29    (5) educate people on their options so they can make well-informed choices and link
53.30them to quality profiles;
53.31    (6) help support the timely resolution of service access and benefit issues;
53.32(7) inform people of their long-term community services and supports;
53.33(8) provide necessary resources and supports that can lead to employment and
53.34increased economic stability of people with disabilities; and
54.1(9) serve as the technical assistance and help center for the Web-based tool,
54.2Minnesota's Disability Benefits 101.org.; and
54.3(10) provide preadmission screening for individuals under 60 years of age using
54.4the procedures as defined in section 256.975, subdivisions 7a to 7c, and 256B.0911,
54.5subdivision 4d.

54.6    Sec. 6. Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:
54.7    Subd. 7. Consumer information and assistance and long-term care options
54.8counseling; Senior LinkAge Line. (a) The Minnesota Board on Aging shall operate a
54.9statewide service to aid older Minnesotans and their families in making informed choices
54.10about long-term care options and health care benefits. Language services to persons
54.11with limited English language skills may be made available. The service, known as
54.12Senior LinkAge Line, shall serve older adults as the designated Aging and Disability
54.13Resource Center under United States Code, title 42, section 3001, the Older Americans
54.14Act Amendments of 2006 in partnership with the Disability LinkAge Line under section
54.15256.01, subdivision 24, and must be available during business hours through a statewide
54.16toll-free number and must also be available through the Internet. The Minnesota Board
54.17on Aging shall consult with, and when appropriate work through, the area agencies on
54.18aging counties, and other entities that serve aging and disabled populations of all ages,
54.19to provide and maintain the telephone infrastructure and related support for the Aging
54.20and Disability Resource Center partners which agree by memorandum to access the
54.21infrastructure, including the designated providers of the Senior LinkAge Line and the
54.22Disability Linkage Line.
54.23    (b) The service must provide long-term care options counseling by assisting older
54.24adults, caregivers, and providers in accessing information and options counseling about
54.25choices in long-term care services that are purchased through private providers or available
54.26through public options. The service must:
54.27    (1) develop and provide for regular updating of a comprehensive database that
54.28includes detailed listings in both consumer- and provider-oriented formats that can provide
54.29search results down to the neighborhood level;
54.30    (2) make the database accessible on the Internet and through other telecommunication
54.31and media-related tools;
54.32    (3) link callers to interactive long-term care screening tools and make these tools
54.33available through the Internet by integrating the tools with the database;
54.34    (4) develop community education materials with a focus on planning for long-term
54.35care and evaluating independent living, housing, and service options;
55.1    (5) conduct an outreach campaign to assist older adults and their caregivers in
55.2finding information on the Internet and through other means of communication;
55.3    (6) implement a messaging system for overflow callers and respond to these callers
55.4by the next business day;
55.5    (7) link callers with county human services and other providers to receive more
55.6in-depth assistance and consultation related to long-term care options;
55.7    (8) link callers with quality profiles for nursing facilities and other home and
55.8community-based services providers developed by the commissioner commissioners of
55.9health and human services;
55.10(9) develop an outreach plan to seniors and their caregivers with a particular focus
55.11on establishing a clear presence in places that seniors recognize and:
55.12(i) place a significant emphasis on improved outreach and service to seniors and
55.13their caregivers by establishing annual plans by neighborhood, city, and county, as
55.14necessary, to address the unique needs of geographic areas in the state where there are
55.15dense populations of seniors;
55.16(ii) establish an efficient workforce management approach and assign community
55.17living specialist staff and volunteers to geographic areas as well as aging and disability
55.18resource center sites so that seniors and their caregivers and professionals recognize the
55.19Senior LinkAge Line as the place to call for aging services and information;
55.20(iii) recognize the size and complexity of the metropolitan area service system by
55.21working with metropolitan counties to establish a clear partnership with them, including
55.22seeking county advice on the establishment of local aging and disabilities resource center
55.23sites; and
55.24(iv) maintain dashboards with metrics that demonstrate how the service is expanding
55.25and extending or enhancing its outreach efforts in dispersed or hard to reach locations in
55.26varied population centers;
55.27    (9) (10) incorporate information about the availability of housing options, as well
55.28as registered housing with services and consumer rights within the MinnesotaHelp.info
55.29network long-term care database to facilitate consumer comparison of services and costs
55.30among housing with services establishments and with other in-home services and to
55.31support financial self-sufficiency as long as possible. Housing with services establishments
55.32and their arranged home care providers shall provide information that will facilitate price
55.33comparisons, including delineation of charges for rent and for services available. The
55.34commissioners of health and human services shall align the data elements required by
55.35section 144G.06, the Uniform Consumer Information Guide, and this section to provide
55.36consumers standardized information and ease of comparison of long-term care options.
56.1The commissioner of human services shall provide the data to the Minnesota Board on
56.2Aging for inclusion in the MinnesotaHelp.info network long-term care database;
56.3(10) (11) provide long-term care options counseling. Long-term care options
56.4counselors shall:
56.5(i) for individuals not eligible for case management under a public program or public
56.6funding source, provide interactive decision support under which consumers, family
56.7members, or other helpers are supported in their deliberations to determine appropriate
56.8long-term care choices in the context of the consumer's needs, preferences, values, and
56.9individual circumstances, including implementing a community support plan;
56.10(ii) provide Web-based educational information and collateral written materials to
56.11familiarize consumers, family members, or other helpers with the long-term care basics,
56.12issues to be considered, and the range of options available in the community;
56.13(iii) provide long-term care futures planning, which means providing assistance to
56.14individuals who anticipate having long-term care needs to develop a plan for the more
56.15distant future; and
56.16(iv) provide expertise in benefits and financing options for long-term care, including
56.17Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
56.18private pay options, and ways to access low or no-cost services or benefits through
56.19volunteer-based or charitable programs;
56.20(11) (12) using risk management and support planning protocols, provide long-term
56.21care options counseling to current residents of nursing homes deemed appropriate for
56.22discharge by the commissioner and older adults who request service after consultation
56.23with the Senior LinkAge Line under clause (12). In order to meet this requirement, The
56.24Senior LinkAge Line shall also receive referrals from the residents or staff of nursing
56.25homes. The Senior LinkAge Line shall identify and contact residents deemed appropriate
56.26for discharge by developing targeting criteria in consultation with the commissioner who
56.27shall provide designated Senior LinkAge Line contact centers with a list of nursing
56.28home residents that meet the criteria as being appropriate for discharge planning via a
56.29secure Web portal. Senior LinkAge Line shall provide these residents, if they indicate a
56.30preference to receive long-term care options counseling, with initial assessment, review of
56.31risk factors, independent living support consultation, or and, if appropriate, a referral to:
56.32(i) long-term care consultation services under section 256B.0911;
56.33(ii) designated care coordinators of contracted entities under section 256B.035 for
56.34persons who are enrolled in a managed care plan; or
57.1(iii) the long-term care consultation team for those who are appropriate eligible
57.2 for relocation service coordination due to high-risk factors or psychological or physical
57.3disability; and
57.4(12) (13) develop referral protocols and processes that will assist certified health
57.5care homes and hospitals to identify at-risk older adults and determine when to refer these
57.6individuals to the Senior LinkAge Line for long-term care options counseling under this
57.7section. The commissioner is directed to work with the commissioner of health to develop
57.8protocols that would comply with the health care home designation criteria and protocols
57.9available at the time of hospital discharge. The commissioner shall keep a record of the
57.10number of people who choose long-term care options counseling as a result of this section.

57.11    Sec. 7. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
57.12to read:
57.13    Subd. 7a. Preadmission screening activities related to nursing facility
57.14admissions. (a) All individuals seeking admission to Medicaid certified nursing facilities,
57.15including certified boarding care facilities, must be screened prior to admission regardless
57.16of income, assets, or funding sources for nursing facility care, except as described in
57.17subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the
57.18need for nursing facility level of care as described in section 256B.0911, subdivision
57.194e, and to complete activities required under federal law related to mental illness and
57.20developmental disability as outlined in paragraph (b).
57.21(b) A person who has a diagnosis or possible diagnosis of mental illness or
57.22developmental disability must receive a preadmission screening before admission
57.23regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify
57.24the need for further evaluation and specialized services, unless the admission prior to
57.25screening is authorized by the local mental health authority or the local developmental
57.26disabilities case manager, or unless authorized by the county agency according to Public
57.27Law 101-508.
57.28(c) The following criteria apply to the preadmission screening:
57.29(1) requests for preadmission screenings must be submitted via an online form
57.30developed by the commissioner;
57.31(2) the Senior LinkAge Line must use forms and criteria developed by the
57.32commissioner to identify persons who require referral for further evaluation and
57.33determination of the need for specialized services; and
57.34(3) the evaluation and determination of the need for specialized services must be
57.35done by:
58.1(i) a qualified independent mental health professional, for persons with a primary or
58.2secondary diagnosis of a serious mental illness; or
58.3(ii) a qualified developmental disability professional, for persons with a primary or
58.4secondary diagnosis of developmental disability. For purposes of this requirement, a
58.5qualified developmental disability professional must meet the standards for a qualified
58.6developmental disability professional under Code of Federal Regulations, title 42, section
58.7483.430.
58.8(d) The local county mental health authority or the state developmental disability
58.9authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
58.10nursing facility if the individual does not meet the nursing facility level of care criteria or
58.11needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
58.12purposes of this section, "specialized services" for a person with developmental disability
58.13means active treatment as that term is defined under Code of Federal Regulations, title
58.1442, section 483.440(a)(1).
58.15(e) In assessing a person's needs, the screener shall:
58.16(1) use an automated system designated by the commissioner;
58.17(2) consult with care transitions coordinators or physician; and
58.18(3) consider the assessment of the individual's physician.
58.19Other personnel may be included in the level of care determination as deemed
58.20necessary by the screener.
58.21EFFECTIVE DATE.This section is effective October 1, 2013.

58.22    Sec. 8. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
58.23to read:
58.24    Subd. 7b. Exemptions and emergency admissions. (a) Exemptions from the federal
58.25screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:
58.26(1) a person who, having entered an acute care facility from a certified nursing
58.27facility, is returning to a certified nursing facility; or
58.28(2) a person transferring from one certified nursing facility in Minnesota to another
58.29certified nursing facility in Minnesota.
58.30(b) Persons who are exempt from preadmission screening for purposes of level of
58.31care determination include:
58.32(1) persons described in paragraph (a);
58.33(2) an individual who has a contractual right to have nursing facility care paid for
58.34indefinitely by the Veterans' Administration;
59.1(3) an individual enrolled in a demonstration project under section 256B.69,
59.2subdivision 8, at the time of application to a nursing facility; and
59.3(4) an individual currently being served under the alternative care program or under
59.4a home and community-based services waiver authorized under section 1915(c) of the
59.5federal Social Security Act.
59.6(c) Persons admitted to a Medicaid-certified nursing facility from the community
59.7on an emergency basis as described in paragraph (d) or from an acute care facility on a
59.8nonworking day must be screened the first working day after admission.
59.9(d) Emergency admission to a nursing facility prior to screening is permitted when
59.10all of the following conditions are met:
59.11(1) a person is admitted from the community to a certified nursing or certified
59.12boarding care facility during Senior LinkAge Line nonworking hours for ages 60 and
59.13older and Disability Linkage Line nonworking hours for under age 60;
59.14(2) a physician has determined that delaying admission until preadmission screening
59.15is completed would adversely affect the person's health and safety;
59.16(3) there is a recent precipitating event that precludes the client from living safely in
59.17the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
59.18inability to continue to provide care;
59.19(4) the attending physician has authorized the emergency placement and has
59.20documented the reason that the emergency placement is recommended; and
59.21(5) the Senior LinkAge Line or Disability Linkage Line is contacted on the first
59.22working day following the emergency admission.
59.23Transfer of a patient from an acute care hospital to a nursing facility is not considered
59.24an emergency except for a person who has received hospital services in the following
59.25situations: hospital admission for observation, care in an emergency room without hospital
59.26admission, or following hospital 24-hour bed care and from whom admission is being
59.27sought on a nonworking day.
59.28(e) A nursing facility must provide written information to all persons admitted
59.29regarding the person's right to request and receive long-term care consultation services as
59.30defined in section 256B.0911, subdivision 1a. The information must be provided prior to
59.31the person's discharge from the facility and in a format specified by the commissioner.
59.32EFFECTIVE DATE.This section is effective October 1, 2013.

59.33    Sec. 9. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
59.34to read:
60.1    Subd. 7c. Screening requirements. (a) A person may be screened for nursing
60.2facility admission by telephone or in a face-to-face screening interview. The Senior
60.3LinkAge Line shall identify each individual's needs using the following categories:
60.4(1) the person needs no face-to-face long-term care consultation assessment
60.5completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
60.6managed care organization under contract with the Department of Human Services to
60.7determine the need for nursing facility level of care based on information obtained from
60.8other health care professionals;
60.9(2) the person needs an immediate face-to-face long-term care consultation
60.10assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county,
60.11tribe, or managed care organization under contract with the Department of Human
60.12Services to determine the need for nursing facility level of care and complete activities
60.13required under subdivision 7a; or
60.14(3) the person may be exempt from screening requirements as outlined in subdivision
60.157b, but will need transitional assistance after admission or in-person follow-along after
60.16a return home.
60.17(b) Individuals between the ages of 60 and 64 who are admitted to nursing facilities
60.18with only a telephone screening must receive a face-to-face assessment from the long-term
60.19care consultation team member of the county in which the facility is located or from the
60.20recipient's county case manager within 40 calendar days of admission as described in
60.21section 256B.0911, subdivision 4d, paragraph (c).
60.22(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
60.23facility must be screened prior to admission.
60.24(d) Screenings provided by the Senior LinkAge Line must include processes
60.25to identify persons who may require transition assistance described in subdivision 7,
60.26paragraph (b), clause (12), and section 256B.0911, subdivision 3b.
60.27EFFECTIVE DATE.This section is effective October 1, 2013.

60.28    Sec. 10. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
60.29to read:
60.30    Subd. 7d. Payment for preadmission screening. Funding for preadmission
60.31screening shall be provided to the Minnesota Board on Aging for the population 60
60.32years of age and older by the Department of Human Services to cover screener salaries
60.33and expenses to provide the services described in subdivisions 7a to 7c. The Minnesota
60.34Board on Aging shall employ, or contract with other agencies to employ, within the limits
60.35of available funding, sufficient personnel to provide preadmission screening and level of
61.1care determination services and shall seek to maximize federal funding for the service as
61.2provided under section 256.01, subdivision 2, paragraph (dd).
61.3EFFECTIVE DATE.This section is effective October 1, 2013.

61.4    Sec. 11. Minnesota Statutes 2012, section 256.9754, is amended by adding a
61.5subdivision to read:
61.6    Subd. 3a. Priority for other grants. The commissioner of health shall give priority
61.7to a grantee selected under subdivision 3 when awarding technology-related grants, if the
61.8grantee is using technology as part of the proposal unless that priority conflicts with
61.9existing state or federal guidance related to grant awards by the Department of Health.
61.10The commissioner of transportation shall give priority to a grantee under subdivision 3
61.11when distributing transportation-related funds to create transportation options for older
61.12adults unless that preference conflicts with existing state or federal guidance related to
61.13grant awards by the Department of Transportation.

61.14    Sec. 12. Minnesota Statutes 2012, section 256.9754, is amended by adding a
61.15subdivision to read:
61.16    Subd. 3b. State waivers. The commissioner of health may waive applicable state
61.17laws and rules on a time-limited basis if the commissioner of health determines that a
61.18participating grantee requires a waiver in order to achieve demonstration project goals.

61.19    Sec. 13. Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:
61.20    Subd. 5. Grant preference. The commissioner of human services shall give
61.21preference when awarding grants under this section to areas where nursing facility
61.22closures have occurred or are occurring or areas with service needs identified by section
61.23144A.351. The commissioner may award grants to the extent grant funds are available
61.24and to the extent applications are approved by the commissioner. Denial of approval of an
61.25application in one year does not preclude submission of an application in a subsequent
61.26year. The maximum grant amount is limited to $750,000.

61.27    Sec. 14. Minnesota Statutes 2012, section 256B.021, is amended by adding a
61.28subdivision to read:
61.29    Subd. 4a. Evaluation. The commissioner shall evaluate the projects contained in
61.30subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:
61.31(1) an impact assessment focusing on program outcomes, especially those
61.32experienced directly by the person receiving services;
62.1(2) study samples drawn from the population of interest for each project; and
62.2(3) a time series analysis to examine aggregate trends in average monthly
62.3utilization, expenditures, and other outcomes in the targeted populations before and after
62.4implementation of the initiatives.

62.5    Sec. 15. Minnesota Statutes 2012, section 256B.021, is amended by adding a
62.6subdivision to read:
62.7    Subd. 6. Work, empower, and encourage independence. As provided under
62.8subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a
62.9demonstration project to provide navigation, employment supports, and benefits planning
62.10services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014.
62.11This demonstration shall promote economic stability, increase independence, and reduce
62.12applications for disability benefits while providing a positive impact on the health and
62.13future of participants.

62.14    Sec. 16. Minnesota Statutes 2012, section 256B.021, is amended by adding a
62.15subdivision to read:
62.16    Subd. 7. Housing stabilization. As provided under subdivision 4, paragraph (e),
62.17upon federal approval, the commissioner shall establish a demonstration project to provide
62.18service coordination, outreach, in-reach, tenancy support, and community living assistance
62.19to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This
62.20demonstration shall promote housing stability, reduce costly medical interventions, and
62.21increase opportunities for independent community living.

62.22    Sec. 17. Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:
62.23    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation
62.24services is to assist persons with long-term or chronic care needs in making care
62.25decisions and selecting support and service options that meet their needs and reflect
62.26their preferences. The availability of, and access to, information and other types of
62.27assistance, including assessment and support planning, is also intended to prevent or delay
62.28institutional placements and to provide access to transition assistance after admission.
62.29Further, the goal of these services is to contain costs associated with unnecessary
62.30institutional admissions. Long-term consultation services must be available to any person
62.31regardless of public program eligibility. The commissioner of human services shall seek
62.32to maximize use of available federal and state funds and establish the broadest program
62.33possible within the funding available.
63.1(b) These services must be coordinated with long-term care options counseling
63.2provided under subdivision 4d, section 256.975, subdivision subdivisions 7 to 7c, and
63.3section 256.01, subdivision 24. The lead agency providing long-term care consultation
63.4services shall encourage the use of volunteers from families, religious organizations, social
63.5clubs, and similar civic and service organizations to provide community-based services.

63.6    Sec. 18. Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to
63.7read:
63.8    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
63.9    (a) Until additional requirements apply under paragraph (b), "long-term care
63.10consultation services" means:
63.11    (1) intake for and access to assistance in identifying services needed to maintain an
63.12individual in the most inclusive environment;
63.13    (2) providing recommendations for and referrals to cost-effective community
63.14services that are available to the individual;
63.15    (3) development of an individual's person-centered community support plan;
63.16    (4) providing information regarding eligibility for Minnesota health care programs;
63.17    (5) face-to-face long-term care consultation assessments, which may be completed
63.18in a hospital, nursing facility, intermediate care facility for persons with developmental
63.19disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
63.20residence;
63.21    (6) federally mandated preadmission screening activities described under
63.22subdivisions 4a and 4b;
63.23    (7) (6) determination of home and community-based waiver and other service
63.24eligibility as required under sections 256B.0913, 256B.0915, and 256B.49, including level
63.25of care determination for individuals who need an institutional level of care as determined
63.26under section 256B.0911, subdivision 4a, paragraph (d) 4e, based on assessment and
63.27community support plan development, appropriate referrals to obtain necessary diagnostic
63.28information, and including an eligibility determination for consumer-directed community
63.29supports;
63.30    (8) (7) providing recommendations for institutional placement when there are no
63.31cost-effective community services available;
63.32    (9) (8) providing access to assistance to transition people back to community settings
63.33after institutional admission; and
63.34(10) (9) providing information about competitive employment, with or without
63.35supports, for school-age youth and working-age adults and referrals to the Disability
64.1Linkage Line and Disability Benefits 101 to ensure that an informed choice about
64.2competitive employment can be made. For the purposes of this subdivision, "competitive
64.3employment" means work in the competitive labor market that is performed on a full-time
64.4or part-time basis in an integrated setting, and for which an individual is compensated at or
64.5above the minimum wage, but not less than the customary wage and level of benefits paid
64.6by the employer for the same or similar work performed by individuals without disabilities.
64.7(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
64.82c, and 3a, "long-term care consultation services" also means:
64.9(1) service eligibility determination for state plan home care services identified in:
64.10(i) section 256B.0625, subdivisions 7, 19a, and 19c;
64.11(ii) section 256B.0657; or
64.12(iii) consumer support grants under section 256.476;
64.13(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
64.14determination of eligibility for case management services available under sections
64.15256B.0621, subdivision 2 , paragraph (4), and 256B.0924 and Minnesota Rules, part
64.169525.0016;
64.17(3) determination of institutional level of care, home and community-based service
64.18waiver, and other service eligibility as required under section 256B.092, determination
64.19of eligibility for family support grants under section 252.32, semi-independent living
64.20services under section 252.275, and day training and habilitation services under section
64.21256B.092 ; and
64.22(4) obtaining necessary diagnostic information to determine eligibility under clauses
64.23(2) and (3).
64.24    (c) "Long-term care options counseling" means the services provided by the linkage
64.25lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and
64.26also includes telephone assistance and follow up once a long-term care consultation
64.27assessment has been completed.
64.28    (d) "Minnesota health care programs" means the medical assistance program under
64.29chapter 256B and the alternative care program under section 256B.0913.
64.30    (e) "Lead agencies" means counties administering or tribes and health plans under
64.31contract with the commissioner to administer long-term care consultation assessment and
64.32support planning services.

64.33    Sec. 19. Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
64.34read:
65.1    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
65.2services planning, or other assistance intended to support community-based living,
65.3including persons who need assessment in order to determine waiver or alternative care
65.4program eligibility, must be visited by a long-term care consultation team within 20
65.5calendar days after the date on which an assessment was requested or recommended.
65.6Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
65.7applies to an assessment of a person requesting personal care assistance services and
65.8private duty nursing. The commissioner shall provide at least a 90-day notice to lead
65.9agencies prior to the effective date of this requirement. Face-to-face assessments must be
65.10conducted according to paragraphs (b) to (i).
65.11    (b) The lead agency may utilize a team of either the social worker or public health
65.12nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
65.13use certified assessors to conduct the assessment. The consultation team members must
65.14confer regarding the most appropriate care for each individual screened or assessed. For
65.15a person with complex health care needs, a public health or registered nurse from the
65.16team must be consulted.
65.17    (c) The assessment must be comprehensive and include a person-centered assessment
65.18of the health, psychological, functional, environmental, and social needs of referred
65.19individuals and provide information necessary to develop a community support plan that
65.20meets the consumers needs, using an assessment form provided by the commissioner.
65.21    (d) The assessment must be conducted in a face-to-face interview with the person
65.22being assessed and the person's legal representative, and other individuals as requested by
65.23the person, who can provide information on the needs, strengths, and preferences of the
65.24person necessary to develop a community support plan that ensures the person's health and
65.25safety, but who is not a provider of service or has any financial interest in the provision
65.26of services. For persons who are to be assessed for elderly waiver customized living
65.27services under section 256B.0915, with the permission of the person being assessed or
65.28the person's designated or legal representative, the client's current or proposed provider
65.29of services may submit a copy of the provider's nursing assessment or written report
65.30outlining its recommendations regarding the client's care needs. The person conducting
65.31the assessment will notify the provider of the date by which this information is to be
65.32submitted. This information shall be provided to the person conducting the assessment
65.33prior to the assessment.
65.34    (e) If the person chooses to use community-based services, the person or the person's
65.35legal representative must be provided with a written community support plan within 40
66.1calendar days of the assessment visit, regardless of whether the individual is eligible for
66.2Minnesota health care programs. The written community support plan must include:
66.3(1) a summary of assessed needs as defined in paragraphs (c) and (d);
66.4(2) the individual's options and choices to meet identified needs, including all
66.5available options for case management services and providers;
66.6(3) identification of health and safety risks and how those risks will be addressed,
66.7including personal risk management strategies;
66.8(4) referral information; and
66.9(5) informal caregiver supports, if applicable.
66.10For a person determined eligible for state plan home care under subdivision 1a,
66.11paragraph (b), clause (1), the person or person's representative must also receive a copy of
66.12the home care service plan developed by the certified assessor.
66.13(f) A person may request assistance in identifying community supports without
66.14participating in a complete assessment. Upon a request for assistance identifying
66.15community support, the person must be transferred or referred to long-term care options
66.16counseling services available under sections 256.975, subdivision 7, and 256.01,
66.17subdivision 24, for telephone assistance and follow up.
66.18    (g) The person has the right to make the final decision between institutional
66.19placement and community placement after the recommendations have been provided,
66.20except as provided in section 256.975, subdivision 4a, paragraph (c) 7a, paragraph (d).
66.21    (h) The lead agency must give the person receiving assessment or support planning,
66.22or the person's legal representative, materials, and forms supplied by the commissioner
66.23containing the following information:
66.24    (1) written recommendations for community-based services and consumer-directed
66.25options;
66.26(2) documentation that the most cost-effective alternatives available were offered to
66.27the individual. For purposes of this clause, "cost-effective" means community services and
66.28living arrangements that cost the same as or less than institutional care. For an individual
66.29found to meet eligibility criteria for home and community-based service programs under
66.30section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
66.31approved waiver plan for each program;
66.32(3) the need for and purpose of preadmission screening conducted by long-term
66.33care options counselors according to section 256.975, subdivisions 7a to 7c, and section
66.34256.01, subdivision 24, if the person selects nursing facility placement. If the individual
66.35selects nursing facility placement, the lead agency shall forward information needed to
66.36complete the level of care determinations and screening for developmental disability and
67.1mental illness collected during the assessment to the long-term care options counselor
67.2using forms provided by the commissioner;
67.3    (4) the role of long-term care consultation assessment and support planning in
67.4eligibility determination for waiver and alternative care programs, and state plan home
67.5care, case management, and other services as defined in subdivision 1a, paragraphs (a),
67.6clause (7), and (b);
67.7    (5) information about Minnesota health care programs;
67.8    (6) the person's freedom to accept or reject the recommendations of the team;
67.9    (7) the person's right to confidentiality under the Minnesota Government Data
67.10Practices Act, chapter 13;
67.11    (8) the certified assessor's decision regarding the person's need for institutional level
67.12of care as determined under criteria established in section 256B.0911, subdivision 4a,
67.13paragraph (d) 4e, and the certified assessor's decision regarding eligibility for all services
67.14and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
67.15    (9) the person's right to appeal the certified assessor's decision regarding eligibility
67.16for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
67.17(b), and incorporating the decision regarding the need for institutional level of care or the
67.18lead agency's final decisions regarding public programs eligibility according to section
67.19256.045, subdivision 3 .
67.20    (i) Face-to-face assessment completed as part of eligibility determination for
67.21the alternative care, elderly waiver, community alternatives for disabled individuals,
67.22community alternative care, and brain injury waiver programs under sections 256B.0913,
67.23256B.0915 , and 256B.49 is valid to establish service eligibility for no more than 60
67.24calendar days after the date of assessment.
67.25(j) The effective eligibility start date for programs in paragraph (i) can never be
67.26prior to the date of assessment. If an assessment was completed more than 60 days
67.27before the effective waiver or alternative care program eligibility start date, assessment
67.28and support plan information must be updated in a face-to-face visit and documented in
67.29the department's Medicaid Management Information System (MMIS). Notwithstanding
67.30retroactive medical assistance coverage of state plan services, the effective date of
67.31eligibility for programs included in paragraph (i) cannot be prior to the date the most
67.32recent updated assessment is completed.

67.33    Sec. 20. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
67.34read:
68.1    Subd. 4d. Preadmission screening of individuals under 65 60 years of age. (a)
68.2It is the policy of the state of Minnesota to ensure that individuals with disabilities or
68.3chronic illness are served in the most integrated setting appropriate to their needs and have
68.4the necessary information to make informed choices about home and community-based
68.5service options.
68.6    (b) Individuals under 65 60 years of age who are admitted to a Medicaid-certified
68.7 nursing facility from a hospital must be screened prior to admission as outlined in
68.8subdivisions 4a through 4c according to the requirements outlined in section 256.975,
68.9subdivisions 7a to 7c. This shall be provided by the Disability Linkage Line as required
68.10under section 256.01, subdivision 24.
68.11    (c) Individuals under 65 years of age who are admitted to nursing facilities with
68.12only a telephone screening must receive a face-to-face assessment from the long-term
68.13care consultation team member of the county in which the facility is located or from the
68.14recipient's county case manager within 40 calendar days of admission.
68.15    (d) Individuals under 65 years of age who are admitted to a nursing facility
68.16without preadmission screening according to the exemption described in subdivision 4b,
68.17paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
68.18a face-to-face assessment within 40 days of admission.
68.19    (e) (d) At the face-to-face assessment, the long-term care consultation team member
68.20or county case manager must perform the activities required under subdivision 3b.
68.21    (f) (e) For individuals under 21 years of age, a screening interview which
68.22recommends nursing facility admission must be face-to-face and approved by the
68.23commissioner before the individual is admitted to the nursing facility.
68.24    (g) (f) In the event that an individual under 65 60 years of age is admitted to a
68.25nursing facility on an emergency basis, the county Disability Linkage Line must be
68.26notified of the admission on the next working day, and a face-to-face assessment as
68.27described in paragraph (c) must be conducted within 40 calendar days of admission.
68.28    (h) (g) At the face-to-face assessment, the long-term care consultation team member
68.29or the case manager must present information about home and community-based options,
68.30including consumer-directed options, so the individual can make informed choices. If the
68.31individual chooses home and community-based services, the long-term care consultation
68.32team member or case manager must complete a written relocation plan within 20 working
68.33days of the visit. The plan shall describe the services needed to move out of the facility
68.34and a time line for the move which is designed to ensure a smooth transition to the
68.35individual's home and community.
69.1    (i) (h) An individual under 65 years of age residing in a nursing facility shall receive
69.2a face-to-face assessment at least every 12 months to review the person's service choices
69.3and available alternatives unless the individual indicates, in writing, that annual visits are
69.4not desired. In this case, the individual must receive a face-to-face assessment at least
69.5once every 36 months for the same purposes.
69.6    (j) (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay
69.7county agencies directly for face-to-face assessments for individuals under 65 years of age
69.8who are being considered for placement or residing in a nursing facility.
69.9(j) Funding for preadmission screening shall be provided to the Disability Linkage
69.10Line for the under 60 population by the Department of Human Services to cover screener
69.11salaries and expenses to provide the services described in subdivisions 7a to 7c. The
69.12Disability Linkage Line shall employ, or contract with other agencies to employ, within
69.13the limits of available funding, sufficient personnel to provide preadmission screening and
69.14level of care determination services and shall seek to maximize federal funding for the
69.15service as provided under section 256.01, subdivision 2, paragraph (dd).
69.16EFFECTIVE DATE.This section is effective October 1, 2013.

69.17    Sec. 21. Minnesota Statutes 2012, section 256B.0911, is amended by adding a
69.18subdivision to read:
69.19    Subd. 4e. Determination of institutional level of care. The determination of the
69.20need for nursing facility, hospital, and intermediate care facility levels of care must be
69.21made according to criteria developed by the commissioner, and in section 256B.092,
69.22using forms developed by the commissioner. Effective January 1, 2014, for individuals
69.23age 21 and older, the determination of need for nursing facility level of care shall be
69.24based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the
69.25determination of the need for nursing facility level of care must be made according to
69.26criteria developed by the commissioner until criteria in section 144.0724, subdivision 11,
69.27becomes effective on or after October 1, 2019.

69.28    Sec. 22. Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:
69.29    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance
69.30reimbursement for nursing facilities shall be authorized for a medical assistance recipient
69.31only if a preadmission screening has been conducted prior to admission or the county has
69.32authorized an exemption. Medical assistance reimbursement for nursing facilities shall
69.33not be provided for any recipient who the local screener has determined does not meet the
69.34level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
70.1if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
70.2Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
70.3mental illness is approved by the local mental health authority or an admission for a
70.4recipient with developmental disability is approved by the state developmental disability
70.5authority.
70.6    (b) The nursing facility must not bill a person who is not a medical assistance
70.7recipient for resident days that preceded the date of completion of screening activities
70.8as required under section 256.975, subdivisions 4a, 4b, and 4c 7a to 7c. The nursing
70.9facility must include unreimbursed resident days in the nursing facility resident day totals
70.10reported to the commissioner.

70.11    Sec. 23. Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:
70.12    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
70.13    (a) Funding for services under the alternative care program is available to persons who
70.14meet the following criteria:
70.15    (1) the person has been determined by a community assessment under section
70.16256B.0911 to be a person who would require the level of care provided in a nursing
70.17facility, as determined under section 256B.0911, subdivision 4a, paragraph (d) 4e, but for
70.18the provision of services under the alternative care program;
70.19    (2) the person is age 65 or older;
70.20    (3) the person would be eligible for medical assistance within 135 days of admission
70.21to a nursing facility;
70.22    (4) the person is not ineligible for the payment of long-term care services by the
70.23medical assistance program due to an asset transfer penalty under section 256B.0595 or
70.24equity interest in the home exceeding $500,000 as stated in section 256B.056;
70.25    (5) the person needs long-term care services that are not funded through other
70.26state or federal funding, or other health insurance or other third-party insurance such as
70.27long-term care insurance;
70.28    (6) except for individuals described in clause (7), the monthly cost of the alternative
70.29care services funded by the program for this person does not exceed 75 percent of the
70.30monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
70.31does not prohibit the alternative care client from payment for additional services, but in no
70.32case may the cost of additional services purchased under this section exceed the difference
70.33between the client's monthly service limit defined under section 256B.0915, subdivision
70.343 , and the alternative care program monthly service limit defined in this paragraph. If
70.35care-related supplies and equipment or environmental modifications and adaptations are or
71.1will be purchased for an alternative care services recipient, the costs may be prorated on a
71.2monthly basis for up to 12 consecutive months beginning with the month of purchase.
71.3If the monthly cost of a recipient's other alternative care services exceeds the monthly
71.4limit established in this paragraph, the annual cost of the alternative care services shall be
71.5determined. In this event, the annual cost of alternative care services shall not exceed 12
71.6times the monthly limit described in this paragraph;
71.7    (7) for individuals assigned a case mix classification A as described under section
71.8256B.0915, subdivision 3a , paragraph (a), with (i) no dependencies in activities of daily
71.9living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating
71.10when the dependency score in eating is three or greater as determined by an assessment
71.11performed under section 256B.0911, the monthly cost of alternative care services funded
71.12by the program cannot exceed $593 per month for all new participants enrolled in
71.13the program on or after July 1, 2011. This monthly limit shall be applied to all other
71.14participants who meet this criteria at reassessment. This monthly limit shall be increased
71.15annually as described in section 256B.0915, subdivision 3a, paragraph (a). This monthly
71.16limit does not prohibit the alternative care client from payment for additional services, but
71.17in no case may the cost of additional services purchased exceed the difference between the
71.18client's monthly service limit defined in this clause and the limit described in clause (6)
71.19for case mix classification A; and
71.20(8) the person is making timely payments of the assessed monthly fee.
71.21A person is ineligible if payment of the fee is over 60 days past due, unless the person
71.22agrees to:
71.23    (i) the appointment of a representative payee;
71.24    (ii) automatic payment from a financial account;
71.25    (iii) the establishment of greater family involvement in the financial management of
71.26payments; or
71.27    (iv) another method acceptable to the lead agency to ensure prompt fee payments.
71.28    The lead agency may extend the client's eligibility as necessary while making
71.29arrangements to facilitate payment of past-due amounts and future premium payments.
71.30Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
71.31reinstated for a period of 30 days.
71.32    (b) Alternative care funding under this subdivision is not available for a person who
71.33is a medical assistance recipient or who would be eligible for medical assistance without a
71.34spenddown or waiver obligation. A person whose initial application for medical assistance
71.35and the elderly waiver program is being processed may be served under the alternative care
71.36program for a period up to 60 days. If the individual is found to be eligible for medical
72.1assistance, medical assistance must be billed for services payable under the federally
72.2approved elderly waiver plan and delivered from the date the individual was found eligible
72.3for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
72.4care funds may not be used to pay for any service the cost of which: (i) is payable by
72.5medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to
72.6pay a medical assistance income spenddown for a person who is eligible to participate in the
72.7federally approved elderly waiver program under the special income standard provision.
72.8    (c) Alternative care funding is not available for a person who resides in a licensed
72.9nursing home, certified boarding care home, hospital, or intermediate care facility, except
72.10for case management services which are provided in support of the discharge planning
72.11process for a nursing home resident or certified boarding care home resident to assist with
72.12a relocation process to a community-based setting.
72.13    (d) Alternative care funding is not available for a person whose income is greater
72.14than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
72.15to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
72.16year for which alternative care eligibility is determined, who would be eligible for the
72.17elderly waiver with a waiver obligation.

72.18    Sec. 24. Minnesota Statutes 2012, section 256B.0913, is amended by adding a
72.19subdivision to read:
72.20    Subd. 17. Essential community supports grants. (a) Notwithstanding subdivisions
72.211 to 14, the purpose of the essential community supports grant program is to provide
72.22targeted services to persons age 65 and older who need essential community support, but
72.23whose needs do not meet the level of care required for nursing facility placement under
72.24section 144.0724, subdivision 11.
72.25(b) Essential community supports grants are available not to exceed $400 per person
72.26per month. Essential community supports service grants may be used as authorized within
72.27an authorization period not to exceed 12 months. Grants must be available to a person who:
72.28(1) is age 65 or older;
72.29(2) is not eligible for medical assistance;
72.30(3) would otherwise be financially eligible for the alternative care program under
72.31subdivision 4;
72.32(4) has received a community assessment under section 256B.0911, subdivision 3a
72.33or 3b, and does not require the level of care provided in a nursing facility;
72.34(5) has a community support plan; and
73.1(6) has been determined by a community assessment under section 256B.0911,
73.2subdivision 3a or 3b, to be a person who would require provision of at least one of the
73.3following services, as defined in the approved elderly waiver plan, in order to maintain
73.4their community residence:
73.5(i) caregiver support;
73.6(ii) homemaker support;
73.7(iii) chores; or
73.8(iv) a personal emergency response device or system.
73.9(c) The person receiving any of the essential community supports in this subdivision
73.10must also receive service coordination, not to exceed $600 in a 12-month authorization
73.11period, as part of their community support plan.
73.12(d) A person who has been determined to be eligible for an essential community
73.13supports grant must be reassessed at least annually and continue to meet the criteria in
73.14paragraph (b) to remain eligible for an essential community supports grant.
73.15(e) The commissioner is authorized to use federal matching funds for essential
73.16community supports as necessary and to meet demand for essential community supports
73.17grants as outlined in paragraphs (f) and (g), and that amount of federal funds is
73.18appropriated to the commissioner for this purpose.
73.19(f) Upon federal approval and following a reasonable implementation period
73.20determined by the commissioner, essential community supports are available to an
73.21individual who:
73.22(1) is receiving nursing facility services or home and community-based long-term
73.23services and supports under section 256B.0915 or 256B.49 on the effective date of
73.24implementation of the revised nursing facility level of care under section 144.0724,
73.25subdivision 11;
73.26(2) meets one of the following criteria:
73.27(i) due to the implementation of the revised nursing facility level of care, loses
73.28eligibility for continuing medical assistance payment of nursing facility services at the
73.29first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or
73.30after the effective date of the revised nursing facility level of care criteria under section
73.31144.0724, subdivision 11; or
73.32(ii) due to the implementation of the revised nursing facility level of care, loses
73.33eligibility for continuing medical assistance payment of home and community-based
73.34long-term services and supports under section 256B.0915 or 256B.49 at the first
73.35reassessment required under those sections that occurs on or after the effective date of
74.1implementation of the revised nursing facility level of care under section 144.0724,
74.2subdivision 11;
74.3(3) is not eligible for personal care attendant services; and
74.4(4) has an assessed need for one or more of the supportive services offered under
74.5essential community supports.
74.6Individuals eligible under this paragraph includes individuals who continue to be
74.7eligible for medical assistance state plan benefits and those who are not or are no longer
74.8financially eligible for medical assistance.
74.9(g) Upon federal approval and following a reasonable implementation period
74.10determined by the commissioner, the services available through essential community
74.11supports include the services and grants provided in paragraphs (b) and (c), home-delivered
74.12meals, and community living assistance as defined by the commissioner. These services
74.13are available to all eligible recipients including those outlined in paragraphs (b) and (f).
74.14Recipients are eligible if they have a need for any of these services and meet all other
74.15eligibility criteria.

74.16    Sec. 25. Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to
74.17read:
74.18    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of
74.19waivered services to an individual elderly waiver client except for individuals described in
74.20paragraph paragraphs (b) and (d) shall be the weighted average monthly nursing facility
74.21rate of the case mix resident class to which the elderly waiver client would be assigned
74.22under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance
74.23needs allowance as described in subdivision 1d, paragraph (a), until the first day of the
74.24state fiscal year in which the resident assessment system as described in section 256B.438
74.25for nursing home rate determination is implemented. Effective on the first day of the state
74.26fiscal year in which the resident assessment system as described in section 256B.438 for
74.27nursing home rate determination is implemented and the first day of each subsequent state
74.28fiscal year, the monthly limit for the cost of waivered services to an individual elderly
74.29waiver client shall be the rate of the case mix resident class to which the waiver client
74.30would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on
74.31the last day of the previous state fiscal year, adjusted by any legislatively adopted home
74.32and community-based services percentage rate adjustment.
74.33    (b) The monthly limit for the cost of waivered services to an individual elderly
74.34waiver client assigned to a case mix classification A under paragraph (a) with:
74.35(1) no dependencies in activities of daily living; or
75.1(2) up to two dependencies in bathing, dressing, grooming, walking, and eating
75.2when the dependency score in eating is three or greater as determined by an assessment
75.3performed under section 256B.0911
75.4shall be $1,750 per month effective on July 1, 2011, for all new participants enrolled in
75.5the program on or after July 1, 2011. This monthly limit shall be applied to all other
75.6participants who meet this criteria at reassessment. This monthly limit shall be increased
75.7annually as described in paragraph (a).
75.8(c) If extended medical supplies and equipment or environmental modifications are
75.9or will be purchased for an elderly waiver client, the costs may be prorated for up to
75.1012 consecutive months beginning with the month of purchase. If the monthly cost of a
75.11recipient's waivered services exceeds the monthly limit established in paragraph (a) or
75.12(b), the annual cost of all waivered services shall be determined. In this event, the annual
75.13cost of all waivered services shall not exceed 12 times the monthly limit of waivered
75.14services as described in paragraph (a) or (b).
75.15(d) Effective July 1, 2013, the monthly cost limit of waiver services, including
75.16any necessary home care services described in section 256B.0651, subdivision 2, for
75.17individuals who meet the criteria as ventilator-dependent given in section 256B.0651,
75.18subdivision 1, paragraph (g), shall be the average of the monthly medical assistance
75.19amount established for home care services as described in section 256B.0652, subdivision
75.207, and the annual average contracted amount established by the commissioner for nursing
75.21facility services for ventilator-dependent individuals. This monthly limit shall be increased
75.22annually as described in paragraph (a).

75.23    Sec. 26. Minnesota Statutes 2012, section 256B.0915, is amended by adding a
75.24subdivision to read:
75.25    Subd. 3j. Individual community living support. Upon federal approval, there
75.26is established a new service called individual community living support (ICLS) that is
75.27available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor
75.28have any interest in the recipient's housing. ICLS must be delivered in a single-family
75.29home or apartment where the service recipient or their family owns or rents, as
75.30demonstrated by a lease agreement, and maintains control over the individual unit. Case
75.31managers or care coordinators must develop individual ICLS plans in consultation with
75.32the client using a tool developed by the commissioner. The commissioner shall establish
75.33payment rates and mechanisms to align payments with the type and amount of service
75.34provided, assure statewide uniformity for payment rates, and assure cost-effectiveness.
75.35Licensing standards for ICLS shall be reviewed jointly by the Departments of Health and
76.1Human Services to avoid conflict with provider regulatory standards pursuant to section
76.2144A.43 and chapter 245D.

76.3    Sec. 27. Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:
76.4    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
76.5shall receive an initial assessment of strengths, informal supports, and need for services
76.6in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
76.7client served under the elderly waiver must be conducted at least every 12 months and at
76.8other times when the case manager determines that there has been significant change in
76.9the client's functioning. This may include instances where the client is discharged from
76.10the hospital. There must be a determination that the client requires nursing facility level
76.11of care as defined in section 256B.0911, subdivision 4a, paragraph (d) 4e, at initial and
76.12subsequent assessments to initiate and maintain participation in the waiver program.
76.13(b) Regardless of other assessments identified in section 144.0724, subdivision
76.144, as appropriate to determine nursing facility level of care for purposes of medical
76.15assistance payment for nursing facility services, only face-to-face assessments conducted
76.16according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
76.17level of care determination will be accepted for purposes of initial and ongoing access to
76.18waiver service payment.

76.19    Sec. 28. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
76.20subdivision to read:
76.21    Subd. 1a. Home and community-based services for older adults. (a) The purpose
76.22of projects selected by the commissioner of human services under this section is to
76.23make strategic changes in the long-term services and supports system for older adults
76.24including statewide capacity for local service development and technical assistance, and
76.25statewide availability of home and community-based services for older adult services,
76.26caregiver support and respite care services, and other supports in the state of Minnesota.
76.27These projects are intended to create incentives for new and expanded home and
76.28community-based services in Minnesota in order to:
76.29(1) reach older adults early in the progression of their need for long-term services
76.30and supports, providing them with low-cost, high-impact services that will prevent or
76.31delay the use of more costly services;
76.32(2) support older adults to live in the most integrated, least restrictive community
76.33setting;
76.34(3) support the informal caregivers of older adults;
77.1(4) develop and implement strategies to integrate long-term services and supports
77.2with health care services, in order to improve the quality of care and enhance the quality
77.3of life of older adults and their informal caregivers;
77.4(5) ensure cost-effective use of financial and human resources;
77.5(6) build community-based approaches and community commitment to delivering
77.6long-term services and supports for older adults in their own homes;
77.7(7) achieve a broad awareness and use of lower-cost in-home services as an
77.8alternative to nursing homes and other residential services;
77.9(8) strengthen and develop additional home and community-based services and
77.10alternatives to nursing homes and other residential services; and
77.11(9) strengthen programs that use volunteers.
77.12(b) The services provided by these projects are available to older adults who are
77.13eligible for medical assistance and the elderly waiver under section 256B.0915, the
77.14alternative care program under section 256B.0913, or essential community supports grant
77.15under subdivision 14, paragraph (b), and to persons who have their own funds to pay for
77.16services.

77.17    Sec. 29. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
77.18subdivision to read:
77.19    Subd. 1b. Definitions. (a) For purposes of this section, the following terms have
77.20the meanings given.
77.21(b) "Community" means a town; township; city; or targeted neighborhood within a
77.22city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.
77.23(c) "Core home and community-based services provider" means a Faith in Action,
77.24Living at Home Block Nurse, Congregational Nurse, or similar community-based
77.25program governed by a board, the majority of whose members reside within the program's
77.26service area, that organizes and uses volunteers and paid staff to deliver nonmedical
77.27services intended to assist older adults to identify and manage risks and to maintain their
77.28community living and integration in the community.
77.29(d) "Eldercare development partnership" means a team of representatives of county
77.30social service and public health agencies, the area agency on aging, local nursing home
77.31providers, local home care providers, and other appropriate home and community-based
77.32providers in the area agency's planning and service area.
77.33(e) "Long-term services and supports" means any service available under the
77.34elderly waiver program or alternative care grant programs; nursing facility services;
77.35transportation services; caregiver support and respite care services; and other home and
78.1community-based services identified as necessary either to maintain lifestyle choices for
78.2older adults or to support them to remain in their own home.
78.3(f) "Older adult" refers to an individual who is 65 years of age or older.

78.4    Sec. 30. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
78.5subdivision to read:
78.6    Subd. 1c. Eldercare development partnerships. The commissioner of human
78.7services shall select and contract with eldercare development partnerships sufficient to
78.8provide statewide availability of service development and technical assistance using a
78.9request for proposals process. Eldercare development partnerships shall:
78.10(1) develop a local long-term services and supports strategy consistent with state
78.11goals and objectives;
78.12(2) identify and use existing local skills, knowledge and relationships, and build
78.13on these assets;
78.14(3) coordinate planning for funds to provide services to older adults, including funds
78.15received under Title III of the Older Americans Act, Title XX of the Social Security Act,
78.16and the Local Public Health Act;
78.17(4) target service development and technical assistance where nursing facility
78.18closures have occurred or are occurring or in areas where service needs have been
78.19identified through activities under section 144A.351;
78.20(5) provide sufficient staff for development and technical support in its designated
78.21area; and
78.22(6) designate a single public or nonprofit member of the eldercare development
78.23partnerships to apply grant funding and manage the project.

78.24    Sec. 31. Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:
78.25    Subd. 6. Caregiver support and respite care projects. (a) The commissioner
78.26shall establish up to 36 projects to expand the respite care network in the state and to
78.27support caregivers in their responsibilities for care. The purpose of each project shall
78.28be to availability of caregiver support and respite care services for family and other
78.29caregivers. The commissioner shall use a request for proposals to select nonprofit entities
78.30to administer the projects. Projects shall:
78.31(1) establish a local coordinated network of volunteer and paid respite workers;
78.32(2) coordinate assignment of respite workers care services to clients and care
78.33receivers and assure the health and safety of the client; and caregivers of older adults;
79.1(3) provide training for caregivers and ensure that support groups are available
79.2in the community.
79.3(3) assure the health and safety of the older adults;
79.4(4) identify at-risk caregivers;
79.5(5) provide information, education, and training for caregivers in the designated
79.6community; and
79.7(6) demonstrate the need in the proposed service area particularly where nursing
79.8facility closures have occurred or are occurring or areas with service needs identified
79.9by section 144A.351. Preference must be given for projects that reach underserved
79.10populations.
79.11(b) The caregiver support and respite care funds shall be available to the four to six
79.12local long-term care strategy projects designated in subdivisions 1 to 5.
79.13(c) The commissioner shall publish a notice in the State Register to solicit proposals
79.14from public or private nonprofit agencies for the projects not included in the four to six
79.15local long-term care strategy projects defined in subdivision 2. A county agency may,
79.16alone or in combination with other county agencies, apply for caregiver support and
79.17respite care project funds. A public or nonprofit agency within a designated SAIL project
79.18area may apply for project funds if the agency has a letter of agreement with the county
79.19or counties in which services will be developed, stating the intention of the county or
79.20counties to coordinate their activities with the agency requesting a grant.
79.21(d) The commissioner shall select grantees based on the following criteria (b)
79.22Projects must clearly describe:
79.23(1) the ability of the proposal to demonstrate need in the area served, as evidenced
79.24by a community needs assessment or other demographic data;
79.25(2) the ability of the proposal to clearly describe how the project (1) how they will
79.26achieve the their purpose defined in paragraph (b);
79.27(3) the ability of the proposal to reach underserved populations;
79.28(4) the ability of the proposal to demonstrate community commitment to the project,
79.29as evidenced by letters of support and cooperation as well as formation of a community
79.30task force;
79.31(5) the ability of the proposal to clearly describe (2) the process for recruiting,
79.32training, and retraining volunteers; and
79.33(6) the inclusion in the proposal of the (3) their plan to promote the project in the
79.34designated community, including outreach to persons needing the services.
79.35(e) (c) Funds for all projects under this subdivision may be used to:
80.1(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
80.2care services and assign workers to clients;
80.3(2) recruit and train volunteer providers;
80.4(3) train provide information, training, and education to caregivers;
80.5(4) ensure the development of support groups for caregivers;
80.6(5) (4) advertise the availability of the caregiver support and respite care project; and
80.7(6) (5) purchase equipment to maintain a system of assigning workers to clients.
80.8(f) (d) Project funds may not be used to supplant existing funding sources.

80.9    Sec. 32. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
80.10subdivision to read:
80.11    Subd. 7a. Core home and community-based services. The commissioner shall
80.12select and contract with core home and community-based services providers for projects
80.13to provide services and supports to older adults both with and without family and other
80.14informal caregivers using a request for proposals process. Projects must:
80.15(1) have a credible, public, or private nonprofit sponsor providing ongoing financial
80.16support;
80.17(2) have a specific, clearly defined geographic service area;
80.18(3) use a practice framework designed to identify high-risk older adults and help them
80.19take action to better manage their chronic conditions and maintain their community living;
80.20(4) have a team approach to coordination and care, ensuring that the older adult
80.21participants, their families, and the formal and informal providers are all part of planning
80.22and providing services;
80.23(5) provide information, support services, homemaking services, counseling, and
80.24training for the older adults and family caregivers;
80.25(6) encourage service area or neighborhood residents and local organizations to
80.26collaborate in meeting the needs of older adults in their geographic service areas;
80.27(7) recruit, train, and direct the use of volunteers to provide informal services and
80.28other appropriate support to older adults and their caregivers; and
80.29(8) provide coordination and management of formal and informal services to older
80.30adults and their families using less expensive alternatives.

80.31    Sec. 33. Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to
80.32read:
80.33    Subd. 13. Community service grants. The commissioner shall award contracts
80.34for grants to public and private nonprofit agencies to establish services that strengthen
81.1a community's ability to provide a system of home and community-based services
81.2for elderly persons. The commissioner shall use a request for proposal process. The
81.3commissioner shall give preference when awarding grants under this section to areas
81.4where nursing facility closures have occurred or are occurring or to areas with service
81.5needs identified under section 144A.351. The commissioner shall consider grants for:
81.6(1) caregiver support and respite care projects under subdivision 6;
81.7(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and
81.8(3) services identified as needed for community transition.

81.9    Sec. 34. Minnesota Statutes 2012, section 256B.092, is amended by adding a
81.10subdivision to read:
81.11    Subd. 14. Reduce avoidable behavioral crisis emergency room, psychiatric
81.12inpatient hospitalizations, and commitments to institutions. (a) Persons receiving
81.13home and community-based services authorized under this section who have had two
81.14or more admissions within a calendar year to an emergency room, psychiatric unit,
81.15or institution must receive consultation from a mental health professional as defined in
81.16section 245.462, subdivision 18, or a behavioral professional as defined in the home and
81.17community-based services state plan within 30 days of discharge. The mental health
81.18professional or behavioral professional must:
81.19(1) conduct a functional assessment of the crisis incident as defined in section
81.20245D.02, subdivision 11, which led to the hospitalization with the goal of developing
81.21proactive strategies as well as necessary reactive strategies to reduce the likelihood of
81.22future avoidable hospitalizations due to a behavioral crisis;
81.23(2) use the results of the functional assessment to amend the coordinated service and
81.24support plan set forth in section 245D.02, subdivision 4b, to address the potential need
81.25for additional staff training, increased staffing, access to crisis mobility services, mental
81.26health services, use of technology, and crisis stabilization services in section 256B.0624,
81.27subdivision 7; and
81.28(3) identify the need for additional consultation, testing, and mental health crisis
81.29intervention team services as defined in section 245D.02, subdivision 20, psychotropic
81.30medication use and monitoring under section 245D.051, as well as the frequency and
81.31duration of ongoing consultation.
81.32(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
81.33the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

81.34    Sec. 35. Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:
82.1    Subdivision 1. Development and implementation of quality profiles. (a) The
82.2commissioner of human services, in cooperation with the commissioner of health,
82.3shall develop and implement a quality profile system profiles for nursing facilities and,
82.4beginning not later than July 1, 2004 2014, other providers of long-term care services,
82.5except when the quality profile system would duplicate requirements under section
82.6256B.5011 , 256B.5012, or 256B.5013. The system quality profiles must be developed
82.7and implemented to the extent possible without the collection of significant amounts of
82.8new data. To the extent possible, the system using existing data sets maintained by the
82.9commissioners of health and human services to the extent possible. The profiles must
82.10incorporate or be coordinated with information on quality maintained by area agencies on
82.11aging, long-term care trade associations, the ombudsman offices, counties, tribes, health
82.12plans, and other entities and the long-term care database maintained under section 256.975,
82.13subdivision 7. The system profiles must be designed to provide information on quality to:
82.14(1) consumers and their families to facilitate informed choices of service providers;
82.15(2) providers to enable them to measure the results of their quality improvement
82.16efforts and compare quality achievements with other service providers; and
82.17(3) public and private purchasers of long-term care services to enable them to
82.18purchase high-quality care.
82.19(b) The system profiles must be developed in consultation with the long-term care
82.20task force, area agencies on aging, and representatives of consumers, providers, and labor
82.21unions. Within the limits of available appropriations, the commissioners may employ
82.22consultants to assist with this project.

82.23    Sec. 36. Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:
82.24    Subd. 2. Quality measurement tools. The commissioners shall identify and apply
82.25existing quality measurement tools to:
82.26(1) emphasize quality of care and its relationship to quality of life; and
82.27(2) address the needs of various users of long-term care services, including, but not
82.28limited to, short-stay residents, persons with behavioral problems, persons with dementia,
82.29and persons who are members of minority groups.
82.30    The tools must be identified and applied, to the extent possible, without requiring
82.31providers to supply information beyond current state and federal requirements.

82.32    Sec. 37. Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:
82.33    Subd. 3. Consumer surveys of nursing facilities residents. Following
82.34identification of the quality measurement tool, the commissioners shall conduct surveys
83.1of long-term care service consumers of nursing facilities to develop quality profiles
83.2of providers. To the extent possible, surveys must be conducted face-to-face by state
83.3employees or contractors. At the discretion of the commissioners, surveys may be
83.4conducted by telephone or by provider staff. Surveys must be conducted periodically to
83.5update quality profiles of individual service nursing facilities providers.

83.6    Sec. 38. Minnesota Statutes 2012, section 256B.439, is amended by adding a
83.7subdivision to read:
83.8    Subd. 3a. Home and community-based services report card in cooperation with
83.9the commissioner of health. The profiles developed for home and community-based
83.10services providers under this section shall be incorporated into a report card and
83.11maintained by the Minnesota Board on Aging pursuant to section 256.975, subdivision
83.127, paragraph (b), clause (2), as data becomes available. The commissioner, in
83.13cooperation with the commissioner of health, shall use consumer choice, quality of life,
83.14care approaches, and cost or flexible purchasing categories to organize the consumer
83.15information in the profiles. The final categories used shall include consumer input and
83.16survey data to the extent that is available through the state agencies. The commissioner
83.17shall develop and disseminate the qualify profiles for a limited number of provider types
83.18initially, and develop quality profiles for additional provider types as measurement tools
83.19are developed and data becomes available. This includes providers of services to older
83.20adults and people with disabilities, regardless of payor source.

83.21    Sec. 39. Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:
83.22    Subd. 4. Dissemination of quality profiles. By July 1, 2003 2014, the
83.23commissioners shall implement a system public awareness effort to disseminate the quality
83.24profiles developed from consumer surveys using the quality measurement tool. Profiles
83.25may be disseminated to through the Senior LinkAge Line and Disability Linkage Line and
83.26to consumers, providers, and purchasers of long-term care services through all feasible
83.27printed and electronic outlets. The commissioners may conduct a public awareness
83.28campaign to inform potential users regarding profile contents and potential uses.

83.29    Sec. 40. Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:
83.30    Subd. 12. Informed choice. Persons who are determined likely to require the level
83.31of care provided in a nursing facility as determined under section 256B.0911, subdivision
83.324e, or a hospital shall be informed of the home and community-based support alternatives
83.33to the provision of inpatient hospital services or nursing facility services. Each person
84.1must be given the choice of either institutional or home and community-based services
84.2using the provisions described in section 256B.77, subdivision 2, paragraph (p).

84.3    Sec. 41. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
84.4    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
84.5shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
84.6With the permission of the recipient or the recipient's designated legal representative,
84.7the recipient's current provider of services may submit a written report outlining their
84.8recommendations regarding the recipient's care needs prepared by a direct service
84.9employee with at least 20 hours of service to that client. The person conducting the
84.10assessment or reassessment must notify the provider of the date by which this information
84.11is to be submitted. This information shall be provided to the person conducting the
84.12assessment and the person or the person's legal representative and must be considered
84.13prior to the finalization of the assessment or reassessment.
84.14(b) There must be a determination that the client requires a hospital level of care or a
84.15nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
84.16(d) 4e, at initial and subsequent assessments to initiate and maintain participation in the
84.17waiver program.
84.18(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
84.19appropriate to determine nursing facility level of care for purposes of medical assistance
84.20payment for nursing facility services, only face-to-face assessments conducted according
84.21to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
84.22determination or a nursing facility level of care determination must be accepted for
84.23purposes of initial and ongoing access to waiver services payment.
84.24(d) Recipients who are found eligible for home and community-based services under
84.25this section before their 65th birthday may remain eligible for these services after their
84.2665th birthday if they continue to meet all other eligibility factors.
84.27(e) The commissioner shall develop criteria to identify recipients whose level of
84.28functioning is reasonably expected to improve and reassess these recipients to establish
84.29a baseline assessment. Recipients who meet these criteria must have a comprehensive
84.30transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
84.31reassessed every six months until there has been no significant change in the recipient's
84.32functioning for at least 12 months. After there has been no significant change in the
84.33recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
84.34informal support systems, and need for services shall be conducted at least every 12
84.35months and at other times when there has been a significant change in the recipient's
85.1functioning. Counties, case managers, and service providers are responsible for
85.2conducting these reassessments and shall complete the reassessments out of existing funds.

85.3    Sec. 42. Minnesota Statutes 2012, section 256B.49, is amended by adding a
85.4subdivision to read:
85.5    Subd. 25. Reduce avoidable behavioral crisis emergency room, psychiatric
85.6inpatient hospitalizations, and commitments to institutions. (a) Persons receiving
85.7home and community-based services authorized under this section who have two or more
85.8admissions within a calendar year to an emergency room, psychiatric unit, or institution
85.9must receive consultation from a mental health professional as defined in section 245.462,
85.10subdivision 18, or a behavioral professional as defined in the home and community-based
85.11services state plan within 30 days of discharge. The mental health professional or
85.12behavioral professional must:
85.13(1) conduct a functional assessment of the crisis incident as defined in section
85.14245D.02, subdivision 11, which led to the hospitalization with the goal of developing
85.15proactive strategies as well as necessary reactive strategies to reduce the likelihood of
85.16future avoidable hospitalizations due to a behavioral crisis;
85.17(2) use the results of the functional assessment to amend the coordinated service and
85.18support plan in section 245D.02, subdivision 4b, to address the potential need for additional
85.19staff training, increased staffing, access to crisis mobility services, mental health services,
85.20use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and
85.21(3) identify the need for additional consultation, testing, mental health crisis
85.22intervention team services as defined in section 245D.02, subdivision 20, psychotropic
85.23medication use and monitoring under section 245D.051, as well as the frequency and
85.24duration of ongoing consultation.
85.25(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
85.26the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

85.27    Sec. 43. [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
85.28    Subdivision 1. Basis and scope. (a) Upon federal approval, the commissioner
85.29shall establish a medical assistance state plan option for the provision of home and
85.30community-based personal assistance service and supports called "community first
85.31services and supports (CFSS)."
85.32(b) CFSS is a participant-controlled method of selecting and providing services
85.33and supports that allows the participant maximum control of the services and supports.
85.34Participants may choose the degree to which they direct and manage their supports by
86.1choosing to have a significant and meaningful role in the management of services and
86.2supports including by directly employing support workers with the necessary supports
86.3to perform that function.
86.4(c) CFSS is available statewide to eligible individuals to assist with accomplishing
86.5activities of daily living (ADLs), instrumental activities of daily living (IADLs), and
86.6health-related procedures and tasks through hands-on assistance to complete the task or
86.7supervision and cueing to complete the task; and to assist with acquiring, maintaining, and
86.8enhancing the skills necessary to accomplish ADLs, IADLs, and health-related procedures
86.9and tasks. CFSS allows payment for certain supports and goods such as environmental
86.10modifications and technology that are intended to replace or decrease the need for human
86.11assistance.
86.12(d) Upon federal approval, CFSS will replace the personal care assistance program
86.13under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
86.14    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
86.15this subdivision have the meanings given.
86.16(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
86.17dressing, bathing, mobility, positioning, and transferring.
86.18(c) "Agency-provider model" means a method of CFSS under which a qualified
86.19agency provides services and supports through the agency's own employees and policies.
86.20The agency must allow the participant to have a significant role in the selection and
86.21dismissal of support workers of their choice for the delivery of their specific services
86.22and supports.
86.23(d) "Behavior" means a category to determine the home care rating and is based on the
86.24criteria in section 256B.0659. "Level I behavior" means physical aggression towards self,
86.25others, or destruction of property that requires the immediate response of another person.
86.26(e) "Complex health-related needs" means a category to determine the home care
86.27rating and is based on the criteria in section 256B.0659.
86.28(f) "Community first services and supports" or "CFSS" means the assistance and
86.29supports program under this section needed for accomplishing activities of daily living,
86.30instrumental activities of daily living, and health-related tasks through hands-on assistance
86.31to complete the task or supervision and cueing to complete the task, or the purchase of
86.32goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for
86.33human assistance.
86.34(g) "Community first services and supports service delivery plan" or "service delivery
86.35plan" means a written summary of the services and supports, that is based on the community
86.36support plan identified in section 256B.0911 and coordinated services and support plan
87.1and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
87.2by the participant to meet the assessed needs, using a person-centered planning process.
87.3(h) "Critical activities of daily living" means transferring, mobility, eating, and
87.4toileting.
87.5(i) "Dependency" in activities of daily living means a person requires assistance to
87.6begin and complete one or more of the activities of daily living.
87.7(j) "Financial management services contractor or vendor" means a qualified
87.8organization having a written contract with the department to provide services necessary
87.9to use the flexible spending model under subdivision 13, that include but are not limited
87.10to: participant education and technical assistance; CFSS service delivery planning and
87.11budgeting; billing, making payments, and monitoring of spending; and assisting the
87.12participant in fulfilling employer-related requirements in accordance with Section 3504 of
87.13the IRS code and the IRS Revenue Procedure 70-6.
87.14(k) "Flexible spending model" means a service delivery method of CFSS that uses
87.15an individualized CFSS service delivery plan and service budget and assistance from the
87.16financial management services contractor to facilitate participant employment of support
87.17workers and the acquisition of supports and goods.
87.18(l) "Health-related procedures and tasks" means procedures and tasks related to
87.19the specific needs of an individual that can be delegated or assigned by a state-licensed
87.20healthcare or behavioral health professional and performed by a support worker.
87.21(m) "Instrumental activities of daily living" means activities related to living
87.22independently in the community, including but not limited to: meal planning, preparation,
87.23and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning;
87.24assistance with medications; managing money; communicating needs, preferences, and
87.25activities; arranging supports; and assistance with traveling around and participating
87.26in the community.
87.27(n) "Legal representative" means parent of a minor, a court-appointed guardian, or
87.28another representative with legal authority to make decisions about services and supports
87.29for the participant. Other representatives with legal authority to make decisions include
87.30but are not limited to a health care agent or an attorney-in-fact authorized through a health
87.31care directive or power of attorney.
87.32(o) "Medication assistance" means providing verbal or visual reminders to take
87.33regularly scheduled medication and includes any of the following supports:
87.34(1) under the direction of the participant or the participant's representative, bringing
87.35medications to the participant including medications given through a nebulizer, opening a
87.36container of previously set up medications, emptying the container into the participant's
88.1hand, opening and giving the medication in the original container to the participant, or
88.2bringing to the participant liquids or food to accompany the medication;
88.3(2) organizing medications as directed by the participant or the participant's
88.4representative; and
88.5(3) providing verbal or visual reminders to perform regularly scheduled medications.
88.6(p) "Participant's representative" means a parent, family member, advocate, or
88.7other adult authorized by the participant to serve as a representative in connection with
88.8the provision of CFSS. This authorization must be in writing or by another method
88.9that clearly indicates the participant's free choice. The participant's representative must
88.10have no financial interest in the provision of any services included in the participant's
88.11service delivery plan and must be capable of providing the support necessary to assist
88.12the participant in the use of CFSS. If through the assessment process described in
88.13subdivision 5 a participant is determined to be in need of a participant's representative, one
88.14must be selected. If the participant is unable to assist in the selection of a participant's
88.15representative, the legal representative shall appoint one. Two persons may be designated
88.16as a participant's representative for reasons such as divided households and court-ordered
88.17custodies. Duties of a participant's representatives may include:
88.18(1) being available while care is provided in a method agreed upon by the participant
88.19or the participant's legal representative and documented in the participant's CFSS service
88.20delivery plan;
88.21(2) monitoring CFSS services to ensure the participant's CFSS service delivery
88.22plan is being followed; and
88.23(3) reviewing and signing CFSS time sheets after services are provided to provide
88.24verification of the CFSS services.
88.25(q) "Person-centered planning process" means a process that is driven by the
88.26participant for discovering and planning services and supports that ensures the participant
88.27makes informed choices and decisions. The person-centered planning process must:
88.28(1) include people chosen by the participant;
88.29(2) provide necessary information and support to ensure that the participant directs
88.30the process to the maximum extent possible, and is enabled to make informed choices
88.31and decisions;
88.32(3) be timely and occur at time and locations of convenience to the participant;
88.33(4) reflect cultural considerations of the participant;
88.34(5) include strategies for solving conflict or disagreement within the process,
88.35including clear conflict-of-interest guidelines for all planning;
89.1(6) offers choices to the participant regarding the services and supports they receive
89.2and from whom;
89.3(7) include a method for the participant to request updates to the plan; and
89.4(8) record the alternative home and community-based settings that were considered
89.5by the participant.
89.6(r) "Shared services" means the provision of CFSS services by the same CFSS
89.7support worker to two or three participants who voluntarily enter into an agreement to
89.8receive services at the same time and in the same setting by the same provider.
89.9(s) "Support specialist" means a professional with the skills and ability to assist the
89.10participant using either the agency provider model under subdivision 11 or the flexible
89.11spending model under subdivision 13, in services including, but not limited to assistance
89.12regarding:
89.13(1) the development, implementation, and evaluation of the CFSS service delivery
89.14plan under subdivision 6;
89.15(2) recruitment, training, or supervision, including supervision of health-related
89.16tasks or behavioral supports appropriately delegated by a health care professional, and
89.17evaluation of support workers; and
89.18(3) facilitating the use of informal and community supports, goods, or resources.
89.19(t) "Support worker" means an employee of the agency provider or of the participant
89.20who has direct contact with the participant and provides services as specified within the
89.21participant's service delivery plan.
89.22(u) "Wages and benefits" means the hourly wages and salaries, the employer's
89.23share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
89.24compensation, mileage reimbursement, health and dental insurance, life insurance,
89.25disability insurance, long-term care insurance, uniform allowance, contributions to
89.26employee retirement accounts, or other forms of employee compensation and benefits.
89.27    Subd. 3. Eligibility. (a) CFSS is available to a person who meets one of the
89.28following:
89.29(1) is a recipient of medical assistance as determined under section 256B.055,
89.30256B.056, or 256B.057, subdivisions 5 and 9;
89.31(2) is a recipient of the alternative care program under section 256B.0913;
89.32(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
89.33or 256B.49; or
89.34(4) has medical services identified in a participant's individualized education
89.35program and is eligible for services as determined in section 256B.0625, subdivision 26.
90.1(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
90.2meet all of the following:
90.3(1) require assistance and be determined dependent in one activity of daily living or
90.4Level I behavior based on assessment under section 256B.0911;
90.5(2) is not a recipient under the family support grant under section 252.32;
90.6(3) lives in the person's own apartment or home including a family foster care setting
90.7licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
90.8noncertified boarding care or boarding and lodging establishments under chapter 157;
90.9unless transitioning into the community from an institution; and
90.10(4) has not been excluded or disenrolled from the flexible spending model.
90.11(c) The commissioner shall disenroll or exclude participants from the flexible
90.12spending model and transfer them to the agency-provider model under the following
90.13circumstances that include but are not limited to:
90.14(1) when a participant has been restricted by the Minnesota restricted recipient
90.15program, the participant may be excluded for a specified time period;
90.16(2) when a participant exits the flexible spending service delivery model during the
90.17participant's service plan year. Upon transfer, the participant shall not access the flexible
90.18spending model for the remainder of that service plan year; or
90.19(3) when the department determines that the participant or participant's representative
90.20or legal representative cannot manage participant responsibilities under the service
90.21delivery model. The commissioner must develop policies for determining if a participant
90.22is unable to manage responsibilities under a service model.
90.23(d) A participant may appeal in writing to the department to contest the department's
90.24decision under paragraph (c), clause (3), to remove or exclude the participant from the
90.25flexible spending model.
90.26    Subd. 4. Eligibility for other services. Selection of CFSS by a participant must not
90.27restrict access to other medically necessary care and services furnished under the state
90.28plan medical assistance benefit or other services available through alternative care.
90.29    Subd. 5. Assessment requirements. (a) The assessment of functional need must:
90.30(1) be conducted by a certified assessor according to the criteria established in
90.31section 256B.0911;
90.32(2) be conducted face-to-face, initially and at least annually thereafter, or when there
90.33is a significant change in the participant's condition or a change in the need for services
90.34and supports; and
90.35(3) be completed using the format established by the commissioner.
91.1(b) A participant who is residing in a facility may be assessed and choose CFSS for
91.2the purpose of using CFSS to return to the community as described in subdivisions 3
91.3and 7, paragraph (a), clause (5).
91.4(c) The results of the assessment and any recommendations and authorizations for
91.5CFSS must be determined and communicated in writing by the lead agency's certified
91.6assessor as defined in section 256B.0911 to the participant and the agency-provider or
91.7financial management services provider chosen by the participant within 40 calendar days
91.8and must include the participant's right to appeal under section 256.045.
91.9    Subd. 6. Community first services and support service delivery plan. (a) The
91.10CFSS service delivery plan must be developed, implemented, and evaluated through a
91.11person-centered planning process by the participant, or the participant's representative
91.12or legal representative who may be assisted by a support specialist. The CFSS service
91.13delivery plan must reflect the services and supports that are important to the participant
91.14and for the participant to meet the needs assessed by the certified assessor and identified
91.15in the community support plan under section 256B.0911 or the coordinated services and
91.16support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS
91.17service delivery plan must be reviewed by the participant and the agency-provider or
91.18financial management services contractor at least annually upon reassessment, or when
91.19there is a significant change in the participant's condition, or a change in the need for
91.20services and supports.
91.21(b) The commissioner shall establish the format and criteria for the CFSS service
91.22delivery plan.
91.23(c) The CFSS service delivery plan must be person-centered and:
91.24(1) specify the agency-provider or financial management services contractor selected
91.25by the participant;
91.26(2) reflect the setting in which the participant resides that is chosen by the participant;
91.27(3) reflect the participant's strengths and preferences;
91.28(4) include the means to address the clinical and support needs as identified through
91.29an assessment of functional needs;
91.30(5) include individually identified goals and desired outcomes;
91.31(6) reflect the services and supports, paid and unpaid, that will assist the participant
91.32to achieve identified goals, and the providers of those services and supports, including
91.33natural supports;
91.34(7) identify the amount and frequency of face-to-face supports and amount and
91.35frequency of remote supports and technology that will be used;
92.1(8) identify risk factors and measures in place to minimize them, including
92.2individualized backup plans;
92.3(9) be understandable to the participant and the individuals providing support;
92.4(10) identify the individual or entity responsible for monitoring the plan;
92.5(11) be finalized and agreed to in writing by the participant and signed by all
92.6individuals and providers responsible for its implementation;
92.7(12) be distributed to the participant and other people involved in the plan; and
92.8(13) prevent the provision of unnecessary or inappropriate care.
92.9(d) The total units of agency-provider services or the budget allocation amount for
92.10the flexible spending model include both annual totals and a monthly average amount
92.11that cover the number of months of the service authorization. The amount used each
92.12month may vary, but additional funds must not be provided above the annual service
92.13authorization amount unless a change in condition is assessed and authorized by the
92.14certified assessor and documented in the community support plan, coordinated services
92.15and supports plan, and service delivery plan.
92.16    Subd. 7. Community first services and supports; covered services. Services
92.17and supports covered under CFSS include:
92.18(1) assistance to accomplish activities of daily living (ADLs), instrumental activities
92.19of daily living (IADLs), and health-related procedures and tasks through hands-on
92.20assistance to complete the task or supervision and cueing to complete the task;
92.21(2) assistance to acquire, maintain, or enhance the skills necessary for the participant
92.22to accomplish activities of daily living, instrumental activities of daily living, or
92.23health-related tasks;
92.24(3) expenditures for items, services, supports, environmental modifications, or
92.25goods, including assistive technology. These expenditures must:
92.26(i) relate to a need identified in a participant's CFSS service delivery plan;
92.27(ii) increase independence or substitute for human assistance to the extent that
92.28expenditures would otherwise be made for human assistance for the participant's assessed
92.29needs; and
92.30(iii) fit within the annual limit of the participant's approved service allocation
92.31or budget;
92.32(4) observation and redirection for episodes where there is a need for redirection
92.33due to participant behaviors or intervention needed due to a participant's symptoms. An
92.34assessment of behaviors must meet the criteria in this clause. A recipient qualifies as
92.35having a need for assistance due to behaviors if the recipient's behavior requires assistance
92.36at least four times per week and shows one or more of the following behaviors:
93.1(i) physical aggression towards self or others, or destruction of property that requires
93.2the immediate response of another person;
93.3(ii) increased vulnerability due to cognitive deficits or socially inappropriate
93.4behavior; or
93.5(iii) increased need for assistance for recipients who are verbally aggressive or
93.6resistive to care so that time needed to perform activities of daily living is increased;
93.7(5) back-up systems or mechanisms, such as the use of pagers or other electronic
93.8devices, to ensure continuity of the participant's services and supports;
93.9(6) transition costs, including:
93.10(i) deposits for rent and utilities;
93.11(ii) first month's rent and utilities;
93.12(iii) bedding;
93.13(iv) basic kitchen supplies;
93.14(v) other necessities, to the extent that these necessities are not otherwise covered
93.15under any other funding that the participant is eligible to receive; and
93.16(vi) other required necessities for an individual to make the transition from a nursing
93.17facility, institution for mental diseases, or intermediate care facility for persons with
93.18developmental disabilities to a community-based home setting where the participant
93.19resides; and
93.20(7) services by a support specialist defined under subdivision 2 that are chosen
93.21by the participant.
93.22    Subd. 8. Determination of CFSS service methodology. (a) All community first
93.23services and supports must be authorized by the commissioner or the commissioner's
93.24designee before services begin except for the assessments established in section
93.25256B.0911. The authorization for CFSS must be completed within 30 days after receiving
93.26a complete request.
93.27(b) The amount of CFSS authorized must be based on the recipient's home
93.28care rating. The home care rating shall be determined by the commissioner or the
93.29commissioner's designee based on information submitted to the commissioner identifying
93.30the following for a recipient:
93.31(1) the total number of dependencies of activities of daily living as defined in
93.32subdivision 2;
93.33(2) the presence of complex health-related needs as defined in subdivision 2; and
93.34(3) the presence of Level I behavior as defined in subdivision 2.
93.35(c) For purposes meeting the criteria in paragraph (b), the methodology to determine
93.36the total minutes for CFSS for each home care rating is based on the median paid units
94.1per day for each home care rating from fiscal year 2007 data for the PCA program. Each
94.2home care rating has a base number of minutes assigned. Additional minutes are added
94.3through the assessment and identification of the following:
94.4(1) 30 additional minutes per day for a dependency in each critical activity of daily
94.5living as defined in subdivision 2;
94.6(2) 30 additional minutes per day for each complex health-related function as
94.7defined in subdivision 2; and
94.8(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.
94.9    Subd. 9. Noncovered services. (a) Services or supports that are not eligible for
94.10payment under this section include those that:
94.11(1) are not authorized by the certified assessor or included in the written service
94.12delivery plan;
94.13(2) are provided prior to the authorization of services and the approval of the written
94.14CFSS service delivery plan;
94.15(3) are duplicative of other paid services in the written service delivery plan;
94.16(4) supplant natural unpaid supports that are provided voluntarily to the participant
94.17and are selected by the participant in lieu of a support worker and appropriately meeting
94.18the participant's needs;
94.19(5) are not effective means to meet the participant's needs; and
94.20(6) are available through other funding sources, including, but not limited to, funding
94.21through Title IV-E of the Social Security Act.
94.22(b) Additional services, goods, or supports that are not covered include:
94.23(1) those that are not for the direct benefit of the participant;
94.24(2) any fees incurred by the participant, such as Minnesota health care programs fees
94.25and co-pays, legal fees, or costs related to advocate agencies;
94.26(3) insurance, except for insurance costs related to employee coverage;
94.27(4) room and board costs for the participant with the exception of allowable
94.28transition costs in subdivision 7, clause (6);
94.29(5) services, supports, or goods that are not related to the assessed needs;
94.30(6) special education and related services provided under the Individuals with
94.31Disabilities Education Act and vocational rehabilitation services provided under the
94.32Rehabilitation Act of 1973;
94.33(7) assistive technology devices and assistive technology services other than those
94.34for back-up systems or mechanisms to ensure continuity of service and supports listed in
94.35subdivision 7;
94.36(8) medical supplies and equipment;
95.1(9) environmental modifications, except as specified in subdivision 7;
95.2(10) expenses for travel, lodging, or meals related to training the participant, the
95.3participant's representative, legal representative, or paid or unpaid caregivers that exceed
95.4$500 in a 12-month period;
95.5(11) experimental treatments;
95.6(12) any service or good covered by other medical assistance state plan services,
95.7including prescription and over-the-counter medications, compounds, and solutions and
95.8related fees, including premiums and co-payments;
95.9(13) membership dues or costs, except when the service is necessary and appropriate
95.10to treat a physical condition or to improve or maintain the participant's physical condition.
95.11The condition must be identified in the participant's CFSS plan and monitored by a
95.12physician enrolled in a Minnesota health care program;
95.13(14) vacation expenses other than the cost of direct services;
95.14(15) vehicle maintenance or modifications not related to the disability, health
95.15condition, or physical need; and
95.16(16) tickets and related costs to attend sporting or other recreational or entertainment
95.17events.
95.18    Subd. 10. Provider qualifications and general requirements. (a)
95.19Agency-providers delivering services under the agency-provider model under subdivision
95.2011 or financial management service (FMS) contractors under subdivision 13 shall:
95.21(1) enroll as a medical assistance Minnesota health care programs provider and meet
95.22all applicable provider standards;
95.23(2) comply with medical assistance provider enrollment requirements;
95.24(3) demonstrate compliance with law and policies of CFSS as determined by the
95.25commissioner;
95.26(4) comply with background study requirements under chapter 245C;
95.27(5) verify and maintain records of all services and expenditures by the participant,
95.28including hours worked by support workers and support specialists;
95.29(6) not engage in any agency-initiated direct contact or marketing in person, by
95.30telephone, or other electronic means to potential participants, guardians, family member
95.31or participants' representatives;
95.32(7) pay support workers and support specialists based upon actual hours of services
95.33provided;
95.34(8) withhold and pay all applicable federal and state payroll taxes;
95.35(9) make arrangements and pay unemployment insurance, taxes, workers'
95.36compensation, liability insurance, and other benefits, if any;
96.1(10) enter into a written agreement with the participant, participant's representative,
96.2or legal representative that assigns roles and responsibilities to be performed before
96.3services, supports, or goods are provided using a format established by the commissioner;
96.4(11) report suspected neglect and abuse to the common entry point according to
96.5sections 256B.0651 and 626.557; and
96.6(12) provide the participant with a copy of the service-related rights under
96.7subdivision 19 at the start of services and supports.
96.8(b) In consultation with the Development and Implementation Council described in
96.9subdivision 21 and other stakeholders, the commissioner shall develop recommendations
96.10for policies and procedures designed to ensure self-direction, program integrity, and fiscal
96.11accountability for goods and services provided in this section. The recommendations shall
96.12be provided to the chairs and ranking minority members of the legislative committees with
96.13jurisdiction over health and human services policy and finance by November 15, 2013.
96.14    Subd. 11. Agency-provider model. (a) The agency-provider model is limited to
96.15the services provided by support workers and support specialists who are employed by
96.16an agency-provider that is licensed according to chapter 245A or meets other criteria
96.17established by the commissioner, including required training.
96.18(b) The agency-provider shall allow the participant to retain the ability to have a
96.19significant role in the selection and dismissal of the support workers for the delivery of the
96.20services and supports specified in the service delivery plan.
96.21(c) A participant may use authorized units of CFSS services as needed within
96.22a service authorization that is not greater than 12 months. Using authorized units
96.23agency-provider services or the budget allocation amount for the flexible spending model
96.24flexibly does not increase the total amount of services and supports authorized for a
96.25participant or included in the participant's service delivery plan.
96.26(d) A participant may share CFSS services. Two or three CFSS participants may
96.27share services at the same time provided by the same support worker.
96.28(e) The agency-provider must use a minimum of 72.5 percent of the revenue
96.29generated by the medical assistance payment for CFSS for support worker wages and
96.30benefits. The agency-provider must document how this requirement is being met. The
96.31revenue generated by the support specialist and the reasonable costs associated with the
96.32support specialist must not be used in making this calculation.
96.33(f) The agency-provider model must be used by individuals who have been restricted
96.34by the Minnesota restricted recipient program.
96.35    Subd. 12. Requirements for initial enrollment of CFSS provider agencies. In
96.36consultation with the Development and Implementation Council described in subdivision
97.121 and other stakeholders, the commissioner shall develop CFSS provider enrollment
97.2standards which are consistent with federal requirements, reflect the principles of
97.3self-direction, and maintain program integrity. The recommendations shall be provided to
97.4the chairs and ranking minority members of the legislative committees with jurisdiction
97.5over health and human services policy and finance by November 15, 2013.
97.6    Subd. 13. Flexible spending model. (a) Under the flexible spending model
97.7participants can exercise more responsibility and control over the services and supports
97.8described and budgeted within the CFSS service delivery plan. Under this model:
97.9(1) participants directly employ support workers;
97.10(2) participants may use a budget allocation to obtain supports and goods as defined
97.11in subdivision 7; and
97.12(3) from the financial management services (FMS) contractor the participant may
97.13choose a range of support assistance services relating to:
97.14(i) planning, budgeting, and management of services and support;
97.15(ii) the participant's employment, training, supervision, and evaluation of workers;
97.16(iii) acquisition and payment for supports and goods; and
97.17(iv) evaluation of individual service outcomes as needed for the scope of the
97.18participant's degree of control and responsibility.
97.19(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
97.20may authorize a legal representative or participant's representative to do so on their behalf.
97.21(c) The FMS contractor shall not provide CFSS services and supports under the
97.22agency-provider service model. The FMS contractor shall provide service functions as
97.23determined by the commissioner that include but are not limited to:
97.24(1) information and consultation about CFSS;
97.25(2) assistance with the development of the service delivery plan and flexible
97.26spending model as requested by the participant;
97.27(3) billing and making payments for flexible spending model expenditures;
97.28(4) assisting participants in fulfilling employer-related requirements according to
97.29Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability,
97.30regulation 137036-08, which includes assistance with filing and paying payroll taxes, and
97.31obtaining worker compensation coverage;
97.32(5) data recording and reporting of participant spending; and
97.33(6) other duties established in the contract with the department.
97.34(d) A participant who requests to purchase goods and supports along with support
97.35worker services under the agency-provider model must use flexible spending model
98.1with a service delivery plan that specifies the amount of services to be authorized to the
98.2agency-provider and the expenditures to be paid by the FMS contractor.
98.3(e) The FMS contractor shall:
98.4(1) not limit or restrict the participant's choice of service or support providers or
98.5service delivery models as authorized by the commissioner;
98.6(2) provide the participant and the targeted case manager, if applicable, with a
98.7monthly written summary of the spending for services and supports that were billed
98.8against the spending budget;
98.9(3) be knowledgeable of state and federal employment regulations under the Fair
98.10Labor Standards Act of 1938, and comply with the requirements under the Internal
98.11Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax
98.12Liability for vendor or fiscal employer agent, and any requirements necessary to process
98.13employer and employee deductions, provide appropriate and timely submission of
98.14employer tax liabilities, and maintain documentation to support medical assistance claims;
98.15(4) have current and adequate liability insurance and bonding and sufficient cash
98.16flow as determined by the commission and have on staff or under contract a certified
98.17public accountant or an individual with a baccalaureate degree in accounting;
98.18(5) assume fiscal accountability for state funds designated for the program; and
98.19(6) maintain documentation of receipts, invoices, and bills to track all services and
98.20supports expenditures for any goods purchased and maintain time records of support
98.21workers. The documentation and time records must be maintained for a minimum of
98.22five years from the claim date and be available for audit or review upon request by the
98.23commissioner. Claims submitted by the FMS contractor to the commissioner for payment
98.24must correspond with services, amounts, and time periods as authorized in the participant's
98.25spending budget and service plan.
98.26(f) The commissioner of human services shall:
98.27(1) establish rates and payment methodology for the FMS contractor;
98.28(2) identify a process to ensure quality and performance standards for the FMS
98.29contractor and ensure statewide access to FMS contractors; and
98.30(3) establish a uniform protocol for delivering and administering CFSS services
98.31to be used by eligible FMS contractors.
98.32(g) Participants who are disenrolled from the model shall be transferred to the
98.33agency-provider model.
98.34    Subd. 14. Participant's responsibilities under flexible spending model. (a) A
98.35participant using the flexible spending model must use a FMS contractor or vendor that is
98.36under contract with the department. Upon a determination of eligibility and completion of
99.1the assessment and community support plan, the participant shall choose a FMS contractor
99.2from a list of eligible vendors maintained by the department.
99.3(b) When the participant, participant's representative, or legal representative chooses
99.4to be the employer of the support worker, they are responsible for recruiting, interviewing,
99.5hiring, training, scheduling, supervising, and discharging direct support workers.
99.6(c) In addition to the employer responsibilities in paragraph (b), the participant,
99.7participant's representative, or legal representative is responsible for:
99.8(1) tracking the services provided and all expenditures for goods or other supports;
99.9(2) preparing and submitting time sheets, signed by both the participant and support
99.10worker, to the FMS contractor on a regular basis and in a timely manner according to
99.11the FMS contractor's procedures;
99.12(3) notifying the FMS contractor within ten days of any changes in circumstances
99.13affecting the CFSS service plan or in the participant's place of residence including, but
99.14not limited to, any hospitalization of the participant or change in the participant's address,
99.15telephone number, or employment;
99.16(4) notifying the FMS contractor of any changes in the employment status of each
99.17participant support worker; and
99.18(5) reporting any problems resulting from the quality of services rendered by the
99.19support worker to the FMS contractor. If the participant is unable to resolve any problems
99.20resulting from the quality of service rendered by the support worker with the assistance of
99.21the FMS contractor, the participant shall report the situation to the department.
99.22    Subd. 15. Documentation of support services provided. In consultation with
99.23the Development and Implementation Council described in subdivision 21 and other
99.24stakeholders, the commissioner shall develop recommendations for CFSS documentation
99.25standards which are consistent with federal requirements, reflect the principles of
99.26self-direction, and maintain program integrity. The recommendations shall be provided to
99.27the chairs and ranking minority members of the legislative committees with jurisdiction
99.28over health and human services policy and finance by November 15, 2013.
99.29    Subd. 16. Support workers requirements. (a) Support workers shall:
99.30(1) enroll with the department as a support worker after a background study under
99.31chapter 245C has been completed and the support worker has received a notice from the
99.32commissioner that:
99.33(i) the support worker is not disqualified under section 245C.14; or
99.34(ii) is disqualified, but the support worker has received a set-aside of the
99.35disqualification under section 245C.22;
100.1(2) have the ability to effectively communicate with the participant or the
100.2participant's representative;
100.3(3) have the skills and ability to provide the services and supports according to the
100.4person's CFSS service delivery plan and respond appropriately to the participant's needs;
100.5(4) not be a participant of CFSS;
100.6(5) complete the basic standardized training as determined by the commissioner
100.7before completing enrollment. The training must be available in languages other than
100.8English and to those who need accommodations due to disabilities. Support worker
100.9training must include successful completion of the following training components: basic
100.10first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
100.11and responsibilities of support workers including information about basic body mechanics,
100.12emergency preparedness, orientation to positive behavioral practices, orientation to
100.13responding to a mental health crisis, fraud issues, time cards and documentation, and an
100.14overview of person-centered planning and self-direction. Upon completion of the training
100.15components, the support worker must pass the certification test to provide assistance
100.16to participants;
100.17(6) complete training and orientation on the participant's individual needs; and
100.18(7) maintain the privacy and confidentiality of the participant, and not independently
100.19determine the medication dose or time for medications for the participant.
100.20(b) In consultation with the Development and Implementation Council described
100.21in subdivision 21 and other stakeholders, the commissioner shall establish reasons for
100.22denying or terminating a support worker's provider enrollment which shall:
100.23(1) reflect the principles of self-direction;
100.24(2) support the participant's choice of support workers; and
100.25(3) maintain program integrity.
100.26The recommendations for denial or termination of support worker enrollment shall
100.27be provided to the chairs and ranking minority members of the legislative committees with
100.28jurisdiction over health and human services policy and finance by November 15, 2013.
100.29(c) A support worker may appeal in writing to the commissioner to contest the
100.30decision to terminate the support worker's provider enrollment and provider number.
100.31    Subd. 17. Support specialist requirements and payments. The commissioner
100.32shall develop qualifications, scope of functions, and payment rates and service limits for a
100.33support specialist that may provide additional or specialized assistance necessary to plan,
100.34implement, arrange, augment, or evaluate services and supports.
100.35    Subd. 18. Service unit and budget allocation requirements. (a) For the
100.36agency-provider model, services will be authorized in units of service. The total service
101.1unit amount must be established based upon the assessed need for CFSS services, and
101.2must not exceed the maximum number of units available as determined by section
101.3256B.0652, subdivision 6. The unit rate established by the commissioner is used with
101.4assessed units to determine the maximum available CFSS allocation.
101.5(b) For the flexible spending model, services and supports are authorized under
101.6a budget limit.
101.7(c) The maximum available CFSS participant budget allocation shall be established
101.8by multiplying the number of units authorized under subdivision 8 by the payment rate
101.9established by the commissioner.
101.10    Subd. 19. Support system. (a) The commissioner shall provide information,
101.11consultation, training, and assistance to ensure the participant is able to manage the
101.12services and supports and budgets, if applicable. This support shall include individual
101.13consultation on how to select and employ workers, manage responsibilities under CFSS,
101.14and evaluate personal outcomes.
101.15(b) The commissioner shall provide assistance with the development of risk
101.16management agreements.
101.17    Subd. 20. Service-related rights. Participants must be provided with adequate
101.18information, counseling, training, and assistance, as needed, to ensure that the participant
101.19is able to choose and manage services, models, and budgets. This support shall include
101.20information regarding: (1) person-centered planning; (2) the range and scope of individual
101.21choices; (3) the process for changing plans, services and budgets; (4) the grievance
101.22process; (5) individual rights; (6) identifying and assessing appropriate services; (7) risks
101.23and responsibilities; and (8) risk management. A participant who appeals a reduction in
101.24previously authorized CFSS services may continue previously authorized services pending
101.25an appeal under section 256.045. The commissioner must ensure that the participant
101.26has a copy of the most recent service delivery plan that contains a detailed explanation
101.27of which areas of covered CFSS are reduced, and provide notice of the amount of the
101.28budget reduction, and the reasons for the reduction in the participant's notice of denial,
101.29termination, or reduction.
101.30    Subd. 21. Development and Implementation Council. The commissioner
101.31shall establish a Development and Implementation Council of which the majority of
101.32members are individuals with disabilities, elderly individuals, and their representatives.
101.33The commissioner shall consult and collaborate with the council when developing and
101.34implementing this section.
101.35    Subd. 22. Quality assurance and risk management system. (a) The commissioner
101.36shall establish quality assurance and risk management measures for use in developing and
102.1implementing CFSS including those that (1) recognize the roles and responsibilities of those
102.2involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and budgets
102.3based upon a recipient's resources and capabilities. Risk management measures must
102.4include background studies, and backup and emergency plans, including disaster planning.
102.5(b) The commissioner shall provide ongoing technical assistance and resource and
102.6educational materials for CFSS participants.
102.7(c) Performance assessment measures, such as a participant's satisfaction with the
102.8services and supports, and ongoing monitoring of health and well-being shall be identified
102.9in consultation with the council established in subdivision 21.
102.10    Subd. 23. Commissioner's access. When the commissioner is investigating a
102.11possible overpayment of Medicaid funds, the commissioner must be given immediate
102.12access without prior notice to the agency provider or FMS contractor's office during
102.13regular business hours and to documentation and records related to services provided and
102.14submission of claims for services provided. Denying the commissioner access to records
102.15is cause for immediate suspension of payment and terminating the agency provider's
102.16enrollment according to section 256B.064 or terminating the FMS contract.
102.17    Subd. 24. CFSS agency-providers; background studies. CFSS agency-providers
102.18enrolled to provide personal care assistance services under the medical assistance program
102.19shall comply with the following:
102.20(1) owners who have a five percent interest or more and all managing employees
102.21are subject to a background study as provided in chapter 245C. This applies to currently
102.22enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
102.23agency-provider. "Managing employee" has the same meaning as Code of Federal
102.24Regulations, title 42, section 455. An organization is barred from enrollment if:
102.25(i) the organization has not initiated background studies on owners managing
102.26employees; or
102.27(ii) the organization has initiated background studies on owners and managing
102.28employees, but the commissioner has sent the organization a notice that an owner or
102.29managing employee of the organization has been disqualified under section 245C.14, and
102.30the owner or managing employee has not received a set-aside of the disqualification
102.31under section 245C.22;
102.32(2) a background study must be initiated and completed for all support specialists; and
102.33(3) a background study must be initiated and completed for all support workers.
102.34EFFECTIVE DATE.This section is effective upon federal approval. The
102.35commissioner of human services shall notify the revisor of statutes when this occurs.

103.1    Sec. 44. Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
103.2to read:
103.3    Subd. 1o. Supplementary service rate; exemptions. A county agency shall not
103.4negotiate a supplementary service rate under this section for any individual that has been
103.5determined to be eligible for Housing Stability Services as approved by the Centers
103.6for Medicare and Medicaid Services, and who resides in an establishment voluntarily
103.7registered under section 144D.025, as a supportive housing establishment or participates
103.8in the Minnesota supportive housing demonstration program under section 256I.04,
103.9subdivision 3, paragraph (a), clause (4).

103.10    Sec. 45. Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:
103.11    Subd. 4. Reporting. (a) Except as provided in paragraph (b), a mandated reporter
103.12shall immediately make an oral report to the common entry point. The common entry
103.13point may accept electronic reports submitted through a Web-based reporting system
103.14established by the commissioner. Use of a telecommunications device for the deaf or other
103.15similar device shall be considered an oral report. The common entry point may not require
103.16written reports. To the extent possible, the report must be of sufficient content to identify
103.17the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment,
103.18any evidence of previous maltreatment, the name and address of the reporter, the time,
103.19date, and location of the incident, and any other information that the reporter believes
103.20might be helpful in investigating the suspected maltreatment. A mandated reporter may
103.21disclose not public data, as defined in section 13.02, and medical records under sections
103.22144.291 to 144.298, to the extent necessary to comply with this subdivision.
103.23(b) A boarding care home that is licensed under sections 144.50 to 144.58 and
103.24certified under Title 19 of the Social Security Act, a nursing home that is licensed under
103.25section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a
103.26hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under
103.27Code of Federal Regulations, title 42, section 482.66, may submit a report electronically
103.28to the common entry point instead of submitting an oral report. The report may be a
103.29duplicate of the initial report the facility submits electronically to the commissioner of
103.30health to comply with the reporting requirements under Code of Federal Regulations, title
103.3142, section 483.13. The commissioner of health may modify these reporting requirements
103.32to include items required under paragraph (a) that are not currently included in the
103.33electronic reporting form.
103.34EFFECTIVE DATE.This section is effective July 1, 2014.

104.1    Sec. 46. Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:
104.2    Subd. 9. Common entry point designation. (a) Each county board shall designate
104.3a common entry point for reports of suspected maltreatment. Two or more county boards
104.4may jointly designate a single The commissioner of human services shall establish a
104.5 common entry point effective July 1, 2014. The common entry point is the unit responsible
104.6for receiving the report of suspected maltreatment under this section.
104.7(b) The common entry point must be available 24 hours per day to take calls from
104.8reporters of suspected maltreatment. The common entry point shall use a standard intake
104.9form that includes:
104.10(1) the time and date of the report;
104.11(2) the name, address, and telephone number of the person reporting;
104.12(3) the time, date, and location of the incident;
104.13(4) the names of the persons involved, including but not limited to, perpetrators,
104.14alleged victims, and witnesses;
104.15(5) whether there was a risk of imminent danger to the alleged victim;
104.16(6) a description of the suspected maltreatment;
104.17(7) the disability, if any, of the alleged victim;
104.18(8) the relationship of the alleged perpetrator to the alleged victim;
104.19(9) whether a facility was involved and, if so, which agency licenses the facility;
104.20(10) any action taken by the common entry point;
104.21(11) whether law enforcement has been notified;
104.22(12) whether the reporter wishes to receive notification of the initial and final
104.23reports; and
104.24(13) if the report is from a facility with an internal reporting procedure, the name,
104.25mailing address, and telephone number of the person who initiated the report internally.
104.26(c) The common entry point is not required to complete each item on the form prior
104.27to dispatching the report to the appropriate lead investigative agency.
104.28(d) The common entry point shall immediately report to a law enforcement agency
104.29any incident in which there is reason to believe a crime has been committed.
104.30(e) If a report is initially made to a law enforcement agency or a lead investigative
104.31agency, those agencies shall take the report on the appropriate common entry point intake
104.32forms and immediately forward a copy to the common entry point.
104.33(f) The common entry point staff must receive training on how to screen and
104.34dispatch reports efficiently and in accordance with this section.
104.35(g) The commissioner of human services shall maintain a centralized database
104.36for the collection of common entry point data, lead investigative agency data including
105.1maltreatment report disposition, and appeals data. The common entry point shall
105.2have access to the centralized database and must log the reports into the database and
105.3immediately identify and locate prior reports of abuse, neglect, or exploitation.
105.4(h) When appropriate, the common entry point staff must refer calls that do not
105.5allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations
105.6that might resolve the reporter's concerns.
105.7(i) a common entry point must be operated in a manner that enables the
105.8commissioner of human services to:
105.9(1) track critical steps in the reporting, evaluation, referral, response, disposition,
105.10and investigative process to ensure compliance with all requirements for all reports;
105.11(2) maintain data to facilitate the production of aggregate statistical reports for
105.12monitoring patterns of abuse, neglect, or exploitation;
105.13(3) serve as a resource for the evaluation, management, and planning of preventative
105.14and remedial services for vulnerable adults who have been subject to abuse, neglect,
105.15or exploitation;
105.16(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
105.17of the common entry point; and
105.18(5) track and manage consumer complaints related to the common entry point.
105.19(j) The commissioners of human services and health shall collaborate on the
105.20creation of a system for referring reports to the lead investigative agencies. This system
105.21shall enable the commissioner of human services to track critical steps in the reporting,
105.22evaluation, referral, response, disposition, investigation, notification, determination, and
105.23appeal processes.

105.24    Sec. 47. Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:
105.25    Subd. 9e. Education requirements. (a) The commissioners of health, human
105.26services, and public safety shall cooperate in the development of a joint program for
105.27education of lead investigative agency investigators in the appropriate techniques for
105.28investigation of complaints of maltreatment. This program must be developed by July
105.291, 1996. The program must include but need not be limited to the following areas: (1)
105.30information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
105.31conclusions based on evidence; (5) interviewing skills, including specialized training to
105.32interview people with unique needs; (6) report writing; (7) coordination and referral
105.33to other necessary agencies such as law enforcement and judicial agencies; (8) human
105.34relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
105.35systems and the appropriate methods for interviewing relatives in the course of the
106.1assessment or investigation; (10) the protective social services that are available to protect
106.2alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
106.3which lead investigative agency investigators and law enforcement workers cooperate in
106.4conducting assessments and investigations in order to avoid duplication of efforts; and
106.5(12) data practices laws and procedures, including provisions for sharing data.
106.6(b) The commissioner of human services shall conduct an outreach campaign to
106.7promote the common entry point for reporting vulnerable adult maltreatment. This
106.8campaign shall use the Internet and other means of communication.
106.9(b) (c) The commissioners of health, human services, and public safety shall offer at
106.10least annual education to others on the requirements of this section, on how this section is
106.11implemented, and investigation techniques.
106.12(c) (d) The commissioner of human services, in coordination with the commissioner
106.13of public safety shall provide training for the common entry point staff as required in this
106.14subdivision and the program courses described in this subdivision, at least four times
106.15per year. At a minimum, the training shall be held twice annually in the seven-county
106.16metropolitan area and twice annually outside the seven-county metropolitan area. The
106.17commissioners shall give priority in the program areas cited in paragraph (a) to persons
106.18currently performing assessments and investigations pursuant to this section.
106.19(d) (e) The commissioner of public safety shall notify in writing law enforcement
106.20personnel of any new requirements under this section. The commissioner of public
106.21safety shall conduct regional training for law enforcement personnel regarding their
106.22responsibility under this section.
106.23(e) (f) Each lead investigative agency investigator must complete the education
106.24program specified by this subdivision within the first 12 months of work as a lead
106.25investigative agency investigator.
106.26A lead investigative agency investigator employed when these requirements take
106.27effect must complete the program within the first year after training is available or as soon
106.28as training is available.
106.29All lead investigative agency investigators having responsibility for investigation
106.30duties under this section must receive a minimum of eight hours of continuing education
106.31or in-service training each year specific to their duties under this section.

106.32    Sec. 48. REPEALER.
106.33(a) Minnesota Statutes 2012, sections 245A.655; and 256B.0917, subdivisions 1, 2,
106.343, 4, 5, 7, 8, 9, 10, 11, 12, and 14, are repealed.
107.1(b) Minnesota Statutes 2012, section 256B.0911, subdivisions 4a, 4b, and 4c, are
107.2repealed effective October 1, 2013.

107.3    Sec. 49. EFFECTIVE DATE; CONTINGENT SYSTEMS MODERNIZATION
107.4APPROPRIATION.
107.5    Subdivision 1. Definitions. (a) For the purposes of this section, the terms in this
107.6subdivision have the meanings given.
107.7(b) Unless otherwise indicated, "commissioner" means the commissioner of human
107.8services.
107.9(c) "Contingent systems modernization appropriation" refers to the appropriation in
107.10article 15, section 2.
107.11(d) "Department" means the Department of Human Services.
107.12(e) "Plan" means the plan that outlines how the provisions in this article, and the
107.13contingent appropriation for systems modernization, are implemented once federal action
107.14on Reform 2020 has occurred.
107.15(f) Unless otherwise indicated, "Reform 2020" means the commissioner's request
107.16for any necessary federal approval of provisions in this article that modify or provide
107.17new medical assistance services, or that otherwise modify the federal role in the state's
107.18long-term care system.
107.19    Subd. 2. Intent; effective dates generally. (a) Because the changes contained in
107.20this article generate savings that are contingent on federal approval of Reform 2020,
107.21the legislature has also made an appropriation for systems modernization contingent on
107.22federal approval of Reform 2020. The purpose of this section is to outline how this article
107.23and the contingent systems modernization appropriation in article 15 are implemented if
107.24Reform 2020 is fully, partially, or incrementally approved or denied.
107.25(b) In order for sections 1 to 48 of this article to be effective, the commissioner must
107.26follow the provisions of subdivisions 3 and 4, as applicable, notwithstanding any other
107.27effective dates for those sections.
107.28    Subd. 3. Federal approval. (a) The implementation of this article is contingent
107.29on federal approval.
107.30(b) Upon full or partial approval of the waiver application, the commissioner shall
107.31develop a plan for implementing the provisions in this article that received federal
107.32approval as well as any that do not require federal approval. The plan must:
107.33(1) include fiscal estimates for the 2014-2015 and 2016-2017 biennia;
107.34(2) include the contingent systems modernization appropriation, which cannot
107.35exceed $16,992,000 for the biennium ending June 30, 2015; and
108.1(3) include spending estimates that, with federal administrative reimbursement, do
108.2not exceed the department's net general fund appropriations for the 2014-2015 biennium.
108.3(c) Upon approval by the commissioner of management and budget, the department
108.4may implement the plan.
108.5(d) The commissioner may follow this plan and implement parts of Reform 2020
108.6consistent with federal law if federal approval is denied, received incrementally, or
108.7significantly delayed.
108.8(e) The commissioner must notify the chairs and ranking minority members of the
108.9legislative committees with jurisdiction over health and human services funding of the
108.10plan. The plan must be made publicly available online.
108.11    Subd. 4. Disbursement; implementation. The commissioner of management and
108.12budget shall disburse the appropriations in article 15, section 2, to the commissioner to
108.13allow for implementation of the approved plan and make necessary adjustments in the
108.14accounting system to reflect any modified funding levels. Notwithstanding Minnesota
108.15Statutes, section 16A.11, subdivision 3, paragraph (b), these fiscal estimates must be
108.16considered in establishing the appropriation base for the biennium ending June 30, 2017.
108.17The commissioner of management and budget shall reflect the modified funding levels in
108.18the first fund balance following the approval of the plan.


108.21    Section 1. Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to
108.22read:
108.23    Subd. 2. Payment methodologies. (a) The commissioner shall establish, as defined
108.24under section 256B.4914, statewide payment methodologies that meet federal waiver
108.25requirements for home and community-based waiver services for individuals with
108.26disabilities. The payment methodologies must abide by the principles of transparency
108.27and equitability across the state. The methodologies must involve a uniform process of
108.28structuring rates for each service and must promote quality and participant choice.
108.29    (b) As of January 1, 2012, counties shall not implement changes to established
108.30processes for rate-setting methodologies for individuals using components of or data
108.31from research rates.

108.32    Sec. 2. Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:
108.33    Subd. 3. Payment requirements. The payment methodologies established under
108.34this section shall accommodate:
109.1(1) supervision costs;
109.2(2) staffing patterns staff compensation;
109.3(3) staffing and supervisory patterns;
109.4(3) (4) program-related expenses;
109.5(4) (5) general and administrative expenses; and
109.6(5) (6) consideration of recipient intensity.

109.7    Sec. 3. Minnesota Statutes 2012, section 256B.4913, is amended by adding a
109.8subdivision to read:
109.9    Subd. 4a. Rate stabilization adjustment. (a) The commissioner of human services
109.10shall adjust individual reimbursement rates by no more than 1.0 percent per year effective
109.11January 1, 2016. Rates determined under section 256B.4914 must be adjusted so that
109.12the unit rate varies no more than 1.0 percent per year from the rate effective December
109.131 of the prior calendar year. This adjustment is made annually for three calendar years
109.14from the date of implementation.
109.15(b) Rate stabilization adjustment applies to services that are authorized in a
109.16recipient's service plan prior to January 1, 2016.
109.17(c) Exemptions shall be made only when there is a significant change in the
109.18recipient's assessed needs which results in a service authorization change. Exemption
109.19adjustments shall be limited to the difference in the authorized framework rate specific to
109.20change in assessed need. Exemptions shall be managed within lead agencies' budgets per
109.21existing allocation procedures.
109.22(d) This subdivision expires January 1, 2019.

109.23    Sec. 4. Minnesota Statutes 2012, section 256B.4913, subdivision 5, is amended to read:
109.24    Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
109.25on regular intervals with the existing stakeholder group established as part of the
109.26rate-setting methodology process and others, to gather input, concerns, and data, and
109.27exchange ideas for the legislative proposals for to assist in the full implementation of
109.28 the new rate payment system and to make pertinent information available to the public
109.29through the department's Web site.

109.30    Sec. 5. Minnesota Statutes 2012, section 256B.4913, subdivision 6, is amended to read:
109.31    Subd. 6. Implementation. (a) The commissioner may shall implement changes
109.32no sooner than on January 1, 2014, to payment rates for individuals receiving home and
109.33community-based waivered services after the enactment of legislation that establishes
110.1specific payment methodology frameworks, processes for rate calculations, and specific
110.2values to populate the payment methodology frameworks disability waiver rates system.
110.3(b) On January 1, 2014, all new service authorizations must use the disability waiver
110.4rates system. Beginning January 1, 2014, all renewing individual service plans must use the
110.5disability waiver rates system as reassessment and reauthorization occurs. By December
110.631, 2014, data for all recipients must be entered into the disability waiver rates system.

110.7    Sec. 6. [256B.4914] HOME AND COMMUNITY-BASED SERVICES WAIVERS;
110.8RATE SETTING.
110.9    Subdivision 1. Application. The payment methodologies in this section apply to
110.10home and community-based services waivers under sections 256B.092 and 256B.49. This
110.11section does not change existing waiver policies and procedures.
110.12    Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
110.13meanings given them, unless the context clearly indicates otherwise.
110.14(b) "Commissioner" means the commissioner of human services.
110.15(c) "Component value" means underlying factors that are part of the cost of providing
110.16services that are built into the waiver rates methodology to calculate service rates.
110.17(d) "Customized living tool" means a methodology for setting service rates which
110.18delineates and documents the amount of each component service included in a recipient's
110.19customized living service plan.
110.20(e) "Disability Waiver Rates System" means a statewide system which establishes
110.21rates that are based on uniform processes and captures the individualized nature of waiver
110.22services and recipient needs.
110.23(f) "Lead agency" means a county, partnership of counties, or tribal agency charged
110.24with administering waivered services under sections 256B.092 and 256B.49.
110.25(g) "Median" means the amount that divides distribution into two equal groups, half
110.26above the median and half below the median.
110.27(h) "Payment or rate" means reimbursement to an eligible provider for services
110.28provided to a qualified individual based on an approved service authorization.
110.29(i) "Rates management system" means a web-based software application that uses
110.30a framework and component values, as determined by the commissioner, to establish
110.31service rates.
110.32(j) "Recipient" means a person receiving home and community-based services
110.33funded under any of the disability waivers.
111.1    Subd. 3. Applicable services. Applicable services are those authorized under the
111.2state's home and community-based services waivers under sections 256B.092 and 256B.49
111.3including, as defined in the federally approved home and community-based services plan:
111.4(1) 24-hour customized living;
111.5(2) adult day care;
111.6(3) adult day care bath;
111.7(4) behavioral programming;
111.8(5) companion services;
111.9(6) customized living;
111.10(7) day training and habilitation;
111.11(8) housing access coordination;
111.12(9) independent living skills;
111.13(10) in-home family support;
111.14(11) night supervision;
111.15(12) personal support;
111.16(13) prevocational services;
111.17(14) residential care services;
111.18(15) residential support services;
111.19(16) respite services;
111.20(17) structured day services;
111.21(18) supported employment services;
111.22(19) supported living services;
111.23(20) transportation services; and
111.24(21) other services as approved by the federal government in the state home and
111.25community-based services plan.
111.26    Subd. 4. Data collection for rate determination. (a) Rates for all applicable home
111.27and community-based waivered services, including rate exceptions under subdivision 12
111.28are set via the rates management system.
111.29(b) Only data and information in the rates management system may be used to
111.30calculate an individual's rate.
111.31(c) Service providers, with information from the community support plan, shall enter
111.32values and information needed to calculate an individual's rate into the rates management
111.33system. These values and information include:
111.34(1) shared staffing hours;
111.35(2) individual staffing hours;
111.36(3) staffing ratios;
112.1(4) information to document variable levels of service qualification for variable
112.2levels of reimbursement in each framework;
112.3(5) shared or individualized arrangements for unit-based services, including the
112.4staffing ratio; and
112.5(6) number of trips and miles for transportation services.
112.6(d) Updates to individual data shall include:
112.7(1) data for each individual that is updated annually when renewing service plans; and
112.8(2) requests by individuals or lead agencies to update a rate whenever there is a
112.9change in an individual's service needs, with accompanying documentation.
112.10(e) Lead agencies shall review and approve values to calculate the final payment rate
112.11for each individual. Lead agencies must notify the individual and the service provider
112.12of the final agreed upon values and rate. If a value used was mistakenly or erroneously
112.13entered and used to calculate a rate, a provider may petition lead agencies to correct it.
112.14Lead agencies must respond to these requests.
112.15    Subd. 5. Base wage index and standard component values. (a) The base wage
112.16index is established to determine staffing costs associated with providing services to
112.17individuals receiving home and community-based services. For purposes of developing
112.18and calculating the proposed base wage, Minnesota-specific wages taken from job
112.19descriptions and standard occupational classification (SOC) codes from the Bureau of
112.20Labor Statistics, as defined in the most recent edition of the Occupational Handbook shall
112.21be used. The base wage index shall be calculated as follows:
112.22(1) for residential direct care basic staff, 50 percent of the median wage for personal
112.23and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing
112.24aide (SOC code 31-1012); and 20 percent of the median wage for social and human
112.25services aide (SOC code 21-1093);
112.26(2) for residential direct care intensive staff, 20 percent of the median wage for home
112.27health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
112.28health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
112.2921-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
112.30and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
112.31(3) for day services, 20 percent of the median wage for nursing aide (SOC Code
112.3231-1012); 20 percent of the median wage for psychiatric technician (SOC Code 29-2053);
112.33and 60 percent of the median wage for social and human services code (SOC Code
112.3421-1093);
112.35(4) for residential asleep overnight staff, the wage will be $7.66 per hour, except
112.36in a family foster care setting the wage is $2.80 per hour;
113.1(5) for behavior program analyst staff: 100 percent of the median wage for mental
113.2health counselors (SOC code 21-1014);
113.3(6) for behavior program professional staff: 100 percent of the median wage for
113.4clinical counseling and school psychologist (SOC code 19-3031);
113.5(7) for behavior program specialist staff: 100 percent of the median wage for
113.6psychiatric technicians (SOC code 29-2053);
113.7(8) for supportive living services staff: 20 percent of the median wage for nursing
113.8aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
113.9code 29-2053); and 60 percent of the median wage for social and human services aide
113.10(SOC code 21-1093);
113.11(9) for housing access coordination staff: 50 percent of the median wage for
113.12community and social services specialist (SOC code 21-1099); and 50 percent of the
113.13median wage for social and human services aide (SOC code 21-1093);
113.14(10) for in-home family support staff: 20 percent of the median wage for nursing
113.15aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code
113.1621-1099); 40 percent of the median wage for social and human services aide (SOC code
113.1721-1093); and 10 percent of the median wage for psychiatric technician (SOC code
113.1829-2053);
113.19(11) for independent living skills staff: 40 percent of the median wage for
113.20community social service specialist (SOC code 21-1099); 50 percent of the median wage
113.21for social and human services aide (SOC code 21-1093); and 10 percent of the median
113.22wage for psychiatric technician (SOC code 29-2053);
113.23(12) for supported employment staff: 20 percent of the median wage for nursing
113.24aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
113.25code 29-2053); and 60 percent of the median wage for social and human services aide
113.26(SOC code 21-1093);
113.27(13) for adult companion staff: 50 percent of the median wage for personal and
113.28home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
113.29orderlies, and attendants (SOC code 31-1012);
113.30(14) for night supervision staff: 20 percent of the median wage for home health aide
113.31(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
113.32(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
113.3320 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
113.34percent of the median wage for social and human services aide (SOC code 21-1093);
114.1(15) for respite staff: 50 percent of the median wage for personal and home care aide
114.2(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
114.3attendants (SOC code 31-1012);
114.4(16) for personal support staff: 50 percent of the median wage for personal and
114.5home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
114.6aides, orderlies, and attendants (SOC code 31-1012); and
114.7(17) for supervisory staff: the basic wage is $17.43 per hour with exception of the
114.8supervisor of behavior analyst and behavior specialists which shall be $30.75 per hour.
114.9(b) Component values for residential support services, excluding family foster
114.10care, are:
114.11(1) supervisory span of control ratio: 11 percent;
114.12(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
114.13(3) employee-related cost ratio: 23.6 percent;
114.14(4) general administrative support ratio: 13.25 percent;
114.15(5) program-related expense ratio: 1.3 percent; and
114.16(6) absence and utilization factor ratio: 3.9 percent.
114.17(c) Component values for family foster care are:
114.18(1) supervisory span of control ratio: 11 percent;
114.19(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
114.20(3) employee-related cost ratio: 23.6 percent;
114.21(4) general administrative support ratio: 3.3 percent; and
114.22(5) program-related expense ratio: 1.3 percent.
114.23(d) Component values for day services for all services are:
114.24(1) supervisory span of control ratio: 11 percent;
114.25(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
114.26(3) employee-related cost ratio: 23.6 percent;
114.27(4) program plan support ratio: 5.6 percent;
114.28(5) client programming and support ratio: 10 percent;
114.29(6) general administrative support ratio: 13.25 percent;
114.30(7) program-related expense ratio: 1.8 percent; and
114.31(8) absence and utilization factor ratio: 3.9 percent.
114.32(e) Component values for unit-based with program services are:
114.33(1) supervisory span of control ratio: 11 percent;
114.34(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
114.35(3) employee-related cost ratio: 23.6 percent;
114.36(4) program plan supports ratio: 3.1 percent;
115.1(5) client programming and support ratio: 8.6 percent;
115.2(6) general administrative support ratio: 13.25 percent;
115.3(7) program-related expense ratio: 6.1 percent; and
115.4(8) absence and utilization factor ratio: 3.9 percent.
115.5(f) Component values for unit-based services without programming except respite
115.6are:
115.7(1) supervisory span of control ratio: 11 percent;
115.8(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
115.9(3) employee-related cost ratio: 23.6 percent;
115.10(4) program plan support ratio: 3.1 percent;
115.11(5) client programming and support ratio: 8.6 percent;
115.12(6) general administrative support ratio: 13.25 percent;
115.13(7) program-related expense ratio: 6.1 percent; and
115.14(8) absence and utilization factor ratio: 3.9 percent.
115.15(g) Component values for unit-based services without programming for respite are:
115.16(1) supervisory span of control ratio: 11 percent;
115.17(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
115.18(3) employee-related cost ratio: 23.6 percent;
115.19(4) general administrative support ratio: 13.25 percent;
115.20(5) program-related expense ratio: 6.1 percent; and
115.21(6) absence and utilization factor ratio: 3.9 percent.
115.22(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
115.23(a) based on the wage data by standard occupational code (SOC) from the Bureau of
115.24Labor Statistics available on December 31, 2016. The commissioner shall publish these
115.25updated values and load them into the rate management system. This adjustment shall
115.26occur every five years. For adjustments in 2021 and beyond, the commissioner shall use
115.27the data available on December 31 of the calendar year five years prior.
115.28(i) On July 1, 2017, the commissioner shall update the framework components in
115.29paragraph (c) for changes in the Consumer Price Index. The commissioner must adjust
115.30these values higher or lower by the percentage change in the Consumer Price Index-All
115.31Items (United States city average) (CPI-U) from January 1, 2014, to January 1, 2017. The
115.32commissioner shall publish these updated values and load them into the rate management
115.33system. This adjustment shall occur every five years. For adjustments in 2021 and
115.34beyond, the commissioner shall use the data available on January 1 of the calendar year
115.35four years prior and January 1 of the current calendar year.
116.1    Subd. 6. Payments for residential support services. (a) Payments for residential
116.2support services, as defined in sections 256B.092, subdivision 11, and 256B.49 subdivision
116.322, must be calculated as follows:
116.4(1) determine the number of units of service to meet a recipient's needs;
116.5(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
116.6national and Minnesota-specific rates or rates derived by the commissioner as provided in
116.7subdivision 5. This is defined as the direct care rate;
116.8(3) for a recipient requiring customization for deaf or hard-of-hearing language
116.9accessibility under subdivision 12, add the customization rate provided in subdivision 12
116.10to the result of clause (2). This is defined as the customized direct care rate;
116.11(4) multiply the number of residential services direct staff hours by the appropriate
116.12staff wage in subdivision 5, paragraph (a), or the customized direct care rate;
116.13(5) multiply the number of direct staff hours by the product of the supervision span
116.14of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
116.15wage in subdivision 5, paragraph (a), clause (17);
116.16(6) combine the results of clauses (4) and (5), and multiply the result by one plus
116.17the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
116.18clause (2). This is defined as the direct staffing cost;
116.19(7) for employee-related expenses, multiply the direct staffing cost by one plus the
116.20employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
116.21(8) for client programming and supports, the commissioner shall add $2,179; and
116.22(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
116.23customized for adapted transport per year.
116.24(b) The total rate shall be calculated using the following steps:
116.25(1) subtotal paragraph (a), clauses (7) to (9);
116.26(2) sum the standard general and administrative rate, the program-related expense
116.27ratio, and the absence and utilization ratio; and
116.28(3) divide the result of clause (1) by one minus the result of clause (2). This is
116.29the total payment amount.
116.30    Subd. 7. Payments for day programs. Payments for services with day programs
116.31including adult day care, day treatment and habilitation, prevocational services, and
116.32structured day services must be calculated as follows:
116.33(1) determine the number of units of service to meet a recipient's needs;
116.34(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
116.35Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
117.1(3) for a recipient requiring customization for deaf or hard-of-hearing language
117.2accessibility under subdivision 12, add the customization rate provided in subdivision 12
117.3to the result of clause (2). This is defined as the customized direct care rate;
117.4(4) multiply the number of day program direct staff hours by the appropriate staff
117.5wage in subdivision 5, paragraph (a), or the customized direct care rate;
117.6(5) multiply the number of day program direct staff hours by the product of the
117.7supervision span of control ratio in subdivision 5, paragraph (d), clause (1), and the
117.8appropriate supervision wage in subdivision 5, paragraph (a), clause (17);
117.9(6) combine the results of clauses (4) and (5), and multiply the result by one plus
117.10the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
117.11clause (2). This is defined as the direct staffing rate;
117.12(7) for program plan support, multiply the result of clause (6) by one plus the
117.13program plan support ratio in subdivision 5, paragraph (d), clause (4);
117.14(8) for employee-related expenses, multiply the result of clause (7) by one plus the
117.15employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
117.16(9) for client programming and supports, multiply the result of clause (8) by one plus
117.17the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
117.18(10) for program facility costs, add $8.30 per week with consideration of staffing
117.19ratios to meet individual needs;
117.20(11) for adult day bath services, add $7.01 per 15 minute unit;
117.21(12) this is the subtotal rate;
117.22(13) sum the standard general and administrative rate, the program-related expense
117.23ratio, and the absence and utilization factor ratio;
117.24(14) divide the result of clause (12) by one minus the result of clause (13). This is
117.25the total payment amount;
117.26(15) for transportation provided as part of day training and habilitation for an
117.27individual who does not require a lift, add:
117.28(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle
117.29without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared
117.30ride in a vehicle with a lift;
117.31(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle
117.32without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared
117.33ride in a vehicle with a lift;
117.34(iii) $25.75 for a trip between 21and 50 miles for a nonshared ride in a vehicle
117.35without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared
117.36ride in a vehicle with a lift; or
118.1(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a
118.2lift, $16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a
118.3vehicle with a lift;
118.4(16) for transportation provide as part of day training and habilitation for an
118.5individual who does require a lift, add:
118.6(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with
118.7a lift, and $15.05 for a shared ride in a vehicle with a lift;
118.8(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
118.9lift, and $28.16 for a shared ride in a vehicle with a lift;
118.10(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with
118.11a lift, and $58.76 for a shared ride in a vehicle with a lift; or
118.12(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a
118.13lift, and $80.93 for a shared ride in a vehicle with a lift.
118.14    Subd. 8. Payments for unit-based services with programming. Payments for
118.15unit-based services with programming, including behavior programming, housing access
118.16coordination, in-home family support, independent living skills training, hourly supported
118.17living services, and supported employment provided to an individual outside of any day or
118.18residential service plan must be calculated as follows, unless the services are authorized
118.19separately under subdivision 6 or 7:
118.20(1) determine the number of units of service to meet a recipient's needs;
118.21(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
118.22Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
118.23(3) for a recipient requiring customization for deaf or hard-of-hearing language
118.24accessibility under subdivision 12, add the customization rate provided in subdivision 12
118.25to the result of clause (2). This is defined as the customized direct care rate;
118.26(4) multiply the number of direct staff hours by the appropriate staff wage in
118.27subdivision 5, paragraph (a), or the customized direct care rate;
118.28(5) multiply the number of direct staff hours by the product of the supervision span
118.29of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
118.30wage in subdivision 5, paragraph (a), clause (17);
118.31(6) combine the results of clauses (4) and (5), and multiply the result by one plus
118.32the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
118.33clause (2). This is defined as the direct staffing rate;
118.34(7) for program plan support, multiply the result of clause (6) by one plus the
118.35program plan supports ratio in subdivision 5, paragraph (e), clause (4);
119.1(8) for employee-related expenses, multiply the result of clause (7) by one plus the
119.2employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
119.3(9) for client programming and supports, multiply the result of clause (8) by one plus
119.4the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
119.5(10) this is the subtotal rate;
119.6(11) sum the standard general and administrative rate, the program-related expense
119.7ratio, and the absence and utilization factor ratio; and
119.8(12) divide the result of clause (10) by one minus the result of clause (11). This is
119.9the total payment amount.
119.10    Subd. 9. Payments for unit-based services without programming. Payments
119.11for unit-based without program services including night supervision, personal support,
119.12respite, and companion care provided to an individual outside of any day or residential
119.13service plan must be calculated as follows unless the services are authorized separately
119.14under subdivision 6 or 7:
119.15(1) for all services except respite, determine the number of units of service to meet
119.16a recipient's needs;
119.17(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
119.18Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
119.19(3) for a recipient requiring customization for deaf or hard-of-hearing language
119.20accessibility under subdivision 12, add the customization rate provided in subdivision 12
119.21to the result of clause (2). This is defined as the customized direct care rate;
119.22(4) multiply the number of direct staff hours by the appropriate staff wage in
119.23subdivision 5 or the customized direct care rate;
119.24(5) multiply the number of direct staff hours by the product of the supervision span
119.25of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
119.26wage in subdivision 5, paragraph (a), clause (17);
119.27(6) combine the results of clauses (4) and (5) and multiply the result by one plus
119.28the employee vacation, sick, and training allowance ratio in, subdivision 5, paragraph (f),
119.29clause (2). This is defined as the direct staffing rate;
119.30(7) for program plan support, multiply the result of clause (6) by one plus the
119.31program plan support ratio in subdivision 5, paragraph (f), clause (4);
119.32(8) for employee-related expenses, multiply the result of clause (7) by one plus the
119.33employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
119.34(9) For client programming and supports, multiply the result of clause (8) by one
119.35plus the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
119.36(10) this is the subtotal rate;
120.1(11) sum the standard general and administrative rate, the program-related expense
120.2ratio, and the absence and utilization factor ratio;
120.3(12) divide the result of clause (10) by one minus the result of clause (11). This is
120.4the total payment amount;
120.5(13) for respite services, determine the number of daily units of service to meet an
120.6individual's needs;
120.7(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
120.8Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
120.9(15) for a recipient requiring deaf or hard-of-hearing customization under
120.10subdivision 12, add the customization rate provided in subdivision 12 to the result of
120.11clause (14). This is defined as the customized direct care rate;
120.12(16) multiply the number of direct staff hours by the appropriate staff wage in
120.13subdivision 5, paragraph (a);
120.14(17) multiply the number of direct staff hours by the product of the supervisory span
120.15of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
120.16wage in subdivision 5, paragraph (a), clause (17);
120.17(18) combine the results of clauses (16) and (17) and multiply the result by one plus
120.18the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
120.19clause (2). This is defined as the direct staffing rate;
120.20(19) for employee-related expenses, multiply the result of clause (18) by one plus
120.21the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
120.22(20) this is the subtotal rate;
120.23(21) sum the standard general and administrative rate, the program-related expense
120.24ratio, and the absence and utilization factor ratio; and
120.25(22) divide the result of clause (20) by one minus the result of clause (21). This is
120.26the total payment amount.
120.27    Subd. 10. Updating payment values and additional information. (a) The
120.28commissioner shall develop and implement uniform procedures to refine terms and update
120.29or adjust values used to calculate payment rates in this section. For calendar year 2014,
120.30the commissioner shall use the values, terms, and procedures provided in this section.
120.31(b) The commissioner shall work with stakeholders to assess efficacy of values
120.32and payment rates. The commissioner shall report back to the legislature with proposed
120.33changes for component values and recommendations for revisions on the schedule
120.34provided in paragraphs (c) and (d).
120.35(c) The commissioner shall work with stakeholders to continue refining a
120.36subset of component values, which are to be referred to as interim values, and report
121.1recommendations to the legislature by February 15, 2014. Interim component values are:
121.2transportation rates for day training and habilitation; transportation for adult day, structured
121.3day, and prevocational services; geographic difference factor; day program facility rate;
121.4services where monitoring technology replaces staff time; shared services for independent
121.5living skills training; and supported employment and billing for indirect services.
121.6(d) The commissioner shall report and make recommendations to the legislature on:
121.7February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
121.82021, reports shall be provided on a four-year cycle.
121.9(e) The commissioner shall provide a public notice via list serve in October of each
121.10year beginning October 1, 2014. The notice shall contain information detailing legislatively
121.11approved changes in: calculation values including derived wage rates and related employee
121.12and administrative factors; services utilization; county and tribal allocation changes
121.13and; information on adjustments to be made to calculation values and timing of those
121.14adjustments. Information in this notice shall be effective January 1 of the following year.
121.15    Subd. 11. Payment implementation. Upon implementation of the payment
121.16methodologies under this section, those payment rates supersede rates established in county
121.17contracts for recipients receiving waiver services under sections 256B.092 or 256B.49.
121.18    Subd. 12. Customization of rates for individuals. (a) For persons determined to
121.19have higher needs based on being deaf or hard-of-hearing, the direct care costs must be
121.20increased by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8,
121.21and 9. The customization rate with respect to deaf or hard-of-hearing persons shall be
121.22$2.50 per hour for waiver recipients who meet the respective criteria as determined by
121.23the commissioner.
121.24(b) For the purposes of this section, "Deaf or Hard of Hearing" means:
121.25(1)(i) the person has a developmental disability and an assessment score which
121.26indicates a hearing impairment that is severe or that the person has no useful hearing;
121.27(ii) the person has a developmental disability and an expressive communications
121.28score that indicates the person uses single signs or gestures, uses an augmentative
121.29communication aid, or does not have functional communication, or the person's expressive
121.30communications are unknown; and
121.31(iii) the person has a developmental disability and a communication score which
121.32indicates the person comprehends signs, gestures, and modeling prompts or does not
121.33comprehend verbal, visual, or gestural communication or that the person's receptive
121.34communications score is unknown; or
122.1(2)(i) the person receives long-term care services and has an assessment score which
122.2indicates they hear only very loud sounds, have no useful hearing, or a determination
122.3cannot be made; and
122.4(ii) the person receives long-term care services and has an assessment which
122.5indicates the person communicates needs with sign language, symbol board, written
122.6messages, gestures or an interpreter; communicates with inappropriate content; makes
122.7garbled sounds or displays echolalia; or does not communicate needs.
122.8    Subd. 13. Transportation. The commissioner shall require that the purchase
122.9of transportation services be cost-effective and be limited to market rates where the
122.10transportation mode is generally available and accessible.
122.11    Subd. 14. Exceptions. (a) In a format prescribed by the commissioner, lead
122.12agencies must identify individuals with exceptional needs that cannot be met under the
122.13disability waiver rate system. The commissioner shall use that information to evaluate
122.14and, if necessary, approve an alternative payment rate for those individuals.
122.15(b) Lead agencies must submit exception requests to the state.
122.16(c) An application for a rate exception may be submitted for the following criteria:
122.17(1) an individual has service needs that cannot be met through additional units
122.18of service; or
122.19(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
122.20individual being discharged.
122.21(d) Exception requests must include the following information:
122.22(1) the service needs required by each individual that are not accounted for in
122.23subdivisions 6, 7, 8, and 9;
122.24(2) the service rate requested and the difference from the rate determined in
122.25subdivisions 6, 7, 8, and 9;
122.26(3) a basis for the underlying costs used for the rate exception and any accompanying
122.27documentation;
122.28(4) the duration of the rate exception; and
122.29(5) any contingencies for approval.
122.30(e) Approved rate exceptions shall be managed within lead agency allocations under
122.31sections 256B.092 and 256B.49.
122.32(f) Individual disability waiver recipients may request that a lead agency submit an
122.33exception request. A lead agency that denies such a request shall notify the individual
122.34waiver recipient of its decision and the reasons for denying the request in writing no later
122.35than 30 days after the individual's request has been made.
123.1(g) The commissioner shall determine whether to approve or deny an exception
123.2request no more than 30 days after receiving the request. If the commissioner denies the
123.3request, the commissioner shall notify the lead agency and the individual disability waiver
123.4recipient in writing of the reasons for the denial.
123.5(h) The individual disability waiver recipient may appeal any denial of an exception
123.6request by either the lead agency or the commissioner, pursuant to sections 256.045 and
123.7256.0451. When the denial of an exception request results in the proposed demission of a
123.8waiver recipient from a residential or day habilitation program, the commissioner shall
123.9issue a temporary stay of demission, when requested by the disability waiver recipient,
123.10consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c).
123.11The temporary stay shall remain in effect until the lead agency can provide an informed
123.12choice of appropriate, alternative services to the disability waiver.
123.13(i) Providers may petition lead agencies to update values that were entered
123.14incorrectly or erroneously into the rate management system, based on past service level
123.15discussions and determination in subdivision 4, without applying for a rate exception.
123.16    Subd. 15. County or tribal allocations. (a) Upon implementation of the Disability
123.17Waiver Rates Management System on January 1, 2014, the commissioner shall establish
123.18a method of tracking and reporting the fiscal impact of the Disability Waiver Rates
123.19Management System on individual lead agencies.
123.20(b) Beginning January 1, 2014, and continuing through full implementation on
123.21December 31, 2017, the commissioner shall make annual adjustments to lead agencies'
123.22home and community-based waivered service budget allocations to adjust for rate
123.23differences and the resulting impact on county allocations upon implementation of the
123.24disability waiver rates system.
123.25    Subd. 16. Budget neutrality adjustment. The commissioner shall calculate the
123.26total spending for all home and community-based waiver services under the payments as
123.27defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
123.28spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
123.29for services in one particular subdivision differs, there will be a percentage adjustment
123.30to increase or decrease individual rates for the services defined in each subdivision so
123.31aggregate spending matches projections under current law.
123.32    Subd. 17. Implementation. (a) On January 1, 2014, the commissioner shall fully
123.33implement the calculation of rates for waivered services under sections 256B.092 and
123.34256B.49, without additional legislative approval.
123.35(b) The commissioner shall phase in the application of rates determined in
123.36subdivisions 6 to 9 for two years.
124.1(c) The commissioner shall preserve rates in effect on December 31, 2013, for
124.2the two-year period.
124.3(d) The commissioner shall calculate and measure the difference in cost per
124.4individual using the historical rate and the rates under subdivisions 6 to 9, for all
124.5individuals enrolled as of December 31, 2013. This measurement shall occur statewide,
124.6and for individuals in every county.
124.7The commissioner shall provide the results of this analysis, by county for calendar
124.8year 2014, to the legislative committees with jurisdiction over health and human services
124.9finance by February 15, 2015.
124.10(e) The commissioner shall calculate the average rate per unit for each service by
124.11county. For individuals enrolled after January 1, 2014, individuals will receive the higher
124.12of the rate produced under subdivisions 6 to 9, or the by-county average rate.
124.13(f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.

124.14    Sec. 7. REPEALER.
124.15Minnesota Statutes 2012, section 256B.4913, subdivisions 1, 2, 3, and 4, are repealed.


124.18    Section 1. Minnesota Statutes 2012, section 245.4661, subdivision 5, is amended to read:
124.19    Subd. 5. Planning for pilot projects. (a) Each local plan for a pilot project, with
124.20the exception of the placement of a Minnesota specialty treatment facility as defined in
124.21paragraph (c), must be developed under the direction of the county board, or multiple
124.22county boards acting jointly, as the local mental health authority. The planning process
124.23for each pilot shall include, but not be limited to, mental health consumers, families,
124.24advocates, local mental health advisory councils, local and state providers, representatives
124.25of state and local public employee bargaining units, and the department of human services.
124.26As part of the planning process, the county board or boards shall designate a managing
124.27entity responsible for receipt of funds and management of the pilot project.
124.28(b) For Minnesota specialty treatment facilities, the commissioner shall issue a
124.29request for proposal for regions in which a need has been identified for services.
124.30(c) For purposes of this section, Minnesota specialty treatment facility is defined as
124.31an intensive rehabilitative mental health service under section 256B.0622, subdivision 2,
124.32paragraph (b).

124.33    Sec. 2. Minnesota Statutes 2012, section 245.4661, subdivision 6, is amended to read:
125.1    Subd. 6. Duties of commissioner. (a) For purposes of the pilot projects, the
125.2commissioner shall facilitate integration of funds or other resources as needed and
125.3requested by each project. These resources may include:
125.4(1) residential services funds administered under Minnesota Rules, parts 9535.2000
125.5to 9535.3000, in an amount to be determined by mutual agreement between the project's
125.6managing entity and the commissioner of human services after an examination of the
125.7county's historical utilization of facilities located both within and outside of the county
125.8and licensed under Minnesota Rules, parts 9520.0500 to 9520.0690;
125.9(2) community support services funds administered under Minnesota Rules, parts
125.109535.1700 to 9535.1760;
125.11(3) other mental health special project funds;
125.12(4) medical assistance, general assistance medical care, MinnesotaCare and group
125.13residential housing if requested by the project's managing entity, and if the commissioner
125.14determines this would be consistent with the state's overall health care reform efforts; and
125.15(5) regional treatment center resources consistent with section 246.0136, subdivision
125.161 .; and
125.17(6) funds transferred from section 246.18, subdivision 8, for grants to providers to
125.18participate in mental health specialty treatment services, awarded to providers through
125.19a request for proposal process.
125.20(b) The commissioner shall consider the following criteria in awarding start-up and
125.21implementation grants for the pilot projects:
125.22(1) the ability of the proposed projects to accomplish the objectives described in
125.23subdivision 2;
125.24(2) the size of the target population to be served; and
125.25(3) geographical distribution.
125.26(c) The commissioner shall review overall status of the projects initiatives at least
125.27every two years and recommend any legislative changes needed by January 15 of each
125.28odd-numbered year.
125.29(d) The commissioner may waive administrative rule requirements which are
125.30incompatible with the implementation of the pilot project.
125.31(e) The commissioner may exempt the participating counties from fiscal sanctions
125.32for noncompliance with requirements in laws and rules which are incompatible with the
125.33implementation of the pilot project.
125.34(f) The commissioner may award grants to an entity designated by a county board or
125.35group of county boards to pay for start-up and implementation costs of the pilot project.

126.1    Sec. 3. Minnesota Statutes 2012, section 245.4682, subdivision 2, is amended to read:
126.2    Subd. 2. General provisions. (a) In the design and implementation of reforms to
126.3the mental health system, the commissioner shall:
126.4    (1) consult with consumers, families, counties, tribes, advocates, providers, and
126.5other stakeholders;
126.6    (2) bring to the legislature, and the State Advisory Council on Mental Health, by
126.7January 15, 2008, recommendations for legislation to update the role of counties and to
126.8clarify the case management roles, functions, and decision-making authority of health
126.9plans and counties, and to clarify county retention of the responsibility for the delivery of
126.10social services as required under subdivision 3, paragraph (a);
126.11    (3) withhold implementation of any recommended changes in case management
126.12roles, functions, and decision-making authority until after the release of the report due
126.13January 15, 2008;
126.14    (4) ensure continuity of care for persons affected by these reforms including
126.15ensuring client choice of provider by requiring broad provider networks and developing
126.16mechanisms to facilitate a smooth transition of service responsibilities;
126.17    (5) provide accountability for the efficient and effective use of public and private
126.18resources in achieving positive outcomes for consumers;
126.19    (6) ensure client access to applicable protections and appeals; and
126.20    (7) make budget transfers necessary to implement the reallocation of services and
126.21client responsibilities between counties and health care programs that do not increase the
126.22state and county costs and efficiently allocate state funds.
126.23    (b) When making transfers under paragraph (a) necessary to implement movement
126.24of responsibility for clients and services between counties and health care programs,
126.25the commissioner, in consultation with counties, shall ensure that any transfer of state
126.26grants to health care programs, including the value of case management transfer grants
126.27under section 256B.0625, subdivision 20, does not exceed the value of the services being
126.28transferred for the latest 12-month period for which data is available. The commissioner
126.29may make quarterly adjustments based on the availability of additional data during the
126.30first four quarters after the transfers first occur. If case management transfer grants under
126.31section 256B.0625, subdivision 20, are repealed and the value, based on the last year prior
126.32to repeal, exceeds the value of the services being transferred, the difference becomes an
126.33ongoing part of each county's adult and children's mental health grants under sections
126.34245.4661 , 245.4889, and 256E.12.
126.35    (c) This appropriation is not authorized to be expended after December 31, 2010,
126.36unless approved by the legislature.

127.1    Sec. 4. Minnesota Statutes 2012, section 246.18, subdivision 8, is amended to read:
127.2    Subd. 8. State-operated services account. (a) The state-operated services account is
127.3established in the special revenue fund. Revenue generated by new state-operated services
127.4listed under this section established after July 1, 2010, that are not enterprise activities must
127.5be deposited into the state-operated services account, unless otherwise specified in law:
127.6(1) intensive residential treatment services;
127.7(2) foster care services; and
127.8(3) psychiatric extensive recovery treatment services.
127.9(b) Funds deposited in the state-operated services account are available to the
127.10commissioner of human services for the purposes of:
127.11(1) providing services needed to transition individuals from institutional settings
127.12within state-operated services to the community when those services have no other
127.13adequate funding source;
127.14(2) grants to providers participating in mental health specialty treatment services
127.15under section 245.4661; and
127.16(3) to fund the operation of the Intensive Residential Treatment Service program in
127.17Willmar.

127.18    Sec. 5. Minnesota Statutes 2012, section 246.18, is amended by adding a subdivision
127.19to read:
127.20    Subd. 9. Transfers. The commissioner may transfer state mental health grant funds
127.21to the account in subdivision 8 for noncovered allowable costs of a provider certified and
127.22licensed under section 256B.0622, and operating under section 246.014.

127.23    Sec. 6. Minnesota Statutes 2012, section 254B.13, is amended to read:
127.24254B.13 PILOT PROJECTS; CHEMICAL HEALTH CARE.
127.25    Subdivision 1. Authorization for navigator pilot projects. The commissioner may
127.26approve and implement navigator pilot projects developed under the planning process
127.27required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and
127.28enhance coordination of the delivery of chemical health services required under section
127.29254B.03 .
127.30    Subd. 2. Program design and implementation. (a) The commissioner and
127.31counties participating in the navigator pilot projects shall continue to work in partnership
127.32to refine and implement the navigator pilot projects initiated under Laws 2009, chapter
127.3379, article 7, section 26.
128.1    (b) The commissioner and counties participating in the navigator pilot projects shall
128.2complete the planning phase by June 30, 2010, and, if approved by the commissioner for
128.3implementation, enter into agreements governing the operation of the navigator pilot
128.4projects with implementation scheduled no earlier than July 1, 2010.
128.5    Subd. 2a. Eligibility for navigator pilot program. (a) To be considered for
128.6participation in a navigator pilot program, an individual must:
128.7    (1) be a resident of a county with an approved navigator program;
128.8    (2) be eligible for consolidated chemical dependency treatment fund services;
128.9    (3) be a voluntary participant in the navigator program;
128.10    (4) satisfy one of the following items:
128.11    (i) have at least one severity rating of three or above in dimension four, five, or six in
128.12a comprehensive assessment under Minnesota Rules, part 9530.6422; or
128.13    (ii) have at least one severity rating of two or above in dimension four, five, or six in
128.14a comprehensive assessment under Minnesota Rules, part 9530.6422, and be currently
128.15participating in a Rule 31 treatment program under Minnesota Rules, parts 9530.6405 to
128.169530.6505, or be within 60 days following discharge after participation in a Rule 31
128.17treatment program; and
128.18    (5) have had at least two treatment episodes in the past two years, not limited
128.19to episodes reimbursed by the consolidated chemical dependency treatment funds. An
128.20admission to an emergency room, a detoxification program, or a hospital may be substituted
128.21for one treatment episode if it resulted from the individual's substance use disorder.
128.22    (b) New eligibility criteria may be added as mutually agreed upon by the
128.23commissioner and participating navigator programs.
128.24    Subd. 3. Program evaluation. The commissioner shall evaluate navigator pilot
128.25projects under this section and report the results of the evaluation to the chairs and
128.26ranking minority members of the legislative committees with jurisdiction over chemical
128.27health issues by January 15, 2014. Evaluation of the navigator pilot projects must be
128.28based on outcome evaluation criteria negotiated with the navigator pilot projects prior
128.29to implementation.
128.30    Subd. 4. Notice of navigator project discontinuation. Each county's participation
128.31in the navigator pilot project may be discontinued for any reason by the county or the
128.32commissioner of human services after 30 days' written notice to the other party. Any
128.33unspent funds held for the exiting county's pro rata share in the special revenue fund under
128.34the authority in subdivision 5, paragraph (d), shall be transferred to the consolidated
128.35chemical dependency treatment fund following discontinuation of the pilot project.
129.1    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in
129.2this chapter, the commissioner may authorize navigator pilot projects to use chemical
129.3dependency treatment funds to pay for nontreatment navigator pilot services:
129.4    (1) in addition to those authorized under section 254B.03, subdivision 2, paragraph
129.5(a); and
129.6    (2) by vendors in addition to those authorized under section 254B.05 when not
129.7providing chemical dependency treatment services.
129.8    (b) For purposes of this section, "nontreatment navigator pilot services" include
129.9navigator services, peer support, family engagement and support, housing support, rent
129.10subsidies, supported employment, and independent living skills.
129.11    (c) State expenditures for chemical dependency services and nontreatment navigator
129.12pilot services provided by or through the navigator pilot projects must not be greater than
129.13the chemical dependency treatment fund expected share of forecasted expenditures in the
129.14absence of the navigator pilot projects. The commissioner may restructure the schedule of
129.15payments between the state and participating counties under the local agency share and
129.16division of cost provisions under section 254B.03, subdivisions 3 and 4, as necessary to
129.17facilitate the operation of the navigator pilot projects.
129.18    (d) To the extent that state fiscal year expenditures within a pilot project are less
129.19than the expected share of forecasted expenditures in the absence of the pilot projects,
129.20the commissioner shall deposit the unexpended funds in a separate account within the
129.21consolidated chemical dependency treatment fund, and make these funds available for
129.22expenditure by the pilot projects the following year. To the extent that treatment and
129.23nontreatment pilot services expenditures within the pilot project exceed the amount
129.24expected in the absence of the pilot projects, the pilot project county or counties are
129.25responsible for the portion of nontreatment pilot services expenditures in excess of the
129.26otherwise expected share of forecasted expenditures.
129.27    (e) (d) The commissioner may waive administrative rule requirements that are
129.28incompatible with the implementation of the navigator pilot project, except that any
129.29chemical dependency treatment funded under this section must continue to be provided
129.30by a licensed treatment provider.
129.31    (f) (e) The commissioner shall not approve or enter into any agreement related to
129.32navigator pilot projects authorized under this section that puts current or future federal
129.33funding at risk.
129.34    (f) The commissioner shall provide participating navigator pilot projects with
129.35transactional data, reports, provider data, and other data generated by county activity to
129.36assess and measure outcomes. This information must be transmitted or made available in
130.1an acceptable form to participating navigator pilot projects at least once every six months
130.2or within a reasonable time following the commissioner's receipt of information from the
130.3counties needed to comply with this paragraph.
130.4    Subd. 6. Duties of county board. The county board, or other county entity that
130.5is approved to administer a navigator pilot project, shall:
130.6    (1) administer the navigator pilot project in a manner consistent with the objectives
130.7described in subdivision 2 and the planning process in subdivision 5;
130.8    (2) ensure that no one is denied chemical dependency treatment services for which
130.9they would otherwise be eligible under section 254A.03, subdivision 3; and
130.10    (3) provide the commissioner with timely and pertinent information as negotiated in
130.11agreements governing operation of the navigator pilot projects.
130.12    Subd. 7. Managed care. An individual who is eligible for the navigator pilot
130.13program under subdivision 2a is excluded from mandatory enrollment in managed care
130.14until these services are included in the health plan's benefit set.
130.15    Subd. 8. Authorization for continuation of navigator pilots. The navigator pilot
130.16projects implemented pursuant to subdivision 1 are authorized to continue operation after
130.17July 1, 2013, under existing agreements governing operation of the pilot projects.
130.18EFFECTIVE DATE.The amendments to subdivisions 1 to 6 and 8 are effective
130.19August 1, 2013. Subdivision 7 is effective July 1, 2013.

130.20    Sec. 7. [254B.14] CONTINUUM OF CARE PILOT PROJECTS; CHEMICAL
130.21HEALTH CARE.
130.22    Subdivision 1. Authorization for continuum of care pilot projects. The
130.23commissioner shall establish chemical dependency continuum of care pilot projects to
130.24begin implementing the measures developed with stakeholder input and identified in the
130.25report completed pursuant to Laws 2012, chapter 247, article 5, section 8. The pilot
130.26projects are intended to improve the effectiveness and efficiency of the service continuum
130.27for chemically dependent individuals in Minnesota while reducing duplication of efforts
130.28and promoting scientifically supported practices.
130.29    Subd. 2. Program implementation. (a) The commissioner, in coordination with
130.30representatives of the Minnesota Association of County Social Service Administrators
130.31and the Minnesota Inter-County Association, shall develop a process for identifying and
130.32selecting interested counties and providers for participation in the continuum of care pilot
130.33projects. There will be three pilot projects; one representing the northern region, one for
130.34the metro region, and one for the southern region. The selection process of counties and
130.35providers must include consideration of population size, geographic distribution, cultural
131.1and racial demographics, and provider accessibility. The commissioner shall identify
131.2counties and providers that are selected for participation in the continuum of care pilot
131.3projects no later than September 30, 2013.
131.4(b) The commissioner and entities participating in the continuum of care pilot
131.5projects shall enter into agreements governing the operation of the continuum of care pilot
131.6projects. The agreements shall identify pilot project outcomes and include timelines for
131.7implementation and beginning operation of the pilot projects.
131.8(c) Entities that are currently participating in the navigator pilot project are
131.9eligible to participate in the continuum of care pilot project subsequent to or instead of
131.10participating in the navigator pilot project.
131.11(d) The commissioner may waive administrative rule requirements that are
131.12incompatible with implementation of the continuum of care pilot projects.
131.13(e) Notwithstanding section 254A.19, the commissioner may designate noncounty
131.14entities to complete chemical use assessments and placement authorizations required
131.15under section 254A.19 and Minnesota Rules, parts 9530.6600 to 9530.6655. Section
131.16254A.19, subdivision 3, is applicable to the continuum of care pilot projects at the
131.17discretion of the commissioner.
131.18    Subd. 3. Program design. (a) The operation of the pilot projects shall include:
131.19(1) new services that are responsive to the chronic nature of substance use disorder;
131.20(2) telehealth services, when appropriate to address barriers to services;
131.21(3) services that assure integration with the mental health delivery system when
131.22appropriate;
131.23(4) services that address the needs of diverse populations; and
131.24(5) an assessment and access process that permits clients to present directly to a
131.25service provider for a substance use disorder assessment and authorization of services.
131.26(b) Prior to implementation of the continuum of care pilot projects, a utilization
131.27review process must be developed and agreed to by the commissioner, participating
131.28counties, and providers. The utilization review process shall be described in the
131.29agreements governing operation of the continuum of care pilot projects.
131.30    Subd. 4. Notice of project discontinuation. Each entity's participation in the
131.31continuum of care pilot project may be discontinued for any reason by the county or the
131.32commissioner after 30 days' written notice to the entity.
131.33    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in this
131.34chapter, the commissioner may authorize chemical dependency treatment funds to pay for
131.35nontreatment services arranged by continuum of care pilot projects. Individuals who are
132.1currently accessing Rule 31 treatment services are eligible for concurrent participation in
132.2the continuum of care pilot projects.
132.3(b) County expenditures for continuum of care pilot project services shall not
132.4be greater than their expected share of forecasted expenditures in the absence of the
132.5continuum of care pilot projects.
132.6EFFECTIVE DATE.This section is effective August 1, 2013.

132.7    Sec. 8. [256.478] HOME AND COMMUNITY-BASED SERVICES
132.8TRANSITIONS GRANTS.
132.9(a) The commissioner shall make available home and community-based services
132.10transition grants to serve individuals who do not meet eligibility criteria for the medical
132.11assistance program under section 256B.056 or 256B.057, but who otherwise meet the
132.12criteria under section 256B.092, subdivision 13, or 256B.49, subdivision 24.
132.13(b) For the purposes of this section, the commissioner has the authority to transfer
132.14funds between the medical assistance account and the home and community-based
132.15services transitions grants account.
132.16EFFECTIVE DATE.This section is effective July 1, 2015.

132.17    Sec. 9. Minnesota Statutes 2012, section 256B.0623, subdivision 2, is amended to read:
132.18    Subd. 2. Definitions. For purposes of this section, the following terms have the
132.19meanings given them.
132.20(a) "Adult rehabilitative mental health services" means mental health services
132.21which are rehabilitative and enable the recipient to develop and enhance psychiatric
132.22stability, social competencies, personal and emotional adjustment, and independent living,
132.23parenting skills, and community skills, when these abilities are impaired by the symptoms
132.24of mental illness. Adult rehabilitative mental health services are also appropriate when
132.25provided to enable a recipient to retain stability and functioning, if the recipient would
132.26be at risk of significant functional decompensation or more restrictive service settings
132.27without these services.
132.28(1) Adult rehabilitative mental health services instruct, assist, and support the
132.29recipient in areas such as: interpersonal communication skills, community resource
132.30utilization and integration skills, crisis assistance, relapse prevention skills, health care
132.31directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking
132.32and nutrition skills, transportation skills, medication education and monitoring, mental
133.1illness symptom management skills, household management skills, employment-related
133.2skills, parenting skills, and transition to community living services.
133.3(2) These services shall be provided to the recipient on a one-to-one basis in the
133.4recipient's home or another community setting or in groups.
133.5(b) "Medication education services" means services provided individually or in
133.6groups which focus on educating the recipient about mental illness and symptoms; the role
133.7and effects of medications in treating symptoms of mental illness; and the side effects of
133.8medications. Medication education is coordinated with medication management services
133.9and does not duplicate it. Medication education services are provided by physicians,
133.10pharmacists, physician's assistants, or registered nurses.
133.11(c) "Transition to community living services" means services which maintain
133.12continuity of contact between the rehabilitation services provider and the recipient and
133.13which facilitate discharge from a hospital, residential treatment program under Minnesota
133.14Rules, chapter 9505, board and lodging facility, or nursing home. Transition to community
133.15living services are not intended to provide other areas of adult rehabilitative mental health
133.16services.

133.17    Sec. 10. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
133.18subdivision to read:
133.19    Subd. 35c. School-linked mental health services. Medical assistance covers mental
133.20health services provided in a school as part of a school-linked mental health program by
133.21an individual who is licensed by the Board of Behavioral Health and Therapy, Board of
133.22Marriage and Family Therapy, Board of Psychology, or Board of Social Work, and who also
133.23meets the definition of a mental health practitioner under section 245.462, subdivision 17,
133.24or 245.4871, subdivision 26. For purposes of this subdivision, an individual who meets the
133.25definition of mental health practitioner under section 245.462, subdivision 17, or 245.4871,
133.26subdivision 26, is not limited to having less than 4,000 hours of post-master's experience.
133.27The mental health practitioner must be supervised by a licensed mental health professional.

133.28    Sec. 11. Minnesota Statutes 2012, section 256B.0625, subdivision 48, is amended to
133.29read:
133.30    Subd. 48. Psychiatric consultation to primary care practitioners. Effective
133.31January 1, 2006, Medical assistance covers consultation provided by a psychiatrist or
133.32psychologist via telephone, e-mail, facsimile, or other means of communication to primary
133.33care practitioners, including pediatricians. The need for consultation and the receipt of the
133.34consultation must be documented in the patient record maintained by the primary care
134.1practitioner. If the patient consents, and subject to federal limitations and data privacy
134.2provisions, the consultation may be provided without the patient present.

134.3    Sec. 12. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
134.4subdivision to read:
134.5    Subd. 61. Family psychoeducation services. Effective July 1, 2013, or upon
134.6federal approval, whichever is later, medical assistance covers family psychoeducation
134.7services provided to a child up to age 21 with a diagnosed mental health condition when
134.8identified in the child's individual treatment plan and provided by a licensed mental health
134.9professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a
134.10clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who
134.11has determined it medically necessary to involve family members in the child's care. For
134.12the purposes of this subdivision, "family psychoeducation services" means information
134.13or demonstration provided to an individual or family as part of an individual, family,
134.14multifamily group, or peer group session to explain, educate, and support the child and
134.15family in understanding a child's symptoms of mental illness, the impact on the child's
134.16development, and needed components of treatment and skill development so that the
134.17individual, family, or group can help the child to prevent relapse, prevent the acquisition
134.18of comorbid disorders, and to achieve optimal mental health and long-term resilience.

134.19    Sec. 13. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
134.20subdivision to read:
134.21    Subd. 62. Mental health clinical care consultation. Effective July 1, 2013, or upon
134.22federal approval, whichever is later, medical assistance covers clinical care consultation
134.23for a person up to age 21 who is diagnosed with a complex mental health condition or a
134.24mental health condition that co-occurs with other complex and chronic conditions, when
134.25described in the person's individual treatment plan and provided by a licensed mental
134.26health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A. For
134.27the purposes of this subdivision, "clinical care consultation" means communication from a
134.28treating mental health professional to other providers not under the clinical supervision of
134.29the treating mental health professional who are working with the same client to inform,
134.30inquire, and instruct regarding the client's symptoms; strategies for effective engagement,
134.31care, and intervention needs; and treatment expectations across service settings; and to
134.32direct and coordinate clinical service components provided to the client and family.

135.1    Sec. 14. Minnesota Statutes 2012, section 256B.092, is amended by adding a
135.2subdivision to read:
135.3    Subd. 13. Waiver allocations for transition populations. (a) The commissioner
135.4shall make available additional waiver allocations and additional necessary resources
135.5to assure timely discharges from the Anoka Metro Regional Treatment Center and the
135.6Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
135.7(1) are otherwise eligible for the developmental disabilities waiver under this section;
135.8(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
135.9the Minnesota Security Hospital;
135.10(3) whose discharge would be significantly delayed without the available waiver
135.11allocation; and
135.12(4) who have met treatment objectives and no longer meet hospital level of care.
135.13(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
135.14requirements of the federal approved waiver plan.
135.15(c) Any corporate foster care home developed under this subdivision must be
135.16considered an exception under section 245A.03, subdivision 7, paragraph (a).
135.17EFFECTIVE DATE.This section is effective July 1, 2015.

135.18    Sec. 15. Minnesota Statutes 2012, section 256B.0946, is amended to read:
135.19256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.
135.20    Subdivision 1. Required covered service components. (a) Effective July 1, 2006,
135.21 upon enactment and subject to federal approval, medical assistance covers medically
135.22necessary intensive treatment services described under paragraph (b) that are provided
135.23by a provider entity eligible under subdivision 3 to a client eligible under subdivision 2
135.24who is placed in a treatment foster home licensed under Minnesota Rules, parts 2960.3000
135.25to 2960.3340.
135.26(b) Intensive treatment services to children with severe emotional disturbance mental
135.27illness residing in treatment foster care family settings must meet the relevant standards
135.28for mental health services under sections 245.487 to 245.4889. In addition, that comprise
135.29 specific required service components provided in clauses (1) to (5), are reimbursed by
135.30medical assistance must when they meet the following standards:
135.31(1) case management service component must meet the standards in Minnesota
135.32Rules, parts 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10;
136.1(1) psychotherapy provided by a mental health professional as defined in Minnesota
136.2Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota
136.3Rules, part 9505.0371, subpart 5, item C;
136.4(2) psychotherapy, crisis assistance, and skills training components must meet the
136.5 provided according to standards for children's therapeutic services and supports in section
136.6256B.0943 ; and
136.7(3) individual family, and group psychoeducation services under supervision of,
136.8defined in subdivision 1a, paragraph (q), provided by a mental health professional. or a
136.9clinical trainee;
136.10(4) clinical care consultation, as defined in subdivision 1a, and provided by a mental
136.11health professional or a clinical trainee; and
136.12(5) service delivery payment requirements as provided under subdivision 4.
136.13    Subd. 1a. Definitions. For the purposes of this section, the following terms have
136.14the meanings given them.
136.15(a) "Clinical care consultation" means communication from a treating clinician to
136.16other providers working with the same client to inform, inquire, and instruct regarding
136.17the client's symptoms, strategies for effective engagement, care and intervention needs,
136.18and treatment expectations across service settings, including but not limited to the client's
136.19school, social services, day care, probation, home, primary care, medication prescribers,
136.20disabilities services, and other mental health providers and to direct and coordinate clinical
136.21service components provided to the client and family.
136.22(b) "Clinical supervision" means the documented time a clinical supervisor and
136.23supervisee spend together to discuss the supervisee's work, to review individual client
136.24cases, and for the supervisee's professional development. It includes the documented
136.25oversight and supervision responsibility for planning, implementation, and evaluation of
136.26services for a client's mental health treatment.
136.27(c) "Clinical supervisor" means the mental health professional who is responsible
136.28for clinical supervision.
136.29(d) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371,
136.30subpart 5, item C;
136.31(e) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a,
136.32including the development of a plan that addresses prevention and intervention strategies
136.33to be used in a potential crisis, but does not include actual crisis intervention.
136.34(f) "Culturally appropriate" means providing mental health services in a manner that
136.35incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370,
137.1subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural
137.2strengths and resources to promote overall wellness.
137.3(g) "Culture" means the distinct ways of living and understanding the world that
137.4are used by a group of people and are transmitted from one generation to another or
137.5adopted by an individual.
137.6(h) "Diagnostic assessment" has the meaning given in Minnesota Rules, part
137.79505.0370, subpart 11.
137.8(i) "Family" means a person who is identified by the client or the client's parent or
137.9guardian as being important to the client's mental health treatment. Family may include,
137.10but is not limited to, parents, foster parents, children, spouse, committed partners, former
137.11spouses, persons related by blood or adoption, persons who are a part of the client's
137.12permanency plan, or persons who are presently residing together as a family unit.
137.13(j) "Foster care" has the meaning given in section 260C.007, subdivision 18.
137.14(k) "Foster family setting" means the foster home in which the license holder resides.
137.15(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part
137.169505.0370, subpart 15.
137.17(m) "Mental health practitioner" has the meaning given in Minnesota Rules, part
137.189505.0370, subpart 17.
137.19(n) "Mental health professional" has the meaning given in Minnesota Rules, part
137.209505.0370, subpart 18.
137.21(o) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370,
137.22subpart 20.
137.23(p) "Parent" has the meaning given in section 260C.007, subdivision 25.
137.24(q) "Psychoeducation services" means information or demonstration provided to
137.25an individual, family, or group to explain, educate, and support the individual, family, or
137.26group in understanding a child's symptoms of mental illness, the impact on the child's
137.27development, and needed components of treatment and skill development so that the
137.28individual, family, or group can help the child to prevent relapse, prevent the acquisition
137.29of comorbid disorders, and to achieve optimal mental health and long-term resilience.
137.30(r) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370,
137.31subpart 27.
137.32(s) "Team consultation and treatment planning" means the coordination of treatment
137.33plans and consultation among providers in a group concerning the treatment needs of the
137.34child, including disseminating the child's treatment service schedule to all members of the
137.35service team. Team members must include all mental health professionals working with
137.36the child, a parent, the child unless the team lead or parent deem it clinically inappropriate,
138.1and at least two of the following: an individualized education program case manager;
138.2probation agent; children's mental health case manager; child welfare worker, including
138.3adoption or guardianship worker; primary care provider; foster parent; and any other
138.4member of the child's service team.
138.5    Subd. 2. Determination of client eligibility. A client's eligibility to receive
138.6treatment foster care under this section shall be determined by An eligible recipient is an
138.7individual, from birth through age 20, who is currently placed in a foster home licensed
138.8under Minnesota Rules, parts 2960.3000 to 2960.3340, and has received a diagnostic
138.9assessment, and an evaluation of level of care needed, and development of an individual
138.10treatment plan, as defined in paragraphs (a) to (c) and (b).
138.11(a) The diagnostic assessment must:
138.12(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
138.13conducted by a psychiatrist, licensed psychologist, or licensed independent clinical social
138.14worker that is mental health professional or a clinical trainee;
138.15(2) determine whether or not a child meets the criteria for mental illness, as defined
138.16in Minnesota Rules, part 9505.0370, subpart 20;
138.17(3) document that intensive treatment services are medically necessary within a
138.18foster family setting to ameliorate identified symptoms and functional impairments;
138.19(4) be performed within 180 days prior to before the start of service; and
138.20(2) include current diagnoses on all five axes of the client's current mental health
138.21status;
138.22(3) determine whether or not a child meets the criteria for severe emotional
138.23disturbance in section 245.4871, subdivision 6, or for serious and persistent mental illness
138.24in section 245.462, subdivision 20; and
138.25(4) be completed annually until age 18. For individuals between age 18 and 21,
138.26unless a client's mental health condition has changed markedly since the client's most
138.27recent diagnostic assessment, annual updating is necessary. For the purpose of this section,
138.28"updating" means a written summary, including current diagnoses on all five axes, by a
138.29mental health professional of the client's current mental status and service needs.
138.30(5) be completed as either a standard or extended diagnostic assessment annually to
138.31determine continued eligibility for the service.
138.32(b) The evaluation of level of care must be conducted by the placing county with
138.33an instrument, tribe, or case manager in conjunction with the diagnostic assessment as
138.34described by Minnesota Rules, part 9505.0372, subpart 1, item B, using a validated tool
138.35 approved by the commissioner of human services and not subject to the rulemaking
138.36process, consistent with section 245.4885, subdivision 1, paragraph (d), the result of which
139.1evaluation demonstrates that the child requires intensive intervention without 24-hour
139.2medical monitoring. The commissioner shall update the list of approved level of care
139.3instruments tools annually and publish on the department's Web site.
139.4(c) The individual treatment plan must be:
139.5(1) based on the information in the client's diagnostic assessment;
139.6(2) developed through a child-centered, family driven planning process that identifies
139.7service needs and individualized, planned, and culturally appropriate interventions that
139.8contain specific measurable treatment goals and objectives for the client and treatment
139.9strategies for the client's family and foster family;
139.10(3) reviewed at least once every 90 days and revised; and
139.11(4) signed by the client or, if appropriate, by the client's parent or other person
139.12authorized by statute to consent to mental health services for the client.
139.13    Subd. 3. Eligible mental health services providers. (a) Eligible providers for
139.14intensive children's mental health services in a foster family setting must be certified
139.15by the state and have a service provision contract with a county board or a reservation
139.16tribal council and must be able to demonstrate the ability to provide all of the services
139.17required in this section.
139.18(b) For purposes of this section, a provider agency must have an individual
139.19placement agreement for each recipient and must be a licensed child placing agency, under
139.20Minnesota Rules, parts 9543.0010 to 9543.0150, and either be:
139.21(1) a county county-operated entity certified by the state;
139.22(2) an Indian Health Services facility operated by a tribe or tribal organization under
139.23funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
139.24Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
139.25(3) a noncounty entity under contract with a county board.
139.26(c) Certified providers that do not meet the service delivery standards required in
139.27this section shall be subject to a decertification process.
139.28(d) For the purposes of this section, all services delivered to a client must be
139.29provided by a mental health professional or a clinical trainee.
139.30    Subd. 4. Eligible provider responsibilities Service delivery payment
139.31requirements. (a) To be an eligible provider for payment under this section, a provider
139.32must develop and practice written policies and procedures for treatment foster care services
139.33 intensive treatment in foster care, consistent with subdivision 1, paragraph (b), clauses (1),
139.34(2), and (3) and comply with the following requirements in paragraphs (b) to (n).
139.35(b) In delivering services under this section, a treatment foster care provider must
139.36ensure that staff caseload size reasonably enables the provider to play an active role in
140.1service planning, monitoring, delivering, and reviewing for discharge planning to meet
140.2the needs of the client, the client's foster family, and the birth family, as specified in each
140.3client's individual treatment plan.
140.4(b) A qualified clinical supervisor, as defined in and performing in compliance with
140.5Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
140.6provision of services described in this section.
140.7(c) Each client receiving treatment services must receive an extended diagnostic
140.8assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within
140.930 days of enrollment in this service unless the client has a previous extended diagnostic
140.10assessment that the client, parent, and mental health professional agree still accurately
140.11describes the client's current mental health functioning.
140.12(d) Each previous and current mental health, school, and physical health treatment
140.13provider must be contacted to request documentation of treatment and assessments that the
140.14eligible client has received and this information must be reviewed and incorporated into
140.15the diagnostic assessment and team consultation and treatment planning review process.
140.16(e) Each client receiving treatment must be assessed for a trauma history and
140.17the client's treatment plan must document how the results of the assessment will be
140.18incorporated into treatment.
140.19(f) Each client receiving treatment services must have an individual treatment plan
140.20that is reviewed, evaluated, and signed every 90 days using the team consultation and
140.21treatment planning process, as defined in subdivision 1a, paragraph (s).
140.22(g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided
140.23in accordance with the client's individual treatment plan.
140.24(h) Each client must have a crisis assistance plan within ten days of initiating
140.25services and must have access to clinical phone support 24 hours per day, seven days per
140.26week, during the course of treatment, and the crisis plan must demonstrate coordination
140.27with the local or regional mobile crisis intervention team.
140.28(i) Services must be delivered and documented at least three days per week, equaling
140.29at least six hours of treatment per week, unless reduced units of service are specified on
140.30the treatment plan as part of transition or on a discharge plan to another service or level of
140.31care. Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
140.32(j) Location of service delivery must be in the client's home, day care setting,
140.33school, or other community-based setting that is specified on the client's individualized
140.34treatment plan.
140.35(k) Treatment must be developmentally and culturally appropriate for the client.
141.1(l) Services must be delivered in continual collaboration and consultation with the
141.2client's medical providers and, in particular, with prescribers of psychotropic medications,
141.3including those prescribed on an off-label basis, and members of the service team must be
141.4aware of the medication regimen and potential side effects.
141.5(m) Parents, siblings, foster parents, and members of the child's permanency plan
141.6must be involved in treatment and service delivery unless otherwise noted in the treatment
141.7plan.
141.8(n) Transition planning for the child must be conducted starting with the first
141.9treatment plan and must be addressed throughout treatment to support the child's
141.10permanency plan and postdischarge mental health service needs.
141.11    Subd. 5. Service authorization. The commissioner will administer authorizations
141.12for services under this section in compliance with section 256B.0625, subdivision 25.
141.13    Subd. 6. Excluded services. (a) Services in clauses (1) to (4) (7) are not covered
141.14under this section and are not eligible for medical assistance payment as components of
141.15intensive treatment in foster care services, but may be billed separately:
141.16(1) treatment foster care services provided in violation of medical assistance policy
141.17in Minnesota Rules, part 9505.0220;
141.18(2) service components of children's therapeutic services and supports
141.19simultaneously provided by more than one treatment foster care provider;
141.20(3) home and community-based waiver services; and
141.21(4) treatment foster care services provided to a child without a level of care
141.22determination according to section 245.4885, subdivision 1.
141.23(1) inpatient psychiatric hospital treatment;
141.24(2) mental health targeted case management;
141.25(3) partial hospitalization;
141.26(4) medication management;
141.27(5) children's mental health day treatment services;
141.28(6) crisis response services under section 256B.0944; and
141.29(7) transportation.
141.30(b) Children receiving intensive treatment in foster care services are not eligible for
141.31medical assistance reimbursement for the following services while receiving intensive
141.32treatment in foster care:
141.33(1) mental health case management services under section 256B.0625, subdivision
141.3420 ; and
141.35(2) (1) psychotherapy and skill skills training components of children's therapeutic
141.36services and supports under section 256B.0625, subdivision 35b.;
142.1(2) mental health behavioral aide services as defined in section 256B.0943,
142.2subdivision 1, paragraph (m);
142.3(3) home and community-based waiver services;
142.4(4) mental health residential treatment; and
142.5(5) room and board costs as defined in section 256I.03, subdivision 6.
142.6    Subd. 7. Medical assistance payment and rate setting. The commissioner shall
142.7establish a single daily per-client encounter rate for intensive treatment in foster care
142.8services. The rate must be constructed to cover only eligible services delivered to an
142.9eligible recipient by an eligible provider, as prescribed in subdivision 1, paragraph (b).

142.10    Sec. 16. Minnesota Statutes 2012, section 256B.49, is amended by adding a
142.11subdivision to read:
142.12    Subd. 24. Waiver allocations for transition populations. (a) The commissioner
142.13shall make available additional waiver allocations and additional necessary resources
142.14to assure timely discharges from the Anoka Metro Regional Treatment Center and the
142.15Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
142.16(1) are otherwise eligible for the brain injury, community alternatives for disabled
142.17individuals, or community alternative care waivers under this section;
142.18(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
142.19the Minnesota Security Hospital;
142.20(3) whose discharge would be significantly delayed without the available waiver
142.21allocation; and
142.22(4) who have met treatment objectives and no longer meet hospital level of care.
142.23(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
142.24requirements of the federal approved waiver plan.
142.25(c) Any corporate foster care home developed under this subdivision must be
142.26considered an exception under section 245A.03, subdivision 7, paragraph (a).
142.27EFFECTIVE DATE.This section is effective July 1, 2015.

142.28    Sec. 17. Minnesota Statutes 2012, section 256B.761, is amended to read:
142.29256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
142.30(a) Effective for services rendered on or after July 1, 2001, payment for medication
142.31management provided to psychiatric patients, outpatient mental health services, day
142.32treatment services, home-based mental health services, and family community support
143.1services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
143.250th percentile of 1999 charges.
143.3(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
143.4services provided by an entity that operates: (1) a Medicare-certified comprehensive
143.5outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
143.61993, with at least 33 percent of the clients receiving rehabilitation services in the most
143.7recent calendar year who are medical assistance recipients, will be increased by 38 percent,
143.8when those services are provided within the comprehensive outpatient rehabilitation
143.9facility and provided to residents of nursing facilities owned by the entity.
143.10(c) The commissioner shall establish three levels of payment for mental health
143.11diagnostic assessment, based on three levels of complexity. The aggregate payment under
143.12the tiered rates must not exceed the projected aggregate payments for mental health
143.13diagnostic assessment under the previous single rate. The new rate structure is effective
143.14January 1, 2011, or upon federal approval, whichever is later.
143.15(d) In addition to rate increases otherwise provided, the commissioner may
143.16restructure coverage policy and rates to improve access to adult rehabilitative mental
143.17health services under section 256B.0623 and related mental health support services under
143.18section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and
143.192016, the projected state share of increased costs due to this paragraph is transferred
143.20from adult mental health grants under sections 245.4661 and 256E.12. The transfer for
143.21fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments
143.22made to managed care plans and county-based purchasing plans under sections 256B.69,
143.23256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.

143.24    Sec. 18. STATE ASSISTANCE TO COUNTIES; TRANSITIONS FOR HIGH
143.25NEEDS POPULATIONS.
143.26(a) Effective immediately, the commissioner of human services shall work with
143.27counties that request assistance to assure timely discharge from Anoka Metro Regional
143.28Treatment Center and the Minnesota Security Hospital for individuals who are ready
143.29for discharge but for whom the county may not have provider resources or appropriate
143.30placement available. Special consideration must be given to uninsured individuals who are
143.31not eligible for medical assistance and who may need continued treatment, and individuals
143.32with complex needs and other factors that hinder county efforts to place the individual in a
143.33safe, affordable setting.
143.34(b) The commissioner shall assure that, given Olmstead court directives and the
143.35role family and friends play in treatment progress, metropolitan area residents are asked
144.1whether they wished to be placed in an Intensive Residential Treatment Service program
144.2at Willmar or Cambridge or to be placed in a location more accessible to family, friends,
144.3and health providers.

144.4    Sec. 19. INSTRUCTIONS TO THE COMMISSIONER.
144.5In consultation with labor organizations, the commissioner of human services shall
144.6develop clear and consistent standards for state-operated services programs to:
144.7(1) address direct service staffing shortages;
144.8(2) identify and help resolve workplace safety issues; and
144.9(3) elevate the use and visibility of performance measures and objectives related to
144.10overtime use.


144.13    Section 1. Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:
144.14    Subd. 7. Use of data. (a) Except as otherwise provided in subdivision 7a or sections
144.15244.052 and 299C.093, the data provided under this section is private data on individuals
144.16under section 13.02, subdivision 12.
144.17(b) The data may be used only for by law enforcement and corrections agencies for
144.18 law enforcement and corrections purposes.
144.19(c) The commissioner of human services is authorized to have access to the data for:
144.20(1) state-operated services, as defined in section 246.014, are also authorized to
144.21have access to the data for the purposes described in section 246.13, subdivision 2,
144.22paragraph (b); and
144.23(2) purposes of completing background studies under chapter 245C.

144.24    Sec. 2. Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision
144.25to read:
144.26    Subd. 4a. Agency background studies. (a) The commissioner shall develop
144.27and implement an electronic process for the regular transfer of new criminal history
144.28information that is added to the Minnesota court information system. The commissioner's
144.29system must include for review only information that relates to individuals who have been
144.30the subject of a background study under this chapter that remain affiliated with the agency
144.31that initiated the background study. For purposes of this paragraph, an individual remains
144.32affiliated with an agency that initiated the background study until the agency informs the
144.33commissioner that the individual is no longer affiliated. When any individual no longer
145.1affiliated according to this paragraph returns to a position requiring a background study
145.2under this chapter, the agency with whom the individual is again affiliated shall initiate
145.3a new background study regardless of the length of time the individual was no longer
145.4affiliated with the agency.
145.5(b) The commissioner shall develop and implement an online system for agencies that
145.6initiate background studies under this chapter to access and maintain records of background
145.7studies initiated by that agency. The system must show all active background study subjects
145.8affiliated with that agency and the status of each individual's background study. Each
145.9agency that initiates background studies must use this system to notify the commissioner
145.10of discontinued affiliation for purposes of the processes required under paragraph (a).

145.11    Sec. 3. Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:
145.12    Subdivision 1. Background studies conducted by Department of Human
145.13Services. (a) For a background study conducted by the Department of Human Services,
145.14the commissioner shall review:
145.15    (1) information related to names of substantiated perpetrators of maltreatment of
145.16vulnerable adults that has been received by the commissioner as required under section
145.17626.557, subdivision 9c , paragraph (j);
145.18    (2) the commissioner's records relating to the maltreatment of minors in licensed
145.19programs, and from findings of maltreatment of minors as indicated through the social
145.20service information system;
145.21    (3) information from juvenile courts as required in subdivision 4 for individuals
145.22listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
145.23    (4) information from the Bureau of Criminal Apprehension, including information
145.24regarding a background study subject's registration in Minnesota as a predatory offender
145.25under section 243.166;
145.26    (5) except as provided in clause (6), information from the national crime information
145.27system when the commissioner has reasonable cause as defined under section 245C.05,
145.28subdivision 5; and
145.29    (6) for a background study related to a child foster care application for licensure or
145.30adoptions, the commissioner shall also review:
145.31    (i) information from the child abuse and neglect registry for any state in which the
145.32background study subject has resided for the past five years; and
145.33    (ii) information from national crime information databases, when the background
145.34study subject is 18 years of age or older.
146.1    (b) Notwithstanding expungement by a court, the commissioner may consider
146.2information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
146.3received notice of the petition for expungement and the court order for expungement is
146.4directed specifically to the commissioner.
146.5    (c) The commissioner shall also review criminal history information received
146.6according to section 245C.04, subdivision 4a, from the Minnesota court information
146.7system that relates to individuals who have already been studied under this chapter and
146.8who remain affiliated with the agency that initiated the background study.

146.9    Sec. 4. Minnesota Statutes 2012, section 256B.04, subdivision 21, is amended to read:
146.10    Subd. 21. Provider enrollment. (a) If the commissioner or the Centers for
146.11Medicare and Medicaid Services determines that a provider is designated "high-risk," the
146.12commissioner may withhold payment from providers within that category upon initial
146.13enrollment for a 90-day period. The withholding for each provider must begin on the date
146.14of the first submission of a claim.
146.15(b) An enrolled provider that is also licensed by the commissioner under chapter
146.16245A must designate an individual as the entity's compliance officer. The compliance
146.17officer must:
146.18(1) develop policies and procedures to assure adherence to medical assistance laws
146.19and regulations and to prevent inappropriate claims submissions;
146.20(2) train the employees of the provider entity, and any agents or subcontractors of
146.21the provider entity including billers, on the policies and procedures under clause (1);
146.22(3) respond to allegations of improper conduct related to the provision or billing of
146.23medical assistance services, and implement action to remediate any resulting problems;
146.24(4) use evaluation techniques to monitor compliance with medical assistance laws
146.25and regulations;
146.26(5) promptly report to the commissioner any identified violations of medical
146.27assistance laws or regulations; and
146.28    (6) within 60 days of discovery by the provider of a medical assistance
146.29reimbursement overpayment, report the overpayment to the commissioner and make
146.30arrangements with the commissioner for the commissioner's recovery of the overpayment.
146.31The commissioner may require, as a condition of enrollment in medical assistance, that a
146.32provider within a particular industry sector or category establish a compliance program that
146.33contains the core elements established by the Centers for Medicare and Medicaid Services.
146.34(c) The commissioner may revoke the enrollment of an ordering or rendering
146.35provider for a period of not more than one year, if the provider fails to maintain and, upon
147.1request from the commissioner, provide access to documentation relating to written orders
147.2or requests for payment for durable medical equipment, certifications for home health
147.3services, or referrals for other items or services written or ordered by such provider, when
147.4the commissioner has identified a pattern of a lack of documentation. A pattern means a
147.5failure to maintain documentation or provide access to documentation on more than one
147.6occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
147.7provider under the provisions of section 256B.064.
147.8(d) The commissioner shall terminate or deny the enrollment of any individual or
147.9entity if the individual or entity has been terminated from participation in Medicare or
147.10under the Medicaid program or Children's Health Insurance Program of any other state.
147.11(e) As a condition of enrollment in medical assistance, the commissioner shall
147.12require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
147.13and Medicaid Services or the Minnesota Department of Human Services commissioner
147.14 permit the Centers for Medicare and Medicaid Services, its agents, or its designated
147.15contractors and the state agency, its agents, or its designated contractors to conduct
147.16unannounced on-site inspections of any provider location. The commissioner shall publish
147.17in the Minnesota Health Care Program Provider Manual a list of provider types designated
147.18"limited," "moderate," or "high-risk," based on the criteria and standards used to designate
147.19Medicare providers in Code of Federal Regulations, title 42, section 424.518. The list and
147.20criteria are not subject to the requirements of chapter 14. The commissioner's designations
147.21are not subject to administrative appeal.
147.22(f) As a condition of enrollment in medical assistance, the commissioner shall
147.23require that a high-risk provider, or a person with a direct or indirect ownership interest in
147.24the provider of five percent or higher, consent to criminal background checks, including
147.25fingerprinting, when required to do so under state law or by a determination by the
147.26commissioner or the Centers for Medicare and Medicaid Services that a provider is
147.27designated high-risk for fraud, waste, or abuse.
147.28(g) As a condition of enrollment, all durable medical equipment, prosthetics,
147.29orthotics, and supplies (DMEPOS) suppliers operating in Minnesota are required to name
147.30the Department of Human Services, in addition to the Centers for Medicare and Medicaid
147.31Services, as an obligee on all surety performance bonds required pursuant to section
147.324312(a) of the Balanced Budget Act of 1997, Public Law 105-33, amending Social
147.33Security Act, section 1834(a). The performance bond must also allow for recovery of
147.34costs and fees in pursuing a claim on the bond.
147.35(h) The Department of Human Services may require a provider to purchase a
147.36performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
148.1or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
148.2department determines there is significant evidence of or potential for fraud and abuse by
148.3the provider, or (3) the provider or category of providers is designated high-risk pursuant
148.4to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450, or the
148.5department otherwise finds it is in the best interest of the Medicaid program to do so. The
148.6performance bond must be in an amount of $100,000 or ten percent of the provider's
148.7payments from Medicaid during the immediately preceding 12 months, whichever is
148.8greater. The performance bond must name the Department of Human Services as an
148.9obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.
148.10EFFECTIVE DATE.This section is effective the day following final enactment.

148.11    Sec. 5. Minnesota Statutes 2012, section 256B.04, is amended by adding a subdivision
148.12to read:
148.13    Subd. 22. Application fee. (a) The commissioner must collect and retain federally
148.14required nonrefundable application fees to pay for provider screening activities in
148.15accordance with Code of Federal Regulations, title 42, section 455, subpart E. The
148.16enrollment application must be made under the procedures specified by the commissioner,
148.17in the form specified by the commissioner, and accompanied by an application fee
148.18described in paragraph (b), or a request for a hardship exception as described in the
148.19specified procedures. Application fees must be deposited in the provider screening account
148.20in the special revenue fund. Amounts in the provider screening account are appropriated
148.21to the commissioner for costs associated with the provider screening activities required
148.22in Code of Federal Regulations, title 42, section 455, subpart E. The commissioner
148.23shall conduct screening activities as required by Code of Federal Regulations, title 42,
148.24section 455, subpart E, and as otherwise provided by law, to include database checks,
148.25unannounced pre- and postenrollment site visits, fingerprinting, and criminal background
148.26studies. The commissioner must revalidate all providers under this subdivision at least
148.27once every five years.
148.28(b) The application fee under this subdivision is $532 for the calendar year 2013.
148.29For calendar year 2014 and subsequent years, the fee:
148.30(1) is adjusted by the percentage change to the consumer price index for all urban
148.31consumers, United States city average, for the 12-month period ending with June of the
148.32previous year. The resulting fee must be announced in the Federal Register;
148.33(2) is effective from January 1 to December 31 of a calendar year;
148.34(3) is required on the submission of an initial application, an application to establish
148.35a new practice location, an application for re-enrollment when the provider is not enrolled
149.1at the time of application of re-enrollment, or at revalidation when required by federal
149.2regulation; and
149.3(4) must be in the amount in effect for the calendar year during which the application
149.4for enrollment, new practice location, or re-enrollment is being submitted.
149.5(c) The application fee under this subdivision cannot be charged to:
149.6(1) providers who are enrolled in Medicare or who provide documentation of
149.7payment of the fee to, and enrollment with, another state;
149.8(2) providers who are enrolled but are required to submit new applications for
149.9purposes of re-enrollment; or
149.10(3) a provider who enrolls as an individual.
149.11EFFECTIVE DATE.This section is effective the day following final enactment.

149.12    Sec. 6. Minnesota Statutes 2012, section 256B.064, subdivision 1a, is amended to read:
149.13    Subd. 1a. Grounds for sanctions against vendors. The commissioner may
149.14impose sanctions against a vendor of medical care for any of the following: (1) fraud,
149.15theft, or abuse in connection with the provision of medical care to recipients of public
149.16assistance; (2) a pattern of presentment of false or duplicate claims or claims for services
149.17not medically necessary; (3) a pattern of making false statements of material facts for
149.18the purpose of obtaining greater compensation than that to which the vendor is legally
149.19entitled; (4) suspension or termination as a Medicare vendor; (5) refusal to grant the state
149.20agency access during regular business hours to examine all records necessary to disclose
149.21the extent of services provided to program recipients and appropriateness of claims for
149.22payment; (6) failure to repay an overpayment or a fine finally established under this
149.23section; and (7) failure to correct errors in the maintenance of health service or financial
149.24records for which a fine was imposed or after issuance of a warning by the commissioner;
149.25and (8) any reason for which a vendor could be excluded from participation in the
149.26Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act.
149.27The determination of services not medically necessary may be made by the commissioner
149.28in consultation with a peer advisory task force appointed by the commissioner on the
149.29recommendation of appropriate professional organizations. The task force expires as
149.30provided in section 15.059, subdivision 5.

149.31    Sec. 7. Minnesota Statutes 2012, section 256B.064, subdivision 1b, is amended to read:
149.32    Subd. 1b. Sanctions available. The commissioner may impose the following
149.33sanctions for the conduct described in subdivision 1a: suspension or withholding of
149.34payments to a vendor and suspending or terminating participation in the program, or
150.1imposition of a fine under subdivision 2, paragraph (f). When imposing sanctions under
150.2this section, the commissioner shall consider the nature, chronicity, or severity of the
150.3conduct and the effect of the conduct on the health and safety of persons served by the
150.4vendor. Regardless of imposition of sanctions, the commissioner may make a referral
150.5to the appropriate state licensing board.

150.6    Sec. 8. Minnesota Statutes 2012, section 256B.064, subdivision 2, is amended to read:
150.7    Subd. 2. Imposition of monetary recovery and sanctions. (a) The commissioner
150.8shall determine any monetary amounts to be recovered and sanctions to be imposed upon
150.9a vendor of medical care under this section. Except as provided in paragraphs (b) and
150.10(d), neither a monetary recovery nor a sanction will be imposed by the commissioner
150.11without prior notice and an opportunity for a hearing, according to chapter 14, on the
150.12commissioner's proposed action, provided that the commissioner may suspend or reduce
150.13payment to a vendor of medical care, except a nursing home or convalescent care facility,
150.14after notice and prior to the hearing if in the commissioner's opinion that action is
150.15necessary to protect the public welfare and the interests of the program.
150.16(b) Except when the commissioner finds good cause not to suspend payments under
150.17Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
150.18withhold or reduce payments to a vendor of medical care without providing advance
150.19notice of such withholding or reduction if either of the following occurs:
150.20(1) the vendor is convicted of a crime involving the conduct described in subdivision
150.211a; or
150.22(2) the commissioner determines there is a credible allegation of fraud for which an
150.23investigation is pending under the program. A credible allegation of fraud is an allegation
150.24which has been verified by the state, from any source, including but not limited to:
150.25(i) fraud hotline complaints;
150.26(ii) claims data mining; and
150.27(iii) patterns identified through provider audits, civil false claims cases, and law
150.28enforcement investigations.
150.29Allegations are considered to be credible when they have an indicia of reliability
150.30and the state agency has reviewed all allegations, facts, and evidence carefully and acts
150.31judiciously on a case-by-case basis.
150.32(c) The commissioner must send notice of the withholding or reduction of payments
150.33under paragraph (b) within five days of taking such action unless requested in writing by a
150.34law enforcement agency to temporarily withhold the notice. The notice must:
150.35(1) state that payments are being withheld according to paragraph (b);
151.1(2) set forth the general allegations as to the nature of the withholding action, but
151.2need not disclose any specific information concerning an ongoing investigation;
151.3(3) except in the case of a conviction for conduct described in subdivision 1a, state
151.4that the withholding is for a temporary period and cite the circumstances under which
151.5withholding will be terminated;
151.6(4) identify the types of claims to which the withholding applies; and
151.7(5) inform the vendor of the right to submit written evidence for consideration by
151.8the commissioner.
151.9The withholding or reduction of payments will not continue after the commissioner
151.10determines there is insufficient evidence of fraud by the vendor, or after legal proceedings
151.11relating to the alleged fraud are completed, unless the commissioner has sent notice of
151.12intention to impose monetary recovery or sanctions under paragraph (a).
151.13(d) The commissioner shall suspend or terminate a vendor's participation in the
151.14program without providing advance notice and an opportunity for a hearing when the
151.15suspension or termination is required because of the vendor's exclusion from participation
151.16in Medicare. Within five days of taking such action, the commissioner must send notice of
151.17the suspension or termination. The notice must:
151.18(1) state that suspension or termination is the result of the vendor's exclusion from
151.19Medicare;
151.20(2) identify the effective date of the suspension or termination; and
151.21(3) inform the vendor of the need to be reinstated to Medicare before reapplying
151.22for participation in the program.
151.23(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or
151.24sanction is to be imposed, a vendor may request a contested case, as defined in section
151.2514.02, subdivision 3 , by filing with the commissioner a written request of appeal. The
151.26appeal request must be received by the commissioner no later than 30 days after the date
151.27the notification of monetary recovery or sanction was mailed to the vendor. The appeal
151.28request must specify:
151.29(1) each disputed item, the reason for the dispute, and an estimate of the dollar
151.30amount involved for each disputed item;
151.31(2) the computation that the vendor believes is correct;
151.32(3) the authority in statute or rule upon which the vendor relies for each disputed item;
151.33(4) the name and address of the person or entity with whom contacts may be made
151.34regarding the appeal; and
151.35(5) other information required by the commissioner.
152.1(f) The commissioner may order a vendor to forfeit a fine for failure to fully
152.2document services according to standards in this chapter and Minnesota Rules, chapter
152.39505. Fines may be assessed when the commissioner has no evidence that services were
152.4not provided and services are partially documented in the health service or financial
152.5record, but specific required components of documentation are missing. The fine for
152.6incomplete documentation shall equal 20 percent of the amount paid on the claims for
152.7reimbursement submitted by the vendor, or up to $5,000, whichever is less.
152.8(g) The vendor shall pay the fine assessed on or before the payment date specified. If
152.9the vendor fails to pay the fine, the commissioner may withhold or reduce payments and
152.10recover the amount of the fine. A timely appeal shall stay payment of the fine until the
152.11commissioner issues a final order.

152.12    Sec. 9. Minnesota Statutes 2012, section 256B.0659, subdivision 21, is amended to read:
152.13    Subd. 21. Requirements for initial enrollment of personal care assistance
152.14provider agencies. (a) All personal care assistance provider agencies must provide, at the
152.15time of enrollment as a personal care assistance provider agency in a format determined
152.16by the commissioner, information and documentation that includes, but is not limited to,
152.17the following:
152.18    (1) the personal care assistance provider agency's current contact information
152.19including address, telephone number, and e-mail address;
152.20    (2) proof of surety bond coverage in the amount of $50,000 $100,000 or ten percent
152.21of the provider's payments from Medicaid in the previous year, whichever is less more.
152.22The performance bond must be in a form approved by the commissioner, must be renewed
152.23annually, and must allow for recovery of costs and fees in pursuing a claim on the bond;
152.24    (3) proof of fidelity bond coverage in the amount of $20,000;
152.25    (4) proof of workers' compensation insurance coverage;
152.26    (5) proof of liability insurance;
152.27    (6) a description of the personal care assistance provider agency's organization
152.28identifying the names of all owners, managing employees, staff, board of directors, and
152.29the affiliations of the directors, owners, or staff to other service providers;
152.30    (7) a copy of the personal care assistance provider agency's written policies and
152.31procedures including: hiring of employees; training requirements; service delivery;
152.32and employee and consumer safety including process for notification and resolution
152.33of consumer grievances, identification and prevention of communicable diseases, and
152.34employee misconduct;
153.1    (8) copies of all other forms the personal care assistance provider agency uses in
153.2the course of daily business including, but not limited to:
153.3    (i) a copy of the personal care assistance provider agency's time sheet if the time
153.4sheet varies from the standard time sheet for personal care assistance services approved
153.5by the commissioner, and a letter requesting approval of the personal care assistance
153.6provider agency's nonstandard time sheet;
153.7    (ii) the personal care assistance provider agency's template for the personal care
153.8assistance care plan; and
153.9    (iii) the personal care assistance provider agency's template for the written
153.10agreement in subdivision 20 for recipients using the personal care assistance choice
153.11option, if applicable;
153.12    (9) a list of all training and classes that the personal care assistance provider agency
153.13requires of its staff providing personal care assistance services;
153.14    (10) documentation that the personal care assistance provider agency and staff have
153.15successfully completed all the training required by this section;
153.16    (11) documentation of the agency's marketing practices;
153.17    (12) disclosure of ownership, leasing, or management of all residential properties
153.18that is used or could be used for providing home care services;
153.19    (13) documentation that the agency will use the following percentages of revenue
153.20generated from the medical assistance rate paid for personal care assistance services
153.21for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
153.22personal care assistance choice option and 72.5 percent of revenue from other personal
153.23care assistance providers. The revenue generated by the qualified professional and the
153.24reasonable costs associated with the qualified professional shall not be used in making
153.25this calculation; and
153.26    (14) effective May 15, 2010, documentation that the agency does not burden
153.27recipients' free exercise of their right to choose service providers by requiring personal
153.28care assistants to sign an agreement not to work with any particular personal care
153.29assistance recipient or for another personal care assistance provider agency after leaving
153.30the agency and that the agency is not taking action on any such agreements or requirements
153.31regardless of the date signed.
153.32    (b) Personal care assistance provider agencies shall provide the information specified
153.33in paragraph (a) to the commissioner at the time the personal care assistance provider
153.34agency enrolls as a vendor or upon request from the commissioner. The commissioner
153.35shall collect the information specified in paragraph (a) from all personal care assistance
153.36providers beginning July 1, 2009.
154.1    (c) All personal care assistance provider agencies shall require all employees in
154.2management and supervisory positions and owners of the agency who are active in the
154.3day-to-day management and operations of the agency to complete mandatory training
154.4as determined by the commissioner before enrollment of the agency as a provider.
154.5Employees in management and supervisory positions and owners who are active in
154.6the day-to-day operations of an agency who have completed the required training as
154.7an employee with a personal care assistance provider agency do not need to repeat
154.8the required training if they are hired by another agency, if they have completed the
154.9training within the past three years. By September 1, 2010, the required training must
154.10be available with meaningful access according to title VI of the Civil Rights Act and
154.11federal regulations adopted under that law or any guidance from the United States Health
154.12and Human Services Department. The required training must be available online or by
154.13electronic remote connection. The required training must provide for competency testing.
154.14Personal care assistance provider agency billing staff shall complete training about
154.15personal care assistance program financial management. This training is effective July 1,
154.162009. Any personal care assistance provider agency enrolled before that date shall, if it
154.17has not already, complete the provider training within 18 months of July 1, 2009. Any new
154.18owners or employees in management and supervisory positions involved in the day-to-day
154.19operations are required to complete mandatory training as a requisite of working for the
154.20agency. Personal care assistance provider agencies certified for participation in Medicare
154.21as home health agencies are exempt from the training required in this subdivision. When
154.22available, Medicare-certified home health agency owners, supervisors, or managers must
154.23successfully complete the competency test.
154.24EFFECTIVE DATE.This section is effective the day following final enactment.

154.25    Sec. 10. Minnesota Statutes 2012, section 270B.14, subdivision 1, is amended to read:
154.26    Subdivision 1. Disclosure to commissioner of human services. (a) On the request
154.27of the commissioner of human services, the commissioner shall disclose return information
154.28regarding taxes imposed by chapter 290, and claims for refunds under chapter 290A, to
154.29the extent provided in paragraph (b) and for the purposes set forth in paragraph (c).
154.30    (b) Data that may be disclosed are limited to data relating to the identity,
154.31whereabouts, employment, income, and property of a person owing or alleged to be owing
154.32an obligation of child support.
154.33    (c) The commissioner of human services may request data only for the purposes of
154.34carrying out the child support enforcement program and to assist in the location of parents
155.1who have, or appear to have, deserted their children. Data received may be used only
155.2as set forth in section 256.978.
155.3    (d) The commissioner shall provide the records and information necessary to
155.4administer the supplemental housing allowance to the commissioner of human services.
155.5    (e) At the request of the commissioner of human services, the commissioner of
155.6revenue shall electronically match the Social Security numbers and names of participants
155.7in the telephone assistance plan operated under sections 237.69 to 237.711, with those of
155.8property tax refund filers, and determine whether each participant's household income is
155.9within the eligibility standards for the telephone assistance plan.
155.10    (f) The commissioner may provide records and information collected under sections
155.11295.50 to 295.59 to the commissioner of human services for purposes of the Medicaid
155.12Voluntary Contribution and Provider-Specific Tax Amendments of 1991, Public Law
155.13102-234. Upon the written agreement by the United States Department of Health and
155.14Human Services to maintain the confidentiality of the data, the commissioner may provide
155.15records and information collected under sections 295.50 to 295.59 to the Centers for
155.16Medicare and Medicaid Services section of the United States Department of Health and
155.17Human Services for purposes of meeting federal reporting requirements.
155.18    (g) The commissioner may provide records and information to the commissioner of
155.19human services as necessary to administer the early refund of refundable tax credits.
155.20    (h) The commissioner may disclose information to the commissioner of human
155.21services necessary to verify income for eligibility and premium payment under
155.22the MinnesotaCare program, under section 256L.05, subdivision 2. Similarly, the
155.23commissioner may disclose information necessary to verify income for eligibility of
155.24applicants and recipients of medical assistance, under chapter 256B, and the supplemental
155.25nutrition assistance program, under section 245.771.
155.26    (i) The commissioner may disclose information to the commissioner of human
155.27services necessary to verify whether applicants or recipients for the Minnesota family
155.28investment program, general assistance, food support, Minnesota supplemental aid
155.29program, and child care assistance have claimed refundable tax credits under chapter 290
155.30and the property tax refund under chapter 290A, and the amounts of the credits.
155.31    (j) The commissioner may disclose information to the commissioner of human
155.32services necessary to verify income for purposes of calculating parental contribution
155.33amounts under section 252.27, subdivision 2a.


156.3    Section 1. Minnesota Statutes 2012, section 256.9657, subdivision 2, is amended to read:
156.4    Subd. 2. Hospital surcharge. (a) Effective October 1, 1992, each Minnesota
156.5hospital except facilities of the federal Indian Health Service and regional treatment
156.6centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net
156.7patient revenues excluding net Medicare revenues reported by that provider to the health
156.8care cost information system according to the schedule in subdivision 4.
156.9(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 1.56
156.10percent.
156.11(c) Effective July 1, 2013, through June 30, 2017, the surcharge under paragraph (b)
156.12is increased to 2.68 percent for all non-government-owned hospitals. Beginning July 1,
156.132017, the surcharge shall revert to the percentage specified in paragraph (b).
156.14(d) Notwithstanding the Medicare cost finding and allowable cost principles, the
156.15hospital surcharge is not an allowable cost for purposes of rate setting under sections
156.16256.9685 to 256.9695.
156.17EFFECTIVE DATE.This section is effective July 1, 2013.

156.18    Sec. 2. Minnesota Statutes 2012, section 256.9685, subdivision 2, is amended to read:
156.19    Subd. 2. Federal requirements. (a) If it is determined that a provision of this
156.20section or section 256.9686, 256.969, or 256.9695 conflicts with existing or future
156.21requirements of the United States government with respect to federal financial participation
156.22in medical assistance, the federal requirements prevail. The commissioner may, in the
156.23aggregate, prospectively and retrospectively, reduce payment rates and payments to avoid
156.24reduced federal financial participation resulting from rates and payments determined by
156.25the commissioner that are in excess of the Medicare upper payment limitations.
156.26(b) For rates and payments determined by the commissioner to be in excess of the
156.27Medicare upper payment limits for the nongovernment-owned limit category, rates and
156.28payments shall be reduced to the limits according to clauses (1) to (4):
156.29(1) rates and payments under section 256.969, subdivision 3a, paragraph (j), shall be
156.30reduced proportionately;
156.31(2) if rates and payments remain above the limit, medical education payments under
156.32section 62J.692, subdivision 8, shall be the first reduction for the government-owned
156.33limit category;
157.1(3) if rates and payments remain above the limit, rates and payments not included
157.2under clause (1) shall be reduced in total; and
157.3(4) the state share of payments under clauses (1) and (2) shall be returned to the
157.4hospital.

157.5    Sec. 3. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
157.6    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
157.7assistance program must not be submitted until the recipient is discharged. However,
157.8the commissioner shall establish monthly interim payments for inpatient hospitals that
157.9have individual patient lengths of stay over 30 days regardless of diagnostic category.
157.10Except as provided in section 256.9693, medical assistance reimbursement for treatment
157.11of mental illness shall be reimbursed based on diagnostic classifications. Individual
157.12hospital payments established under this section and sections 256.9685, 256.9686, and
157.13256.9695 , in addition to third-party and recipient liability, for discharges occurring during
157.14the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
157.15inpatient services paid for the same period of time to the hospital. This payment limitation
157.16shall be calculated separately for medical assistance and general assistance medical
157.17care services. The limitation on general assistance medical care shall be effective for
157.18admissions occurring on or after July 1, 1991. Services that have rates established under
157.19subdivision 11 or 12, must be limited separately from other services. After consulting with
157.20the affected hospitals, the commissioner may consider related hospitals one entity and
157.21may merge the payment rates while maintaining separate provider numbers. The operating
157.22and property base rates per admission or per day shall be derived from the best Medicare
157.23and claims data available when rates are established. The commissioner shall determine
157.24the best Medicare and claims data, taking into consideration variables of recency of the
157.25data, audit disposition, settlement status, and the ability to set rates in a timely manner.
157.26The commissioner shall notify hospitals of payment rates by December 1 of the year
157.27preceding the rate year. The rate setting data must reflect the admissions data used to
157.28establish relative values. Base year changes from 1981 to the base year established for the
157.29rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
157.30to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
157.311. The commissioner may adjust base year cost, relative value, and case mix index data
157.32to exclude the costs of services that have been discontinued by the October 1 of the year
157.33preceding the rate year or that are paid separately from inpatient services. Inpatient stays
157.34that encompass portions of two or more rate years shall have payments established based
157.35on payment rates in effect at the time of admission unless the date of admission preceded
158.1the rate year in effect by six months or more. In this case, operating payment rates for
158.2services rendered during the rate year in effect and established based on the date of
158.3admission shall be adjusted to the rate year in effect by the hospital cost index.
158.4    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
158.5payment, before third-party liability and spenddown, made to hospitals for inpatient
158.6services is reduced by .5 percent from the current statutory rates.
158.7    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
158.8admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
158.9before third-party liability and spenddown, is reduced five percent from the current
158.10statutory rates. Mental health services within diagnosis related groups 424 to 432, and
158.11facilities defined under subdivision 16 are excluded from this paragraph.
158.12    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
158.13fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
158.14inpatient services before third-party liability and spenddown, is reduced 6.0 percent
158.15from the current statutory rates. Mental health services within diagnosis related groups
158.16424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
158.17Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
158.18assistance does not include general assistance medical care. Payments made to managed
158.19care plans shall be reduced for services provided on or after January 1, 2006, to reflect
158.20this reduction.
158.21    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
158.22fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
158.23to hospitals for inpatient services before third-party liability and spenddown, is reduced
158.243.46 percent from the current statutory rates. Mental health services with diagnosis related
158.25groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
158.26paragraph. Payments made to managed care plans shall be reduced for services provided
158.27on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
158.28    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
158.29fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
158.30to hospitals for inpatient services before third-party liability and spenddown, is reduced
158.311.9 percent from the current statutory rates. Mental health services with diagnosis related
158.32groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
158.33paragraph. Payments made to managed care plans shall be reduced for services provided
158.34on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
158.35    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
158.36for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
159.1inpatient services before third-party liability and spenddown, is reduced 1.79 percent
159.2from the current statutory rates. Mental health services with diagnosis related groups
159.3424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
159.4Payments made to managed care plans shall be reduced for services provided on or after
159.5July 1, 2011, to reflect this reduction.
159.6(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
159.7payment for fee-for-service admissions occurring on or after July 1, 2009, made to
159.8hospitals for inpatient services before third-party liability and spenddown, is reduced
159.9one percent from the current statutory rates. Facilities defined under subdivision 16 are
159.10excluded from this paragraph. Payments made to managed care plans shall be reduced for
159.11services provided on or after October 1, 2009, to reflect this reduction.
159.12(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
159.13payment for fee-for-service admissions occurring on or after July 1, 2011, made to
159.14hospitals for inpatient services before third-party liability and spenddown, is reduced
159.151.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
159.16excluded from this paragraph. Payments made to managed care plans shall be reduced for
159.17services provided on or after January 1, 2011, to reflect this reduction.
159.18(j) In order to offset the rateable reductions provided for in this subdivision, the total
159.19payment rate for medical assistance admissions for non-government-owned hospitals
159.20occurring on or after July 1, 2013, through June 30, 2017, made to Minnesota hospitals
159.21for inpatient services before third-party liability and spenddown, shall be increased by
159.22a dollar amount equivalent to 30 percent from the current statutory rates, but the funds
159.23available shall be further distributed as follows:
159.24(1) 25 percent of available funding under this paragraph shall be for an across the
159.25board inpatient services rate increase;
159.26(2) nine percent of available funding under this paragraph shall be to increase the
159.27medical assistance rates paid for services at Minnesota non-government-owned hospitals
159.28above the 85th percentile for patient days for patients under 18 years of age in calendar
159.29year 2012 of all Minnesota private, nonprofit hospitals;
159.30(3) two percent of available funding under this paragraph shall be to increase
159.31the rates paid for medical assistance admissions occurring on or after July 1, 2013, at
159.32Minnesota non-government-owned hospitals above the 90th percentile for patient days for
159.33patients under 18 years of age in calendar year 2011 of all Minnesota private, nonprofit
159.34hospitals for diagnosis-related groups 453 to 517, 533 to 541, 906, and 956;
160.1(4) 14 percent of available funding under this paragraph shall be to increase the
160.2medical assistance rates paid for inpatient mental health and chemical dependency
160.3treatment services under section 256.969, subdivision 21;
160.4(5) 14 percent of available funding under this paragraph shall be to increase the
160.5medical assistance rates paid for inpatient birth and delivery services under section
160.6256.969, subdivision 30;
160.7(6) two percent of available funding shall be to increase the rates paid to critical
160.8access hospitals, as designated under section 144.1483, clause (9);
160.9(7) 33 percent of available funding under this paragraph shall be to increase the
160.10medical assistance inpatient rates paid for services on or after July 1, 2013, at Minnesota
160.11non-government-owned hospitals determined to have experienced the most significant
160.12losses of federal Medicare funding in 2013; and
160.13(8) one percent of available funding under this paragraph shall be to increase the
160.14medical assistance rates paid for services occurring on or after July 1, 2013, at Minnesota
160.15non-government-owned hospitals verified by the American College of Surgeons as Level I
160.16trauma centers.
160.17The commissioner shall not adjust rates paid to a prepaid health plan under contract with
160.18the commissioner to reflect payments provided in this paragraph. The commissioner shall
160.19adjust rates and payments in excess of the Medicare upper limits on payments according
160.20to section 256.9685, subdivision 2.
160.21EFFECTIVE DATE.This section is effective July 1, 2013.

160.22    Sec. 4. Minnesota Statutes 2012, section 256.969, subdivision 29, is amended to read:
160.23    Subd. 29. Reimbursement for the fee increase for the early hearing detection
160.24and intervention program. (a) For admissions occurring on or after July 1, 2010,
160.25payment rates shall be adjusted to include the increase to the fee that is effective on July 1,
160.262010, for the early hearing detection and intervention program recipients under section
160.27144.125, subdivision 1 , that is paid by the hospital for public program recipients. This
160.28payment increase shall be in effect until the increase is fully recognized in the base year
160.29cost under subdivision 2b. This payment shall be included in payments to contracted
160.30managed care organizations.
160.31    (b) For admissions occurring on or after July 1, 2013, payment rates shall be
160.32adjusted to include the increase to the fee that is effective July 1, 2013, for the early
160.33hearing detection and intervention program recipients under section 144.125, subdivision
160.341 , that is paid by the hospital for public program recipients. This payment increase shall
161.1be in effect until the increase is fully recognized in the base year cost under subdivision
161.22b. This payment shall be included in payments to contracted managed care organizations.

161.3    Sec. 5. Minnesota Statutes 2012, section 256B.055, subdivision 14, is amended to read:
161.4    Subd. 14. Persons detained by law. (a) Medical assistance may be paid for an
161.5inmate of a correctional facility who is conditionally released as authorized under section
161.6241.26 , 244.065, or 631.425, if the individual does not require the security of a public
161.7detention facility and is housed in a halfway house or community correction center, or
161.8under house arrest and monitored by electronic surveillance in a residence approved
161.9by the commissioner of corrections, and if the individual meets the other eligibility
161.10requirements of this chapter.
161.11    (b) An individual who is enrolled in medical assistance, and who is charged with a
161.12crime and incarcerated for less than 12 months shall be suspended from eligibility at the
161.13time of incarceration until the individual is released. Upon release, medical assistance
161.14eligibility is reinstated without reapplication using a reinstatement process and form, if the
161.15individual is otherwise eligible.
161.16    (c) An individual, regardless of age, who is considered an inmate of a public
161.17institution as defined in Code of Federal Regulations, title 42, section 435.1010, and
161.18who meets the eligibility requirements in section 256B.056, is not eligible for medical
161.19assistance, except for covered services received while an inpatient in a medical institution
161.20as defined in the Code of Federal Regulations, title 42, section 435.1010. Security issues
161.21related to the inpatient treatment of an inmate are the responsibility of the entity with
161.22jurisdiction over the inmate.
161.23EFFECTIVE DATE.This section is effective January 1, 2014.

161.24    Sec. 6. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
161.25    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
161.26to citizens of the United States, qualified noncitizens as defined in this subdivision, and
161.27other persons residing lawfully in the United States. Citizens or nationals of the United
161.28States must cooperate in obtaining satisfactory documentary evidence of citizenship or
161.29nationality according to the requirements of the federal Deficit Reduction Act of 2005,
161.30Public Law 109-171.
161.31(b) "Qualified noncitizen" means a person who meets one of the following
161.32immigration criteria:
161.33(1) admitted for lawful permanent residence according to United States Code, title 8;
162.1(2) admitted to the United States as a refugee according to United States Code,
162.2title 8, section 1157;
162.3(3) granted asylum according to United States Code, title 8, section 1158;
162.4(4) granted withholding of deportation according to United States Code, title 8,
162.5section 1253(h);
162.6(5) paroled for a period of at least one year according to United States Code, title 8,
162.7section 1182(d)(5);
162.8(6) granted conditional entrant status according to United States Code, title 8,
162.9section 1153(a)(7);
162.10(7) determined to be a battered noncitizen by the United States Attorney General
162.11according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
162.12title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
162.13(8) is a child of a noncitizen determined to be a battered noncitizen by the United
162.14States Attorney General according to the Illegal Immigration Reform and Immigrant
162.15Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
162.16Public Law 104-200; or
162.17(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
162.18Law 96-422, the Refugee Education Assistance Act of 1980.
162.19(c) All qualified noncitizens who were residing in the United States before August
162.2022, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
162.21medical assistance with federal financial participation.
162.22(d) Beginning December 1, 1996, qualified noncitizens who entered the United
162.23States on or after August 22, 1996, and who otherwise meet the eligibility requirements
162.24of this chapter are eligible for medical assistance with federal participation for five years
162.25if they meet one of the following criteria:
162.26(1) refugees admitted to the United States according to United States Code, title 8,
162.27section 1157;
162.28(2) persons granted asylum according to United States Code, title 8, section 1158;
162.29(3) persons granted withholding of deportation according to United States Code,
162.30title 8, section 1253(h);
162.31(4) veterans of the United States armed forces with an honorable discharge for
162.32a reason other than noncitizen status, their spouses and unmarried minor dependent
162.33children; or
162.34(5) persons on active duty in the United States armed forces, other than for training,
162.35their spouses and unmarried minor dependent children.
163.1 Beginning July 1, 2010, children and pregnant women who are noncitizens
163.2described in paragraph (b) or who are lawfully present in the United States as defined
163.3in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
163.4eligibility requirements of this chapter, are eligible for medical assistance with federal
163.5financial participation as provided by the federal Children's Health Insurance Program
163.6Reauthorization Act of 2009, Public Law 111-3.
163.7(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
163.8are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
163.9subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
163.10Code, title 8, section 1101(a)(15).
163.11(f) Payment shall also be made for care and services that are furnished to noncitizens,
163.12regardless of immigration status, who otherwise meet the eligibility requirements of
163.13this chapter, if such care and services are necessary for the treatment of an emergency
163.14medical condition.
163.15(g) For purposes of this subdivision, the term "emergency medical condition" means
163.16a medical condition that meets the requirements of United States Code, title 42, section
163.171396b(v).
163.18(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
163.19of an emergency medical condition are limited to the following:
163.20(i) services delivered in an emergency room or by an ambulance service licensed
163.21under chapter 144E that are directly related to the treatment of an emergency medical
163.22condition;
163.23(ii) services delivered in an inpatient hospital setting following admission from an
163.24emergency room or clinic for an acute emergency condition; and
163.25(iii) follow-up services that are directly related to the original service provided
163.26to treat the emergency medical condition and are covered by the global payment made
163.27to the provider.
163.28    (2) Services for the treatment of emergency medical conditions do not include:
163.29(i) services delivered in an emergency room or inpatient setting to treat a
163.30nonemergency condition;
163.31(ii) organ transplants, stem cell transplants, and related care;
163.32(iii) services for routine prenatal care;
163.33(iv) continuing care, including long-term care, nursing facility services, home health
163.34care, adult day care, day training, or supportive living services;
163.35(v) elective surgery;
164.1(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
164.2part of an emergency room visit;
164.3(vii) preventative health care and family planning services;
164.4(viii) dialysis;
164.5(ix) chemotherapy or therapeutic radiation services;
164.6(x) (viii) rehabilitation services;
164.7(xi) (ix) physical, occupational, or speech therapy;
164.8(xii) (x) transportation services;
164.9(xiii) (xi) case management;
164.10(xiv) (xii) prosthetics, orthotics, durable medical equipment, or medical supplies;
164.11(xv) (xiii) dental services;
164.12(xvi) (xiv) hospice care;
164.13(xvii) (xv) audiology services and hearing aids;
164.14(xviii) (xvi) podiatry services;
164.15(xix) (xvii) chiropractic services;
164.16(xx) (xviii) immunizations;
164.17(xxi) (xix) vision services and eyeglasses;
164.18(xxii) (xx) waiver services;
164.19(xxiii) (xxi) individualized education programs; or
164.20(xxiv) (xxii) chemical dependency treatment.
164.21(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
164.22nonimmigrants, or lawfully present in the United States as defined in Code of Federal
164.23Regulations, title 8, section 103.12, are not covered by a group health plan or health
164.24insurance coverage according to Code of Federal Regulations, title 42, section 457.310,
164.25and who otherwise meet the eligibility requirements of this chapter, are eligible for
164.26medical assistance through the period of pregnancy, including labor and delivery, and 60
164.27days postpartum, to the extent federal funds are available under title XXI of the Social
164.28Security Act, and the state children's health insurance program.
164.29(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
164.30services from a nonprofit center established to serve victims of torture and are otherwise
164.31ineligible for medical assistance under this chapter are eligible for medical assistance
164.32without federal financial participation. These individuals are eligible only for the period
164.33during which they are receiving services from the center. Individuals eligible under this
164.34paragraph shall not be required to participate in prepaid medical assistance.
165.1(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
165.2emergency medical conditions under paragraph (f) except where coverage is prohibited
165.3under federal law:
165.4(1) dialysis services provided in a hospital or freestanding dialysis facility; and
165.5(2) surgery and the administration of chemotherapy, radiation, and related services
165.6necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission
165.7and requires surgery, chemotherapy, or radiation treatment.
165.8EFFECTIVE DATE.This section is effective July 1, 2013.

165.9    Sec. 7. Minnesota Statutes 2012, section 256B.0625, subdivision 9, is amended to read:
165.10    Subd. 9. Dental services. (a) Medical assistance covers dental services.
165.11(b) Medical assistance dental coverage for nonpregnant adults is limited to the
165.12following services:
165.13(1) comprehensive exams, limited to once every five years;
165.14(2) periodic exams, limited to one per year;
165.15(3) limited exams;
165.16(4) bitewing x-rays, limited to one per year;
165.17(5) periapical x-rays;
165.18(6) panoramic x-rays, limited to one every five years except (1) when medically
165.19necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
165.20or (2) once every two years for patients who cannot cooperate for intraoral film due to
165.21a developmental disability or medical condition that does not allow for intraoral film
165.22placement;
165.23(7) prophylaxis, limited to one per year;
165.24(8) application of fluoride varnish, limited to one per year;
165.25(9) posterior fillings, all at the amalgam rate;
165.26(10) anterior fillings;
165.27(11) endodontics, limited to root canals on the anterior and premolars only;
165.28(12) removable prostheses, each dental arch limited to one every six years;
165.29(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
165.30abscesses;
165.31(14) palliative treatment and sedative fillings for relief of pain; and
165.32(15) full-mouth debridement, limited to one every five years.
165.33(c) In addition to the services specified in paragraph (b), medical assistance
165.34covers the following services for adults, if provided in an outpatient hospital setting or
165.35freestanding ambulatory surgical center as part of outpatient dental surgery:
166.1(1) periodontics, limited to periodontal scaling and root planing once every two years;
166.2(2) general anesthesia; and
166.3(3) full-mouth survey once every five years.
166.4(d) Medical assistance covers medically necessary dental services for children and
166.5pregnant women. The following guidelines apply:
166.6(1) posterior fillings are paid at the amalgam rate;
166.7(2) application of sealants are covered once every five years per permanent molar for
166.8children only;
166.9(3) application of fluoride varnish is covered once every six months; and
166.10(4) orthodontia is eligible for coverage for children only.
166.11(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
166.12covers the following services for adults:
166.13(1) house calls or extended care facility calls for on-site delivery of covered services;
166.14(2) behavioral management when additional staff time is required to accommodate
166.15behavioral challenges and sedation is not used;
166.16(3) oral or IV sedation, if the covered dental service cannot be performed safely
166.17without it or would otherwise require the service to be performed under general anesthesia
166.18in a hospital or surgical center; and
166.19(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
166.20no more than four times per year.

166.21    Sec. 8. Minnesota Statutes 2012, section 256B.0625, subdivision 13e, is amended to
166.22read:
166.23    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment
166.24shall be the lower of the actual acquisition costs of the drugs or the maximum allowable
166.25cost by the commissioner plus the fixed dispensing fee; or the usual and customary price
166.26charged to the public. The amount of payment basis must be reduced to reflect all discount
166.27amounts applied to the charge by any provider/insurer agreement or contract for submitted
166.28charges to medical assistance programs. The net submitted charge may not be greater
166.29than the patient liability for the service. The pharmacy dispensing fee shall be $3.65,
166.30except that the dispensing fee for intravenous solutions which must be compounded by
166.31the pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and
166.32$30 per bag for total parenteral nutritional products dispensed in one liter quantities,
166.33or $44 per bag for total parenteral nutritional products dispensed in quantities greater
166.34than one liter. Actual acquisition cost includes quantity and other special discounts
166.35except time and cash discounts. The actual acquisition cost of a drug shall be estimated
167.1by the commissioner at wholesale acquisition cost plus four percent for independently
167.2owned pharmacies located in a designated rural area within Minnesota, and at wholesale
167.3acquisition cost plus two percent for all other pharmacies. A pharmacy is "independently
167.4owned" if it is one of four or fewer pharmacies under the same ownership nationally.
167.5A "designated rural area" means an area defined as a small rural area or isolated rural
167.6area according to the four-category classification of the Rural Urban Commuting Area
167.7system developed for the United States Health Resources and Services Administration.
167.8The actual acquisition cost of a drug acquired through the federal 340B Drug Pricing
167.9Program shall be estimated by the commissioner at wholesale acquisition cost minus 44
167.10percent. Wholesale acquisition cost is defined as the manufacturer's list price for a drug or
167.11biological to wholesalers or direct purchasers in the United States, not including prompt
167.12pay or other discounts, rebates, or reductions in price, for the most recent month for which
167.13information is available, as reported in wholesale price guides or other publications of
167.14drug or biological pricing data. The maximum allowable cost of a multisource drug may
167.15be set by the commissioner and it shall be comparable to, but no higher than, the maximum
167.16amount paid by other third-party payors in this state who have maximum allowable cost
167.17programs. Establishment of the amount of payment for drugs shall not be subject to the
167.18requirements of the Administrative Procedure Act.
167.19    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
167.20to pharmacists for legend drug prescriptions dispensed to residents of long-term care
167.21facilities when a unit dose blister card system, approved by the department, is used. Under
167.22this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. The
167.23National Drug Code (NDC) from the drug container used to fill the blister card must be
167.24identified on the claim to the department. The unit dose blister card containing the drug
167.25must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, that
167.26govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider will
167.27be required to credit the department for the actual acquisition cost of all unused drugs that
167.28are eligible for reuse. The commissioner may permit the drug clozapine to be dispensed in
167.29a quantity that is less than a 30-day supply.
167.30    (c) Whenever a maximum allowable cost has been set for a multisource drug,
167.31payment shall be the lower of the usual and customary price charged to the public or the
167.32maximum allowable cost established by the commissioner unless prior authorization
167.33for the brand name product has been granted according to the criteria established by
167.34the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the
167.35prescriber has indicated "dispense as written" on the prescription in a manner consistent
167.36with section 151.21, subdivision 2.
168.1    (d) The basis for determining the amount of payment for drugs administered in an
168.2outpatient setting shall be the lower of the usual and customary cost submitted by the
168.3provider or, 106 percent of the average sales price as determined by the United States
168.4Department of Health and Human Services pursuant to title XVIII, section 1847a of the
168.5federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
168.6set by the commissioner. If average sales price is unavailable, the amount of payment
168.7must be lower of the usual and customary cost submitted by the provider or, the wholesale
168.8acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the
168.9commissioner. The commissioner shall discount the payment rate for drugs obtained
168.10through the federal 340B Drug Pricing Program by 33 percent. The payment for drugs
168.11administered in an outpatient setting shall be made to the administering facility or
168.12practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
168.13outpatient setting is not eligible for direct reimbursement.
168.14    (e) The commissioner may negotiate lower reimbursement rates for specialty
168.15pharmacy products than the rates specified in paragraph (a). The commissioner may
168.16require individuals enrolled in the health care programs administered by the department
168.17to obtain specialty pharmacy products from providers with whom the commissioner has
168.18negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
168.19used by a small number of recipients or recipients with complex and chronic diseases
168.20that require expensive and challenging drug regimens. Examples of these conditions
168.21include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
168.22C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
168.23of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
168.24biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies
168.25that require complex care. The commissioner shall consult with the formulary committee
168.26to develop a list of specialty pharmacy products subject to this paragraph. In consulting
168.27with the formulary committee in developing this list, the commissioner shall take into
168.28consideration the population served by specialty pharmacy products, the current delivery
168.29system and standard of care in the state, and access to care issues. The commissioner shall
168.30have the discretion to adjust the reimbursement rate to prevent access to care issues.
168.31(f) Home infusion therapy services provided by home infusion therapy pharmacies
168.32must be paid at rates according to subdivision 8d.
168.33EFFECTIVE DATE.This section is effective January 1, 2014.

168.34    Sec. 9. Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to read:
169.1    Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical
169.2supplies and equipment. Separate payment outside of the facility's payment rate shall
169.3be made for wheelchairs and wheelchair accessories for recipients who are residents
169.4of intermediate care facilities for the developmentally disabled. Reimbursement for
169.5wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
169.6conditions and limitations as coverage for recipients who do not reside in institutions. A
169.7wheelchair purchased outside of the facility's payment rate is the property of the recipient.
169.8The commissioner may set reimbursement rates for specified categories of medical
169.9supplies at levels below the Medicare payment rate.
169.10(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
169.11must enroll as a Medicare provider.
169.12(c) When necessary to ensure access to durable medical equipment, prosthetics,
169.13orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
169.14enrollment requirement if:
169.15(1) the vendor supplies only one type of durable medical equipment, prosthetic,
169.16orthotic, or medical supply;
169.17(2) the vendor serves ten or fewer medical assistance recipients per year;
169.18(3) the commissioner finds that other vendors are not available to provide same or
169.19similar durable medical equipment, prosthetics, orthotics, or medical supplies; and
169.20(4) the vendor complies with all screening requirements in this chapter and Code of
169.21Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
169.22the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
169.23and Medicaid Services approved national accreditation organization as complying with
169.24the Medicare program's supplier and quality standards and the vendor serves primarily
169.25pediatric patients.
169.26(d) Durable medical equipment means a device or equipment that:
169.27(1) can withstand repeated use;
169.28(2) is generally not useful in the absence of an illness, injury, or disability; and
169.29(3) is provided to correct or accommodate a physiological disorder or physical
169.30condition or is generally used primarily for a medical purpose.
169.31(e) Electronic tablets may be considered durable medical equipment if the electronic
169.32tablet will be used as an augmentative and alternative communication system as defined
169.33under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
169.34must be locked in order to prevent use not related to communication.

170.1    Sec. 10. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
170.2subdivision to read:
170.3    Subd. 31b. Preferred diabetic testing supply program. (a) The commissioner
170.4shall adopt and implement a point of sale preferred diabetic testing supply program by
170.5January 1, 2014. Medical assistance coverage for diabetic testing supplies shall conform
170.6to the limitations established under the program. The commissioner may enter into a
170.7contract with a vendor for the purpose of participating in a preferred diabetic testing
170.8supply list and supplemental rebate program. The commissioner shall ensure that any
170.9contract meets all federal requirements and maximizes federal financial participation. The
170.10commissioner shall maintain an accurate and up-to-date list on the agency Web site.
170.11(b) The commissioner may add to, delete from, and otherwise modify the preferred
170.12diabetic testing supply program drug list after consulting with the Drug Formulary
170.13Committee and appropriate medial specialists and providing public notice and the
170.14opportunity for public comment.
170.15(c) The commissioner shall adopt and administer the preferred diabetic testing
170.16supply program as part of the administration of the diabetic testing supply rebate program.
170.17Reimbursement for diabetic testing supplies not on the preferred diabetic testing supply
170.18list may be subject to prior authorization.
170.19(d) All claims for diabetic testing supplies in categories on the preferred diabetic
170.20testing supply list must be submitted by enrolled pharmacy providers using the most
170.21current National Council of Prescription Drug Providers electronic claims standard.
170.22(e) For purposes of this subdivision, "preferred diabetic testing supply list" means a
170.23list of diabetic testing supplies selected by the commissioner, for which prior authorization
170.24is not required.
170.25(f) The commissioner shall seek any federal waivers or approvals necessary to
170.26implement this subdivision.

170.27    Sec. 11. Minnesota Statutes 2012, section 256B.0625, subdivision 39, is amended to
170.28read:
170.29    Subd. 39. Childhood immunizations. Providers who administer pediatric vaccines
170.30within the scope of their licensure, and who are enrolled as a medical assistance provider,
170.31must enroll in the pediatric vaccine administration program established by section 13631
170.32of the Omnibus Budget Reconciliation Act of 1993. Medical assistance shall pay an
170.33$8.50 fee per dose for administration of the vaccine to children eligible for medical
170.34assistance. Medical assistance does not pay for vaccines that are available at no cost from
170.35the pediatric vaccine administration program.

171.1    Sec. 12. Minnesota Statutes 2012, section 256B.0625, subdivision 58, is amended to
171.2read:
171.3    Subd. 58. Early and periodic screening, diagnosis, and treatment services.
171.4Medical assistance covers early and periodic screening, diagnosis, and treatment services
171.5(EPSDT). The payment amount for a complete EPSDT screening shall not include charges
171.6for vaccines that are available at no cost to the provider and shall not exceed the rate
171.7established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.

171.8    Sec. 13. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to read:
171.9    Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
171.10assistance benefit plan shall include the following cost-sharing for all recipients, effective
171.11for services provided on or after September 1, 2011:
171.12    (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
171.13of this subdivision, a visit means an episode of service which is required because of
171.14a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
171.15ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
171.16midwife, advanced practice nurse, audiologist, optician, or optometrist;
171.17    (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
171.18this co-payment shall be increased to $20 upon federal approval;
171.19    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
171.20subject to a $12 per month maximum for prescription drug co-payments. No co-payments
171.21shall apply to antipsychotic drugs when used for the treatment of mental illness;
171.22(4) effective January 1, 2012, a family deductible equal to the maximum amount
171.23allowed under Code of Federal Regulations, title 42, part 447.54; and
171.24    (5) for individuals identified by the commissioner with income at or below 100
171.25percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
171.26percent of family income. For purposes of this paragraph, family income is the total
171.27earned and unearned income of the individual and the individual's spouse, if the spouse is
171.28enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
171.29    (b) Recipients of medical assistance are responsible for all co-payments and
171.30deductibles in this subdivision.
171.31(c) Notwithstanding paragraph (b), the commissioner, through the contracting
171.32process under sections 256B.69 and 256B.692, may allow managed care plans and
171.33county-based purchasing plans to waive the family deductible under paragraph (a),
171.34clause (4). The value of the family deductible shall not be included in the capitation
171.35payment to managed care plans and county-based purchasing plans. Managed care plans
172.1and county-based purchasing plans shall certify annually to the commissioner the dollar
172.2value of the family deductible.
172.3(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
172.4the family deductible described under paragraph (a), clause (4), from individuals and
172.5allow long-term care and waivered service providers to assume responsibility for payment.
172.6(e) Notwithstanding paragraph (b), the commissioner, through the contracting
172.7process under section 256B.0756 shall allow the pilot program in Hennepin County to
172.8waive co-payments. The value of the co-payments shall not be included in the capitation
172.9amount to the managed care organization.

172.10    Sec. 14. Minnesota Statutes 2012, section 256B.0756, is amended to read:
172.11256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
172.12(a) The commissioner, upon federal approval of a new waiver request or amendment
172.13of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey
172.14County, or both, to test alternative and innovative integrated health care delivery networks.
172.15(b) Individuals eligible for the pilot program shall be individuals who are eligible for
172.16medical assistance under section 256B.055, subdivision 15, and who reside in Hennepin
172.17County or Ramsey County. The commissioner may identify individuals to be enrolled in
172.18the Hennepin County pilot program based on zip code in Hennepin County or whether the
172.19individuals would benefit from an integrated health care delivery network.
172.20(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
172.21health care delivery network in their county of residence. The integrated health care
172.22delivery network in Hennepin County shall be a network, such as an accountable care
172.23organization or a community-based collaborative care network, created by or including
172.24Hennepin County Medical Center. The integrated health care delivery network in Ramsey
172.25County shall be a network, such as an accountable care organization or community-based
172.26collaborative care network, created by or including Regions Hospital.
172.27(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for
172.28Hennepin County and 3,500 enrollees for Ramsey County.
172.29(e) (d) In developing a payment system for the pilot programs, the commissioner
172.30shall establish a total cost of care for the recipients enrolled in the pilot programs that
172.31equals the cost of care that would otherwise be spent for these enrollees in the prepaid
172.32medical assistance program.
172.33(f) Counties may transfer funds necessary to support the nonfederal share of
172.34payments for integrated health care delivery networks in their county. Such transfers per
172.35county shall not exceed 15 percent of the expected expenses for county enrollees.
173.1(g) (e) The commissioner shall apply to the federal government for, or as appropriate,
173.2cooperate with counties, providers, or other entities that are applying for any applicable
173.3grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
173.4Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
173.5111-152, that would further the purposes of or assist in the creation of an integrated health
173.6care delivery network for the purposes of this subdivision, including, but not limited to, a
173.7global payment demonstration or the community-based collaborative care network grants.

173.8    Sec. 15. Minnesota Statutes 2012, section 256B.69, subdivision 5c, is amended to read:
173.9    Subd. 5c. Medical education and research fund. (a) The commissioner of human
173.10services shall transfer each year to the medical education and research fund established
173.11under section 62J.692, an amount specified in this subdivision. The commissioner shall
173.12calculate the following:
173.13(1) an amount equal to the reduction in the prepaid medical assistance payments as
173.14specified in this clause. Until January 1, 2002, the county medical assistance capitation
173.15base rate prior to plan specific adjustments and after the regional rate adjustments under
173.16subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
173.17metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
173.18January 1, 2002, the county medical assistance capitation base rate prior to plan specific
173.19adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
173.20metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
173.21facility and elderly waiver payments and demonstration project payments operating
173.22under subdivision 23 are excluded from this reduction. The amount calculated under
173.23this clause shall not be adjusted for periods already paid due to subsequent changes to
173.24the capitation payments;
173.25(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
173.26section;
173.27(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
173.28paid under this section; and
173.29(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
173.30under this section.
173.31(b) This subdivision shall be effective upon approval of a federal waiver which
173.32allows federal financial participation in the medical education and research fund. The
173.33amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount
173.34transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under
174.1paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally
174.2reduce the amount specified under paragraph (a), clause (1).
174.3(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
174.4shall transfer $21,714,000 each fiscal year to the medical education and research fund.
174.5(d) Beginning September 1, 2011, of the amount in paragraph (a), following the
174.6transfer under paragraph (c), the commissioner shall transfer to the medical education
174.7research fund $23,936,000 in fiscal years 2012 and 2013 and $36,744,000 $49,552,000 in
174.8fiscal year 2014 and thereafter.

174.9    Sec. 16. Minnesota Statutes 2012, section 256B.69, subdivision 31, is amended to read:
174.10    Subd. 31. Payment reduction. (a) Beginning September 1, 2011, the commissioner
174.11shall reduce payments and limit future rate increases paid to managed care plans and
174.12county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved
174.13on a statewide aggregate basis by program. The commissioner may use competitive
174.14bidding, payment reductions, or other reductions to achieve the reductions and limits
174.15in this subdivision.
174.16    (b) Beginning September 1, 2011, the commissioner shall reduce payments to
174.17managed care plans and county-based purchasing plans as follows:
174.18    (1) 2.0 percent for medical assistance elderly basic care. This shall not apply
174.19to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
174.20services;
174.21    (2) 2.82 percent for medical assistance families and children;
174.22    (3) 10.1 percent for medical assistance adults without children; and
174.23    (4) 6.0 percent for MinnesotaCare families and children.
174.24    (c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed
174.25care plans and county-based purchasing plans for calendar year 2012 to a percentage of
174.26the rates in effect on August 31, 2011, as follows:
174.27    (1) 98 percent for medical assistance elderly basic care. This shall not apply to
174.28Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
174.29services;
174.30    (2) 97.18 percent for medical assistance families and children;
174.31    (3) 89.9 percent for medical assistance adults without children; and
174.32    (4) 94 percent for MinnesotaCare families and children.
174.33    (d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit
174.34the maximum annual trend increases to rates paid to managed care plans and county-based
174.35purchasing plans as follows:
175.1    (1) 7.5 percent for medical assistance elderly basic care. This shall not apply
175.2to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
175.3services;
175.4    (2) 5.0 percent for medical assistance special needs basic care;
175.5    (3) 2.0 percent for medical assistance families and children;
175.6    (4) 3.0 percent for medical assistance adults without children;
175.7    (5) 3.0 percent for MinnesotaCare families and children; and
175.8    (6) 3.0 percent for MinnesotaCare adults without children.
175.9    (e) The commissioner may limit trend increases to less than the maximum.
175.10Beginning July January 1, 2014, the commissioner shall limit the maximum annual trend
175.11increases to rates paid to managed care plans and county-based purchasing plans as
175.12follows for calendar years 2014 and 2015:
175.13    (1) 7.5 3.25 percent for medical assistance elderly basic care. This shall not apply
175.14to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
175.15services;
175.16    (2) 5.0 2.5 percent for medical assistance special needs basic care;
175.17    (3) 2.0 percent for medical assistance families and children;
175.18    (4) 3.0 percent for medical assistance adults without children;
175.19    (5) 3.0 percent for MinnesotaCare families and children; and
175.20    (6) 4.0 3.0 percent for MinnesotaCare adults without children.
175.21    The commissioner may limit trend increases to less than the maximum.

175.22    Sec. 17. Minnesota Statutes 2012, section 256B.76, subdivision 2, is amended to read:
175.23    Subd. 2. Dental reimbursement. (a) Effective for services rendered on or after
175.24October 1, 1992, the commissioner shall make payments for dental services as follows:
175.25    (1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
175.26percent above the rate in effect on June 30, 1992; and
175.27    (2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
175.28percentile of 1989, less the percent in aggregate necessary to equal the above increases.
175.29    (b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
175.30shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.
175.31    (c) Effective for services rendered on or after January 1, 2000, payment rates for
175.32dental services shall be increased by three percent over the rates in effect on December
175.3331, 1999.
176.1    (d) Effective for services provided on or after January 1, 2002, payment for
176.2diagnostic examinations and dental x-rays provided to children under age 21 shall be the
176.3lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.
176.4    (e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
176.52000, for managed care.
176.6(f) Effective for dental services rendered on or after October 1, 2010, by a
176.7state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
176.8on the Medicare principles of reimbursement. This payment shall be effective for services
176.9rendered on or after January 1, 2011, to recipients enrolled in managed care plans or
176.10county-based purchasing plans.
176.11(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics
176.12in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal
176.13year, a supplemental state payment equal to the difference between the total payments
176.14in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated
176.15services for the operation of the dental clinics.
176.16(h) If the cost-based payment system for state-operated dental clinics described in
176.17paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
176.18designated as critical access dental providers under subdivision 4, paragraph (b), and shall
176.19receive the critical access dental reimbursement rate as described under subdivision 4,
176.20paragraph (a).
176.21(i) Effective for services rendered on or after September 1, 2011, through June 30,
176.222013, payment rates for dental services shall be reduced by three percent. This reduction
176.23does not apply to state-operated dental clinics in paragraph (f).
176.24(j) Effective for services rendered on or after January 1, 2014, payment rates for
176.25dental services shall be increased by five percent from the rates in effect on December
176.2631, 2013. This increase does not apply to state-operated dental clinics in paragraph (f),
176.27federally qualified health centers, rural health centers, and Indian health services. Effective
176.28January 1, 2014, payments made to managed care plans and county-based purchasing
176.29plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
176.30described in this paragraph.

176.31    Sec. 18. Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:
176.32    Subd. 4. Critical access dental providers. (a) Effective for dental services
176.33rendered on or after January 1, 2002, the commissioner shall increase reimbursements
176.34to dentists and dental clinics deemed by the commissioner to be critical access dental
176.35providers. For dental services rendered on or after July 1, 2007, the commissioner shall
177.1increase reimbursement by 30 percent above the reimbursement rate that would otherwise
177.2be paid to the critical access dental provider. The commissioner shall pay the managed
177.3care plans and county-based purchasing plans in amounts sufficient to reflect increased
177.4reimbursements to critical access dental providers as approved by the commissioner.
177.5    (b) The commissioner shall designate the following dentists and dental clinics as
177.6critical access dental providers:
177.7    (1) nonprofit community clinics that:
177.8    (i) have nonprofit status in accordance with chapter 317A;
177.9    (ii) have tax exempt status in accordance with the Internal Revenue Code, section
177.10501(c)(3);
177.11    (iii) are established to provide oral health services to patients who are low income,
177.12uninsured, have special needs, and are underserved;
177.13    (iv) have professional staff familiar with the cultural background of the clinic's
177.14patients;
177.15    (v) charge for services on a sliding fee scale designed to provide assistance to
177.16low-income patients based on current poverty income guidelines and family size;
177.17    (vi) do not restrict access or services because of a patient's financial limitations
177.18or public assistance status; and
177.19    (vii) have free care available as needed;
177.20    (2) federally qualified health centers, rural health clinics, and public health clinics;
177.21    (3) city or county owned and operated hospital-based dental clinics;
177.22    (4) a dental clinic or dental group that is part of a dental group owned and operated
177.23by a nonprofit corporation in accordance with chapter 317A with more than 10,000 dental
177.24group patient encounters per year with patients who are uninsured or covered by medical
177.25assistance, general assistance medical care, or MinnesotaCare, if more than 50 percent
177.26of the individual dental clinic's patient encounters per year are with patients who are
177.27uninsured or covered by medical assistance or MinnesotaCare; and
177.28    (5) a dental clinic owned and operated by the University of Minnesota or the
177.29Minnesota State Colleges and Universities system.; and
177.30    (6) private practicing dentists if:
177.31    (i) the dentist's office is located within a health professional shortage area as defined
177.32under Code of Federal Regulations, title 42, part 5, and United States Code, title 42,
177.33section 254E;
177.34    (ii) more than 50 percent of the dentist's patient encounters per year are with patients
177.35who are uninsured or covered by medical assistance or MinnesotaCare;
178.1    (iii) the dentist does not restrict access or services because of a patient's financial
178.2limitations or public assistance status; and
178.3    (iv) the level of service provided by the dentist is critical to maintaining adequate
178.4levels of patient access within the service area in which the dentist operates.
178.5    (c) The commissioner may designate a dentist or dental clinic as a critical access
178.6dental provider if the dentist or dental clinic is willing to provide care to patients covered
178.7by medical assistance, general assistance medical care, or MinnesotaCare at a level which
178.8significantly increases access to dental care in the service area.
178.9    (d) A designated critical access clinic shall receive the reimbursement rate specified
178.10in paragraph (a) for dental services provided off site at a private dental office if the
178.11following requirements are met:
178.12    (1) the designated critical access dental clinic is located within a health professional
178.13shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
178.14States Code, title 42, section 254E, and is located outside the seven-county metropolitan
178.15area;
178.16    (2) the designated critical access dental clinic is not able to provide the service
178.17and refers the patient to the off-site dentist;
178.18    (3) the service, if provided at the critical access dental clinic, would be reimbursed
178.19at the critical access reimbursement rate;
178.20    (4) the dentist and allied dental professionals providing the services off site are
178.21licensed and in good standing under chapter 150A;
178.22    (5) the dentist providing the services is enrolled as a medical assistance provider;
178.23    (6) the critical access dental clinic submits the claim for services provided off site
178.24and receives the payment for the services; and
178.25    (7) the critical access dental clinic maintains dental records for each claim submitted
178.26under this paragraph, including the name of the dentist, the off-site location, and the
178.27license number of the dentist and allied dental professionals providing the services.

178.28    Sec. 19. Minnesota Statutes 2012, section 256B.76, is amended by adding a
178.29subdivision to read:
178.30    Subd. 7. Payment for certain primary care services and immunization
178.31administration. Payment for certain primary care services and immunization
178.32administration services rendered on or after January 1, 2013, through December 31, 2014,
178.33shall be made in accordance with section 1902(a)(13) of the Social Security Act.

179.1    Sec. 20. Minnesota Statutes 2012, section 256B.764, is amended to read:
179.2256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
179.3    (a) Effective for services rendered on or after July 1, 2007, payment rates for family
179.4planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
179.5when these services are provided by a community clinic as defined in section 145.9268,
179.6subdivision 1.
179.7    (b) Effective for services rendered on or after July 1, 2013, payment rates for
179.8family planning services shall be increased by 20 percent over the rates in effect June
179.930, 2013, when these services are provided by a community clinic as defined in section
179.10145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care
179.11and county-based purchasing plans to reflect this increase, and shall require plans to pass
179.12on the full amount of the rate increase to eligible community clinics, in the form of higher
179.13payment rates for family planning services.
179.14EFFECTIVE DATE.This section is effective July 1, 2013.

179.15    Sec. 21. Minnesota Statutes 2012, section 256B.766, is amended to read:
179.16256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
179.17(a) Effective for services provided on or after July 1, 2009, total payments for basic
179.18care services, shall be reduced by three percent, except that for the period July 1, 2009,
179.19through June 30, 2011, total payments shall be reduced by 4.5 percent for the medical
179.20assistance and general assistance medical care programs, prior to third-party liability and
179.21spenddown calculation. Effective July 1, 2010, the commissioner shall classify physical
179.22therapy services, occupational therapy services, and speech-language pathology and
179.23related services as basic care services. The reduction in this paragraph shall apply to
179.24physical therapy services, occupational therapy services, and speech-language pathology
179.25and related services provided on or after July 1, 2010.
179.26(b) Payments made to managed care plans and county-based purchasing plans shall
179.27be reduced for services provided on or after October 1, 2009, to reflect the reduction
179.28effective July 1, 2009, and payments made to the plans shall be reduced effective October
179.291, 2010, to reflect the reduction effective July 1, 2010.
179.30(c) Effective for services provided on or after September 1, 2011, through June 30,
179.312013, total payments for outpatient hospital facility fees shall be reduced by five percent
179.32from the rates in effect on August 31, 2011.
179.33(d) Effective for services provided on or after September 1, 2011, through June
179.3430, 2013, total payments for ambulatory surgery centers facility fees, medical supplies
180.1and durable medical equipment not subject to a volume purchase contract, prosthetics
180.2and orthotics, renal dialysis services, laboratory services, public health nursing services,
180.3physical therapy services, occupational therapy services, speech therapy services,
180.4eyeglasses not subject to a volume purchase contract, hearing aids not subject to a volume
180.5purchase contract, anesthesia services, and hospice services shall be reduced by three
180.6percent from the rates in effect on August 31, 2011.
180.7(e) This section does not apply to physician and professional services, inpatient
180.8hospital services, family planning services, mental health services, dental services,
180.9prescription drugs, medical transportation, federally qualified health centers, rural health
180.10centers, Indian health services, and Medicare cost-sharing.
180.11(f) For services provided on or after July 1, 2013, fee-for-service payments made
180.12to pediatric hospitals as referenced in the Social Security Act, section 1886(d)(1)(B)(iii)
180.13and nonstate government hospitals located in cities of the first class for the provision of
180.14outpatient basic care services to persons under age 21 shall be increased by one percent,
180.15subject to an aggregate spending limit under this paragraph of $450,000 for the biennium
180.16ending June 30, 2015.

180.17    Sec. 22. PAYMENT FOR MULTIPLE SERVICES PROVIDED ON THE SAME
180.18DAY.
180.19The commissioner of human services shall report by December 15, 2013, to the
180.20chairs and ranking minority members of the legislative committees with jurisdiction over
180.21health and human services policy and finance on the costs and savings to the medical
180.22assistance program of allowing medical assistance payment, including supplemental
180.23payments, for mental health services or dental services provided to a patient by a federally
180.24qualified health center, federally qualified health care center look-alike, or a rural health
180.25clinic on the same day as other covered health services furnished by the same provider.

180.26    Sec. 23. DENTAL ADMINISTRATION AND REIMBURSEMENT REPORT.
180.27(a) The commissioner of human services shall study the feasibility of a single
180.28administrator for all dental services provided under medical assistance and MinnesotaCare.
180.29Dental services shall include services provided through the prepaid medical assistance
180.30program and the fee-for-service system administered by the Department of Human
180.31Services. The commissioner's study shall address and include recommendations on:
180.32(1) possible administrative savings under a single administrator;
180.33(2) current reimbursement levels and alternative reimbursement that could target
180.34funding to assure greater access to dental services;
181.1(3) flexible scheduling and the coordination of referrals to encourage greater
181.2participation from private dental practitioners and clinics;
181.3(4) approaches to reduce emergency room visits; and
181.4(5) the use of a streamlined information system to provide information on patient
181.5eligibility and restrictions on benefits.
181.6(b) The commissioner shall also make recommendations on service delivery and
181.7reimbursement methods, including the continuation or modification of critical access dental
181.8provider payments under sections 256B.76, subdivision 4, and 256L.11, subdivision 7.
181.9(c) In conducting the study, the commissioner shall consult with dental providers
181.10currently providing services to enrollees of Minnesota health care programs, including
181.11those receiving enhanced payments through critical access dental provider payments,
181.12private practice dentists, safety net clinics, and the University of Minnesota Dental School.
181.13(d) The commissioner shall submit a report and recommendations relating to dental
181.14administration and reimbursement to the chairs and ranking minority members of the
181.15legislative committees with jurisdiction over health and human services policy and finance
181.16by December 15, 2013.

181.17    Sec. 24. REQUEST FOR INFORMATION; EMERGENCY MEDICAL
181.18ASSISTANCE.
181.19(a) The commissioner of human services shall issue a request for information (RFI)
181.20to identify and develop options for a program to provide emergency medical assistance
181.21recipients with coverage for medically necessary services not eligible for federal financial
181.22participation. The RFI must focus on providing coverage for nonemergent services
181.23for recipients who have two or more chronic conditions and have had two or more
181.24hospitalizations covered by emergency medical assistance in a one-year period.
181.25(b) The RFI must be issued by August 1, 2013, and require respondents to submit
181.26information to the commissioner by November 1, 2013. The RFI must request information
181.27on:
181.28(1) services necessary to reduce emergency department and inpatient hospital use for
181.29emergency medical assistance recipients;
181.30(2) methods of service delivery that promote efficiency and cost-effectiveness, and
181.31provide statewide access;
181.32(3) funding options for the services to be covered under the program;
181.33(4) coordination of service delivery and funding with services covered under
181.34emergency medical assistance;
181.35(5) options for program administration; and
182.1(6) methods to evaluate the program, including evaluation of cost-effectiveness and
182.2health outcomes for those emergency medical assistance recipients eligible for coverage
182.3of additional services under the program.
182.4(c) The commissioner shall make information submitted in response to the RFI
182.5available on the agency Web site. The commissioner, based on the responses to the RFI,
182.6shall submit recommendations on providing emergency medical assistance recipients
182.7with coverage for nonemergent services, as described in paragraph (a), to the chairs and
182.8ranking minority members of the legislative committees with jurisdiction over health and
182.9human services policy and finance by January 15, 2014.


182.12    Section 1. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
182.13    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
182.14initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
182.152960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
182.169555.6265, under this chapter for a physical location that will not be the primary residence
182.17of the license holder for the entire period of licensure. If a license is issued during this
182.18moratorium, and the license holder changes the license holder's primary residence away
182.19from the physical location of the foster care license, the commissioner shall revoke the
182.20license according to section 245A.07. Exceptions to the moratorium include:
182.21(1) foster care settings that are required to be registered under chapter 144D;
182.22(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
182.23and determined to be needed by the commissioner under paragraph (b);
182.24(3) new foster care licenses determined to be needed by the commissioner under
182.25paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or
182.26restructuring of state-operated services that limits the capacity of state-operated facilities;
182.27(4) new foster care licenses determined to be needed by the commissioner under
182.28paragraph (b) for persons requiring hospital level care; or
182.29(5) new foster care licenses determined to be needed by the commissioner for the
182.30transition of people from personal care assistance to the home and community-based
182.31services.
182.32(b) The commissioner shall determine the need for newly licensed foster care homes
182.33as defined under this subdivision. As part of the determination, the commissioner shall
182.34consider the availability of foster care capacity in the area in which the licensee seeks to
182.35operate, and the recommendation of the local county board. The determination by the
183.1commissioner must be final. A determination of need is not required for a change in
183.2ownership at the same address.
183.3(c) The commissioner shall study the effects of the license moratorium under this
183.4subdivision and shall report back to the legislature by January 15, 2011. This study shall
183.5include, but is not limited to the following:
183.6(1) the overall capacity and utilization of foster care beds where the physical location
183.7is not the primary residence of the license holder prior to and after implementation
183.8of the moratorium;
183.9(2) the overall capacity and utilization of foster care beds where the physical
183.10location is the primary residence of the license holder prior to and after implementation
183.11of the moratorium; and
183.12(3) the number of licensed and occupied ICF/MR beds prior to and after
183.13implementation of the moratorium.
183.14(d) (c) When a foster care recipient moves out of a foster home that is not the
183.15primary residence of the license holder according to section 256B.49, subdivision 15,
183.16paragraph (f), the county shall immediately inform the Department of Human Services
183.17Licensing Division. The department shall decrease the statewide licensed capacity for
183.18foster care settings where the physical location is not the primary residence of the license
183.19holder, if the voluntary changes described in paragraph (f) (e) are not sufficient to meet the
183.20savings required by reductions in licensed bed capacity under Laws 2011, First Special
183.21Session chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide
183.22long-term care residential services capacity within budgetary limits. Implementation of
183.23the statewide licensed capacity reduction shall begin on July 1, 2013. The commissioner
183.24shall delicense up to 128 beds by June 30, 2014, using the needs determination process.
183.25Under this paragraph, the commissioner has the authority to reduce unused licensed
183.26capacity of a current foster care program to accomplish the consolidation or closure of
183.27settings. A decreased licensed capacity according to this paragraph is not subject to appeal
183.28under this chapter.
183.29(e) (d) Residential settings that would otherwise be subject to the decreased license
183.30capacity established in paragraph (d) (c) shall be exempt under the following circumstances:
183.31(1) until August 1, 2013, the license holder's beds occupied by residents whose
183.32primary diagnosis is mental illness and the license holder is:
183.33(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
183.34health services (ARMHS) as defined in section 256B.0623;
183.35(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
183.369520.0870;
184.1(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
184.29520.0870; or
184.3(iv) a provider of intensive residential treatment services (IRTS) licensed under
184.4Minnesota Rules, parts 9520.0500 to 9520.0670; or
184.5(2) the license holder is certified under the requirements in subdivision 6a.
184.6(f) (e) A resource need determination process, managed at the state level, using the
184.7available reports required by section 144A.351, and other data and information shall
184.8be used to determine where the reduced capacity required under paragraph (d) (c) will
184.9be implemented. The commissioner shall consult with the stakeholders described in
184.10section 144A.351, and employ a variety of methods to improve the state's capacity to
184.11meet long-term care service needs within budgetary limits, including seeking proposals
184.12from service providers or lead agencies to change service type, capacity, or location to
184.13improve services, increase the independence of residents, and better meet needs identified
184.14by the long-term care services reports and statewide data and information. By February
184.151 of each 2013 and August 1 of 2014 and each following year, the commissioner shall
184.16provide information and data on the overall capacity of licensed long-term care services,
184.17actions taken under this subdivision to manage statewide long-term care services and
184.18supports resources, and any recommendations for change to the legislative committees
184.19with jurisdiction over health and human services budget.
184.20    (g) (f) At the time of application and reapplication for licensure, the applicant and the
184.21license holder that are subject to the moratorium or an exclusion established in paragraph
184.22(a) are required to inform the commissioner whether the physical location where the foster
184.23care will be provided is or will be the primary residence of the license holder for the entire
184.24period of licensure. If the primary residence of the applicant or license holder changes, the
184.25applicant or license holder must notify the commissioner immediately. The commissioner
184.26shall print on the foster care license certificate whether or not the physical location is the
184.27primary residence of the license holder.
184.28    (h) (g) License holders of foster care homes identified under paragraph (g) (f) that
184.29are not the primary residence of the license holder and that also provide services in the
184.30foster care home that are covered by a federally approved home and community-based
184.31services waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must
184.32inform the human services licensing division that the license holder provides or intends to
184.33provide these waiver-funded services. These license holders must be considered registered
184.34under section 256B.092, subdivision 11, paragraph (c), and this registration status must
184.35be identified on their license certificates.

185.1    Sec. 2. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
185.2to read:
185.3    Subd. 35. Commissioner must annually report certain prepaid medical
185.4assistance plan data. (a) The commissioner of human services and the commissioner
185.5of education may share private or nonpublic data to allow the commissioners to analyze
185.6the screening, diagnosis, and treatment of children with autism spectrum disorder and
185.7other developmental conditions. The commissioners may share the individual-level data
185.8necessary to:
185.9    (1) measure the prevalence of autism spectrum disorder and other developmental
185.10conditions;
185.11    (2) analyze the effectiveness of existing policies and procedures in the early
185.12identification of children with autism spectrum disorder and other developmental
185.13conditions;
185.14    (3) assess the effectiveness of screening, diagnosis, and treatment to allow children
185.15with autism spectrum disorder and other developmental conditions to meet developmental
185.16and social-emotional milestones;
185.17    (4) identify and address disparities in screening, diagnosis, and treatment related
185.18to the native language or race and ethnicity of the child;
185.19    (5) measure the effectiveness of public health care programs in addressing the medical
185.20needs of children with autism spectrum disorder and other developmental conditions; and
185.21    (6) determine the capacity of educational systems and health care systems to meet
185.22the needs of children with autism spectrum disorder and other developmental conditions.
185.23    (b) The commissioner of human services shall use the data shared with the
185.24commissioner of education under this subdivision to improve public health care program
185.25performance in early screening, diagnosis, and treatment for children once data are
185.26available and shall report on the results and any summary data, as defined in section 13.02,
185.27subdivision 19, on the department's public Web site by September 30 each year.

185.28    Sec. 3. Minnesota Statutes 2012, section 256.9657, subdivision 1, is amended to read:
185.29    Subdivision 1. Nursing home license surcharge. (a) Effective July 1, 1993,
185.30each non-state-operated nursing home licensed under chapter 144A shall pay to the
185.31commissioner an annual surcharge according to the schedule in subdivision 4. The
185.32surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds
185.33is reduced, the surcharge shall be based on the number of remaining licensed beds the
185.34second month following the receipt of timely notice by the commissioner of human
185.35services that beds have been delicensed. The nursing home must notify the commissioner
186.1of health in writing when beds are delicensed. The commissioner of health must notify
186.2the commissioner of human services within ten working days after receiving written
186.3notification. If the notification is received by the commissioner of human services by
186.4the 15th of the month, the invoice for the second following month must be reduced
186.5to recognize the delicensing of beds. Beds on layaway status continue to be subject to
186.6the surcharge. The commissioner of human services must acknowledge a medical care
186.7surcharge appeal within 30 days of receipt of the written appeal from the provider.
186.8(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
186.9(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased
186.10to $990.
186.11(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased
186.12to $2,815.
186.13(e) Effective July 15, 2015, the surcharge under paragraph (d) shall be decreased
186.14to $2,375.
186.15(e) (f) The commissioner may reduce, and may subsequently restore, the surcharge
186.16under paragraph (d) (e) based on the commissioner's determination of a permissible
186.17surcharge.
186.18(f) (g) Between April 1, 2002, and August 15, 2004 July 1, 2015, and June 30, 2016,
186.19a facility governed by this subdivision may elect to assume full participation in the medical
186.20assistance program by agreeing to comply with all of the requirements of the medical
186.21assistance program, including the rate equalization law in section 256B.48, subdivision 1,
186.22paragraph (a), and all other requirements established in law or rule, and to begin intake
186.23of new medical assistance recipients. Rates will be determined under Minnesota Rules,
186.24parts 9549.0010 to 9549.0080. Rate calculations will be subject to limits as prescribed
186.25in rule and law. Other than the adjustments in sections 256B.431, subdivisions 30 and
186.2632; 256B.437, subdivision 3, paragraph (b), Minnesota Rules, part 9549.0057, and any
186.27other applicable legislation enacted prior to the finalization of rates, facilities assuming
186.28full participation in medical assistance under this paragraph are not eligible for any rate
186.29adjustments until the July 1 following their settle-up period.
186.30EFFECTIVE DATE.This section is effective July 1, 2015.

186.31    Sec. 4. Minnesota Statutes 2012, section 256.9657, subdivision 3a, is amended to read:
186.32    Subd. 3a. ICF/MR ICF/DD license surcharge. (a) Effective July 1, 2003, each
186.33non-state-operated facility as defined under section 256B.501, subdivision 1, shall pay
186.34to the commissioner an annual surcharge according to the schedule in subdivision 4,
186.35paragraph (d). The annual surcharge shall be $1,040 per licensed bed. If the number of
187.1licensed beds is reduced, the surcharge shall be based on the number of remaining licensed
187.2beds the second month following the receipt of timely notice by the commissioner of
187.3human services that beds have been delicensed. The facility must notify the commissioner
187.4of health in writing when beds are delicensed. The commissioner of health must notify
187.5the commissioner of human services within ten working days after receiving written
187.6notification. If the notification is received by the commissioner of human services by
187.7the 15th of the month, the invoice for the second following month must be reduced to
187.8recognize the delicensing of beds. The commissioner may reduce, and may subsequently
187.9restore, the surcharge under this subdivision based on the commissioner's determination of
187.10a permissible surcharge.
187.11(b) Effective July 1, 2013, the surcharge under paragraph (a) is increased to$3,679
187.12per licensed bed.
187.13EFFECTIVE DATE.This section is effective July 1, 2013.

187.14    Sec. 5. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to read:
187.15    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a)
187.16It is the policy of the state of Minnesota to ensure that individuals with disabilities or
187.17chronic illness are served in the most integrated setting appropriate to their needs and have
187.18the necessary information to make informed choices about home and community-based
187.19service options.
187.20    (b) Individuals under 65 years of age who are admitted to a nursing facility from a
187.21hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.
187.22    (c) Individuals under 65 years of age who are admitted to nursing facilities with
187.23only a telephone screening must receive a face-to-face assessment from the long-term
187.24care consultation team member of the county in which the facility is located or from the
187.25recipient's county case manager within 40 calendar days of admission.
187.26    (d) Individuals under 65 years of age who are admitted to a nursing facility
187.27without preadmission screening according to the exemption described in subdivision 4b,
187.28paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
187.29a face-to-face assessment within 40 days of admission.
187.30    (e) At the face-to-face assessment, the long-term care consultation team member or
187.31county case manager must perform the activities required under subdivision 3b.
187.32    (f) For individuals under 21 years of age, a screening interview which recommends
187.33nursing facility admission must be face-to-face and approved by the commissioner before
187.34the individual is admitted to the nursing facility.
188.1    (g) In the event that an individual under 65 years of age is admitted to a nursing
188.2facility on an emergency basis, the county must be notified of the admission on the
188.3next working day, and a face-to-face assessment as described in paragraph (c) must be
188.4conducted within 40 calendar days of admission.
188.5    (h) At the face-to-face assessment, the long-term care consultation team member or
188.6the case manager must present information about home and community-based options,
188.7including consumer-directed options, so the individual can make informed choices. If the
188.8individual chooses home and community-based services, the long-term care consultation
188.9team member or case manager must complete a written relocation plan within 20 working
188.10days of the visit. The plan shall describe the services needed to move out of the facility
188.11and a time line for the move which is designed to ensure a smooth transition to the
188.12individual's home and community.
188.13    (i) An individual under 65 years of age residing in a nursing facility shall receive a
188.14face-to-face assessment at least every 12 months to review the person's service choices
188.15and available alternatives unless the individual indicates, in writing, that annual visits are
188.16not desired. In this case, the individual must receive a face-to-face assessment at least
188.17once every 36 months for the same purposes.
188.18    (j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
188.19county agencies directly for face-to-face assessments for individuals under 65 years of age
188.20who are being considered for placement or residing in a nursing facility. Until September
188.2130, 2013, payments for individuals under 65 years of age shall be made as described
188.22in this subdivision.

188.23    Sec. 6. Minnesota Statutes 2012, section 256B.0911, subdivision 6, is amended to read:
188.24    Subd. 6. Payment for long-term care consultation services. (a) Until September
188.2530, 2013, payment for long-term care consultation face-to-face assessment shall be made
188.26as described in this subdivision.
188.27    (b) The total payment for each county must be paid monthly by certified nursing
188.28facilities in the county. The monthly amount to be paid by each nursing facility for each
188.29fiscal year must be determined by dividing the county's annual allocation for long-term
188.30care consultation services by 12 to determine the monthly payment and allocating the
188.31monthly payment to each nursing facility based on the number of licensed beds in the
188.32nursing facility. Payments to counties in which there is no certified nursing facility must be
188.33made by increasing the payment rate of the two facilities located nearest to the county seat.
189.1    (b) (c) The commissioner shall include the total annual payment determined under
189.2paragraph (a) for each nursing facility reimbursed under section 256B.431, 256B.434,
189.3or 256B.441.
189.4    (c) (d) In the event of the layaway, delicensure and decertification, or removal from
189.5layaway of 25 percent or more of the beds in a facility, the commissioner may adjust the
189.6per diem payment amount in paragraph (b) (c) and may adjust the monthly payment
189.7amount in paragraph (a). The effective date of an adjustment made under this paragraph
189.8shall be on or after the first day of the month following the effective date of the layaway,
189.9delicensure and decertification, or removal from layaway.
189.10    (d) (e) Payments for long-term care consultation services are available to the county
189.11or counties to cover staff salaries and expenses to provide the services described in
189.12subdivision 1a. The county shall employ, or contract with other agencies to employ,
189.13within the limits of available funding, sufficient personnel to provide long-term care
189.14consultation services while meeting the state's long-term care outcomes and objectives as
189.15defined in subdivision 1. The county shall be accountable for meeting local objectives
189.16as approved by the commissioner in the biennial home and community-based services
189.17quality assurance plan on a form provided by the commissioner.
189.18    (e) (f) Notwithstanding section 256B.0641, overpayments attributable to payment
189.19of the screening costs under the medical assistance program may not be recovered from
189.20a facility.
189.21    (f) (g) The commissioner of human services shall amend the Minnesota medical
189.22assistance plan to include reimbursement for the local consultation teams.
189.23    (g) (h) Until the alternative payment methodology in paragraph (h) (i) is implemented,
189.24the county may bill, as case management services, assessments, support planning, and
189.25follow-along provided to persons determined to be eligible for case management under
189.26Minnesota health care programs. No individual or family member shall be charged for an
189.27initial assessment or initial support plan development provided under subdivision 3a or 3b.
189.28(h) (i) The commissioner shall develop an alternative payment methodology,
189.29effective on October 1, 2013, for long-term care consultation services that includes
189.30the funding available under this subdivision, and for assessments authorized under
189.31sections 256B.092 and 256B.0659. In developing the new payment methodology, the
189.32commissioner shall consider the maximization of other funding sources, including federal
189.33administrative reimbursement through federal financial participation funding, for all
189.34long-term care consultation and preadmission screening activity. The alternative payment
189.35methodology shall include the use of the appropriate time studies and the state financing
189.36of nonfederal share as part of the state's medical assistance program.

190.1    Sec. 7. Minnesota Statutes 2012, section 256B.0916, is amended by adding a
190.2subdivision to read:
190.3    Subd. 11. Excess spending. County and tribal agencies are responsible for spending
190.4in excess of the allocation made by the commissioner. In the event a county or tribal
190.5agency spends in excess of the allocation made by the commissioner for a given allocation
190.6period, they must submit a corrective action plan to the commissioner. The plan must state
190.7the actions the agency will take to correct their overspending for the year following the
190.8period when the overspending occurred. Failure to correct overspending shall result in
190.9recoupment of spending in excess of the allocation. Nothing in this subdivision shall be
190.10construed as reducing the county's responsibility to offer and make available feasible
190.11home and community-based options to eligible waiver recipients within the resources
190.12allocated to them for that purpose.

190.13    Sec. 8. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
190.14    Subd. 11. Residential support services. (a) Upon federal approval, there is
190.15established a new service called residential support that is available on the community
190.16alternative care, community alternatives for disabled individuals, developmental
190.17disabilities, and brain injury waivers. Existing waiver service descriptions must be
190.18modified to the extent necessary to ensure there is no duplication between other services.
190.19Residential support services must be provided by vendors licensed as a community
190.20residential setting as defined in section 245A.11, subdivision 8.
190.21    (b) Residential support services must meet the following criteria:
190.22    (1) providers of residential support services must own or control the residential site;
190.23    (2) the residential site must not be the primary residence of the license holder;
190.24    (3) the residential site must have a designated program supervisor responsible for
190.25program oversight, development, and implementation of policies and procedures;
190.26    (4) the provider of residential support services must provide supervision, training,
190.27and assistance as described in the person's coordinated service and support plan; and
190.28    (5) the provider of residential support services must meet the requirements of
190.29licensure and additional requirements of the person's coordinated service and support plan.
190.30    (c) Providers of residential support services that meet the definition in paragraph
190.31(a) must be registered using a process determined by the commissioner beginning July
190.321, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
190.332960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
190.349555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
190.357 , paragraph (g) (f), are considered registered under this section.

191.1    Sec. 9. Minnesota Statutes 2012, section 256B.092, subdivision 12, is amended to read:
191.2    Subd. 12. Waivered services statewide priorities. (a) The commissioner shall
191.3establish statewide priorities for individuals on the waiting list for developmental
191.4disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must
191.5include, but are not limited to, individuals who continue to have a need for waiver services
191.6after they have maximized the use of state plan services and other funding resources,
191.7including natural supports, prior to accessing waiver services, and who meet at least one
191.8of the following criteria:
191.9(1) have unstable living situations due to the age, incapacity, or sudden loss of
191.10the primary caregivers;
191.11(2) are moving from an institution due to bed closures;
191.12(3) experience a sudden closure of their current living arrangement;
191.13(4) require protection from confirmed abuse, neglect, or exploitation;
191.14(5) experience a sudden change in need that can no longer be met through state plan
191.15services or other funding resources alone; or
191.16(6) meet other priorities established by the department.
191.17(b) When allocating resources to lead agencies, the commissioner must take into
191.18consideration the number of individuals waiting who meet statewide priorities and the
191.19lead agencies' current use of waiver funds and existing service options. The commissioner
191.20has the authority to transfer funds between counties, groups of counties, and tribes to
191.21accommodate statewide priorities and resource needs while accounting for a necessary
191.22base level reserve amount for each county, group of counties, and tribe.
191.23(c) The commissioner shall evaluate the impact of the use of statewide priorities and
191.24provide recommendations to the legislature on whether to continue the use of statewide
191.25priorities in the November 1, 2011, annual report required by the commissioner in sections
191.26256B.0916, subdivision 7, and 256B.49, subdivision 21.

191.27    Sec. 10. [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
191.28    Subdivision 1. Purpose. This section creates a new benefit to provide early intensive
191.29intervention to a child with an autism spectrum disorder diagnosis. This benefit shall be
191.30available under the medical assistance state plan when federal approval consistent with the
191.31provisions in subdivision 11 is obtained for a 1915(i) waiver pursuant to the Affordable
191.32Care Act, section 2402(c), amending United States Code, title 42, section 1396n(i)(1),
191.33or other option. This benefit must provide coverage for diagnosis, multidisciplinary
191.34assessment, ongoing progress evaluation, and medically necessary treatment of autism
191.35spectrum disorder.
192.1    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
192.2this subdivision have the meanings given.
192.3    (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
192.4current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
192.5    (c) "Child" means a person under the age of 18.
192.6    (d) "Commissioner" means the commissioner of human services, unless otherwise
192.7specified.
192.8    (e) "Early intensive intervention benefit" means autism treatment options based in
192.9behavioral and developmental science, which may include modalities such as applied
192.10behavior analysis, developmental treatment approaches, and naturalistic and parent
192.11training models.
192.12    (f) "Generalizable goals" means results or gains that are observed during a variety
192.13of activities with different people, such as providers, family members, other adults, and
192.14children, and in different environments including, but not limited to, clinics, homes,
192.15schools, and the community.
192.16    Subd. 3. Initial eligibility. This benefit is available to a child enrolled in medical
192.17assistance who:
192.18    (1) has an autism spectrum disorder diagnosis;
192.19    (2) has had a diagnostic assessment described in subdivision 5, which recommends
192.20early intensive intervention services; and
192.21    (3) meets the criteria for medically necessary autism early intensive intervention
192.22services.
192.23    Subd. 4. Diagnosis. (a) A diagnosis must:
192.24    (1) be based upon current DSM criteria including direct observations of the child
192.25and reports from parents or primary caregivers;
192.26    (2) be completed by a professional who has expertise and training in autism spectrum
192.27disorder and child development and who is a licensed physician, or nurse practitioner,
192.28and a licensed mental health professional until the commissioner's assessment required in
192.29subdivision 8, clause (7), shows there are adequate professionals to avoid access problems
192.30or delays in diagnosis for young children if two professionals are required for a diagnosis
192.31pursuant to clause (3); and
192.32    (3) be completed by both a licensed physician or nurse practitioner and a mental
192.33health professional who have expertise and training in autism spectrum disorder and
192.34child development when the assessment in subdivision 8, clause (7), demonstrates that
192.35there are sufficient professionals available.
193.1    (b) Additional diagnostic assessment information may be considered including from
193.2special education evaluations and licensed school personnel, and from professionals
193.3licensed in the fields of medicine, speech and language, psychology, occupational therapy,
193.4and physical therapy.
193.5    Subd. 5. Diagnostic assessment. The following information and assessments must
193.6be performed, reviewed, and relied upon for the eligibility determination, treatment and
193.7services recommendations, and treatment plan development for the child:
193.8    (1) an assessment of the child's developmental skills, functional behavior, needs,
193.9and capacities based on direct observation of the child which must be administered by
193.10a licensed mental health professional and may also include observations from family
193.11members, licensed school personnel, child care providers, or other caregivers, as well as
193.12any medical or assessment information from other licensed professionals such as the
193.13child's physician, rehabilitation therapists, or mental health professionals; and
193.14    (2) an assessment of parental or caregiver capacity to participate in therapy including
193.15the type and level of parental or caregiver involvement and training recommended.
193.16    Subd. 6. Treatment plan. (a) Each child's treatment plan must be:
193.17    (1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
193.18    (2) coordinated with medically necessary occupational, physical, and speech and
193.19language therapies, special education, and other services the child and family are receiving;
193.20    (3) family-centered;
193.21    (4) culturally sensitive; and
193.22    (5) individualized based on the child's developmental status and the child's and
193.23family's identified needs.
193.24    (b) The treatment plan must specify the:
193.25    (1) child's goals which are developmentally appropriate, functional, and
193.26generalizable;
193.27    (2) treatment modality;
193.28    (3) treatment intensity;
193.29    (4) setting; and
193.30    (5) level and type of parental or caregiver involvement.
193.31    (c) The treatment must be supervised by a professional with expertise and training in
193.32autism and child development who is a licensed physician, nurse practitioner, or mental
193.33health professional.
193.34    (d) The treatment plan must be submitted to the commissioner for approval in a
193.35manner determined by the commissioner for this purpose.
193.36    (e) Services authorized must be consistent with the child's approved treatment plan.
194.1    Subd. 7. Ongoing eligibility. (a) An independent progress evaluation conducted
194.2by a licensed mental health professional with expertise and training in autism spectrum
194.3disorder and child development must be completed after each six months of treatment,
194.4or more frequently as determined by the commissioner, to determine if progress is being
194.5made toward achieving generalizable goals and meeting functional goals contained in
194.6the treatment plan.
194.7    (b) The progress evaluation must include:
194.8    (1) the treating provider's report;
194.9    (2) parental or caregiver input;
194.10    (3) an independent observation of the child which can be performed by the child's
194.11licensed special education staff;
194.12    (4) any treatment plan modifications; and
194.13    (5) recommendations for continued treatment services.
194.14    (c) Progress evaluations must be submitted to the commissioner in a manner
194.15determined by the commissioner for this purpose.
194.16    (d) A child who continues to achieve generalizable goals and treatment goals as
194.17specified in the treatment plan is eligible to continue receiving this benefit.
194.18    (e) A child's treatment shall continue during the progress evaluation and during an
194.19appeal pursuant to section 256.045, if continuation of services pending appeal has been
194.20requested within ten days of receipt of notice of reduction or termination or before the
194.21effective date of the action.
194.22    Subd. 8. Refining the benefit with stakeholders. The commissioner must develop
194.23the implementation details of the benefit in consultation with stakeholders and consider
194.24recommendations from the Health Services Advisory Council, the Department of Human
194.25Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum
194.26Disorder Task Force, and the Interagency Task Force of the Departments of Health,
194.27Education, and Human Services. The commissioner must release these details for a 30-day
194.28public comment period prior to submission to the federal government for approval. The
194.29implementation details must include, but are not limited to, the following components:
194.30    (1) a definition of the qualifications, standards, and roles of the treatment team,
194.31including recommendations after stakeholder consultation on whether board-certified
194.32behavior analysts and other types of professionals trained in autism spectrum disorder and
194.33child development should be added as mental health or other professionals for treatment
194.34supervision or other functions under medical assistance;
194.35    (2) development of initial, uniform parameters for comprehensive multidisciplinary
194.36diagnostic assessment information and progress evaluation standards;
195.1    (3) the design of an effective and consistent process for assessing parent and
195.2caregiver capacity to participate in the child's early intervention treatment and methods of
195.3involving the parents and caregivers in the treatment of the child;
195.4    (4) formulation of a collaborative process in which professionals have opportunities
195.5to collectively inform the comprehensive, multidisciplinary diagnostic assessment and
195.6progress evaluation processes and standards to support quality improvement of early
195.7intensive intervention services;
195.8    (5) coordination of this benefit and its interaction with other services provided by the
195.9Departments of Human Services, Health, and Education;
195.10    (6) evaluation, on an ongoing basis, of research regarding the program and treatment
195.11modalities provided to children under this benefit; and
195.12    (7) determination of the availability of licensed physicians, nurse practitioners,
195.13and mental health professionals with expertise and training in autism spectrum disorder
195.14throughout the state to assess whether there are sufficient professionals to require
195.15involvement of both a physician or nurse practitioner and a mental health professional to
195.16provide access and prevent delay in the diagnosis and treatment of young children and to
195.17ensure treatment is effective, timely, and accessible.
195.18    Subd. 9. Revision of treatment options. (a) The commissioner may revise covered
195.19treatment options as needed based on outcome data and other evidence.
195.20    (b) Before the changes become effective, the commissioner must provide public
195.21notice of the changes, the reasons for the change, and a 30-day public comment period
195.22to those who request notice through an electronic list accessible to the public on the
195.23department's Web site.
195.24    Subd. 10. Coordination between agencies. The commissioners of human services
195.25and education must develop the capacity to coordinate services and information including
195.26diagnostic, functional, developmental, medical, and educational assessments; service
195.27delivery; and progress evaluations across health and education sectors.
195.28    Subd. 11. Federal approval of the autism benefit. The provisions of subdivision 9
195.29shall apply to state plan services under Title XIX of the Social Security Act when federal
195.30approval is granted under a 1915(i) waiver or other authority which allows children
195.31eligible for medical assistance through the TEFRA option under section 256B.055,
195.32subdivision 12, to qualify and includes children eligible for medical assistance in families
195.33over 150 percent of the federal poverty guidelines.
195.34EFFECTIVE DATE.The autism benefit under subdivisions 1 to 7, and 9, is
195.35effective upon federal approval for the benefit under a 1915(i) waiver or other federal
196.1authority needed to meet the requirements of subdivision 11, but no earlier than March 1,
196.22014. Subdivisions 8, 10, and 11 are effective July 1, 2013.

196.3    Sec. 11. Minnesota Statutes 2012, section 256B.095, is amended to read:
196.4256B.095 QUALITY ASSURANCE SYSTEM ESTABLISHED.
196.5    (a) Effective July 1, 1998, a quality assurance system for persons with developmental
196.6disabilities, which includes an alternative quality assurance licensing system for programs,
196.7is established in Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice,
196.8Steele, Wabasha, and Winona Counties for the purpose of improving the quality of
196.9services provided to persons with developmental disabilities. A county, at its option, may
196.10choose to have all programs for persons with developmental disabilities located within
196.11the county licensed under chapter 245A using standards determined under the alternative
196.12quality assurance licensing system or may continue regulation of these programs under the
196.13licensing system operated by the commissioner. The project expires on June 30, 2014.
196.14    (b) Effective July 1, 2003, a county not listed in paragraph (a) may apply to
196.15participate in the quality assurance system established under paragraph (a). The
196.16commission established under section 256B.0951 may, at its option, allow additional
196.17counties to participate in the system.
196.18    (c) Effective July 1, 2003, any county or group of counties not listed in paragraph (a)
196.19may establish a quality assurance system under this section. A new system established
196.20under this section shall have the same rights and duties as the system established
196.21under paragraph (a). A new system shall be governed by a commission under section
196.22256B.0951 . The commissioner shall appoint the initial commission members based
196.23on recommendations from advocates, families, service providers, and counties in the
196.24geographic area included in the new system. Counties that choose to participate in a
196.25new system shall have the duties assigned under section 256B.0952. The new system
196.26shall establish a quality assurance process under section 256B.0953. The provisions of
196.27section 256B.0954 shall apply to a new system established under this paragraph. The
196.28commissioner shall delegate authority to a new system established under this paragraph
196.29according to section 256B.0955.
196.30    (d) Effective July 1, 2007, the quality assurance system may be expanded to include
196.31programs for persons with disabilities and older adults.
196.32(e) Effective July 1, 2013, a provider of service located in a county listed in
196.33paragraph (a) that is a non-opted-in county may opt-in to the quality assurance system
196.34provided the county where services are provided indicates its agreement with a county
196.35with a delegation agreement with the Department of Human Services.
197.1EFFECTIVE DATE.This section is effective July 1, 2013.

197.2    Sec. 12. Minnesota Statutes 2012, section 256B.0951, subdivision 1, is amended to read:
197.3    Subdivision 1. Membership. The Quality Assurance Commission is established.
197.4The commission consists of at least 14 but not more than 21 members as follows: at
197.5least three but not more than five members representing advocacy organizations; at
197.6least three but not more than five members representing consumers, families, and their
197.7legal representatives; at least three but not more than five members representing service
197.8providers; at least three but not more than five members representing counties; and the
197.9commissioner of human services or the commissioner's designee. The first commission
197.10shall establish membership guidelines for the transition and recruitment of membership for
197.11the commission's ongoing existence. Members of the commission who do not receive a
197.12salary or wages from an employer for time spent on commission duties may receive a per
197.13diem payment when performing commission duties and functions. All members may be
197.14reimbursed for expenses related to commission activities. Notwithstanding the provisions
197.15of section 15.059, subdivision 5, the commission expires on June 30, 2014.

197.16    Sec. 13. Minnesota Statutes 2012, section 256B.0951, subdivision 4, is amended to read:
197.17    Subd. 4. Commission's authority to recommend variances of licensing
197.18standards. The commission may recommend to the commissioners of human services
197.19and health variances from the standards governing licensure of programs for persons with
197.20developmental disabilities in order to improve the quality of services by implementing
197.21an alternative developmental disabilities licensing system if the commission determines
197.22that the alternative licensing system does not adversely affect the health or safety of
197.23persons being served by the licensed program nor compromise the qualifications of staff
197.24to provide services.

197.25    Sec. 14. Minnesota Statutes 2012, section 256B.0952, subdivision 1, is amended to read:
197.26    Subdivision 1. Notification. Counties or providers shall give notice to the
197.27commission and commissioners of human services and health of intent to join the
197.28alternative quality assurance licensing system. A county or provider choosing to participate
197.29in the alternative quality assurance licensing system commits to participate for three years.

197.30    Sec. 15. Minnesota Statutes 2012, section 256B.0952, subdivision 5, is amended to read:
197.31    Subd. 5. Quality assurance teams. Quality assurance teams shall be comprised
197.32of county staff; providers; consumers, families, and their legal representatives; members
198.1of advocacy organizations; and other involved community members. Team members
198.2must satisfactorily complete the training program approved by the commission and must
198.3demonstrate performance-based competency. Team members are not considered to be
198.4county employees for purposes of workers' compensation, unemployment insurance, or
198.5state retirement laws solely on the basis of participation on a quality assurance team. The
198.6county may pay A per diem may be paid to team members for time spent on alternative
198.7quality assurance process matters. All team members may be reimbursed for expenses
198.8related to their participation in the alternative process.

198.9    Sec. 16. Minnesota Statutes 2012, section 256B.097, subdivision 1, is amended to read:
198.10    Subdivision 1. Scope. (a) In order to improve the quality of services provided to
198.11Minnesotans with disabilities and to meet the requirements of the federally approved home
198.12and community-based waivers under section 1915c of the Social Security Act, a State
198.13Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving
198.14disability services is enacted. This system is a partnership between the Department of
198.15Human Services and the State Quality Council established under subdivision 3.
198.16    (b) This system is a result of the recommendations from the Department of Human
198.17Services' licensing and alternative quality assurance study mandated under Laws 2005,
198.18First Special Session chapter 4, article 7, section 57, and presented to the legislature
198.19in February 2007.
198.20    (c) The disability services eligible under this section include:
198.21    (1) the home and community-based services waiver programs for persons with
198.22developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
198.23including brain injuries and services for those who qualify for nursing facility level of care
198.24or hospital facility level of care and any other services licensed under chapter 245D;
198.25    (2) home care services under section 256B.0651;
198.26    (3) family support grants under section 252.32;
198.27    (4) consumer support grants under section 256.476;
198.28    (5) semi-independent living services under section 252.275; and
198.29    (6) services provided through an intermediate care facility for the developmentally
198.30disabled.
198.31    (d) For purposes of this section, the following definitions apply:
198.32    (1) "commissioner" means the commissioner of human services;
198.33    (2) "council" means the State Quality Council under subdivision 3;
198.34    (3) "Quality Assurance Commission" means the commission under section
198.35256B.0951 ; and
199.1    (4) "system" means the State Quality Assurance, Quality Improvement and
199.2Licensing System under this section.

199.3    Sec. 17. Minnesota Statutes 2012, section 256B.097, subdivision 3, is amended to read:
199.4    Subd. 3. State Quality Council. (a) There is hereby created a State Quality
199.5Council which must define regional quality councils, and carry out a community-based,
199.6person-directed quality review component, and a comprehensive system for effective
199.7incident reporting, investigation, analysis, and follow-up.
199.8    (b) By August 1, 2011, the commissioner of human services shall appoint the
199.9members of the initial State Quality Council. Members shall include representatives
199.10from the following groups:
199.11    (1) disability service recipients and their family members;
199.12    (2) during the first two four years of the State Quality Council, there must be at least
199.13three members from the Region 10 stakeholders. As regional quality councils are formed
199.14under subdivision 4, each regional quality council shall appoint one member;
199.15    (3) disability service providers;
199.16    (4) disability advocacy groups; and
199.17    (5) county human services agencies and staff from the Department of Human
199.18Services and Ombudsman for Mental Health and Developmental Disabilities.
199.19    (c) Members of the council who do not receive a salary or wages from an employer
199.20for time spent on council duties may receive a per diem payment when performing council
199.21duties and functions.
199.22    (d) The State Quality Council shall:
199.23    (1) assist the Department of Human Services in fulfilling federally mandated
199.24obligations by monitoring disability service quality and quality assurance and
199.25improvement practices in Minnesota;
199.26    (2) establish state quality improvement priorities with methods for achieving results
199.27and provide an annual report to the legislative committees with jurisdiction over policy
199.28and funding of disability services on the outcomes, improvement priorities, and activities
199.29undertaken by the commission during the previous state fiscal year;
199.30(3) identify issues pertaining to financial and personal risk that impede Minnesotans
199.31with disabilities from optimizing choice of community-based services; and
199.32(4) recommend to the chairs and ranking minority members of the legislative
199.33committees with jurisdiction over human services and civil law by January 15, 2013
199.34 2014, statutory and rule changes related to the findings under clause (3) that promote
200.1individualized service and housing choices balanced with appropriate individualized
200.2protection.
200.3    (e) The State Quality Council, in partnership with the commissioner, shall:
200.4    (1) approve and direct implementation of the community-based, person-directed
200.5system established in this section;
200.6    (2) recommend an appropriate method of funding this system, and determine the
200.7feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;
200.8    (3) approve measurable outcomes in the areas of health and safety, consumer
200.9evaluation, education and training, providers, and systems;
200.10    (4) establish variable licensure periods not to exceed three years based on outcomes
200.11achieved; and
200.12    (5) in cooperation with the Quality Assurance Commission, design a transition plan
200.13for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.
200.14    (f) The State Quality Council shall notify the commissioner of human services that a
200.15facility, program, or service has been reviewed by quality assurance team members under
200.16subdivision 4, paragraph (b), clause (13), and qualifies for a license.
200.17    (g) The State Quality Council, in partnership with the commissioner, shall establish
200.18an ongoing review process for the system. The review shall take into account the
200.19comprehensive nature of the system which is designed to evaluate the broad spectrum of
200.20licensed and unlicensed entities that provide services to persons with disabilities. The
200.21review shall address efficiencies and effectiveness of the system.
200.22    (h) The State Quality Council may recommend to the commissioner certain
200.23variances from the standards governing licensure of programs for persons with disabilities
200.24in order to improve the quality of services so long as the recommended variances do
200.25not adversely affect the health or safety of persons being served or compromise the
200.26qualifications of staff to provide services.
200.27    (i) The safety standards, rights, or procedural protections referenced under
200.28subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make
200.29recommendations to the commissioner or to the legislature in the report required under
200.30paragraph (c) regarding alternatives or modifications to the safety standards, rights, or
200.31procedural protections referenced under subdivision 2, paragraph (c).
200.32    (j) The State Quality Council may hire staff to perform the duties assigned in this
200.33subdivision.

200.34    Sec. 18. Minnesota Statutes 2012, section 256B.431, subdivision 44, is amended to read:
201.1    Subd. 44. Property rate increase increases for a facility in Bloomington effective
201.2November 1, 2010 certain nursing facilities. (a) Notwithstanding any other law to the
201.3contrary, money available for moratorium projects under section 144A.073, subdivision
201.411 , shall be used, effective November 1, 2010, to fund an approved moratorium exception
201.5project for a nursing facility in Bloomington licensed for 137 beds as of November 1,
201.62010, up to a total property rate adjustment of $19.33.
201.7(b) Effective June 1, 2012, any nursing facility in McLeod County licensed for 110
201.8beds shall have its replacement-cost-new limit under subdivision 17e adjusted to allow
201.9$1,129,463 of a completed construction project to increase the property payment rate.
201.10Notwithstanding any other law to the contrary, money available under section 144A.073,
201.11subdivision 11, after the completion of the moratorium exception approval process in 2013
201.12under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to the
201.13medical assistance budget for the increase in the replacement-cost-new limit.
201.14    (c) Effective July 1, 2013, or later, any boarding care facility in Hennepin
201.15County licensed for 100 beds shall be allowed to receive a property rate adjustment
201.16for a construction project that takes action to come into compliance with Minnesota
201.17Department of Labor and Industry elevator upgrade requirements, with costs below the
201.18minimum threshold under subdivision 16. Only costs related to the construction project
201.19that brings the facility into compliance with the elevator requirements shall be allowed.
201.20Notwithstanding any other law to the contrary, money available under section 144A.073,
201.21subdivision 11, after the completion of the moratorium exception approval process in
201.222013 under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to
201.23the medical assistance program.
201.24EFFECTIVE DATE.Paragraph (b) is effective retroactively from June 1, 2012.

201.25    Sec. 19. Minnesota Statutes 2012, section 256B.434, subdivision 4, is amended to read:
201.26    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which
201.27have their payment rates determined under this section rather than section 256B.431, the
201.28commissioner shall establish a rate under this subdivision. The nursing facility must enter
201.29into a written contract with the commissioner.
201.30    (b) A nursing facility's case mix payment rate for the first rate year of a facility's
201.31contract under this section is the payment rate the facility would have received under
201.32section 256B.431.
201.33    (c) A nursing facility's case mix payment rates for the second and subsequent years
201.34of a facility's contract under this section are the previous rate year's contract payment
201.35rates plus an inflation adjustment and, for facilities reimbursed under this section or
202.1section 256B.431, an adjustment to include the cost of any increase in Health Department
202.2licensing fees for the facility taking effect on or after July 1, 2001. The index for the
202.3inflation adjustment must be based on the change in the Consumer Price Index-All Items
202.4(United States City average) (CPI-U) forecasted by the commissioner of management and
202.5budget's national economic consultant, as forecasted in the fourth quarter of the calendar
202.6year preceding the rate year. The inflation adjustment must be based on the 12-month
202.7period from the midpoint of the previous rate year to the midpoint of the rate year for
202.8which the rate is being determined. For the rate years beginning on July 1, 1999, July 1,
202.92000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006,
202.10July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall
202.11apply only to the property-related payment rate. For the rate years beginning on October
202.121, 2011, and October 1, 2012, October 1, 2013, October 1, 2014, October 1, 2015, and
202.13October 1, 2016, the rate adjustment under this paragraph shall be suspended. Beginning
202.14in 2005, adjustment to the property payment rate under this section and section 256B.431
202.15shall be effective on October 1. In determining the amount of the property-related payment
202.16rate adjustment under this paragraph, the commissioner shall determine the proportion of
202.17the facility's rates that are property-related based on the facility's most recent cost report.
202.18    (d) The commissioner shall develop additional incentive-based payments of up to
202.19five percent above a facility's operating payment rate for achieving outcomes specified
202.20in a contract. The commissioner may solicit contract amendments and implement those
202.21which, on a competitive basis, best meet the state's policy objectives. The commissioner
202.22shall limit the amount of any incentive payment and the number of contract amendments
202.23under this paragraph to operate the incentive payments within funds appropriated for this
202.24purpose. The contract amendments may specify various levels of payment for various
202.25levels of performance. Incentive payments to facilities under this paragraph may be in the
202.26form of time-limited rate adjustments or onetime supplemental payments. In establishing
202.27the specified outcomes and related criteria, the commissioner shall consider the following
202.28state policy objectives:
202.29    (1) successful diversion or discharge of residents to the residents' prior home or other
202.30community-based alternatives;
202.31    (2) adoption of new technology to improve quality or efficiency;
202.32    (3) improved quality as measured in the Nursing Home Report Card;
202.33    (4) reduced acute care costs; and
202.34    (5) any additional outcomes proposed by a nursing facility that the commissioner
202.35finds desirable.
203.1    (e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
203.2take action to come into compliance with existing or pending requirements of the life
203.3safety code provisions or federal regulations governing sprinkler systems must receive
203.4reimbursement for the costs associated with compliance if all of the following conditions
203.5are met:
203.6    (1) the expenses associated with compliance occurred on or after January 1, 2005,
203.7and before December 31, 2008;
203.8    (2) the costs were not otherwise reimbursed under subdivision 4f or section
203.9144A.071 or 144A.073; and
203.10    (3) the total allowable costs reported under this paragraph are less than the minimum
203.11threshold established under section 256B.431, subdivision 15, paragraph (e), and
203.12subdivision 16.
203.13The commissioner shall use money appropriated for this purpose to provide to qualifying
203.14nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
203.152008. Nursing facilities that have spent money or anticipate the need to spend money
203.16to satisfy the most recent life safety code requirements by (1) installing a sprinkler
203.17system or (2) replacing all or portions of an existing sprinkler system may submit to the
203.18commissioner by June 30, 2007, on a form provided by the commissioner the actual
203.19costs of a completed project or the estimated costs, based on a project bid, of a planned
203.20project. The commissioner shall calculate a rate adjustment equal to the allowable
203.21costs of the project divided by the resident days reported for the report year ending
203.22September 30, 2006. If the costs from all projects exceed the appropriation for this
203.23purpose, the commissioner shall allocate the money appropriated on a pro rata basis to the
203.24qualifying facilities by reducing the rate adjustment determined for each facility by an
203.25equal percentage. Facilities that used estimated costs when requesting the rate adjustment
203.26shall report to the commissioner by January 31, 2009, on the use of this money on a
203.27form provided by the commissioner. If the nursing facility fails to provide the report, the
203.28commissioner shall recoup the money paid to the facility for this purpose. If the facility
203.29reports expenditures allowable under this subdivision that are less than the amount received
203.30in the facility's annualized rate adjustment, the commissioner shall recoup the difference.

203.31    Sec. 20. Minnesota Statutes 2012, section 256B.434, is amended by adding a
203.32subdivision to read:
203.33    Subd. 19a. Nursing facility rate adjustments beginning October 1, 2013. (a)
203.34For the rate year beginning October 1, 2013, the commissioner shall make available to
204.1each nursing facility reimbursed under this section a three percent operating payment
204.2rate increase.
204.3(b) Seventy-five percent of the money resulting from the rate adjustment under
204.4paragraph (a) must be used for increases in compensation-related costs for employees
204.5directly employed by the nursing facility on or after the effective date of the rate
204.6adjustment, except:
204.7(1) the administrator;
204.8(2) persons employed in the central office of a corporation that has an ownership
204.9interest in the nursing facility or exercises control over the nursing facility; and
204.10(3) persons paid by the nursing facility under a management contract.
204.11(c) The commissioner shall allow as compensation-related costs all costs for:
204.12(1) wages and salaries;
204.13(2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
204.14compensation;
204.15(3) the employer's share of health and dental insurance, life insurance, disability
204.16insurance, long-term care insurance, uniform allowance, and pensions; and
204.17(4) other benefits provided and workforce needs including the recruiting and training
204.18of employees, subject to the approval of the commissioner.
204.19(d) The portion of the rate adjustment under paragraph (a) that is not subject to the
204.20requirements of paragraph (b) shall be provided to nursing facilities effective October 1.
204.21Nursing facilities may apply for the portion of the rate adjustment under paragraph (a)
204.22that is subject to the requirements in paragraph (b). The application must be submitted
204.23to the commissioner within six months of the effective date of the rate adjustment, and
204.24the nursing facility must provide additional information required by the commissioner
204.25within nine months of the effective date of the rate adjustment. The commissioner must
204.26respond to all applications within three weeks of receipt. The commissioner may waive
204.27the deadlines in this paragraph under extraordinary circumstances, to be determined at the
204.28sole discretion of the commissioner. The application must contain:
204.29(1) an estimate of the amounts of money that must be used as specified in paragraph
204.30(b);
204.31(2) a detailed distribution plan specifying the allowable compensation-related and
204.32wage increases the nursing facility will implement to use the funds available in clause (1);
204.33(3) a description of how the nursing facility will notify eligible employees of
204.34the contents of the approved application, which must provide for giving each eligible
204.35employee a copy of the approved application, excluding the information required in clause
204.36(1), or posting a copy of the approved application, excluding the information required in
205.1clause (1), for a period of at least six weeks in an area of the nursing facility to which all
205.2eligible employees have access; and
205.3(4) instructions for employees who believe they have not received the
205.4compensation-related or wage increases specified in clause (2), as approved by the
205.5commissioner, and which must include a mailing address, e-mail address, and the
205.6telephone number that may be used by the employee to contact the commissioner or the
205.7commissioner's representative.
205.8(e) For the October 1, 2013, rate increase, the commissioner shall ensure that cost
205.9increases in distribution plans under paragraph (d), clause (2), that may be included in
205.10approved applications, comply with the following requirements:
205.11(1) a portion of the costs resulting from tenure-related wage or salary increases
205.12may be considered to be allowable wage increases, according to formulas that the
205.13commissioner shall provide, where employee retention is above the average statewide
205.14rate of retention of direct care employees;
205.15(2) the annualized amount of increases in costs for the employer's share of health
205.16and dental insurance, life insurance, disability insurance, and workers' compensation
205.17shall be allowable compensation-related increases if they are effective on or after April
205.181, 2013, and prior to April 1, 2014; and
205.19(3) for nursing facilities in which employees are represented by an exclusive
205.20bargaining representative, the commissioner shall approve the application only upon
205.21receipt of a letter of acceptance of the distribution plan, in regard to members of the
205.22bargaining unit, signed by the exclusive bargaining agent and dated after May 25, 2013.
205.23Upon receipt of the letter of acceptance, the commissioner shall deem all requirements of
205.24this provision as having been met in regard to the members of the bargaining unit.
205.25(f) The commissioner shall review applications received under paragraph (e) and
205.26shall provide the portion of the rate adjustment under paragraph (b) if the requirements
205.27of this statute have been met. The rate adjustment shall be effective October 1.
205.28Notwithstanding paragraph (a), if the approved application distributes less money than is
205.29available, the amount of the rate adjustment shall be reduced so that the amount of money
205.30made available is equal to the amount to be distributed.
205.31(g) The increase in this subdivision shall be applied as a total percentage to
205.32operating rates effective September 30, 2013, except that they shall not increase any
205.33performance-based incentive payments under section 256B.434, subdivision 4, paragraph
205.34(d), awarded prior to the effective date of the rate adjustment. Facilities receiving equitable
205.35cost-sharing for publicly owned nursing facilities program rate adjustments under section
206.1256B.441, subdivision 55a, must have rate increases under this paragraph computed based
206.2on rates in effect before the increases given under section 256B.441, subdivision 55a.

206.3    Sec. 21. Minnesota Statutes 2012, section 256B.437, subdivision 6, is amended to read:
206.4    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human
206.5services shall calculate the amount of the planned closure rate adjustment available under
206.6subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):
206.7(1) the amount available is the net reduction of nursing facility beds multiplied
206.8by $2,080;
206.9(2) the total number of beds in the nursing facility or facilities receiving the planned
206.10closure rate adjustment must be identified;
206.11(3) capacity days are determined by multiplying the number determined under
206.12clause (2) by 365; and
206.13(4) the planned closure rate adjustment is the amount available in clause (1), divided
206.14by capacity days determined under clause (3).
206.15(b) A planned closure rate adjustment under this section is effective on the first day
206.16of the month following completion of closure of the facility designated for closure in
206.17the application and becomes part of the nursing facility's total operating external fixed
206.18 payment rate.
206.19(c) Applicants may use the planned closure rate adjustment to allow for a property
206.20payment for a new nursing facility or an addition to an existing nursing facility or as
206.21an operating payment external fixed rate adjustment. Applications approved under this
206.22subdivision are exempt from other requirements for moratorium exceptions under section
206.23144A.073 , subdivisions 2 and 3.
206.24(d) Upon the request of a closing facility, the commissioner must allow the facility a
206.25closure rate adjustment as provided under section 144A.161, subdivision 10.
206.26(e) A facility that has received a planned closure rate adjustment may reassign it
206.27to another facility that is under the same ownership at any time within three years of its
206.28effective date. The amount of the adjustment shall be computed according to paragraph (a).
206.29(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
206.30the commissioner shall recalculate planned closure rate adjustments for facilities that
206.31delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
206.32bed dollar amount. The recalculated planned closure rate adjustment shall be effective
206.33from the date the per bed dollar amount is increased.
207.1(g) For planned closures approved after June 30, 2009, the commissioner of human
207.2services shall calculate the amount of the planned closure rate adjustment available under
207.3subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).
207.4(h) Beginning Between July 16, 2011, and June 30, 2013, the commissioner shall no
207.5longer not accept applications for planned closure rate adjustments under subdivision 3.

207.6    Sec. 22. Minnesota Statutes 2012, section 256B.441, subdivision 13, is amended to read:
207.7    Subd. 13. External fixed costs. "External fixed costs" means costs related to the
207.8nursing home surcharge under section 256.9657, subdivision 1; licensure fees under
207.9section 144.122; until September 30, 2013, long-term care consultation fees under
207.10section 256B.0911, subdivision 6; family advisory council fee under section 144A.33;
207.11scholarships under section 256B.431, subdivision 36; planned closure rate adjustments
207.12under section 256B.437; or single bed room incentives under section 256B.431,
207.13subdivision 42 ; property taxes and property insurance; and PERA.

207.14    Sec. 23. Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:
207.15    Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
207.16shall calculate a payment rate for external fixed costs.
207.17    (a) For a facility licensed as a nursing home, the portion related to section 256.9657
207.18shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
207.19home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
207.20result of its number of nursing home beds divided by its total number of licensed beds.
207.21    (b) The portion related to the licensure fee under section 144.122, paragraph (d),
207.22shall be the amount of the fee divided by actual resident days.
207.23    (c) The portion related to scholarships shall be determined under section 256B.431,
207.24subdivision 36.
207.25    (d) Until September 30, 2013, the portion related to long-term care consultation shall
207.26be determined according to section 256B.0911, subdivision 6.
207.27    (e) The portion related to development and education of resident and family advisory
207.28councils under section 144A.33 shall be $5 divided by 365.
207.29    (f) The portion related to planned closure rate adjustments shall be as determined
207.30under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.
207.31Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
207.32be included in the payment rate for external fixed costs beginning October 1, 2016.
207.33Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
208.1longer be included in the payment rate for external fixed costs beginning on October 1 of
208.2the first year not less than two years after their effective date.
208.3    (g) The portions related to property insurance, real estate taxes, special assessments,
208.4and payments made in lieu of real estate taxes directly identified or allocated to the nursing
208.5facility shall be the actual amounts divided by actual resident days.
208.6    (h) The portion related to the Public Employees Retirement Association shall be
208.7actual costs divided by resident days.
208.8    (i) The single bed room incentives shall be as determined under section 256B.431,
208.9subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
208.10no longer be included in the payment rate for external fixed costs beginning October 1,
208.112016. Single bed room incentives that take effect on or after October 1, 2014, shall no
208.12longer be included in the payment rate for external fixed costs beginning on October 1 of
208.13the first year not less than two years after their effective date.
208.14    (j) The payment rate for external fixed costs shall be the sum of the amounts in
208.15paragraphs (a) to (i).

208.16    Sec. 24. Minnesota Statutes 2012, section 256B.49, subdivision 11a, is amended to read:
208.17    Subd. 11a. Waivered services statewide priorities. (a) The commissioner shall
208.18establish statewide priorities for individuals on the waiting list for community alternative
208.19care, community alternatives for disabled individuals, and brain injury waiver services,
208.20as of January 1, 2010. The statewide priorities must include, but are not limited to,
208.21individuals who continue to have a need for waiver services after they have maximized the
208.22use of state plan services and other funding resources, including natural supports, prior to
208.23accessing waiver services, and who meet at least one of the following criteria:
208.24(1) have unstable living situations due to the age, incapacity, or sudden loss of
208.25the primary caregivers;
208.26(2) are moving from an institution due to bed closures;
208.27(3) experience a sudden closure of their current living arrangement;
208.28(4) require protection from confirmed abuse, neglect, or exploitation;
208.29(5) experience a sudden change in need that can no longer be met through state plan
208.30services or other funding resources alone; or
208.31(6) meet other priorities established by the department.
208.32(b) When allocating resources to lead agencies, the commissioner must take into
208.33consideration the number of individuals waiting who meet statewide priorities and the
208.34lead agencies' current use of waiver funds and existing service options. The commissioner
208.35has the authority to transfer funds between counties, groups of counties, and tribes to
209.1accommodate statewide priorities and resource needs while accounting for a necessary
209.2base level reserve amount for each county, group of counties, and tribe.
209.3(c) The commissioner shall evaluate the impact of the use of statewide priorities and
209.4provide recommendations to the legislature on whether to continue the use of statewide
209.5priorities in the November 1, 2011, annual report required by the commissioner in sections
209.6256B.0916, subdivision 7, and 256B.49, subdivision 21.

209.7    Sec. 25. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
209.8    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
209.9shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
209.10With the permission of the recipient or the recipient's designated legal representative,
209.11the recipient's current provider of services may submit a written report outlining their
209.12recommendations regarding the recipient's care needs prepared by a direct service
209.13employee with at least 20 hours of service to that client. The person conducting the
209.14assessment or reassessment must notify the provider of the date by which this information
209.15is to be submitted. This information shall be provided to the person conducting the
209.16assessment and the person or the person's legal representative and must be considered
209.17prior to the finalization of the assessment or reassessment.
209.18(b) There must be a determination that the client requires a hospital level of care or a
209.19nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
209.20(d), at initial and subsequent assessments to initiate and maintain participation in the
209.21waiver program.
209.22(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
209.23appropriate to determine nursing facility level of care for purposes of medical assistance
209.24payment for nursing facility services, only face-to-face assessments conducted according
209.25to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
209.26determination or a nursing facility level of care determination must be accepted for
209.27purposes of initial and ongoing access to waiver services payment.
209.28(d) Recipients who are found eligible for home and community-based services under
209.29this section before their 65th birthday may remain eligible for these services after their
209.3065th birthday if they continue to meet all other eligibility factors.
209.31(e) The commissioner shall develop criteria to identify recipients whose level of
209.32functioning is reasonably expected to improve and reassess these recipients to establish
209.33a baseline assessment. Recipients who meet these criteria must have a comprehensive
209.34transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
209.35reassessed every six months until there has been no significant change in the recipient's
210.1functioning for at least 12 months. Upon federal approval, if the recipient is able to have
210.2the recipient's needs met through alternative services in a less restrictive setting, the
210.3case manager shall help the recipient develop a plan to transition to an appropriate less
210.4restrictive setting. After there has been no significant change in the recipient's functioning
210.5for at least 12 months, reassessments of the recipient's strengths, informal support systems,
210.6and need for services shall be conducted at least every 12 months and at other times
210.7when there has been a significant change in the recipient's functioning. Counties, case
210.8managers, and service providers are responsible for conducting these reassessments and
210.9shall complete the reassessments out of existing funds.
210.10EFFECTIVE DATE.This section is effective January 1, 2014.

210.11    Sec. 26. Minnesota Statutes 2012, section 256B.49, subdivision 15, is amended to read:
210.12    Subd. 15. Coordinated service and support plan; comprehensive transitional
210.13service plan; maintenance service plan. (a) Each recipient of home and community-based
210.14waivered services shall be provided a copy of the written coordinated service and support
210.15plan which meets the requirements in section 256B.092, subdivision 1b.
210.16(b) In developing the comprehensive transitional service plan, the individual
210.17receiving services, the case manager, and the guardian, if applicable, will identify the
210.18transitional service plan fundamental service outcome and anticipated timeline to achieve
210.19this outcome. Within the first 20 days following a recipient's request for an assessment or
210.20reassessment, the transitional service planning team must be identified. A team leader must
210.21be identified who will be responsible for assigning responsibility and communicating with
210.22team members to ensure implementation of the transition plan and ongoing assessment and
210.23communication process. The team leader should be an individual, such as the case manager
210.24or guardian, who has the opportunity to follow the recipient to the next level of service.
210.25Within ten days following an assessment, a comprehensive transitional service plan
210.26must be developed incorporating elements of a comprehensive functional assessment and
210.27including short-term measurable outcomes and timelines for achievement of and reporting
210.28on these outcomes. Functional milestones must also be identified and reported according
210.29to the timelines agreed upon by the transitional service planning team. In addition, the
210.30comprehensive transitional service plan must identify additional supports that may assist
210.31in the achievement of the fundamental service outcome such as the development of greater
210.32natural community support, increased collaboration among agencies, and technological
210.33supports.
210.34The timelines for reporting on functional milestones will prompt a reassessment of
210.35services provided, the units of services, rates, and appropriate service providers. It is
211.1the responsibility of the transitional service planning team leader to review functional
211.2milestone reporting to determine if the milestones are consistent with observable skills
211.3and that milestone achievement prompts any needed changes to the comprehensive
211.4transitional service plan.
211.5For those whose fundamental transitional service outcome involves the need to
211.6procure housing, a plan for the recipient to seek the resources necessary to secure the least
211.7restrictive housing possible should be incorporated into the plan, including employment
211.8and public supports such as housing access and shelter needy funding.
211.9(c) Counties and other agencies responsible for funding community placement and
211.10ongoing community supportive services are responsible for the implementation of the
211.11comprehensive transitional service plans. Oversight responsibilities include both ensuring
211.12effective transitional service delivery and efficient utilization of funding resources.
211.13(d) Following one year of transitional services, the transitional services planning team
211.14will make a determination as to whether or not the individual receiving services requires
211.15the current level of continuous and consistent support in order to maintain the recipient's
211.16current level of functioning. Recipients who are determined to have not had a significant
211.17change in functioning for 12 months must move from a transitional to a maintenance
211.18service plan. Recipients on a maintenance service plan must be reassessed to determine if
211.19the recipient would benefit from a transitional service plan at least every 12 months and at
211.20other times when there has been a significant change in the recipient's functioning. This
211.21assessment should consider any changes to technological or natural community supports.
211.22(e) When a county is evaluating denials, reductions, or terminations of home and
211.23community-based services under section 256B.49 for an individual, the case manager
211.24shall offer to meet with the individual or the individual's guardian in order to discuss
211.25the prioritization of service needs within the coordinated service and support plan,
211.26comprehensive transitional service plan, or maintenance service plan. The reduction in
211.27the authorized services for an individual due to changes in funding for waivered services
211.28may not exceed the amount needed to ensure medically necessary services to meet the
211.29individual's health, safety, and welfare.
211.30(f) At the time of reassessment, local agency case managers shall assess each recipient
211.31of community alternatives for disabled individuals or brain injury waivered services
211.32currently residing in a licensed adult foster home that is not the primary residence of the
211.33license holder, or in which the license holder is not the primary caregiver, to determine if
211.34that recipient could appropriately be served in a community-living setting. If appropriate
211.35for the recipient, the case manager shall offer the recipient, through a person-centered
211.36planning process, the option to receive alternative housing and service options. In the
212.1event that the recipient chooses to transfer from the adult foster home, the vacated bed
212.2shall not be filled with another recipient of waiver services and group residential housing
212.3and the licensed capacity shall be reduced accordingly, unless the savings required by the
212.4licensed bed closure reductions under Laws 2011, First Special Session chapter 9, article 7,
212.5sections 1 and 40, paragraph (f), for foster care settings where the physical location is not
212.6the primary residence of the license holder are met through voluntary changes described
212.7in section 245A.03, subdivision 7, paragraph (f) (e), or as provided under paragraph (a),
212.8clauses (3) and (4). If the adult foster home becomes no longer viable due to these transfers,
212.9the county agency, with the assistance of the department, shall facilitate a consolidation of
212.10settings or closure. This reassessment process shall be completed by July 1, 2013.

212.11    Sec. 27. Minnesota Statutes 2012, section 256B.49, is amended by adding a
212.12subdivision to read:
212.13    Subd. 25. Excess allocations. County and tribal agencies will be responsible for
212.14authorizations in excess of the allocation made by the commissioner. In the event a county
212.15or tribal agency authorizes in excess of the allocation made by the commissioner for a
212.16given allocation period, they must submit a corrective action plan to the commissioner.
212.17The plan must state the actions the agency will take to correct their over-authorization for
212.18the year following the period when the over-authorization occurred. Failure to correct
212.19over-authorizations shall result in recoupment of authorizations in excess of the allocation.
212.20Nothing in this subdivision shall be construed as reducing the county's responsibility to
212.21offer and make available feasible home and community-based options to eligible waiver
212.22recipients within the resources allocated to them for that purpose.

212.23    Sec. 28. Minnesota Statutes 2012, section 256B.492, is amended to read:
212.24256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
212.25WITH DISABILITIES.
212.26(a) Individuals receiving services under a home and community-based waiver under
212.27section 256B.092 or 256B.49 may receive services in the following settings:
212.28(1) an individual's own home or family home;
212.29(2) a licensed adult foster care setting of up to five people; and
212.30(3) community living settings as defined in section 256B.49, subdivision 23, where
212.31individuals with disabilities may reside in all of the units in a building of four or fewer
212.32units, and no more than the greater of four or 25 percent of the units in a multifamily
212.33building of more than four units, unless required by the Housing Opportunities for Persons
212.34with AIDS program.
213.1(b) The settings in paragraph (a) must not:
213.2(1) be located in a building that is a publicly or privately operated facility that
213.3provides institutional treatment or custodial care;
213.4(2) be located in a building on the grounds of or adjacent to a public or private
213.5institution;
213.6(3) be a housing complex designed expressly around an individual's diagnosis or
213.7disability, unless required by the Housing Opportunities for Persons with AIDS program;
213.8(4) be segregated based on a disability, either physically or because of setting
213.9characteristics, from the larger community; and
213.10(5) have the qualities of an institution which include, but are not limited to:
213.11regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
213.12agreed to and documented in the person's individual service plan shall not result in a
213.13residence having the qualities of an institution as long as the restrictions for the person are
213.14not imposed upon others in the same residence and are the least restrictive alternative,
213.15imposed for the shortest possible time to meet the person's needs.
213.16(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
213.17individuals receive services under a home and community-based waiver as of July 1,
213.182012, and the setting does not meet the criteria of this section.
213.19(d) Notwithstanding paragraph (c), a program in Hennepin County established as
213.20part of a Hennepin County demonstration project is qualified for the exception allowed
213.21under paragraph (c).
213.22(e) The commissioner shall submit an amendment to the waiver plan no later than
213.23December 31, 2012.

213.24    Sec. 29. Minnesota Statutes 2012, section 256B.493, subdivision 2, is amended to read:
213.25    Subd. 2. Planned closure process needs determination. The commissioner shall
213.26announce and implement a program for planned closure of adult foster care homes. Planned
213.27closure shall be the preferred method for achieving necessary budgetary savings required by
213.28the licensed bed closure budget reduction in section 245A.03, subdivision 7, paragraph (d)
213.29 (c). If additional closures are required to achieve the necessary savings, the commissioner
213.30shall use the process and priorities in section 245A.03, subdivision 7, paragraph (d) (c).

213.31    Sec. 30. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
213.32subdivision to read:
213.33    Subd. 14. Rate increase effective June 1, 2013. For rate periods beginning on or
213.34after June 1, 2013, the commissioner shall increase the total operating payment rate for
214.1each facility reimbursed under this section by $7.81 per day. The increase shall not be
214.2subject to any annual percentage increase.
214.3EFFECTIVE DATE.This section is effective June 1, 2013.

214.4    Sec. 31. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
214.5subdivision to read:
214.6    Subd. 15. ICF/DD rate increases effective July 1, 2013. (a) Notwithstanding
214.7subdivision 12, for each facility reimbursed under this section, for the rate period
214.8beginning July 1, 2013, the commissioner shall increase operating payments equal to two
214.9percent of the operating payment rates in effect on June 30, 2013.
214.10(b) For each facility, the commissioner shall apply the rate increase based on
214.11occupied beds, using the percentage specified in this subdivision multiplied by the total
214.12payment rate, including the variable rate, but excluding the property-related payment
214.13rate in effect on the preceding date. The total rate increase shall include the adjustment
214.14provided in section 256B.501, subdivision 12.

214.15    Sec. 32. Minnesota Statutes 2012, section 256B.69, is amended by adding a
214.16subdivision to read:
214.17    Subd. 32a. Initiatives to improve early screening, diagnosis, and treatment of
214.18children with autism spectrum disorder and other developmental conditions. (a) The
214.19commissioner shall require managed care plans and county-based purchasing plans, as
214.20a condition of contract, to implement strategies that facilitate access for young children
214.21between the ages of one and three years to periodic developmental and social-emotional
214.22screenings, as recommended by the Minnesota Interagency Developmental Screening
214.23Task Force, and that those children who do not meet milestones are provided access to
214.24appropriate evaluation and assessment, including treatment recommendations, expected to
214.25improve the child's functioning, with the goal of meeting milestones by age five.
214.26    (b) The managed care plans must report the following data annually:
214.27    (1) the number of children who received a diagnostic assessment;
214.28    (2) the total number of children ages one to six with a diagnosis of autism spectrum
214.29disorder who received treatments;
214.30    (3) the number of children identified under clause (2) reported by each 12-month
214.31age group beginning with age one and ending with age six;
214.32    (4) the types of treatments provided to children identified under clause (2) listed by
214.33billing code, including the number of units billed for each child;
215.1    (5) barriers to providing screening, diagnosis, and treatment of young children
215.2between the ages of one and three years and any strategies implemented to address
215.3those barriers; and
215.4    (6) recommendations on how to measure and report on the effectiveness of the
215.5strategies implemented to facilitate access for young children to provide developmental
215.6and social-emotional screening, diagnosis, and treatment.

215.7    Sec. 33. Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision
215.83, as amended by Laws 2012, chapter 247, article 4, section 43, is amended to read:

215.9

Subd. 3.Forecasted Programs

215.10The amounts that may be spent from this
215.11appropriation for each purpose are as follows:

215.12

(a) MFIP/DWP Grants

215.13	Appropriations by Fund
215.14	General	84,680,000	91,978,000
215.15	Federal TANF	84,425,000	75,417,000

215.16

(b) MFIP Child Care Assistance Grants

55,456,000

30,923,000

215.17

(c) General Assistance Grants

49,192,000

46,938,000

215.18General Assistance Standard. The
215.19commissioner shall set the monthly standard
215.20of assistance for general assistance units
215.21consisting of an adult recipient who is
215.22childless and unmarried or living apart
215.23from parents or a legal guardian at $203.
215.24The commissioner may reduce this amount
215.25according to Laws 1997, chapter 85, article
215.263, section 54.
215.27Emergency General Assistance. The
215.28amount appropriated for emergency general
215.29assistance funds is limited to no more than
215.30$6,689,812 in fiscal year 2012 and $6,729,812
215.31in fiscal year 2013. Funds to counties shall
215.32be allocated by the commissioner using the
216.1allocation method specified in Minnesota
216.2Statutes, section 256D.06.

216.3

(d) Minnesota Supplemental Aid Grants

38,095,000

39,120,000

216.4

(e) Group Residential Housing Grants

121,080,000

129,238,000

216.5

(f) MinnesotaCare Grants

295,046,000

317,272,000

216.6This appropriation is from the health care
216.7access fund.

216.8

(g) Medical Assistance Grants

4,501,582,000

4,437,282,000

216.9Managed Care Incentive Payments. The
216.10commissioner shall not make managed care
216.11incentive payments for expanding preventive
216.12services during fiscal years beginning July 1,
216.132011, and July 1, 2012.
216.14Reduction of Rates for Congregate
216.15Living for Individuals with Lower Needs.
216.16Beginning October 1, 2011, lead agencies
216.17must reduce rates in effect on January 1, 2011,
216.18by ten percent for individuals with lower
216.19needs living in foster care settings where the
216.20license holder does not share the residence
216.21with recipients on the CADI and DD waivers
216.22and customized living settings for CADI.
216.23Lead agencies shall consult with providers to
216.24review individual service plans and identify
216.25changes or modifications to reduce the
216.26utilization of services while maintaining the
216.27health and safety of the individual receiving
216.28services. Lead agencies must adjust contracts
216.29within 60 days of the effective date. If
216.30federal waiver approval is obtained under
216.31the long-term care realignment waiver
216.32application submitted on February 13,
216.332012, and federal financial participation is
216.34authorized for the alternative care program,
217.1the commissioner shall adjust this payment
217.2rate reduction from ten to five percent for
217.3services rendered on or after July 1, 2012, or
217.4the first day of the month following federal
217.5approval, whichever is later. Effective
217.6August 1, 2013, this provision does not apply
217.7to individuals whose primary diagnosis is
217.8mental illness and who are living in foster
217.9care settings where the license holder is
217.10also (1) a provider of assertive community
217.11treatment (ACT) or adult rehabilitative
217.12mental health services (ARMHS) as defined
217.13in Minnesota Statutes, section 256B.0623;
217.14(2) a mental health center or mental health
217.15clinic certified under Minnesota Rules, parts
217.169520.0750 to 9520.0870; or (3) a provider
217.17of intensive residential treatment services
217.18(IRTS) licensed under Minnesota Rules,
217.19parts 9520.0500 to 9520.0670.
217.20Reduction of Lead Agency Waiver
217.21Allocations to Implement Rate Reductions
217.22for Congregate Living for Individuals
217.23with Lower Needs. Beginning October 1,
217.242011, the commissioner shall reduce lead
217.25agency waiver allocations to implement the
217.26reduction of rates for individuals with lower
217.27needs living in foster care settings where the
217.28license holder does not share the residence
217.29with recipients on the CADI and DD waivers
217.30and customized living settings for CADI.
217.31Reduce customized living and 24-hour
217.32customized living component rates.
217.33Effective July 1, 2011, the commissioner
217.34shall reduce elderly waiver customized living
217.35and 24-hour customized living component
217.36service spending by five percent through
218.1reductions in component rates and service
218.2rate limits. The commissioner shall adjust
218.3the elderly waiver capitation payment
218.4rates for managed care organizations paid
218.5under Minnesota Statutes, section 256B.69,
218.6subdivisions 6a and 23, to reflect reductions
218.7in component spending for customized living
218.8services and 24-hour customized living
218.9services under Minnesota Statutes, section
218.10256B.0915, subdivisions 3e and 3h, for the
218.11contract period beginning January 1, 2012.
218.12To implement the reduction specified in
218.13this provision, capitation rates paid by the
218.14commissioner to managed care organizations
218.15under Minnesota Statutes, section 256B.69,
218.16shall reflect a ten percent reduction for the
218.17specified services for the period January 1,
218.182012, to June 30, 2012, and a five percent
218.19reduction for those services on or after July
218.201, 2012.
218.21Limit Growth in the Developmental
218.22Disability Waiver. The commissioner
218.23shall limit growth in the developmental
218.24disability waiver to six diversion allocations
218.25per month beginning July 1, 2011, through
218.26June 30, 2013, and 15 diversion allocations
218.27per month beginning July 1, 2013, through
218.28June 30, 2015. Waiver allocations shall
218.29be targeted to individuals who meet the
218.30priorities for accessing waiver services
218.31identified in Minnesota Statutes, 256B.092,
218.32subdivision 12 . The limits do not include
218.33conversions from intermediate care facilities
218.34for persons with developmental disabilities.
218.35Notwithstanding any contrary provisions in
219.1this article, this paragraph expires June 30,
219.22015.
219.3Limit Growth in the Community
219.4Alternatives for Disabled Individuals
219.5Waiver. The commissioner shall limit
219.6growth in the community alternatives for
219.7disabled individuals waiver to 60 allocations
219.8per month beginning July 1, 2011, through
219.9June 30, 2013, and 85 allocations per
219.10month beginning July 1, 2013, through
219.11June 30, 2015. Waiver allocations must
219.12be targeted to individuals who meet the
219.13priorities for accessing waiver services
219.14identified in Minnesota Statutes, section
219.15256B.49, subdivision 11a . The limits include
219.16conversions and diversions, unless the
219.17commissioner has approved a plan to convert
219.18funding due to the closure or downsizing
219.19of a residential facility or nursing facility
219.20to serve directly affected individuals on
219.21the community alternatives for disabled
219.22individuals waiver. Notwithstanding any
219.23contrary provisions in this article, this
219.24paragraph expires June 30, 2015.
219.25Personal Care Assistance Relative
219.26Care. The commissioner shall adjust the
219.27capitation payment rates for managed care
219.28organizations paid under Minnesota Statutes,
219.29section 256B.69, to reflect the rate reductions
219.30for personal care assistance provided by
219.31a relative pursuant to Minnesota Statutes,
219.32section 256B.0659, subdivision 11. This rate
219.33reduction is effective July 1, 2013.

219.34

(h) Alternative Care Grants

46,421,000

46,035,000

220.1Alternative Care Transfer. Any money
220.2allocated to the alternative care program that
220.3is not spent for the purposes indicated does
220.4not cancel but shall be transferred to the
220.5medical assistance account.

220.6

(i) Chemical Dependency Entitlement Grants

94,675,000

93,298,000

220.7EFFECTIVE DATE.This section is effective August 1, 2013.

220.8    Sec. 34. RECOMMENDATIONS FOR CONCENTRATION LIMITS ON HOME
220.9AND COMMUNITY-BASED SETTINGS.
220.10The commissioner of human services shall consult with the Minnesota Olmstead
220.11subcabinet, advocates, providers, and city representatives to develop recommendations
220.12on concentration limits on home and community-based settings, as defined in
220.13Minnesota Statutes, section 256B.492, as well as any other exceptions to the definition.
220.14The recommendations must be consistent with Minnesota's Olmstead plan. The
220.15recommendations and proposed legislation must be submitted to the chairs and ranking
220.16minority members of the legislative committees with jurisdiction over health and human
220.17services policy and finance by February 1, 2014.

220.18    Sec. 35. PROVIDER RATE AND GRANT INCREASES EFFECTIVE JULY
220.191, 2013.
220.20(a) The commissioner of human services shall increase reimbursement rates, grants,
220.21allocations, individual limits, and rate limits, as applicable, by two percent for the rate
220.22period beginning July 1, 2013, for services rendered on or after those dates. County or
220.23tribal contracts for services specified in this section must be amended to pass through
220.24these rate increases within 60 days of the effective date.
220.25(b) The rate changes described in this section must be provided to:
220.26(1) home and community-based waivered services for persons with developmental
220.27disabilities or related conditions, including consumer-directed community supports, under
220.28Minnesota Statutes, section 256B.501;
220.29(2) waivered services under community alternatives for disabled individuals,
220.30including consumer-directed community supports, under Minnesota Statutes, section
220.31256B.49;
220.32(3) community alternative care waivered services, including consumer-directed
220.33community supports, under Minnesota Statutes, section 256B.49;
221.1(4) traumatic brain injury waivered services, including consumer-directed
221.2community supports, under Minnesota Statutes, section 256B.49;
221.3(5) home and community-based waivered services for the elderly under Minnesota
221.4Statutes, section 256B.0915;
221.5(6) nursing services and home health services under Minnesota Statutes, section
221.6256B.0625, subdivision 6a;
221.7(7) personal care services and qualified professional supervision of personal care
221.8services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
221.9(8) private duty nursing services under Minnesota Statutes, section 256B.0625,
221.10subdivision 7;
221.11(9) day training and habilitation services for adults with developmental disabilities
221.12or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
221.13additional cost of rate adjustments on day training and habilitation services, provided as a
221.14social service, under Minnesota Statutes, section 256M.60;
221.15(10) alternative care services under Minnesota Statutes, section 256B.0913;
221.16(11) living skills training programs for persons with intractable epilepsy who need
221.17assistance in the transition to independent living under Laws 1988, chapter 689;
221.18(12) semi-independent living services (SILS) under Minnesota Statutes, section
221.19252.275, including SILS funding under county social services grants formerly funded
221.20under Minnesota Statutes, chapter 256I;
221.21(13) consumer support grants under Minnesota Statutes, section 256.476;
221.22(14) family support grants under Minnesota Statutes, section 252.32;
221.23(15) housing access grants under Minnesota Statutes, section 256B.0658;
221.24(16) self-advocacy grants under Laws 2009, chapter 101; and
221.25(17) technology grants under Laws 2009, chapter 79.
221.26(c) A managed care plan receiving state payments for the services in this section
221.27must include these increases in their payments to providers. To implement the rate increase
221.28in this section, capitation rates paid by the commissioner to managed care organizations
221.29under Minnesota Statutes, section 256B.69, shall reflect a two percent increase for the
221.30specified services for the period beginning July 1, 2013.
221.31(d) Counties shall increase the budget for each recipient of consumer-directed
221.32community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).

221.33    Sec. 36. TRAINING OF AUTISM SERVICE PROVIDERS.
221.34    The commissioners of health and human services shall ensure that the departments'
221.35autism-related service providers receive training in culturally appropriate approaches to
222.1serving the Somali, Latino, Hmong, and Indigenous American Indian communities, and
222.2other cultural groups experiencing a disproportionate incidence of autism.

222.3    Sec. 37. DIRECTION TO COMMISSIONER.
222.4    By January 1, 2014, the commissioner of human services shall apply to the federal
222.5Centers for Medicare and Medicaid Services for a waiver or other authority to provide
222.6applied behavioral analysis services to children with autism spectrum disorder and related
222.7conditions under the medical assistance program.
222.8EFFECTIVE DATE.This section is effective the day following final enactment.

222.9    Sec. 38. RECOMMENDATIONS ON RAISING THE ASSET LIMITS FOR
222.10SENIORS AND PERSONS WITH DISABILITIES.
222.11The commissioner of human services shall consult with interested stakeholders to
222.12develop recommendations to increase the asset limit a reasonable amount considering
222.13changes since the limit was established for (1) individuals who are not homeowners and (2)
222.14homeowners eligible for medical assistance due to disability or age who are not residing in
222.15a nursing facility, intermediate care facility for persons with developmental disabilities,
222.16or other institution whose costs for room and board are covered by medical assistance or
222.17state funds. The recommendations must be provided to the legislative committees with
222.18jurisdiction over health and human services policy and finance by February 1, 2014.

222.19    Sec. 39. NURSING HOME LEVEL OF CARE REPORT.
222.20(a) The commissioner of human services shall report on the impact of the nursing
222.21facility level of care to be implemented January 1, 2014, including the following:
222.22(1) the number of individuals who lose eligibility for home and community-based
222.23services waivers under Minnesota Statutes, sections 256B.0915 and 256B.49, and
222.24alternative care under Minnesota Statutes, section 256B.0913;
222.25    (2) the number of individuals who lose eligibility for medical assistance; and
222.26    (3) for individuals reported under clauses (1) and (2), and to the extent possible:
222.27    (i) their living situation before and after nursing facility level of care implementation;
222.28and
222.29    (ii) the programs or services they received before and after nursing facility level of
222.30care implementation, including, but not limited to, personal care assistant services and
222.31essential community supports.
222.32(b) The commissioner of human services shall report to the chairs of the legislative
222.33committees with jurisdiction over health and human services policy and finance with the
223.1information required under paragraph (a). A preliminary report shall be submitted on
223.2October 1, 2014, and a final report shall be submitted February 15, 2015.

223.3    Sec. 40. HOME AND COMMUNITY-BASED SERVICES REPORT CARD.
223.4    (a) The commissioner of human services shall work with existing advisory groups
223.5to develop recommendations for a home and community-based services report card.
223.6The advisory committee shall consider the requirements from the Minnesota Consumer
223.7Information Guide under Minnesota Statutes, section 144G.06, as a base for development
223.8of a home and community-based services report card to compare the housing options
223.9available to consumers. Other items to be considered by the advisory committee in
223.10developing recommendations include:
223.11    (1) defining the goal of the report card;
223.12    (2) measuring outcomes, consumer information, and options for pay for performance;
223.13    (3) developing separate measures for programs for the elderly population and for
223.14persons with disabilities;
223.15    (4) identifying sources of information that are standardized and contain sufficient
223.16data;
223.17    (5) identifying the financial support needed to create and publicize the housing
223.18information guide, and ongoing funding for data collection and staffing to monitor,
223.19report, and analyze data;
223.20    (6) recognizing that home and community-based services settings exist with
223.21significant variations as to size, settings, and services available;
223.22    (7) ensuring that consumer choice and consumer information is retained and valued;
223.23and
223.24    (8) considering the applicability of these measures on providers based on payer
223.25source, size, and population served.
223.26    (b) The workgroup shall discuss whether additional funding, resources, or research
223.27is needed. The workgroup shall report recommendations to the legislative committees
223.28with jurisdiction over health and human services policy and finance by August 1, 2014.
223.29The report card shall be available on July 1, 2015.

223.30    Sec. 41. REPEALER.
223.31(a) Minnesota Statutes 2012, sections 256B.14, subdivision 3a; and 256B.5012,
223.32subdivision 13; and Laws 2011, First Special Session chapter 9, article 7, section 54, as
223.33amended by Laws 2012, chapter 247, article 4, section 42, and Laws 2012, chapter 298,
223.34section 3, are repealed.
224.1(b) Minnesota Statutes 2012, section 256B.096, subdivisions 1, 2, 3, and 4, are
224.2repealed.


224.5    Section 1. Minnesota Statutes 2012, section 145C.01, subdivision 7, is amended to read:
224.6    Subd. 7. Health care facility. "Health care facility" means a hospital or other entity
224.7licensed under sections 144.50 to 144.58, a nursing home licensed to serve adults under
224.8section 144A.02, a home care provider licensed under sections 144A.43 to 144A.47,
224.9an adult foster care provider licensed under chapter 245A and Minnesota Rules, parts
224.109555.5105 to 9555.6265, a community residential setting licensed under chapter 245D, or
224.11a hospice provider licensed under sections 144A.75 to 144A.755.

224.12    Sec. 2. Minnesota Statutes 2012, section 243.166, subdivision 4b, is amended to read:
224.13    Subd. 4b. Health care facility; notice of status. (a) For the purposes of this
224.14subdivision, "health care facility" means a facility:
224.15(1) licensed by the commissioner of health as a hospital, boarding care home or
224.16supervised living facility under sections 144.50 to 144.58, or a nursing home under
224.17chapter 144A;
224.18(2) registered by the commissioner of health as a housing with services establishment
224.19as defined in section 144D.01; or
224.20(3) licensed by the commissioner of human services as a residential facility under
224.21chapter 245A to provide adult foster care, adult mental health treatment, chemical
224.22dependency treatment to adults, or residential services to persons with developmental
224.23 disabilities.
224.24(b) Prior to admission to a health care facility, a person required to register under
224.25this section shall disclose to:
224.26(1) the health care facility employee processing the admission the person's status
224.27as a registered predatory offender under this section; and
224.28(2) the person's corrections agent, or if the person does not have an assigned
224.29corrections agent, the law enforcement authority with whom the person is currently
224.30required to register, that inpatient admission will occur.
224.31(c) A law enforcement authority or corrections agent who receives notice under
224.32paragraph (b) or who knows that a person required to register under this section is
224.33planning to be admitted and receive, or has been admitted and is receiving health care
224.34at a health care facility shall notify the administrator of the facility and deliver a fact
225.1sheet to the administrator containing the following information: (1) name and physical
225.2description of the offender; (2) the offender's conviction history, including the dates of
225.3conviction; (3) the risk level classification assigned to the offender under section 244.052,
225.4if any; and (4) the profile of likely victims.
225.5(d) Except for a hospital licensed under sections 144.50 to 144.58, if a health care
225.6facility receives a fact sheet under paragraph (c) that includes a risk level classification for
225.7the offender, and if the facility admits the offender, the facility shall distribute the fact
225.8sheet to all residents at the facility. If the facility determines that distribution to a resident
225.9is not appropriate given the resident's medical, emotional, or mental status, the facility
225.10shall distribute the fact sheet to the patient's next of kin or emergency contact.

225.11    Sec. 3. [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY
225.12MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
225.13    Subdivision 1. Rules. The commissioner of human services shall, within 24 months
225.14of enactment of this section, adopt rules governing the use of positive support strategies,
225.15safety interventions, and emergency use of manual restraint in facilities and services
225.16licensed under chapter 245D.
225.17    Subd. 2. Data collection. (a) The commissioner shall, with stakeholder input,
225.18develop data collection elements specific to incidents on the use of controlled procedures
225.19with persons receiving services from providers regulated under Minnesota Rules, parts
225.209525.2700 to 9525.2810, and incidents involving persons receiving services from
225.21providers identified to be licensed under chapter 245D effective January 1, 2014. Providers
225.22shall report the data in a format and at a frequency provided by the commissioner of
225.23human services.
225.24(b) Beginning July 1, 2013, providers regulated under Minnesota Rules, parts
225.259525.2700 to 9525.2810, shall submit data regarding the use of all controlled procedures
225.26in a format and at a frequency provided by the commissioner.

225.27    Sec. 4. Minnesota Statutes 2012, section 245A.02, subdivision 10, is amended to read:
225.28    Subd. 10. Nonresidential program. "Nonresidential program" means care,
225.29supervision, rehabilitation, training or habilitation of a person provided outside the
225.30person's own home and provided for fewer than 24 hours a day, including adult day
225.31care programs; and chemical dependency or chemical abuse programs that are located
225.32in a nursing home or hospital and receive public funds for providing chemical abuse or
225.33chemical dependency treatment services under chapter 254B. Nonresidential programs
225.34include home and community-based services and semi-independent living services for
226.1persons with developmental disabilities or persons age 65 and older that are provided in
226.2or outside of a person's own home under chapter 245D.

226.3    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 14, is amended to read:
226.4    Subd. 14. Residential program. "Residential program" means a program
226.5that provides 24-hour-a-day care, supervision, food, lodging, rehabilitation, training,
226.6education, habilitation, or treatment outside a person's own home, including a program
226.7in an intermediate care facility for four or more persons with developmental disabilities;
226.8and chemical dependency or chemical abuse programs that are located in a hospital
226.9or nursing home and receive public funds for providing chemical abuse or chemical
226.10dependency treatment services under chapter 254B. Residential programs include home
226.11and community-based services for persons with developmental disabilities or persons age
226.1265 and older that are provided in or outside of a person's own home under chapter 245D.

226.13    Sec. 6. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
226.14    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an initial
226.15license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340,
226.16or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under
226.17this chapter for a physical location that will not be the primary residence of the license
226.18holder for the entire period of licensure. If a license is issued during this moratorium, and
226.19the license holder changes the license holder's primary residence away from the physical
226.20location of the foster care license, the commissioner shall revoke the license according
226.21to section 245A.07. The commissioner shall not issue an initial license for a community
226.22residential setting licensed under chapter 245D. Exceptions to the moratorium include:
226.23(1) foster care settings that are required to be registered under chapter 144D;
226.24(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
226.25community residential setting licenses replacing adult foster care licenses in existence on
226.26December 31, 2013, and determined to be needed by the commissioner under paragraph (b);
226.27(3) new foster care licenses or community residential setting licenses determined to
226.28be needed by the commissioner under paragraph (b) for the closure of a nursing facility,
226.29ICF/MR, or regional treatment center, or restructuring of state-operated services that
226.30limits the capacity of state-operated facilities;
226.31(4) new foster care licenses or community residential setting licenses determined
226.32to be needed by the commissioner under paragraph (b) for persons requiring hospital
226.33level care; or
227.1(5) new foster care licenses or community residential setting licenses determined to
227.2be needed by the commissioner for the transition of people from personal care assistance
227.3to the home and community-based services.
227.4(b) The commissioner shall determine the need for newly licensed foster care
227.5homes or community residential settings as defined under this subdivision. As part of the
227.6determination, the commissioner shall consider the availability of foster care capacity in
227.7the area in which the licensee seeks to operate, and the recommendation of the local
227.8county board. The determination by the commissioner must be final. A determination of
227.9need is not required for a change in ownership at the same address.
227.10(c) The commissioner shall study the effects of the license moratorium under this
227.11subdivision and shall report back to the legislature by January 15, 2011. This study shall
227.12include, but is not limited to the following:
227.13(1) the overall capacity and utilization of foster care beds where the physical location
227.14is not the primary residence of the license holder prior to and after implementation
227.15of the moratorium;
227.16(2) the overall capacity and utilization of foster care beds where the physical
227.17location is the primary residence of the license holder prior to and after implementation
227.18of the moratorium; and
227.19(3) the number of licensed and occupied ICF/MR beds prior to and after
227.20implementation of the moratorium.
227.21(d) When a foster care recipient resident served by the program moves out of a
227.22foster home that is not the primary residence of the license holder according to section
227.23256B.49, subdivision 15 , paragraph (f), or the community residential setting, the county
227.24shall immediately inform the Department of Human Services Licensing Division.
227.25The department shall decrease the statewide licensed capacity for foster care settings
227.26where the physical location is not the primary residence of the license holder, or for
227.27community residential settings, if the voluntary changes described in paragraph (f) are
227.28not sufficient to meet the savings required by reductions in licensed bed capacity under
227.29Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f),
227.30and maintain statewide long-term care residential services capacity within budgetary
227.31limits. Implementation of the statewide licensed capacity reduction shall begin on July
227.321, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the
227.33needs determination process. Under this paragraph, the commissioner has the authority
227.34to reduce unused licensed capacity of a current foster care program, or the community
227.35residential settings, to accomplish the consolidation or closure of settings. A decreased
227.36licensed capacity according to this paragraph is not subject to appeal under this chapter.
228.1(e) Residential settings that would otherwise be subject to the decreased license
228.2capacity established in paragraph (d) shall be exempt under the following circumstances:
228.3(1) until August 1, 2013, the license holder's beds occupied by residents whose
228.4primary diagnosis is mental illness and the license holder is:
228.5(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
228.6health services (ARMHS) as defined in section 256B.0623;
228.7(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
228.89520.0870;
228.9(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
228.109520.0870; or
228.11(iv) a provider of intensive residential treatment services (IRTS) licensed under
228.12Minnesota Rules, parts 9520.0500 to 9520.0670; or
228.13(2) the license holder is certified under the requirements in subdivision 6a or section
228.14245D.33.
228.15(f) A resource need determination process, managed at the state level, using the
228.16available reports required by section 144A.351, and other data and information shall
228.17be used to determine where the reduced capacity required under paragraph (d) will be
228.18implemented. The commissioner shall consult with the stakeholders described in section
228.19144A.351 , and employ a variety of methods to improve the state's capacity to meet
228.20long-term care service needs within budgetary limits, including seeking proposals from
228.21service providers or lead agencies to change service type, capacity, or location to improve
228.22services, increase the independence of residents, and better meet needs identified by the
228.23long-term care services reports and statewide data and information. By February 1 of each
228.24year, the commissioner shall provide information and data on the overall capacity of
228.25licensed long-term care services, actions taken under this subdivision to manage statewide
228.26long-term care services and supports resources, and any recommendations for change to
228.27the legislative committees with jurisdiction over health and human services budget.
228.28    (g) At the time of application and reapplication for licensure, the applicant and the
228.29license holder that are subject to the moratorium or an exclusion established in paragraph
228.30(a) are required to inform the commissioner whether the physical location where the foster
228.31care will be provided is or will be the primary residence of the license holder for the entire
228.32period of licensure. If the primary residence of the applicant or license holder changes, the
228.33applicant or license holder must notify the commissioner immediately. The commissioner
228.34shall print on the foster care license certificate whether or not the physical location is the
228.35primary residence of the license holder.
229.1    (h) License holders of foster care homes identified under paragraph (g) that are not
229.2the primary residence of the license holder and that also provide services in the foster care
229.3home that are covered by a federally approved home and community-based services
229.4waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must inform the
229.5human services licensing division that the license holder provides or intends to provide
229.6these waiver-funded services. These license holders must be considered registered under
229.7section 256B.092, subdivision 11, paragraph (c), and this registration status must be
229.8identified on their license certificates.

229.9    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 8, is amended to read:
229.10    Subd. 8. Excluded providers seeking licensure. Nothing in this section shall
229.11prohibit a program that is excluded from licensure under subdivision 2, paragraph
229.12(a), clause (28) (26), from seeking licensure. The commissioner shall ensure that any
229.13application received from such an excluded provider is processed in the same manner as
229.14all other applications for child care center licensure.

229.15    Sec. 8. Minnesota Statutes 2012, section 245A.042, subdivision 3, is amended to read:
229.16    Subd. 3. Implementation. (a) The commissioner shall implement the
229.17responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
229.18only within the limits of available appropriations or other administrative cost recovery
229.19methodology.
229.20(b) The licensure of home and community-based services according to this section
229.21shall be implemented January 1, 2014. License applications shall be received and
229.22processed on a phased-in schedule as determined by the commissioner beginning July
229.231, 2013. Licenses will be issued thereafter upon the commissioner's determination that
229.24the application is complete according to section 245A.04.
229.25(c) Within the limits of available appropriations or other administrative cost recovery
229.26methodology, implementation of compliance monitoring must be phased in after January
229.271, 2014.
229.28(1) Applicants who do not currently hold a license issued under this chapter 245B
229.29 must receive an initial compliance monitoring visit after 12 months of the effective date of
229.30the initial license for the purpose of providing technical assistance on how to achieve and
229.31maintain compliance with the applicable law or rules governing the provision of home and
229.32community-based services under chapter 245D. If during the review the commissioner
229.33finds that the license holder has failed to achieve compliance with an applicable law or
229.34rule and this failure does not imminently endanger the health, safety, or rights of the
230.1persons served by the program, the commissioner may issue a licensing review report with
230.2recommendations for achieving and maintaining compliance.
230.3(2) Applicants who do currently hold a license issued under this chapter must receive
230.4a compliance monitoring visit after 24 months of the effective date of the initial license.
230.5(d) Nothing in this subdivision shall be construed to limit the commissioner's
230.6authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
230.7or make issue correction orders and make a license conditional for failure to comply with
230.8applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
230.9of the violation of law or rule and the effect of the violation on the health, safety, or
230.10rights of persons served by the program.

230.11    Sec. 9. Minnesota Statutes 2012, section 245A.08, subdivision 2a, is amended to read:
230.12    Subd. 2a. Consolidated contested case hearings. (a) When a denial of a license
230.13under section 245A.05 or a licensing sanction under section 245A.07, subdivision 3, is
230.14based on a disqualification for which reconsideration was requested and which was not
230.15set aside under section 245C.22, the scope of the contested case hearing shall include the
230.16disqualification and the licensing sanction or denial of a license, unless otherwise specified
230.17in this subdivision. When the licensing sanction or denial of a license is based on a
230.18determination of maltreatment under section 626.556 or 626.557, or a disqualification for
230.19serious or recurring maltreatment which was not set aside, the scope of the contested case
230.20hearing shall include the maltreatment determination, disqualification, and the licensing
230.21sanction or denial of a license, unless otherwise specified in this subdivision. In such
230.22cases, a fair hearing under section 256.045 shall not be conducted as provided for in
230.23sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d.
230.24    (b) Except for family child care and child foster care, reconsideration of a
230.25maltreatment determination under sections 626.556, subdivision 10i, and 626.557,
230.26subdivision 9d, and reconsideration of a disqualification under section 245C.22, shall
230.27not be conducted when:
230.28    (1) a denial of a license under section 245A.05, or a licensing sanction under section
230.29245A.07 , is based on a determination that the license holder is responsible for maltreatment
230.30or the disqualification of a license holder is based on serious or recurring maltreatment;
230.31    (2) the denial of a license or licensing sanction is issued at the same time as the
230.32maltreatment determination or disqualification; and
230.33    (3) the license holder appeals the maltreatment determination or disqualification,
230.34and denial of a license or licensing sanction. In these cases, a fair hearing shall not be
230.35conducted under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision
231.19d. The scope of the contested case hearing must include the maltreatment determination,
231.2disqualification, and denial of a license or licensing sanction.
231.3    Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
231.4determination or disqualification, but does not appeal the denial of a license or a licensing
231.5sanction, reconsideration of the maltreatment determination shall be conducted under
231.6sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
231.7disqualification shall be conducted under section 245C.22. In such cases, a fair hearing
231.8shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
231.9626.557, subdivision 9d .
231.10    (c) In consolidated contested case hearings regarding sanctions issued in family child
231.11care, child foster care, family adult day services, and adult foster care, and community
231.12residential settings, the county attorney shall defend the commissioner's orders in
231.13accordance with section 245A.16, subdivision 4.
231.14    (d) The commissioner's final order under subdivision 5 is the final agency action
231.15on the issue of maltreatment and disqualification, including for purposes of subsequent
231.16background studies under chapter 245C and is the only administrative appeal of the final
231.17agency determination, specifically, including a challenge to the accuracy and completeness
231.18of data under section 13.04.
231.19    (e) When consolidated hearings under this subdivision involve a licensing sanction
231.20based on a previous maltreatment determination for which the commissioner has issued
231.21a final order in an appeal of that determination under section 256.045, or the individual
231.22failed to exercise the right to appeal the previous maltreatment determination under
231.23section 626.556, subdivision 10i, or 626.557, subdivision 9d, the commissioner's order is
231.24conclusive on the issue of maltreatment. In such cases, the scope of the administrative
231.25law judge's review shall be limited to the disqualification and the licensing sanction or
231.26denial of a license. In the case of a denial of a license or a licensing sanction issued to
231.27a facility based on a maltreatment determination regarding an individual who is not the
231.28license holder or a household member, the scope of the administrative law judge's review
231.29includes the maltreatment determination.
231.30    (f) The hearings of all parties may be consolidated into a single contested case
231.31hearing upon consent of all parties and the administrative law judge, if:
231.32    (1) a maltreatment determination or disqualification, which was not set aside under
231.33section 245C.22, is the basis for a denial of a license under section 245A.05 or a licensing
231.34sanction under section 245A.07;
231.35    (2) the disqualified subject is an individual other than the license holder and upon
231.36whom a background study must be conducted under section 245C.03; and
232.1    (3) the individual has a hearing right under section 245C.27.
232.2    (g) When a denial of a license under section 245A.05 or a licensing sanction under
232.3section 245A.07 is based on a disqualification for which reconsideration was requested
232.4and was not set aside under section 245C.22, and the individual otherwise has no hearing
232.5right under section 245C.27, the scope of the administrative law judge's review shall
232.6include the denial or sanction and a determination whether the disqualification should
232.7be set aside, unless section 245C.24 prohibits the set-aside of the disqualification. In
232.8determining whether the disqualification should be set aside, the administrative law judge
232.9shall consider the factors under section 245C.22, subdivision 4, to determine whether the
232.10individual poses a risk of harm to any person receiving services from the license holder.
232.11    (h) Notwithstanding section 245C.30, subdivision 5, when a licensing sanction
232.12under section 245A.07 is based on the termination of a variance under section 245C.30,
232.13subdivision 4 , the scope of the administrative law judge's review shall include the sanction
232.14and a determination whether the disqualification should be set aside, unless section
232.15245C.24 prohibits the set-aside of the disqualification. In determining whether the
232.16disqualification should be set aside, the administrative law judge shall consider the factors
232.17under section 245C.22, subdivision 4, to determine whether the individual poses a risk of
232.18harm to any person receiving services from the license holder.

232.19    Sec. 10. Minnesota Statutes 2012, section 245A.10, is amended to read:
232.20245A.10 FEES.
232.21    Subdivision 1. Application or license fee required, programs exempt from fee.
232.22(a) Unless exempt under paragraph (b), the commissioner shall charge a fee for evaluation
232.23of applications and inspection of programs which are licensed under this chapter.
232.24(b) Except as provided under subdivision 2, no application or license fee shall be
232.25charged for child foster care, adult foster care, or family and group family child care, or
232.26a community residential setting.
232.27    Subd. 2. County fees for background studies and licensing inspections. (a) For
232.28purposes of family and group family child care licensing under this chapter, a county
232.29agency may charge a fee to an applicant or license holder to recover the actual cost of
232.30background studies, but in any case not to exceed $100 annually. A county agency may
232.31also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
232.32license or $100 for a two-year license.
232.33    (b) A county agency may charge a fee to a legal nonlicensed child care provider or
232.34applicant for authorization to recover the actual cost of background studies completed
232.35under section 119B.125, but in any case not to exceed $100 annually.
233.1    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
233.2    (1) in cases of financial hardship;
233.3    (2) if the county has a shortage of providers in the county's area;
233.4    (3) for new providers; or
233.5    (4) for providers who have attained at least 16 hours of training before seeking
233.6initial licensure.
233.7    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
233.8an installment basis for up to one year. If the provider is receiving child care assistance
233.9payments from the state, the provider may have the fees under paragraph (a) or (b)
233.10deducted from the child care assistance payments for up to one year and the state shall
233.11reimburse the county for the county fees collected in this manner.
233.12    (e) For purposes of adult foster care and child foster care licensing, and licensing
233.13the physical plant of a community residential setting, under this chapter, a county agency
233.14may charge a fee to a corporate applicant or corporate license holder to recover the actual
233.15cost of licensing inspections, not to exceed $500 annually.
233.16    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the
233.17following circumstances:
233.18(1) in cases of financial hardship;
233.19(2) if the county has a shortage of providers in the county's area; or
233.20(3) for new providers.
233.21    Subd. 3. Application fee for initial license or certification. (a) For fees required
233.22under subdivision 1, an applicant for an initial license or certification issued by the
233.23commissioner shall submit a $500 application fee with each new application required
233.24under this subdivision. An applicant for an initial day services facility license under
233.25chapter 245D shall submit a $250 application fee with each new application. The
233.26application fee shall not be prorated, is nonrefundable, and is in lieu of the annual license
233.27or certification fee that expires on December 31. The commissioner shall not process an
233.28application until the application fee is paid.
233.29(b) Except as provided in clauses (1) to (4) (3), an applicant shall apply for a license
233.30to provide services at a specific location.
233.31(1) For a license to provide residential-based habilitation services to persons with
233.32developmental disabilities under chapter 245B, an applicant shall submit an application
233.33for each county in which the services will be provided. Upon licensure, the license
233.34holder may provide services to persons in that county plus no more than three persons
233.35at any one time in each of up to ten additional counties. A license holder in one county
233.36may not provide services under the home and community-based waiver for persons with
234.1developmental disabilities to more than three people in a second county without holding
234.2a separate license for that second county. Applicants or licensees providing services
234.3under this clause to not more than three persons remain subject to the inspection fees
234.4established in section 245A.10, subdivision 2, for each location. The license issued by
234.5the commissioner must state the name of each additional county where services are being
234.6provided to persons with developmental disabilities. A license holder must notify the
234.7commissioner before making any changes that would alter the license information listed
234.8under section 245A.04, subdivision 7, paragraph (a), including any additional counties
234.9where persons with developmental disabilities are being served. For a license to provide
234.10home and community-based services to persons with disabilities or age 65 and older under
234.11chapter 245D, an applicant shall submit an application to provide services statewide.
234.12(2) For a license to provide supported employment, crisis respite, or
234.13semi-independent living services to persons with developmental disabilities under chapter
234.14245B, an applicant shall submit a single application to provide services statewide.
234.15(3) For a license to provide independent living assistance for youth under section
234.16245A.22 , an applicant shall submit a single application to provide services statewide.
234.17(4) (3) For a license for a private agency to provide foster care or adoption services
234.18under Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single
234.19application to provide services statewide.
234.20(c) The initial application fee charged under this subdivision does not include the
234.21temporary license surcharge under section 16E.22.
234.22    Subd. 4. License or certification fee for certain programs. (a) Child care centers
234.23shall pay an annual nonrefundable license fee based on the following schedule:

234.24		Licensed Capacity	Child Care CenterLicense Fee
234.25		1 to 24 persons	$200
234.26		25 to 49 persons	$300
234.27		50 to 74 persons	$400
234.28		75 to 99 persons	$500
234.29		100 to 124 persons	$600
234.30		125 to 149 persons	$700
234.31		150 to 174 persons	$800
234.32		175 to 199 persons	$900
234.33		200 to 224 persons	$1,000
234.34		225 or more persons	$1,100

234.35    (b) A day training and habilitation program serving persons with developmental
234.36disabilities or related conditions shall pay an annual nonrefundable license fee based on
234.37the following schedule:

235.1		Licensed Capacity	License Fee
235.2		1 to 24 persons	$800
235.3		25 to 49 persons	$1,000
235.4		50 to 74 persons	$1,200
235.5		75 to 99 persons	$1,400
235.6		100 to 124 persons	$1,600
235.7		125 to 149 persons	$1,800
235.8		150 or more persons	$2,000

235.9Except as provided in paragraph (c), when a day training and habilitation program
235.10serves more than 50 percent of the same persons in two or more locations in a community,
235.11the day training and habilitation program shall pay a license fee based on the licensed
235.12capacity of the largest facility and the other facility or facilities shall be charged a license
235.13fee based on a licensed capacity of a residential program serving one to 24 persons.
235.14    (c) When a day training and habilitation program serving persons with developmental
235.15disabilities or related conditions seeks a single license allowed under section 245B.07,
235.16subdivision 12, clause (2) or (3), the licensing fee must be based on the combined licensed
235.17capacity for each location.
235.18(d) A program licensed to provide supported employment services to persons
235.19with developmental disabilities under chapter 245B shall pay an annual nonrefundable
235.20license fee of $650.
235.21(e) A program licensed to provide crisis respite services to persons with
235.22developmental disabilities under chapter 245B shall pay an annual nonrefundable license
235.23fee of $700.
235.24(f) A program licensed to provide semi-independent living services to persons
235.25with developmental disabilities under chapter 245B shall pay an annual nonrefundable
235.26license fee of $700.
235.27(g) A program licensed to provide residential-based habilitation services under the
235.28home and community-based waiver for persons with developmental disabilities shall pay
235.29an annual license fee that includes a base rate of $690 plus $60 times the number of clients
235.30served on the first day of July of the current license year.
235.31(h) A residential program certified by the Department of Health as an intermediate
235.32care facility for persons with developmental disabilities (ICF/MR) and a noncertified
235.33residential program licensed to provide health or rehabilitative services for persons
235.34with developmental disabilities shall pay an annual nonrefundable license fee based on
235.35the following schedule:

235.36		Licensed Capacity	License Fee
235.37		1 to 24 persons	$535
236.1		25 to 49 persons	$735
236.2		50 or more persons	$935

236.3(b) A program licensed to provide one or more of the home and community-based
236.4services and supports identified under chapter 245D to persons with disabilities or age
236.565 and older, shall pay an annual nonrefundable license fee that includes a base rate of
236.6$2,250, plus $92 times the number of persons served, on average, greater than 40 hours per
236.7week for the month of June of the current license year for programs serving ten or more
236.8persons. The fee is limited to a maximum of 200 persons, regardless of the actual number
236.9of persons served. Programs serving nine or fewer persons pay only half of the base rate.
236.10(c) A facility licensed under chapter 245D to provide day services shall pay an
236.11annual nonrefundable license fee of $100.
236.12(i) (d) A chemical dependency treatment program licensed under Minnesota Rules,
236.13parts 9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an
236.14annual nonrefundable license fee based on the following schedule:

236.15		Licensed Capacity	License Fee
236.16		1 to 24 persons	$600
236.17		25 to 49 persons	$800
236.18		50 to 74 persons	$1,000
236.19		75 to 99 persons	$1,200
236.20		100 or more persons	$1,400

236.21(j) (e) A chemical dependency program licensed under Minnesota Rules, parts
236.229530.6510 to 9530.6590, to provide detoxification services shall pay an annual
236.23nonrefundable license fee based on the following schedule:

236.24		Licensed Capacity	License Fee
236.25		1 to 24 persons	$760
236.26		25 to 49 persons	$960
236.27		50 or more persons	$1,160

236.28(k) (f) Except for child foster care, a residential facility licensed under Minnesota
236.29Rules, chapter 2960, to serve children shall pay an annual nonrefundable license fee
236.30based on the following schedule:

236.31		Licensed Capacity	License Fee
236.32		1 to 24 persons	$1,000
236.33		25 to 49 persons	$1,100
236.34		50 to 74 persons	$1,200
236.35		75 to 99 persons	$1,300
236.36		100 or more persons	$1,400

237.1(l) (g) A residential facility licensed under Minnesota Rules, parts 9520.0500 to
237.29520.0670, to serve persons with mental illness shall pay an annual nonrefundable license
237.3fee based on the following schedule:

237.4		Licensed Capacity	License Fee
237.5		1 to 24 persons	$2,525
237.6		25 or more persons	$2,725

237.7(m) (h) A residential facility licensed under Minnesota Rules, parts 9570.2000 to
237.89570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable
237.9license fee based on the following schedule:

237.10		Licensed Capacity	License Fee
237.11		1 to 24 persons	$450
237.12		25 to 49 persons	$650
237.13		50 to 74 persons	$850
237.14		75 to 99 persons	$1,050
237.15		100 or more persons	$1,250

237.16(n) (i) A program licensed to provide independent living assistance for youth under
237.17section 245A.22 shall pay an annual nonrefundable license fee of $1,500.
237.18(o) (j) A private agency licensed to provide foster care and adoption services under
237.19Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable
237.20license fee of $875.
237.21(p) (k) A program licensed as an adult day care center licensed under Minnesota
237.22Rules, parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based
237.23on the following schedule:

237.24		Licensed Capacity	License Fee
237.25		1 to 24 persons	$500
237.26		25 to 49 persons	$700
237.27		50 to 74 persons	$900
237.28		75 to 99 persons	$1,100
237.29		100 or more persons	$1,300

237.30(q) (l) A program licensed to provide treatment services to persons with sexual
237.31psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts
237.329515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.
237.33(r) (m) A mental health center or mental health clinic requesting certification for
237.34purposes of insurance and subscriber contract reimbursement under Minnesota Rules,
237.35parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,550 per year. If the
237.36mental health center or mental health clinic provides services at a primary location with
238.1satellite facilities, the satellite facilities shall be certified with the primary location without
238.2an additional charge.
238.3    Subd. 6. License not issued until license or certification fee is paid. The
238.4commissioner shall not issue a license or certification until the license or certification fee
238.5is paid. The commissioner shall send a bill for the license or certification fee to the billing
238.6address identified by the license holder. If the license holder does not submit the license or
238.7certification fee payment by the due date, the commissioner shall send the license holder
238.8a past due notice. If the license holder fails to pay the license or certification fee by the
238.9due date on the past due notice, the commissioner shall send a final notice to the license
238.10holder informing the license holder that the program license will expire on December 31
238.11unless the license fee is paid before December 31. If a license expires, the program is no
238.12longer licensed and, unless exempt from licensure under section 245A.03, subdivision 2,
238.13must not operate after the expiration date. After a license expires, if the former license
238.14holder wishes to provide licensed services, the former license holder must submit a new
238.15license application and application fee under subdivision 3.
238.16    Subd. 7. Human services licensing fees to recover expenditures. Notwithstanding
238.17section 16A.1285, subdivision 2, related to activities for which the commissioner charges
238.18a fee, the commissioner must plan to fully recover direct expenditures for licensing
238.19activities under this chapter over a five-year period. The commissioner may have
238.20anticipated expenditures in excess of anticipated revenues in a biennium by using surplus
238.21revenues accumulated in previous bienniums.
238.22    Subd. 8. Deposit of license fees. A human services licensing account is created in
238.23the state government special revenue fund. Fees collected under subdivisions 3 and 4 must
238.24be deposited in the human services licensing account and are annually appropriated to the
238.25commissioner for licensing activities authorized under this chapter.
238.26EFFECTIVE DATE.This section is effective July 1, 2013.

238.27    Sec. 11. Minnesota Statutes 2012, section 245A.11, subdivision 2a, is amended to read:
238.28    Subd. 2a. Adult foster care and community residential setting license capacity.
238.29(a) The commissioner shall issue adult foster care and community residential setting
238.30 licenses with a maximum licensed capacity of four beds, including nonstaff roomers and
238.31boarders, except that the commissioner may issue a license with a capacity of five beds,
238.32including roomers and boarders, according to paragraphs (b) to (f).
238.33(b) An adult foster care The license holder may have a maximum license capacity
238.34of five if all persons in care are age 55 or over and do not have a serious and persistent
238.35mental illness or a developmental disability.
239.1(c) The commissioner may grant variances to paragraph (b) to allow a foster care
239.2provider facility with a licensed capacity of five persons to admit an individual under the
239.3age of 55 if the variance complies with section 245A.04, subdivision 9, and approval of
239.4the variance is recommended by the county in which the licensed foster care provider
239.5 facility is located.
239.6(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
239.7bed for emergency crisis services for a person with serious and persistent mental illness
239.8or a developmental disability, regardless of age, if the variance complies with section
239.9245A.04, subdivision 9 , and approval of the variance is recommended by the county in
239.10which the licensed foster care provider facility is located.
239.11(e) The commissioner may grant a variance to paragraph (b) to allow for the use of a
239.12fifth bed for respite services, as defined in section 245A.02, for persons with disabilities,
239.13regardless of age, if the variance complies with sections 245A.03, subdivision 7, and
239.14245A.04, subdivision 9 , and approval of the variance is recommended by the county in
239.15which the licensed foster care provider facility is licensed located. Respite care may be
239.16provided under the following conditions:
239.17(1) staffing ratios cannot be reduced below the approved level for the individuals
239.18being served in the home on a permanent basis;
239.19(2) no more than two different individuals can be accepted for respite services in
239.20any calendar month and the total respite days may not exceed 120 days per program in
239.21any calendar year;
239.22(3) the person receiving respite services must have his or her own bedroom, which
239.23could be used for alternative purposes when not used as a respite bedroom, and cannot be
239.24the room of another person who lives in the foster care home facility; and
239.25(4) individuals living in the foster care home facility must be notified when the
239.26variance is approved. The provider must give 60 days' notice in writing to the residents
239.27and their legal representatives prior to accepting the first respite placement. Notice must
239.28be given to residents at least two days prior to service initiation, or as soon as the license
239.29holder is able if they receive notice of the need for respite less than two days prior to
239.30initiation, each time a respite client will be served, unless the requirement for this notice is
239.31waived by the resident or legal guardian.
239.32(f) The commissioner may issue an adult foster care or community residential setting
239.33 license with a capacity of five adults if the fifth bed does not increase the overall statewide
239.34capacity of licensed adult foster care or community residential setting beds in homes that
239.35are not the primary residence of the license holder, as identified in a plan submitted to the
240.1commissioner by the county, when the capacity is recommended by the county licensing
240.2agency of the county in which the facility is located and if the recommendation verifies that:
240.3(1) the facility meets the physical environment requirements in the adult foster
240.4care licensing rule;
240.5(2) the five-bed living arrangement is specified for each resident in the resident's:
240.6(i) individualized plan of care;
240.7(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
240.8(iii) individual resident placement agreement under Minnesota Rules, part
240.99555.5105, subpart 19, if required;
240.10(3) the license holder obtains written and signed informed consent from each
240.11resident or resident's legal representative documenting the resident's informed choice
240.12to remain living in the home and that the resident's refusal to consent would not have
240.13resulted in service termination; and
240.14(4) the facility was licensed for adult foster care before March 1, 2011.
240.15(g) The commissioner shall not issue a new adult foster care license under paragraph
240.16(f) after June 30, 2016. The commissioner shall allow a facility with an adult foster care
240.17license issued under paragraph (f) before June 30, 2016, to continue with a capacity of five
240.18adults if the license holder continues to comply with the requirements in paragraph (f).

240.19    Sec. 12. Minnesota Statutes 2012, section 245A.11, subdivision 7, is amended to read:
240.20    Subd. 7. Adult foster care; variance for alternate overnight supervision. (a) The
240.21commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts
240.22requiring a caregiver to be present in an adult foster care home during normal sleeping
240.23hours to allow for alternative methods of overnight supervision. The commissioner may
240.24grant the variance if the local county licensing agency recommends the variance and the
240.25county recommendation includes documentation verifying that:
240.26    (1) the county has approved the license holder's plan for alternative methods of
240.27providing overnight supervision and determined the plan protects the residents' health,
240.28safety, and rights;
240.29    (2) the license holder has obtained written and signed informed consent from
240.30each resident or each resident's legal representative documenting the resident's or legal
240.31representative's agreement with the alternative method of overnight supervision; and
240.32    (3) the alternative method of providing overnight supervision, which may include
240.33the use of technology, is specified for each resident in the resident's: (i) individualized
240.34plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if
241.1required; or (iii) individual resident placement agreement under Minnesota Rules, part
241.29555.5105, subpart 19, if required.
241.3    (b) To be eligible for a variance under paragraph (a), the adult foster care license
241.4holder must not have had a conditional license issued under section 245A.06, or any
241.5other licensing sanction issued under section 245A.07 during the prior 24 months based
241.6on failure to provide adequate supervision, health care services, or resident safety in
241.7the adult foster care home.
241.8    (c) A license holder requesting a variance under this subdivision to utilize
241.9technology as a component of a plan for alternative overnight supervision may request
241.10the commissioner's review in the absence of a county recommendation. Upon receipt of
241.11such a request from a license holder, the commissioner shall review the variance request
241.12with the county.
241.13(d) A variance granted by the commissioner according to this subdivision before
241.14January 1, 2014, to a license holder for an adult foster care home must transfer with the
241.15license when the license converts to a community residential setting license under chapter
241.16245D. The terms and conditions of the variance remain in effect as approved at the time
241.17the variance was granted.

241.18    Sec. 13. Minnesota Statutes 2012, section 245A.11, subdivision 7a, is amended to read:
241.19    Subd. 7a. Alternate overnight supervision technology; adult foster care license
241.20 and community residential setting licenses. (a) The commissioner may grant an
241.21applicant or license holder an adult foster care or community residential setting license
241.22for a residence that does not have a caregiver in the residence during normal sleeping
241.23hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, or section
241.24245D.02, subdivision 33b, but uses monitoring technology to alert the license holder
241.25when an incident occurs that may jeopardize the health, safety, or rights of a foster
241.26care recipient. The applicant or license holder must comply with all other requirements
241.27under Minnesota Rules, parts 9555.5105 to 9555.6265, or applicable requirements under
241.28chapter 245D, and the requirements under this subdivision. The license printed by the
241.29commissioner must state in bold and large font:
241.30    (1) that the facility is under electronic monitoring; and
241.31    (2) the telephone number of the county's common entry point for making reports of
241.32suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
241.33(b) Applications for a license under this section must be submitted directly to
241.34the Department of Human Services licensing division. The licensing division must
241.35immediately notify the host county and lead county contract agency and the host county
242.1licensing agency. The licensing division must collaborate with the county licensing
242.2agency in the review of the application and the licensing of the program.
242.3    (c) Before a license is issued by the commissioner, and for the duration of the
242.4license, the applicant or license holder must establish, maintain, and document the
242.5implementation of written policies and procedures addressing the requirements in
242.6paragraphs (d) through (f).
242.7    (d) The applicant or license holder must have policies and procedures that:
242.8    (1) establish characteristics of target populations that will be admitted into the home,
242.9and characteristics of populations that will not be accepted into the home;
242.10    (2) explain the discharge process when a foster care recipient resident served by the
242.11program requires overnight supervision or other services that cannot be provided by the
242.12license holder due to the limited hours that the license holder is on site;
242.13    (3) describe the types of events to which the program will respond with a physical
242.14presence when those events occur in the home during time when staff are not on site, and
242.15how the license holder's response plan meets the requirements in paragraph (e), clause
242.16(1) or (2);
242.17    (4) establish a process for documenting a review of the implementation and
242.18effectiveness of the response protocol for the response required under paragraph (e),
242.19clause (1) or (2). The documentation must include:
242.20    (i) a description of the triggering incident;
242.21    (ii) the date and time of the triggering incident;
242.22    (iii) the time of the response or responses under paragraph (e), clause (1) or (2);
242.23    (iv) whether the response met the resident's needs;
242.24    (v) whether the existing policies and response protocols were followed; and
242.25    (vi) whether the existing policies and protocols are adequate or need modification.
242.26    When no physical presence response is completed for a three-month period, the
242.27license holder's written policies and procedures must require a physical presence response
242.28drill to be conducted for which the effectiveness of the response protocol under paragraph
242.29(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
242.30    (5) establish that emergency and nonemergency phone numbers are posted in a
242.31prominent location in a common area of the home where they can be easily observed by a
242.32person responding to an incident who is not otherwise affiliated with the home.
242.33    (e) The license holder must document and include in the license application which
242.34response alternative under clause (1) or (2) is in place for responding to situations that
242.35present a serious risk to the health, safety, or rights of people receiving foster care services
242.36in the home residents served by the program:
243.1    (1) response alternative (1) requires only the technology to provide an electronic
243.2notification or alert to the license holder that an event is underway that requires a response.
243.3Under this alternative, no more than ten minutes will pass before the license holder will be
243.4physically present on site to respond to the situation; or
243.5    (2) response alternative (2) requires the electronic notification and alert system under
243.6alternative (1), but more than ten minutes may pass before the license holder is present on
243.7site to respond to the situation. Under alternative (2), all of the following conditions are met:
243.8    (i) the license holder has a written description of the interactive technological
243.9applications that will assist the license holder in communicating with and assessing the
243.10needs related to the care, health, and safety of the foster care recipients. This interactive
243.11technology must permit the license holder to remotely assess the well being of the foster
243.12care recipient resident served by the program without requiring the initiation of the
243.13foster care recipient. Requiring the foster care recipient to initiate a telephone call does
243.14not meet this requirement;
243.15(ii) the license holder documents how the remote license holder is qualified and
243.16capable of meeting the needs of the foster care recipients and assessing foster care
243.17recipients' needs under item (i) during the absence of the license holder on site;
243.18(iii) the license holder maintains written procedures to dispatch emergency response
243.19personnel to the site in the event of an identified emergency; and
243.20    (iv) each foster care recipient's resident's individualized plan of care, individual
243.21service plan coordinated service and support plan under section sections 256B.0913,
243.22subdivision 8; 256B.0915, subdivision 6; 256B.092, subdivision 1b; and 256B.49,
243.23subdivision 15, if required, or individual resident placement agreement under Minnesota
243.24Rules, part 9555.5105, subpart 19, if required, identifies the maximum response time,
243.25which may be greater than ten minutes, for the license holder to be on site for that foster
243.26care recipient resident.
243.27    (f) Each foster care recipient's resident's placement agreement, individual service
243.28agreement, and plan must clearly state that the adult foster care or community residential
243.29setting license category is a program without the presence of a caregiver in the residence
243.30during normal sleeping hours; the protocols in place for responding to situations that
243.31present a serious risk to the health, safety, or rights of foster care recipients residents
243.32served by the program under paragraph (e), clause (1) or (2); and a signed informed
243.33consent from each foster care recipient resident served by the program or the person's
243.34legal representative documenting the person's or legal representative's agreement with
243.35placement in the program. If electronic monitoring technology is used in the home, the
243.36informed consent form must also explain the following:
244.1    (1) how any electronic monitoring is incorporated into the alternative supervision
244.2system;
244.3    (2) the backup system for any electronic monitoring in times of electrical outages or
244.4other equipment malfunctions;
244.5    (3) how the caregivers or direct support staff are trained on the use of the technology;
244.6    (4) the event types and license holder response times established under paragraph (e);
244.7    (5) how the license holder protects the foster care recipient's each resident's privacy
244.8related to electronic monitoring and related to any electronically recorded data generated
244.9by the monitoring system. A foster care recipient resident served by the program may
244.10not be removed from a program under this subdivision for failure to consent to electronic
244.11monitoring. The consent form must explain where and how the electronically recorded
244.12data is stored, with whom it will be shared, and how long it is retained; and
244.13    (6) the risks and benefits of the alternative overnight supervision system.
244.14    The written explanations under clauses (1) to (6) may be accomplished through
244.15cross-references to other policies and procedures as long as they are explained to the
244.16person giving consent, and the person giving consent is offered a copy.
244.17(g) Nothing in this section requires the applicant or license holder to develop or
244.18maintain separate or duplicative policies, procedures, documentation, consent forms, or
244.19individual plans that may be required for other licensing standards, if the requirements of
244.20this section are incorporated into those documents.
244.21(h) The commissioner may grant variances to the requirements of this section
244.22according to section 245A.04, subdivision 9.
244.23(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
244.24under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
244.25contractors affiliated with the license holder.
244.26(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to
244.27remotely determine what action the license holder needs to take to protect the well-being
244.28of the foster care recipient.
244.29(k) The commissioner shall evaluate license applications using the requirements
244.30in paragraphs (d) to (f). The commissioner shall provide detailed application forms,
244.31including a checklist of criteria needed for approval.
244.32(l) To be eligible for a license under paragraph (a), the adult foster care or community
244.33residential setting license holder must not have had a conditional license issued under
244.34section 245A.06 or any licensing sanction under section 245A.07 during the prior 24
244.35months based on failure to provide adequate supervision, health care services, or resident
244.36safety in the adult foster care home or community residential setting.
245.1(m) The commissioner shall review an application for an alternative overnight
245.2supervision license within 60 days of receipt of the application. When the commissioner
245.3receives an application that is incomplete because the applicant failed to submit required
245.4documents or that is substantially deficient because the documents submitted do not meet
245.5licensing requirements, the commissioner shall provide the applicant written notice
245.6that the application is incomplete or substantially deficient. In the written notice to the
245.7applicant, the commissioner shall identify documents that are missing or deficient and
245.8give the applicant 45 days to resubmit a second application that is substantially complete.
245.9An applicant's failure to submit a substantially complete application after receiving
245.10notice from the commissioner is a basis for license denial under section 245A.05. The
245.11commissioner shall complete subsequent review within 30 days.
245.12(n) Once the application is considered complete under paragraph (m), the
245.13commissioner will approve or deny an application for an alternative overnight supervision
245.14license within 60 days.
245.15(o) For the purposes of this subdivision, "supervision" means:
245.16(1) oversight by a caregiver or direct support staff as specified in the individual
245.17resident's place agreement or coordinated service and support plan and awareness of the
245.18resident's needs and activities; and
245.19(2) the presence of a caregiver or direct support staff in a residence during normal
245.20sleeping hours, unless a determination has been made and documented in the individual's
245.21 coordinated service and support plan that the individual does not require the presence of a
245.22caregiver or direct support staff during normal sleeping hours.

245.23    Sec. 14. Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to read:
245.24    Subd. 7b. Adult foster care data privacy and security. (a) An adult foster care
245.25 or community residential setting license holder who creates, collects, records, maintains,
245.26stores, or discloses any individually identifiable recipient data, whether in an electronic
245.27or any other format, must comply with the privacy and security provisions of applicable
245.28privacy laws and regulations, including:
245.29(1) the federal Health Insurance Portability and Accountability Act of 1996
245.30(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
245.31title 45, part 160, and subparts A and E of part 164; and
245.32(2) the Minnesota Government Data Practices Act as codified in chapter 13.
245.33(b) For purposes of licensure, the license holder shall be monitored for compliance
245.34with the following data privacy and security provisions:
246.1(1) the license holder must control access to data on foster care recipients residents
246.2served by the program according to the definitions of public and private data on individuals
246.3under section 13.02; classification of the data on individuals as private under section
246.413.46, subdivision 2 ; and control over the collection, storage, use, access, protection,
246.5and contracting related to data according to section 13.05, in which the license holder is
246.6assigned the duties of a government entity;
246.7(2) the license holder must provide each foster care recipient resident served by
246.8the program with a notice that meets the requirements under section 13.04, in which
246.9the license holder is assigned the duties of the government entity, and that meets the
246.10requirements of Code of Federal Regulations, title 45, part 164.52. The notice shall
246.11describe the purpose for collection of the data, and to whom and why it may be disclosed
246.12pursuant to law. The notice must inform the recipient individual that the license holder
246.13uses electronic monitoring and, if applicable, that recording technology is used;
246.14(3) the license holder must not install monitoring cameras in bathrooms;
246.15(4) electronic monitoring cameras must not be concealed from the foster care
246.16recipients residents served by the program; and
246.17(5) electronic video and audio recordings of foster care recipients residents served
246.18by the program shall be stored by the license holder for five days unless: (i) a foster care
246.19recipient resident served by the program or legal representative requests that the recording
246.20be held longer based on a specific report of alleged maltreatment; or (ii) the recording
246.21captures an incident or event of alleged maltreatment under section 626.556 or 626.557 or
246.22a crime under chapter 609. When requested by a recipient resident served by the program
246.23 or when a recording captures an incident or event of alleged maltreatment or a crime, the
246.24license holder must maintain the recording in a secured area for no longer than 30 days
246.25to give the investigating agency an opportunity to make a copy of the recording. The
246.26investigating agency will maintain the electronic video or audio recordings as required in
246.27section 626.557, subdivision 12b.
246.28(c) The commissioner shall develop, and make available to license holders and
246.29county licensing workers, a checklist of the data privacy provisions to be monitored
246.30for purposes of licensure.

246.31    Sec. 15. Minnesota Statutes 2012, section 245A.11, subdivision 8, is amended to read:
246.32    Subd. 8. Community residential setting license. (a) The commissioner shall
246.33establish provider standards for residential support services that integrate service standards
246.34and the residential setting under one license. The commissioner shall propose statutory
246.35language and an implementation plan for licensing requirements for residential support
247.1services to the legislature by January 15, 2012, as a component of the quality outcome
247.2standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
247.3(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
247.4for services in settings licensed as adult foster care under Minnesota Rules, parts 9555.5105
247.5to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 2960.3340;
247.6and meeting the provisions of section 256B.092, subdivision 11, paragraph (b) section
247.7245D.02, subdivision 4a, must be required to obtain a community residential setting license.

247.8    Sec. 16. Minnesota Statutes 2012, section 245A.16, subdivision 1, is amended to read:
247.9    Subdivision 1. Delegation of authority to agencies. (a) County agencies and
247.10private agencies that have been designated or licensed by the commissioner to perform
247.11licensing functions and activities under section 245A.04 and background studies for family
247.12child care under chapter 245C; to recommend denial of applicants under section 245A.05;
247.13to issue correction orders, to issue variances, and recommend a conditional license under
247.14section 245A.06, or to recommend suspending or revoking a license or issuing a fine under
247.15section 245A.07, shall comply with rules and directives of the commissioner governing
247.16those functions and with this section. The following variances are excluded from the
247.17delegation of variance authority and may be issued only by the commissioner:
247.18    (1) dual licensure of family child care and child foster care, dual licensure of child
247.19and adult foster care, and adult foster care and family child care;
247.20    (2) adult foster care maximum capacity;
247.21    (3) adult foster care minimum age requirement;
247.22    (4) child foster care maximum age requirement;
247.23    (5) variances regarding disqualified individuals except that county agencies may
247.24issue variances under section 245C.30 regarding disqualified individuals when the county
247.25is responsible for conducting a consolidated reconsideration according to sections 245C.25
247.26and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
247.27and a disqualification based on serious or recurring maltreatment; and
247.28    (6) the required presence of a caregiver in the adult foster care residence during
247.29normal sleeping hours; and
247.30    (7) variances for community residential setting licenses under chapter 245D.
247.31Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency
247.32must not grant a license holder a variance to exceed the maximum allowable family child
247.33care license capacity of 14 children.
247.34    (b) County agencies must report information about disqualification reconsiderations
247.35under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
248.1granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
248.2prescribed by the commissioner.
248.3    (c) For family day care programs, the commissioner may authorize licensing reviews
248.4every two years after a licensee has had at least one annual review.
248.5    (d) For family adult day services programs, the commissioner may authorize
248.6licensing reviews every two years after a licensee has had at least one annual review.
248.7    (e) A license issued under this section may be issued for up to two years.

248.8    Sec. 17. Minnesota Statutes 2012, section 245D.02, is amended to read:
248.9245D.02 DEFINITIONS.
248.10    Subdivision 1. Scope. The terms used in this chapter have the meanings given
248.11them in this section.
248.12    Subd. 2. Annual and annually. "Annual" and "annually" have the meaning given
248.13in section 245A.02, subdivision 2b.
248.14    Subd. 2a. Authorized representative. "Authorized representative" means a parent,
248.15family member, advocate, or other adult authorized by the person or the person's legal
248.16representative, to serve as a representative in connection with the provision of services
248.17licensed under this chapter. This authorization must be in writing or by another method
248.18that clearly indicates the person's free choice. The authorized representative must have no
248.19financial interest in the provision of any services included in the person's service delivery
248.20plan and must be capable of providing the support necessary to assist the person in the use
248.21of home and community-based services licensed under this chapter.
248.22    Subd. 3. Case manager. "Case manager" means the individual designated
248.23to provide waiver case management services, care coordination, or long-term care
248.24consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
248.25or successor provisions.
248.26    Subd. 3a. Certification. "Certification" means the commissioner's written
248.27authorization for a license holder to provide specialized services based on certification
248.28standards in section 245D.33. The term certification and its derivatives have the same
248.29meaning and may be substituted for the term licensure and its derivatives in this chapter
248.30and chapter 245A.
248.31    Subd. 4. Commissioner. "Commissioner" means the commissioner of the
248.32Department of Human Services or the commissioner's designated representative.
248.33    Subd. 4a. Community residential setting. "Community residential setting" means
248.34a residential program as identified in section 245A.11, subdivision 8, where residential
248.35supports and services identified in section 245D.03, subdivision 1, paragraph (c), clause
249.1(3), items (i) and (ii), are provided and the license holder is the owner, lessor, or tenant
249.2of the facility licensed according to this chapter, and the license holder does not reside
249.3in the facility.
249.4    Subd. 4b. Coordinated service and support plan. "Coordinated service and support
249.5plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915, subdivision
249.66; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor provisions.
249.7    Subd. 4c. Coordinated service and support plan addendum. "Coordinated
249.8service and support plan addendum" means the documentation that this chapter requires
249.9of the license holder for each person receiving services.
249.10    Subd. 4d. Corporate foster care. "Corporate foster care" means a child foster
249.11residence setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340,
249.12or an adult foster care home licensed according to Minnesota Rules, parts 9555.5105 to
249.139555.6265, where the license holder does not live in the home.
249.14    Subd. 4e. Cultural competence or culturally competent. "Cultural competence"
249.15or "culturally competent" means the ability and the will to respond to the unique needs of
249.16a person that arise from the person's culture and the ability to use the person's culture as a
249.17resource or tool to assist with the intervention and help meet the person's needs.
249.18    Subd. 4f. Day services facility. "Day services facility" means a facility licensed
249.19according to this chapter at which persons receive day services licensed under this chapter
249.20from the license holder's direct support staff for a cumulative total of more than 30 days
249.21within any 12-month period and the license holder is the owner, lessor, or tenant of the
249.22facility.
249.23    Subd. 5. Department. "Department" means the Department of Human Services.
249.24    Subd. 6. Direct contact. "Direct contact" has the meaning given in section 245C.02,
249.25subdivision 11 , and is used interchangeably with the term "direct support service."
249.26    Subd. 6a. Direct support staff or staff. "Direct support staff" or "staff" means
249.27employees of the license holder who have direct contact with persons served by the
249.28program and includes temporary staff or subcontractors, regardless of employer, providing
249.29program services for hire under the control of the license holder who have direct contact
249.30with persons served by the program.
249.31    Subd. 7. Drug. "Drug" has the meaning given in section 151.01, subdivision 5.
249.32    Subd. 8. Emergency. "Emergency" means any event that affects the ordinary
249.33daily operation of the program including, but not limited to, fires, severe weather, natural
249.34disasters, power failures, or other events that threaten the immediate health and safety of
249.35a person receiving services and that require calling 911, emergency evacuation, moving
250.1to an emergency shelter, or temporary closure or relocation of the program to another
250.2facility or service site for more than 24 hours.
250.3    Subd. 8a. Emergency use of manual restraint. "Emergency use of manual
250.4restraint" means using a manual restraint when a person poses an imminent risk of
250.5physical harm to self or others and is the least restrictive intervention that would achieve
250.6safety. Property damage, verbal aggression, or a person's refusal to receive or participate
250.7in treatment or programming on their own, do not constitute an emergency.
250.8    Subd. 8b. Expanded support team. "Expanded support team" means the members
250.9of the support team defined in subdivision 46, and a licensed health or mental health
250.10professional or other licensed, certified, or qualified professionals or consultants working
250.11with the person and included in the team at the request of the person or the person's legal
250.12representative.
250.13    Subd. 8c. Family foster care. "Family foster care" means a child foster family
250.14setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340, or an adult
250.15foster care home licensed according to Minnesota Rules, parts 9555.5105 to 9555.6265,
250.16where the license holder lives in the home.
250.17    Subd. 9. Health services. "Health services" means any service or treatment
250.18consistent with the physical and mental health needs of the person, such as medication
250.19administration and monitoring, medical, dental, nutritional, health monitoring, wellness
250.20education, and exercise.
250.21    Subd. 10. Home and community-based services. "Home and community-based
250.22services" means the services subject to the provisions of this chapter identified in section
250.23245D.03, subdivision 1, and as defined in:
250.24(1) the federal federally approved waiver plans governed by United States Code,
250.25title 42, sections 1396 et seq., or the state's alternative care program according to section
250.26256B.0913, including the waivers for persons with disabilities under section 256B.49,
250.27subdivision 11, including the brain injury (BI) waiver, plan; the community alternative
250.28care (CAC) waiver, plan; the community alternatives for disabled individuals (CADI)
250.29waiver, plan; the developmental disability (DD) waiver, plan under section 256B.092,
250.30subdivision 5; the elderly waiver (EW), and plan under section 256B.0915, subdivision 1;
250.31or successor plans respective to each waiver; or
250.32(2) the alternative care (AC) program under section 256B.0913.
250.33    Subd. 11. Incident. "Incident" means an occurrence that affects the which involves
250.34a person and requires the program to make a response that is not a part of the program's
250.35 ordinary provision of services to a that person, and includes any of the following:
250.36(1) serious injury of a person as determined by section 245.91, subdivision 6;
251.1(2) a person's death;
251.2(3) any medical emergency, unexpected serious illness, or significant unexpected
251.3change in an illness or medical condition, or the mental health status of a person that
251.4requires calling the program to call 911 or a mental health crisis intervention team,
251.5physician treatment, or hospitalization;
251.6(4) any mental health crisis that requires the program to call 911 or a mental health
251.7crisis intervention team;
251.8(5) an act or situation involving a person that requires the program to call 911,
251.9law enforcement, or the fire department;
251.10(4) (6) a person's unauthorized or unexplained absence from a program;
251.11(5) (7) physical aggression conduct by a person receiving services against another
251.12person receiving services that causes physical pain, injury, or persistent emotional distress,
251.13including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting,
251.14pushing, and spitting;:
251.15(i) is so severe, pervasive, or objectively offensive that it substantially interferes with
251.16a person's opportunities to participate in or receive service or support;
251.17(ii) places the person in actual and reasonable fear of harm;
251.18(iii) places the person in actual and reasonable fear of damage to property of the
251.19person; or
251.20(iv) substantially disrupts the orderly operation of the program;
251.21(6) (8) any sexual activity between persons receiving services involving force or
251.22coercion as defined under section 609.341, subdivisions 3 and 14; or
251.23(9) any emergency use of manual restraint as identified in section 245D.061; or
251.24(7) (10) a report of alleged or suspected child or vulnerable adult maltreatment
251.25under section 626.556 or 626.557.
251.26    Subd. 11a. Intermediate care facility for persons with developmental disabilities
251.27or ICF/DD. "Intermediate care facility for persons with developmental disabilities" or
251.28"ICF/DD" means a residential program licensed to serve four or more persons with
251.29developmental disabilities under section 252.28 and chapter 245A and licensed as a
251.30supervised living facility under chapter 144, which together are certified by the Department
251.31of Health as an intermediate care facility for persons with developmental disabilities.
251.32    Subd. 11b. Least restrictive alternative. "Least restrictive alternative" means
251.33the alternative method for providing supports and services that is the least intrusive and
251.34most normalized given the level of supervision and protection required for the person.
251.35This level of supervision and protection allows risk taking to the extent that there is no
251.36reasonable likelihood that serious harm will happen to the person or others.
252.1    Subd. 12. Legal representative. "Legal representative" means the parent of a
252.2person who is under 18 years of age, a court-appointed guardian, or other representative
252.3with legal authority to make decisions about services for a person. Other representatives
252.4with legal authority to make decisions include but are not limited to a health care agent or
252.5an attorney-in-fact authorized through a health care directive or power of attorney.
252.6    Subd. 13. License. "License" has the meaning given in section 245A.02,
252.7subdivision 8 .
252.8    Subd. 14. Licensed health professional. "Licensed health professional" means a
252.9person licensed in Minnesota to practice those professions described in section 214.01,
252.10subdivision 2 .
252.11    Subd. 15. License holder. "License holder" has the meaning given in section
252.12245A.02, subdivision 9 .
252.13    Subd. 16. Medication. "Medication" means a prescription drug or over-the-counter
252.14drug. For purposes of this chapter, "medication" includes dietary supplements.
252.15    Subd. 17. Medication administration. "Medication administration" means
252.16performing the following set of tasks to ensure a person takes both prescription and
252.17over-the-counter medications and treatments according to orders issued by appropriately
252.18licensed professionals, and includes the following:
252.19(1) checking the person's medication record;
252.20(2) preparing the medication for administration;
252.21(3) administering the medication to the person;
252.22(4) documenting the administration of the medication or the reason for not
252.23administering the medication; and
252.24(5) reporting to the prescriber or a nurse any concerns about the medication,
252.25including side effects, adverse reactions, effectiveness, or the person's refusal to take the
252.26medication or the person's self-administration of the medication.
252.27    Subd. 18. Medication assistance. "Medication assistance" means providing verbal
252.28or visual reminders to take regularly scheduled medication, which includes either of
252.29the following:
252.30(1) bringing to the person and opening a container of previously set up medications
252.31and emptying the container into the person's hand or opening and giving the medications
252.32in the original container to the person, or bringing to the person liquids or food to
252.33accompany the medication; or
252.34(2) providing verbal or visual reminders to perform regularly scheduled treatments
252.35and exercises.
253.1    Subd. 19. Medication management. "Medication management" means the
253.2provision of any of the following:
253.3(1) medication-related services to a person;
253.4(2) medication setup;
253.5(3) medication administration;
253.6(4) medication storage and security;
253.7(5) medication documentation and charting;
253.8(6) verification and monitoring of effectiveness of systems to ensure safe medication
253.9handling and administration;
253.10(7) coordination of medication refills;
253.11(8) handling changes to prescriptions and implementation of those changes;
253.12(9) communicating with the pharmacy; or
253.13(10) coordination and communication with prescriber.
253.14For the purposes of this chapter, medication management does not mean "medication
253.15therapy management services" as identified in section 256B.0625, subdivision 13h.
253.16    Subd. 20. Mental health crisis intervention team. "Mental health crisis
253.17intervention team" means a mental health crisis response providers provider as identified
253.18in section 256B.0624, subdivision 2, paragraph (d), for adults, and in section 256B.0944,
253.19subdivision 1 , paragraph (d), for children.
253.20    Subd. 20a. Most integrated setting. "Most integrated setting" means a setting that
253.21enables individuals with disabilities to interact with nondisabled persons to the fullest
253.22extent possible.
253.23    Subd. 21. Over-the-counter drug. "Over-the-counter drug" means a drug that
253.24is not required by federal law to bear the statement "Caution: Federal law prohibits
253.25dispensing without prescription."
253.26    Subd. 21a. Outcome. "Outcome" means the behavior, action, or status attained by
253.27the person that can be observed, measured, and determined reliable and valid.
253.28    Subd. 22. Person. "Person" has the meaning given in section 245A.02, subdivision
253.2911 .
253.30    Subd. 23. Person with a disability. "Person with a disability" means a person
253.31determined to have a disability by the commissioner's state medical review team as
253.32identified in section 256B.055, subdivision 7, the Social Security Administration, or
253.33the person is determined to have a developmental disability as defined in Minnesota
253.34Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section
253.35252.27, subdivision 1a .
254.1    Subd. 23a. Physician. "Physician" means a person who is licensed under chapter
254.2147.
254.3    Subd. 24. Prescriber. "Prescriber" means a licensed practitioner as defined in
254.4section 151.01, subdivision 23, person who is authorized under section sections 148.235;
254.5151.01, subdivision 23; or 151.37 to prescribe drugs. For the purposes of this chapter, the
254.6term "prescriber" is used interchangeably with "physician."
254.7    Subd. 25. Prescription drug. "Prescription drug" has the meaning given in section
254.8151.01, subdivision 17 16 .
254.9    Subd. 26. Program. "Program" means either the nonresidential or residential
254.10program as defined in section 245A.02, subdivisions 10 and 14.
254.11    Subd. 27. Psychotropic medication. "Psychotropic medication" means any
254.12medication prescribed to treat the symptoms of mental illness that affect thought processes,
254.13mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic
254.14(neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and
254.15stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder.
254.16Other miscellaneous medications are considered to be a psychotropic medication when
254.17they are specifically prescribed to treat a mental illness or to control or alter behavior.
254.18    Subd. 28. Restraint. "Restraint" means physical or mechanical limiting of the free
254.19and normal movement of body or limbs.
254.20    Subd. 29. Seclusion. "Seclusion" means separating a person from others in a way
254.21that prevents social contact and prevents the person from leaving the situation if he or she
254.22chooses the placement of a person alone in a room from which exit is prohibited by a staff
254.23person or a mechanism such as a lock, a device, or an object positioned to hold the door
254.24closed or otherwise prevent the person from leaving the room.
254.25    Subd. 29a. Self-determination. "Self-determination" means the person makes
254.26decisions independently, plans for the person's own future, determines how money is spent
254.27for the person's supports, and takes responsibility for making these decisions. If a person
254.28has a legal representative, the legal representative's decision-making authority is limited to
254.29the scope of authority granted by the court or allowed in the document authorizing the
254.30legal representative to act.
254.31    Subd. 29b. Semi-independent living services. "Semi-independent living services"
254.32has the meaning given in section 252.275.
254.33    Subd. 30. Service. "Service" means care, training, supervision, counseling,
254.34consultation, or medication assistance assigned to the license holder in the coordinated
254.35service and support plan.
255.1    Subd. 31. Service plan. "Service plan" means the individual service plan or
255.2individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
255.3or successor provisions, and includes any support plans or service needs identified as
255.4a result of long-term care consultation, or a support team meeting that includes the
255.5participation of the person, the person's legal representative, and case manager, or assigned
255.6to a license holder through an authorized service agreement.
255.7    Subd. 32. Service site. "Service site" means the location where the service is
255.8provided to the person, including, but not limited to, a facility licensed according to
255.9chapter 245A; a location where the license holder is the owner, lessor, or tenant; a person's
255.10own home; or a community-based location.
255.11    Subd. 33. Staff. "Staff" means an employee who will have direct contact with a
255.12person served by the facility, agency, or program.
255.13    Subd. 33a. Supervised living facility. "Supervised living facility" has the meaning
255.14given in Minnesota Rules, part 4665.0100, subpart 10.
255.15    Subd. 33b. Supervision. (a) "Supervision" means:
255.16(1) oversight by direct support staff as specified in the person's coordinated service
255.17and support plan or coordinated service and support plan addendum and awareness of
255.18the person's needs and activities;
255.19(2) responding to situations that present a serious risk to the health, safety, or rights
255.20of the person while services are being provided; and
255.21(3) the presence of direct support staff at a service site while services are being
255.22provided, unless a determination has been made and documented in the person's coordinated
255.23service and support plan or coordinated service and support plan addendum that the person
255.24does not require the presence of direct support staff while services are being provided.
255.25(b) For the purposes of this definition, "while services are being provided," means
255.26any period of time during which the license holder will seek reimbursement for services.
255.27    Subd. 34. Support team. "Support team" means the service planning team
255.28identified in section 256B.49, subdivision 15, or the interdisciplinary team identified in
255.29Minnesota Rules, part 9525.0004, subpart 14.
255.30    Subd. 34a. Time out. "Time out" means removing a person involuntarily from an
255.31ongoing activity to a room, either locked or unlocked, or otherwise separating a person
255.32from others in a way that prevents social contact and prevents the person from leaving
255.33the situation if the person chooses. For the purpose of chapter 245D, "time out" does
255.34not mean voluntary removal or self-removal for the purpose of calming, prevention of
255.35escalation, or de-escalation of behavior for a period of up to 15 minutes. "Time out"
255.36does not include a person voluntarily moving from an ongoing activity to an unlocked
256.1room or otherwise separating from a situation or social contact with others if the person
256.2chooses. For the purposes of this definition, "voluntarily" means without being forced,
256.3compelled, or coerced.
256.4    Subd. 35. Unit of government. "Unit of government" means every city, county,
256.5town, school district, other political subdivisions of the state, and any agency of the state
256.6or the United States, and includes any instrumentality of a unit of government.
256.7    Subd. 35a. Treatment. "Treatment" means the provision of care, other than
256.8medications, ordered or prescribed by a licensed health or mental health professional,
256.9provided to a person to cure, rehabilitate, or ease symptoms.
256.10    Subd. 36. Volunteer. "Volunteer" means an individual who, under the direction of the
256.11license holder, provides direct services without pay to a person served by the license holder.
256.12EFFECTIVE DATE.This section is effective January 1, 2014.

256.13    Sec. 18. Minnesota Statutes 2012, section 245D.03, is amended to read:
256.14245D.03 APPLICABILITY AND EFFECT.
256.15    Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of
256.16home and community-based services to persons with disabilities and persons age 65 and
256.17older pursuant to this chapter. The licensing standards in this chapter govern the provision
256.18of the following basic support services: and intensive support services.
256.19(1) housing access coordination as defined under the current BI, CADI, and DD
256.20waiver plans or successor plans;
256.21(2) respite services as defined under the current CADI, BI, CAC, DD, and EW
256.22waiver plans or successor plans when the provider is an individual who is not an employee
256.23of a residential or nonresidential program licensed by the Department of Human Services
256.24or the Department of Health that is otherwise providing the respite service;
256.25(3) behavioral programming as defined under the current BI and CADI waiver
256.26plans or successor plans;
256.27(4) specialist services as defined under the current DD waiver plan or successor plans;
256.28(5) companion services as defined under the current BI, CADI, and EW waiver
256.29plans or successor plans, excluding companion services provided under the Corporation
256.30for National and Community Services Senior Companion Program established under the
256.31Domestic Volunteer Service Act of 1973, Public Law 98-288;
256.32(6) personal support as defined under the current DD waiver plan or successor plans;
256.33(7) 24-hour emergency assistance, on-call and personal emergency response as
256.34defined under the current CADI and DD waiver plans or successor plans;
257.1(8) night supervision services as defined under the current BI waiver plan or
257.2successor plans;
257.3(9) homemaker services as defined under the current CADI, BI, CAC, DD, and EW
257.4waiver plans or successor plans, excluding providers licensed by the Department of Health
257.5under chapter 144A and those providers providing cleaning services only;
257.6(10) independent living skills training as defined under the current BI and CADI
257.7waiver plans or successor plans;
257.8(11) prevocational services as defined under the current BI and CADI waiver plans
257.9or successor plans;
257.10(12) structured day services as defined under the current BI waiver plan or successor
257.11plans; or
257.12(13) supported employment as defined under the current BI and CADI waiver plans
257.13or successor plans.
257.14(b) Basic support services provide the level of assistance, supervision, and care that
257.15is necessary to ensure the health and safety of the person and do not include services that
257.16are specifically directed toward the training, treatment, habilitation, or rehabilitation of
257.17the person. Basic support services include:
257.18(1) in-home and out-of-home respite care services as defined in section 245A.02,
257.19subdivision 15, and under the brain injury, community alternative care, community
257.20alternatives for disabled individuals, developmental disability, and elderly waiver plans;
257.21(2) companion services as defined under the brain injury, community alternatives for
257.22disabled individuals, and elderly waiver plans, excluding companion services provided
257.23under the Corporation for National and Community Services Senior Companion Program
257.24established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
257.25(3) personal support as defined under the developmental disability waiver plan;
257.26(4) 24-hour emergency assistance, personal emergency response as defined under the
257.27community alternatives for disabled individuals and developmental disability waiver plans;
257.28(5) night supervision services as defined under the brain injury waiver plan; and
257.29(6) homemaker services as defined under the community alternatives for disabled
257.30individuals, brain injury, community alternative care, developmental disability, and elderly
257.31waiver plans, excluding providers licensed by the Department of Health under chapter
257.32144A and those providers providing cleaning services only.
257.33(c) Intensive support services provide assistance, supervision, and care that is
257.34necessary to ensure the health and safety of the person and services specifically directed
257.35toward the training, habilitation, or rehabilitation of the person. Intensive support services
257.36include:
258.1(1) intervention services, including:
258.2(i) behavioral support services as defined under the brain injury and community
258.3alternatives for disabled individuals waiver plans;
258.4(ii) in-home or out-of-home crisis respite services as defined under the developmental
258.5disability waiver plan; and
258.6(iii) specialist services as defined under the current developmental disability waiver
258.7plan;
258.8(2) in-home support services, including:
258.9(i) in-home family support and supported living services as defined under the
258.10developmental disability waiver plan;
258.11(ii) independent living services training as defined under the brain injury and
258.12community alternatives for disabled individuals waiver plans; and
258.13(iii) semi-independent living services;
258.14(3) residential supports and services, including:
258.15(i) supported living services as defined under the developmental disability waiver
258.16plan provided in a family or corporate child foster care residence, a family adult foster
258.17care residence, a community residential setting, or a supervised living facility;
258.18(ii) foster care services as defined in the brain injury, community alternative care,
258.19and community alternatives for disabled individuals waiver plans provided in a family or
258.20corporate child foster care residence, a family adult foster care residence, or a community
258.21residential setting; and
258.22(iii) residential services provided in a supervised living facility that is certified by
258.23the Department of Health as an ICF/DD;
258.24(4) day services, including:
258.25(i) structured day services as defined under the brain injury waiver plan;
258.26(ii) day training and habilitation services under sections 252.40 to 252.46, and as
258.27defined under the developmental disability waiver plan; and
258.28(iii) prevocational services as defined under the brain injury and community
258.29alternatives for disabled individuals waiver plans; and
258.30(5) supported employment as defined under the brain injury, developmental
258.31disability, and community alternatives for disabled individuals waiver plans.
258.32    Subd. 2. Relationship to other standards governing home and community-based
258.33services. (a) A license holder governed by this chapter is also subject to the licensure
258.34requirements under chapter 245A.
258.35(b) A license holder concurrently providing child foster care services licensed
258.36according to Minnesota Rules, chapter 2960, to the same person receiving a service licensed
259.1under this chapter is exempt from section 245D.04 as it applies to the person. A corporate
259.2or family child foster care site controlled by a license holder and providing services
259.3governed by this chapter is exempt from compliance with section 245D.04. This exemption
259.4applies to foster care homes where at least one resident is receiving residential supports
259.5and services licensed according to this chapter. This chapter does not apply to corporate or
259.6family child foster care homes that do not provide services licensed under this chapter.
259.7(c) A family adult foster care site controlled by a license holder and providing
259.8services governed by this chapter is exempt from compliance with Minnesota Rules, parts
259.99555.6185; 9555.6225, subpart 8; 9555.6235, item C; 9555.6245; 9555.6255, subpart
259.102; and 9555.6265. These exemptions apply to family adult foster care homes where at
259.11least one resident is receiving residential supports and services licensed according to this
259.12chapter. This chapter does not apply to family adult foster care homes that do not provide
259.13services licensed under this chapter.
259.14(d) A license holder providing services licensed according to this chapter in a
259.15supervised living facility is exempt from compliance with sections 245D.04; 245D.05,
259.16subdivision 2; and 245D.06, subdivision 2, clauses (1), (4), and (5).
259.17(e) A license holder providing residential services to persons in an ICF/DD is exempt
259.18from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision
259.192, clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09,
259.20subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.
259.21(c) (f) A license holder concurrently providing home care homemaker services
259.22registered licensed according to sections 144A.43 to 144A.49 to the same person receiving
259.23home management services licensed under this chapter and registered according to chapter
259.24144A is exempt from compliance with section 245D.04 as it applies to the person.
259.25(d) A license holder identified in subdivision 1, clauses (1), (5), and (9), is exempt
259.26from compliance with sections 245A.65, subdivision 2, paragraph (a), and 626.557,
259.27subdivision 14 , paragraph (b).
259.28(e) Notwithstanding section 245D.06, subdivision 5, a license holder providing
259.29structured day, prevocational, or supported employment services under this chapter
259.30and day training and habilitation or supported employment services licensed under
259.31chapter 245B within the same program is exempt from compliance with this chapter
259.32when the license holder notifies the commissioner in writing that the requirements under
259.33chapter 245B will be met for all persons receiving these services from the program. For
259.34the purposes of this paragraph, if the license holder has obtained approval from the
259.35commissioner for an alternative inspection status according to section 245B.031, that
259.36approval will apply to all persons receiving services in the program.
260.1(g) Nothing in this chapter prohibits a license holder from concurrently serving
260.2persons without disabilities or people who are or are not age 65 and older, provided this
260.3chapter's standards are met as well as other relevant standards.
260.4(h) The documentation required under sections 245D.07 and 245D.071 must meet
260.5the individual program plan requirements identified in section 256B.092 or successor
260.6provisions.
260.7    Subd. 3. Variance. If the conditions in section 245A.04, subdivision 9, are met,
260.8the commissioner may grant a variance to any of the requirements in this chapter, except
260.9sections 245D.04, and 245D.10, subdivision 4, paragraph (b) 245D.06, subdivision 4,
260.10paragraph (b), and 245D.061, subdivision 3, or provisions governing data practices and
260.11information rights of persons.
260.12    Subd. 4. License holders with multiple 245D licenses. (a) When a person changes
260.13service from one license to a different license held by the same license holder, the license
260.14holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).
260.15(b) When a staff person begins providing direct service under one or more licenses
260.16held by the same license holder, other than the license for which staff orientation was
260.17initially provided according to section 245D.09, subdivision 4, the license holder is
260.18exempt from those staff orientation requirements, except the staff person must review each
260.19person's service plan and medication administration procedures in accordance with section
260.20245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.
260.21    Subd. 5. Program certification. An applicant or a license holder may apply for
260.22program certification as identified in section 245D.33.
260.23EFFECTIVE DATE.This section is effective January 1, 2014.

260.24    Sec. 19. Minnesota Statutes 2012, section 245D.04, is amended to read:
260.25245D.04 SERVICE RECIPIENT RIGHTS.
260.26    Subdivision 1. License holder responsibility for individual rights of persons
260.27served by the program. The license holder must:
260.28(1) provide each person or each person's legal representative with a written notice
260.29that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of
260.30those rights within five working days of service initiation and annually thereafter;
260.31(2) make reasonable accommodations to provide this information in other formats
260.32or languages as needed to facilitate understanding of the rights by the person and the
260.33person's legal representative, if any;
261.1(3) maintain documentation of the person's or the person's legal representative's
261.2receipt of a copy and an explanation of the rights; and
261.3(4) ensure the exercise and protection of the person's rights in the services provided
261.4by the license holder and as authorized in the coordinated service and support plan.
261.5    Subd. 2. Service-related rights. A person's service-related rights include the right to:
261.6(1) participate in the development and evaluation of the services provided to the
261.7person;
261.8(2) have services and supports identified in the coordinated service and support plan
261.9and the coordinated service and support plan addendum provided in a manner that respects
261.10and takes into consideration the person's preferences according to the requirements in
261.11sections 245D.07 and 245D.071;
261.12(3) refuse or terminate services and be informed of the consequences of refusing
261.13or terminating services;
261.14(4) know, in advance, limits to the services available from the license holder,
261.15including the license holder's knowledge, skill, and ability to meet the person's service and
261.16support needs based on the information required in section 245D.031, subdivision 2;
261.17(5) know conditions and terms governing the provision of services, including the
261.18license holder's admission criteria and policies and procedures related to temporary
261.19service suspension and service termination;
261.20(6) a coordinated transfer to ensure continuity of care when there will be a change
261.21in the provider;
261.22(7) know what the charges are for services, regardless of who will be paying for the
261.23services, and be notified of changes in those charges;
261.24(7) (8) know, in advance, whether services are covered by insurance, government
261.25funding, or other sources, and be told of any charges the person or other private party
261.26may have to pay; and
261.27(8) (9) receive services from an individual who is competent and trained, who has
261.28professional certification or licensure, as required, and who meets additional qualifications
261.29identified in the person's coordinated service and support plan. or coordinated service and
261.30support plan addendum.
261.31    Subd. 3. Protection-related rights. (a) A person's protection-related rights include
261.32the right to:
261.33(1) have personal, financial, service, health, and medical information kept private,
261.34and be advised of disclosure of this information by the license holder;
261.35(2) access records and recorded information about the person in accordance with
261.36applicable state and federal law, regulation, or rule;
262.1(3) be free from maltreatment;
262.2(4) be free from restraint, time out, or seclusion used for a purpose other than except
262.3for emergency use of manual restraint to protect the person from imminent danger to self
262.4or others according to the requirements in section 245D.06;
262.5(5) receive services in a clean and safe environment when the license holder is the
262.6owner, lessor, or tenant of the service site;
262.7(6) be treated with courtesy and respect and receive respectful treatment of the
262.8person's property;
262.9(7) reasonable observance of cultural and ethnic practice and religion;
262.10(8) be free from bias and harassment regarding race, gender, age, disability,
262.11spirituality, and sexual orientation;
262.12(9) be informed of and use the license holder's grievance policy and procedures,
262.13including knowing how to contact persons responsible for addressing problems and to
262.14appeal under section 256.045;
262.15(10) know the name, telephone number, and the Web site, e-mail, and street
262.16addresses of protection and advocacy services, including the appropriate state-appointed
262.17ombudsman, and a brief description of how to file a complaint with these offices;
262.18(11) assert these rights personally, or have them asserted by the person's family,
262.19authorized representative, or legal representative, without retaliation;
262.20(12) give or withhold written informed consent to participate in any research or
262.21experimental treatment;
262.22(13) associate with other persons of the person's choice;
262.23(14) personal privacy; and
262.24(15) engage in chosen activities.
262.25(b) For a person residing in a residential site licensed according to chapter 245A,
262.26or where the license holder is the owner, lessor, or tenant of the residential service site,
262.27protection-related rights also include the right to:
262.28(1) have daily, private access to and use of a non-coin-operated telephone for local
262.29calls and long-distance calls made collect or paid for by the person;
262.30(2) receive and send, without interference, uncensored, unopened mail or electronic
262.31correspondence or communication; and
262.32(3) have use of and free access to common areas in the residence; and
262.33(4) privacy for visits with the person's spouse, next of kin, legal counsel, religious
262.34advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
262.35privacy in the person's bedroom.
263.1(c) Restriction of a person's rights under subdivision 2, clause (10), or paragraph (a),
263.2clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure
263.3the health, safety, and well-being of the person. Any restriction of those rights must be
263.4documented in the person's coordinated service and support plan for the person and or
263.5coordinated service and support plan addendum. The restriction must be implemented
263.6in the least restrictive alternative manner necessary to protect the person and provide
263.7support to reduce or eliminate the need for the restriction in the most integrated setting
263.8and inclusive manner. The documentation must include the following information:
263.9(1) the justification for the restriction based on an assessment of the person's
263.10vulnerability related to exercising the right without restriction;
263.11(2) the objective measures set as conditions for ending the restriction;
263.12(3) a schedule for reviewing the need for the restriction based on the conditions for
263.13ending the restriction to occur, at a minimum, every three months for persons who do not
263.14have a legal representative and annually for persons who do have a legal representative
263.15 semiannually from the date of initial approval, at a minimum, or more frequently if
263.16requested by the person, the person's legal representative, if any, and case manager; and
263.17(4) signed and dated approval for the restriction from the person, or the person's
263.18legal representative, if any. A restriction may be implemented only when the required
263.19approval has been obtained. Approval may be withdrawn at any time. If approval is
263.20withdrawn, the right must be immediately and fully restored.
263.21EFFECTIVE DATE.This section is effective January 1, 2014.

263.22    Sec. 20. Minnesota Statutes 2012, section 245D.05, is amended to read:
263.23245D.05 HEALTH SERVICES.
263.24    Subdivision 1. Health needs. (a) The license holder is responsible for providing
263.25 meeting health services service needs assigned in the coordinated service and support plan
263.26and or the coordinated service and support plan addendum, consistent with the person's
263.27health needs. The license holder is responsible for promptly notifying the person or
263.28 the person's legal representative, if any, and the case manager of changes in a person's
263.29physical and mental health needs affecting assigned health services service needs assigned
263.30to the license holder in the coordinated service and support plan or the coordinated service
263.31and support plan addendum, when discovered by the license holder, unless the license
263.32holder has reason to know the change has already been reported. The license holder
263.33must document when the notice is provided.
264.1(b) When assigned in the service plan, If responsibility for meeting the person's
264.2health service needs has been assigned to the license holder in the coordinated service and
264.3support plan or the coordinated service and support plan addendum, the license holder is
264.4required to must maintain documentation on how the person's health needs will be met,
264.5including a description of the procedures the license holder will follow in order to:
264.6(1) provide medication administration, assistance or medication assistance, or
264.7medication management administration according to this chapter;
264.8(2) monitor health conditions according to written instructions from the person's
264.9physician or a licensed health professional;
264.10(3) assist with or coordinate medical, dental, and other health service appointments; or
264.11(4) use medical equipment, devices, or adaptive aides or technology safely and
264.12correctly according to written instructions from the person's physician or a licensed
264.13health professional.
264.14    Subd. 1a. Medication setup. For the purposes of this subdivision, "medication
264.15setup" means the arranging of medications according to instructions from the pharmacy,
264.16the prescriber, or a licensed nurse, for later administration when the license holder
264.17is assigned responsibility for medication assistance or medication administration in
264.18the coordinated service and support plan or the coordinated service and support plan
264.19addendum. A prescription label or the prescriber's written or electronically recorded order
264.20for the prescription is sufficient to constitute written instructions from the prescriber. The
264.21license holder must document in the person's medication administration record: dates
264.22of setup, name of medication, quantity of dose, times to be administered, and route of
264.23administration at time of setup; and, when the person will be away from home, to whom
264.24the medications were given.
264.25    Subd. 1b. Medication assistance. If responsibility for medication assistance
264.26is assigned to the license holder in the coordinated service and support plan or the
264.27coordinated service and support plan addendum, the license holder must ensure that
264.28the requirements of subdivision 2, paragraph (b), have been met when staff provides
264.29medication assistance to enable a person to self-administer medication or treatment when
264.30the person is capable of directing the person's own care, or when the person's legal
264.31representative is present and able to direct care for the person. For the purposes of this
264.32subdivision, "medication assistance" means any of the following:
264.33(1) bringing to the person and opening a container of previously set up medications,
264.34emptying the container into the person's hand, or opening and giving the medications in
264.35the original container to the person;
264.36(2) bringing to the person liquids or food to accompany the medication; or
265.1(3) providing reminders to take regularly scheduled medication or perform regularly
265.2scheduled treatments and exercises.
265.3    Subd. 2. Medication administration. (a) If responsibility for medication
265.4administration is assigned to the license holder in the coordinated service and support plan
265.5or the coordinated service and support plan addendum, the license holder must implement
265.6the following medication administration procedures to ensure a person takes medications
265.7and treatments as prescribed:
265.8(1) checking the person's medication record;
265.9(2) preparing the medication as necessary;
265.10(3) administering the medication or treatment to the person;
265.11(4) documenting the administration of the medication or treatment or the reason for
265.12not administering the medication or treatment; and
265.13(5) reporting to the prescriber or a nurse any concerns about the medication or
265.14treatment, including side effects, effectiveness, or a pattern of the person refusing to
265.15take the medication or treatment as prescribed. Adverse reactions must be immediately
265.16reported to the prescriber or a nurse.
265.17(b)(1) The license holder must ensure that the following criteria requirements in
265.18clauses (2) to (4) have been met before staff that is not a licensed health professional
265.19administers administering medication or treatment:.
265.20(1) (2) The license holder must obtain written authorization has been obtained from
265.21the person or the person's legal representative to administer medication or treatment
265.22orders; and must obtain reauthorization annually as needed. If the person or the person's
265.23legal representative refuses to authorize the license holder to administer medication, the
265.24medication must not be administered. The refusal to authorize medication administration
265.25must be reported to the prescriber as expediently as possible.
265.26(2) (3) The staff person has completed responsible for administering the medication
265.27or treatment must complete medication administration training according to section
265.28245D.09, subdivision 4 , paragraph 4a, paragraphs (a) and (c), clause (2); and, as applicable
265.29to the person, paragraph (d).
265.30(3) The medication or treatment will be administered under administration
265.31procedures established for the person in consultation with a licensed health professional.
265.32written instruction from the person's physician may constitute the medication
265.33administration procedures. A prescription label or the prescriber's order for the
265.34prescription is sufficient to constitute written instructions from the prescriber. A licensed
265.35health professional may delegate medication administration procedures.
266.1(4) For a license holder providing intensive support services, the medication or
266.2treatment must be administered according to the license holder's medication administration
266.3policy and procedures as required under section 245D.11, subdivision 2, clause (3).
266.4(b) (c) The license holder must ensure the following information is documented in
266.5the person's medication administration record:
266.6(1) the information on the current prescription label or the prescriber's current written
266.7or electronically recorded order or prescription that includes directions for the person's
266.8name, description of the medication or treatment to be provided, and the frequency and
266.9other information needed to safely and correctly administering administer the medication
266.10or treatment to ensure effectiveness;
266.11(2) information on any discomforts, risks, or other side effects that are reasonable to
266.12expect, and any contraindications to its use. This information must be readily available
266.13to all staff administering the medication;
266.14(3) the possible consequences if the medication or treatment is not taken or
266.15administered as directed;
266.16(4) instruction from the prescriber on when and to whom to report the following:
266.17(i) if the a dose of medication or treatment is not administered or treatment is not
266.18performed as prescribed, whether by error by the staff or the person or by refusal by
266.19the person; and
266.20(ii) the occurrence of possible adverse reactions to the medication or treatment;
266.21(5) notation of any occurrence of a dose of medication not being administered or
266.22treatment not performed as prescribed, whether by error by the staff or the person or by
266.23refusal by the person, or of adverse reactions, and when and to whom the report was
266.24made; and
266.25(6) notation of when a medication or treatment is started, administered, changed, or
266.26discontinued.
266.27(c) The license holder must ensure that the information maintained in the medication
266.28administration record is current and is regularly reviewed with the person or the person's
266.29legal representative and the staff administering the medication to identify medication
266.30administration issues or errors. At a minimum, the review must be conducted every three
266.31months or more often if requested by the person or the person's legal representative.
266.32Based on the review, the license holder must develop and implement a plan to correct
266.33medication administration issues or errors. If issues or concerns are identified related to
266.34the medication itself, the license holder must report those as required under subdivision 4.
266.35    Subd. 3. Medication assistance. The license holder must ensure that the
266.36requirements of subdivision 2, paragraph (a), have been met when staff provides assistance
267.1to enable a person to self-administer medication when the person is capable of directing
267.2the person's own care, or when the person's legal representative is present and able to
267.3direct care for the person.
267.4    Subd. 4. Reviewing and reporting medication and treatment issues. The
267.5following medication administration issues must be reported to the person or the person's
267.6legal representative and case manager as they occur or following timelines established
267.7in the person's service plan or as requested in writing by the person or the person's legal
267.8representative, or the case manager: (a) When assigned responsibility for medication
267.9administration, the license holder must ensure that the information maintained in
267.10the medication administration record is current and is regularly reviewed to identify
267.11medication administration errors. At a minimum, the review must be conducted every
267.12three months, or more frequently as directed in the coordinated service and support plan
267.13or coordinated service and support plan addendum or as requested by the person or the
267.14person's legal representative. Based on the review, the license holder must develop and
267.15implement a plan to correct patterns of medication administration errors when identified.
267.16(b) If assigned responsibility for medication assistance or medication administration,
267.17the license holder must report the following to the person's legal representative and case
267.18manager as they occur or as otherwise directed in the coordinated service and support plan
267.19or the coordinated service and support plan addendum:
267.20(1) any reports made to the person's physician or prescriber required under
267.21subdivision 2, paragraph (b) (c), clause (4);
267.22(2) a person's refusal or failure to take or receive medication or treatment as
267.23prescribed; or
267.24(3) concerns about a person's self-administration of medication or treatment.
267.25    Subd. 5. Injectable medications. Injectable medications may be administered
267.26according to a prescriber's order and written instructions when one of the following
267.27conditions has been met:
267.28(1) a registered nurse or licensed practical nurse will administer the subcutaneous or
267.29intramuscular injection;
267.30(2) a supervising registered nurse with a physician's order has delegated the
267.31administration of subcutaneous injectable medication to an unlicensed staff member
267.32and has provided the necessary training; or
267.33(3) there is an agreement signed by the license holder, the prescriber, and the
267.34person or the person's legal representative specifying what subcutaneous injections may
267.35be given, when, how, and that the prescriber must retain responsibility for the license
268.1holder's giving the injections. A copy of the agreement must be placed in the person's
268.2service recipient record.
268.3Only licensed health professionals are allowed to administer psychotropic
268.4medications by injection.
268.5EFFECTIVE DATE.This section is effective January 1, 2014.

268.6    Sec. 21. [245D.051] PSYCHOTROPIC MEDICATION USE AND
268.7MONITORING.
268.8    Subdivision 1. Conditions for psychotropic medication administration. (a)
268.9When a person is prescribed a psychotropic medication and the license holder is assigned
268.10responsibility for administration of the medication in the person's coordinated service
268.11and support plan or the coordinated service and support plan addendum, the license
268.12holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05,
268.13subdivision 2, are met.
268.14(b) Use of the medication must be included in the person's coordinated service and
268.15support plan or in the coordinated service and support plan addendum and based on a
268.16prescriber's current written or electronically recorded prescription.
268.17(c) The license holder must develop, implement, and maintain the following
268.18documentation in the person's coordinated service and support plan addendum according
268.19to the requirements in sections 245D.07 and 245D.071:
268.20(1) a description of the target symptoms that the psychotropic medication is to
268.21alleviate; and
268.22(2) documentation methods the license holder will use to monitor and measure
268.23changes in the target symptoms that are to be alleviated by the psychotropic medication if
268.24required by the prescriber. The license holder must collect and report on medication and
268.25symptom-related data as instructed by the prescriber. The license holder must provide
268.26the monitoring data to the expanded support team for review every three months, or as
268.27otherwise requested by the person or the person's legal representative.
268.28For the purposes of this section, "target symptom" refers to any perceptible
268.29diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic
268.30and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
268.31successive editions that has been identified for alleviation.
268.32(d) If a person is prescribed a psychotropic medication, monitoring the use of the
268.33psychotropic medication must be assigned to the license holder in the coordinated service
268.34and support plan or the coordinated service and support plan addendum. The assigned
268.35license holder must monitor the psychotropic medication as required by this section.
269.1    Subd. 2. Refusal to authorize psychotropic medication. If the person or the
269.2person's legal representative refuses to authorize the administration of a psychotropic
269.3medication as ordered by the prescriber, the license holder must follow the requirement
269.4in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal
269.5to the prescriber, the license holder must follow any directives or orders given by the
269.6prescriber. A court order must be obtained to override the refusal. Refusal to authorize
269.7administration of a specific psychotropic medication is not grounds for service termination
269.8and does not constitute an emergency. A decision to terminate services must be reached in
269.9compliance with section 245D.10, subdivision 3.
269.10EFFECTIVE DATE.This section is effective January 1, 2014.

269.11    Sec. 22. Minnesota Statutes 2012, section 245D.06, is amended to read:
269.12245D.06 PROTECTION STANDARDS.
269.13    Subdivision 1. Incident response and reporting. (a) The license holder must
269.14respond to all incidents under section 245D.02, subdivision 11, that occur while providing
269.15services to protect the health and safety of and minimize risk of harm to the person.
269.16(b) The license holder must maintain information about and report incidents to the
269.17person's legal representative or designated emergency contact and case manager within 24
269.18hours of an incident occurring while services are being provided, or within 24 hours of
269.19discovery or receipt of information that an incident occurred, unless the license holder
269.20has reason to know that the incident has already been reported, or as otherwise directed
269.21in a person's coordinated service and support plan or coordinated service and support
269.22plan addendum. An incident of suspected or alleged maltreatment must be reported as
269.23required under paragraph (d), and an incident of serious injury or death must be reported
269.24as required under paragraph (e).
269.25(c) When the incident involves more than one person, the license holder must not
269.26disclose personally identifiable information about any other person when making the report
269.27to each person and case manager unless the license holder has the consent of the person.
269.28(d) Within 24 hours of reporting maltreatment as required under section 626.556
269.29or 626.557, the license holder must inform the case manager of the report unless there is
269.30reason to believe that the case manager is involved in the suspected maltreatment. The
269.31license holder must disclose the nature of the activity or occurrence reported and the
269.32agency that received the report.
269.33(e) The license holder must report the death or serious injury of the person to the legal
269.34representative, if any, and case manager, as required in paragraph (b) and to the Department
270.1of Human Services Licensing Division, and the Office of Ombudsman for Mental Health
270.2and Developmental Disabilities as required under section 245.94, subdivision 2a, within
270.324 hours of the death, or receipt of information that the death occurred, unless the license
270.4holder has reason to know that the death has already been reported.
270.5(f) When a death or serious injury occurs in a facility certified as an intermediate
270.6care facility for persons with developmental disabilities, the death or serious injury must
270.7be reported to the Department of Health, Office of Health Facility Complaints, and the
270.8Office of Ombudsman for Mental Health and Developmental Disabilities, as required
270.9under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
270.10know that the death has already been reported.
270.11(f) (g) The license holder must conduct a an internal review of incident reports of
270.12deaths and serious injuries that occurred while services were being provided and that
270.13were not reported by the program as alleged or suspected maltreatment, for identification
270.14of incident patterns, and implementation of corrective action as necessary to reduce
270.15occurrences. The review must include an evaluation of whether related policies and
270.16procedures were followed, whether the policies and procedures were adequate, whether
270.17there is a need for additional staff training, whether the reported event is similar to past
270.18events with the persons or the services involved, and whether there is a need for corrective
270.19action by the license holder to protect the health and safety of persons receiving services.
270.20Based on the results of this review, the license holder must develop, document, and
270.21implement a corrective action plan designed to correct current lapses and prevent future
270.22lapses in performance by staff or the license holder, if any.
270.23(h) The license holder must verbally report the emergency use of manual restraint of
270.24a person as required in paragraph (b), within 24 hours of the occurrence. The license holder
270.25must ensure the written report and internal review of all incident reports of the emergency
270.26use of manual restraints are completed according to the requirements in section 245D.061.
270.27    Subd. 2. Environment and safety. The license holder must:
270.28(1) ensure the following when the license holder is the owner, lessor, or tenant
270.29of the an unlicensed service site:
270.30(i) the service site is a safe and hazard-free environment;
270.31(ii) doors are locked or toxic substances or dangerous items normally accessible are
270.32inaccessible to persons served by the program are stored in locked cabinets, drawers, or
270.33containers only to protect the safety of a person receiving services and not as a substitute
270.34for staff supervision or interactions with a person who is receiving services. If doors are
270.35locked or toxic substances or dangerous items normally accessible to persons served by the
270.36program are stored in locked cabinets, drawers, or containers are made inaccessible, the
271.1license holder must justify and document how this determination was made in consultation
271.2with the person or person's legal representative, and how access will otherwise be provided
271.3to the person and all other affected persons receiving services; and document an assessment
271.4of the physical plant, its environment, and its population identifying the risk factors which
271.5require toxic substances or dangerous items to be inaccessible and a statement of specific
271.6measures to be taken to minimize the safety risk to persons receiving services;
271.7(iii) doors are locked from the inside to prevent a person from exiting only when
271.8necessary to protect the safety of a person receiving services and not as a substitute for
271.9staff supervision or interactions with the person. If doors are locked from the inside, the
271.10license holder must document an assessment of the physical plant, the environment and
271.11the population served, identifying the risk factors which require the use of locked doors,
271.12and a statement of specific measures to be taken to minimize the safety risk to persons
271.13receiving services at the service site; and
271.14(iii) (iv) a staff person is available on site who is trained in basic first aid and, when
271.15required in a person's coordinated service and support plan or coordinated service and
271.16support plan addendum, cardiopulmonary resuscitation, whenever persons are present and
271.17staff are required to be at the site to provide direct service. The training must include
271.18in-person instruction, hands-on practice, and an observed skills assessment under the
271.19direct supervision of a first aid instructor;
271.20(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
271.21license holder in good condition when used to provide services;
271.22(3) follow procedures to ensure safe transportation, handling, and transfers of the
271.23person and any equipment used by the person, when the license holder is responsible for
271.24transportation of a person or a person's equipment;
271.25(4) be prepared for emergencies and follow emergency response procedures to
271.26ensure the person's safety in an emergency; and
271.27(5) follow universal precautions and sanitary practices, including hand washing, for
271.28infection prevention and control, and to prevent communicable diseases.
271.29    Subd. 3. Compliance with fire and safety codes. When services are provided at a
271.30 service site licensed according to chapter 245A or where the license holder is the owner,
271.31lessor, or tenant of the service site, the license holder must document compliance with
271.32applicable building codes, fire and safety codes, health rules, and zoning ordinances, or
271.33document that an appropriate waiver has been granted.
271.34    Subd. 4. Funds and property. (a) Whenever the license holder assists a person
271.35with the safekeeping of funds or other property according to section 245A.04, subdivision
271.3613 , the license holder must have obtain written authorization to do so from the person or
272.1the person's legal representative and the case manager. Authorization must be obtained
272.2within five working days of service initiation and renewed annually thereafter. At the time
272.3initial authorization is obtained, the license holder must survey, document, and implement
272.4the preferences of the person or the person's legal representative and the case manager
272.5for frequency of receiving a statement that itemizes receipts and disbursements of funds
272.6or other property. The license holder must document changes to these preferences when
272.7they are requested.
272.8(b) A license holder or staff person may not accept powers-of-attorney from a
272.9person receiving services from the license holder for any purpose, and may not accept an
272.10appointment as guardian or conservator of a person receiving services from the license
272.11holder. This does not apply to license holders that are Minnesota counties or other
272.12units of government or to staff persons employed by license holders who were acting
272.13as power-of-attorney, guardian, or conservator attorney-in-fact for specific individuals
272.14prior to April 23, 2012 implementation of this chapter. The license holder must maintain
272.15documentation of the power-of-attorney, guardianship, or conservatorship in the service
272.16recipient record.
272.17(c) Upon the transfer or death of a person, any funds or other property of the person
272.18must be surrendered to the person or the person's legal representative, or given to the
272.19executor or administrator of the estate in exchange for an itemized receipt.
272.20    Subd. 5. Prohibitions. (a) The license holder is prohibited from using psychotropic
272.21medication chemical restraints, mechanical restraint practices, manual restraints, time out,
272.22or seclusion as a substitute for adequate staffing, for a behavioral or therapeutic program
272.23to reduce or eliminate behavior, as punishment, or for staff convenience, or for any reason
272.24other than as prescribed.
272.25(b) The license holder is prohibited from using restraints or seclusion under any
272.26circumstance, unless the commissioner has approved a variance request from the license
272.27holder that allows for the emergency use of restraints and seclusion according to terms
272.28and conditions approved in the variance. Applicants and license holders who have
272.29reason to believe they may be serving an individual who will need emergency use of
272.30restraints or seclusion may request a variance on the application or reapplication, and
272.31the commissioner shall automatically review the request for a variance as part of the
272.32application or reapplication process. License holders may also request the variance any
272.33time after issuance of a license. In the event a license holder uses restraint or seclusion for
272.34any reason without first obtaining a variance as required, the license holder must report
272.35the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the
272.36occurrence and request the required variance.
273.1(b) For the purposes of this subdivision, "chemical restraint" means the
273.2administration of a drug or medication to control the person's behavior or restrict the
273.3person's freedom of movement and is not a standard treatment of dosage for the person's
273.4medical or psychological condition.
273.5(c) For the purposes of this subdivision, "mechanical restraint practice" means the
273.6use of any adaptive equipment or safety device to control the person's behavior or restrict
273.7the person's freedom of movement and not as ordered by a licensed health professional.
273.8Mechanical restraint practices include, but are not limited to, the use of bed rails or similar
273.9devices on a bed to prevent the person from getting out of bed, chairs that prevent a person
273.10from rising, or placing a person in a wheelchair so close to a wall that the wall prevents
273.11the person from rising. Wrist bands or devices on clothing that trigger electronic alarms to
273.12warn staff that a person is leaving a room or area do not, in and of themselves, restrict
273.13freedom of movement and should not be considered restraints.
273.14(d) A license holder must not use manual restraints, time out, or seclusion under any
273.15circumstance, except for emergency use of manual restraints according to the requirements
273.16in section 245D.061 or the use of controlled procedures with a person with a developmental
273.17disability as governed by Minnesota Rules, parts 9525.2700 to 9525.2810, or its successor
273.18provisions. License holders implementing nonemergency use of manual restraint, or any
273.19other programmatic use of mechanical restraint, time out, or seclusion with persons who
273.20do not have a developmental disability that is not subject to the requirements of Minnesota
273.21Rules, parts 9525.2700 to 9525.2810, must submit a variance request to the commissioner
273.22for continued use of the procedure within three months of implementation of this chapter.
273.23EFFECTIVE DATE.This section is effective January 1, 2014.

273.24    Sec. 23. [245D.061] EMERGENCY USE OF MANUAL RESTRAINTS.
273.25    Subdivision 1. Standards for emergency use of manual restraints. Except
273.26for the emergency use of controlled procedures with a person with a developmental
273.27disability as governed by Minnesota Rules, part 9525.2770, or its successor provisions,
273.28the license holder must ensure that emergency use of manual restraints complies with the
273.29requirements of this chapter and the license holder's policy and procedures as required
273.30under subdivision 10.
273.31    Subd. 2. Definitions. (a) The terms used in this section have the meaning given
273.32them in this subdivision.
273.33(b) "Manual restraint" means physical intervention intended to hold a person
273.34immobile or limit a person's voluntary movement by using body contact as the only source
273.35of physical restraint.
274.1(c) "Mechanical restraint" means the use of devices, materials, or equipment attached
274.2or adjacent to the person's body, or the use of practices which restrict freedom of movement
274.3or normal access to one's body or body parts, or limits a person's voluntary movement
274.4or holds a person immobile as an intervention precipitated by a person's behavior. The
274.5term does apply to mechanical restraint used to prevent injury with persons who engage in
274.6self-injurious behaviors, such as head-banging, gouging, or other actions resulting in tissue
274.7damage that have caused or could cause medical problems resulting from the self-injury.
274.8    Subd. 3. Conditions for emergency use of manual restraint. Emergency use of
274.9manual restraint must meet the following conditions:
274.10(1) immediate intervention must be needed to protect the person or others from
274.11imminent risk of physical harm; and
274.12(2) the type of manual restraint used must be the least restrictive intervention to
274.13eliminate the immediate risk of harm and effectively achieve safety. The manual restraint
274.14must end when the threat of harm ends.
274.15    Subd. 4. Permitted instructional techniques and therapeutic conduct. (a) Use of
274.16physical contact as therapeutic conduct or as an instructional technique as identified in
274.17paragraphs (b) and (c), is permitted and is not subject to the requirements of this section
274.18when such use is addressed in a person's coordinated service and support plan addendum
274.19and the required conditions have been met. For the purposes of this subdivision,
274.20"therapeutic conduct" has the meaning given in section 626.5572, subdivision 20.
274.21(b) Physical contact or instructional techniques must use the least restrictive
274.22alternative possible to meet the needs of the person and may be used:
274.23(1) to calm or comfort a person by holding that person with no resistance from
274.24that person;
274.25(2) to protect a person known to be at risk of injury due to frequent falls as a result of
274.26a medical condition; or
274.27(3) to position a person with physical disabilities in a manner specified in the
274.28person's coordinated service and support plan addendum.
274.29(c) Restraint may be used as therapeutic conduct:
274.30(1) to allow a licensed health care professional to safely conduct a medical
274.31examination or to provide medical treatment ordered by a licensed health care professional
274.32to a person necessary to promote healing or recovery from an acute, meaning short-term,
274.33medical condition;
274.34(2) to facilitate the person's completion of a task or response when the person does
274.35not resist or the person's resistance is minimal in intensity and duration;
275.1(3) to briefly block or redirect a person's limbs or body without holding the person
275.2or limiting the person's movement to interrupt the person's behavior that may result in
275.3injury to self or others; or
275.4(4) to assist in the safe evacuation of a person in the event of an emergency or to
275.5redirect a person who is at imminent risk of harm in a dangerous situation.
275.6(d) A plan for using restraint as therapeutic conduct must be developed according to
275.7the requirements in sections 245D.07 and 245D.071, and must include methods to reduce
275.8or eliminate the use of and need for restraint.
275.9    Subd. 5. Restrictions when implementing emergency use of manual restraint.
275.10(a) Emergency use of manual restraint procedures must not:
275.11(1) be implemented with a child in a manner that constitutes sexual abuse, neglect,
275.12physical abuse, or mental injury, as defined in section 626.556, subdivision 2;
275.13(2) be implemented with an adult in a manner that constitutes abuse or neglect as
275.14defined in section 626.5572, subdivisions 2 and 17;
275.15(3) be implemented in a manner that violates a person's rights and protections
275.16identified in section 245D.04;
275.17(4) restrict a person's normal access to a nutritious diet, drinking water, adequate
275.18ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping
275.19conditions, or necessary clothing, or to any protection required by state licensing standards
275.20and federal regulations governing the program;
275.21(5) deny the person visitation or ordinary contact with legal counsel, a legal
275.22representative, or next of kin;
275.23(6) be used as a substitute for adequate staffing, for the convenience of staff, as
275.24punishment, or as a consequence if the person refuses to participate in the treatment
275.25or services provided by the program; or
275.26(7) use prone restraint. For the purposes of this section, "prone restraint" means use
275.27of manual restraint that places a person in a face-down position. This does not include
275.28brief physical holding of a person who, during an emergency use of manual restraint, rolls
275.29into a prone position, and the person is restored to a standing, sitting, or side-lying position
275.30as quickly as possible. Applying back or chest pressure while a person is in the prone or
275.31supine position or face-up is prohibited.
275.32    Subd. 6. Monitoring emergency use of manual restraint. The license holder shall
275.33monitor a person's health and safety during an emergency use of a manual restraint. Staff
275.34monitoring the procedure must not be the staff implementing the procedure when possible.
275.35The license holder shall complete a monitoring form, approved by the commissioner, for
275.36each incident involving the emergency use of a manual restraint.
276.1    Subd. 7. Reporting emergency use of manual restraint incident. (a) Within
276.2three calendar days after an emergency use of a manual restraint, the staff person who
276.3implemented the emergency use must report in writing to the designated coordinator the
276.4following information about the emergency use:
276.5(1) the staff and persons receiving services who were involved in the incident
276.6leading up to the emergency use of manual restraint;
276.7(2) a description of the physical and social environment, including who was present
276.8before and during the incident leading up to the emergency use of manual restraint;
276.9(3) a description of what less restrictive alternative measures were attempted to
276.10de-escalate the incident and maintain safety before the manual restraint was implemented
276.11that identifies when, how, and how long the alternative measures were attempted before
276.12manual restraint was implemented;
276.13(4) a description of the mental, physical, and emotional condition of the person who
276.14was restrained, and other persons involved in the incident leading up to, during, and
276.15following the manual restraint;
276.16(5) whether there was any injury to the person who was restrained or other persons
276.17involved in the incident, including staff, before or as a result of the use of manual
276.18restraint; and
276.19(6) whether there was an attempt to debrief with the staff, and, if not contraindicated,
276.20with the person who was restrained and other persons who were involved in or who
276.21witnessed the restraint, following the incident and the outcome of the debriefing. If the
276.22debriefing was not conducted at the time the incident report was made, the report should
276.23identify whether a debriefing is planned.
276.24(b) Each single incident of emergency use of manual restraint must be reported
276.25separately. For the purposes of this subdivision, an incident of emergency use of manual
276.26restraint is a single incident when the following conditions have been met:
276.27(1) after implementing the manual restraint, staff attempt to release the person at the
276.28moment staff believe the person's conduct no longer poses an imminent risk of physical
276.29harm to self or others and less restrictive strategies can be implemented to maintain safety;
276.30(2) upon the attempt to release the restraint, the person's behavior immediately
276.31re-escalates; and
276.32(3) staff must immediately reimplement the restraint in order to maintain safety.
276.33    Subd. 8. Internal review of emergency use of manual restraint. (a) Within five
276.34working days of the emergency use of manual restraint, the license holder must complete
276.35an internal review of each report of emergency use of manual restraint. The review must
276.36include an evaluation of whether:
277.1(1) the person's service and support strategies developed according to sections
277.2245D.07 and 245D.071 need to be revised;
277.3(2) related policies and procedures were followed;
277.4(3) the policies and procedures were adequate;
277.5(4) there is a need for additional staff training;
277.6(5) the reported event is similar to past events with the persons, staff, or the services
277.7involved; and
277.8(6) there is a need for corrective action by the license holder to protect the health
277.9and safety of persons.
277.10(b) Based on the results of the internal review, the license holder must develop,
277.11document, and implement a corrective action plan for the program designed to correct
277.12current lapses and prevent future lapses in performance by individuals or the license
277.13holder, if any. The corrective action plan, if any, must be implemented within 30 days of
277.14the internal review being completed.
277.15    Subd. 9. Expanded support team review. (a) Within five working days after the
277.16completion of the internal review required in subdivision 8, the license holder must consult
277.17with the expanded support team following the emergency use of manual restraint to:
277.18(1) discuss the incident reported in subdivision 7, to define the antecedent or event
277.19that gave rise to the behavior resulting in the manual restraint and identify the perceived
277.20function the behavior served; and
277.21(2) determine whether the person's coordinated service and support plan addendum
277.22needs to be revised according to sections 245D.07 and 245D.071 to positively and
277.23effectively help the person maintain stability and to reduce or eliminate future occurrences
277.24requiring emergency use of manual restraint.
277.25    Subd. 10. Emergency use of manual restraints policy and procedures. The
277.26license holder must develop, document, and implement a policy and procedures that
277.27promote service recipient rights and protect health and safety during the emergency use of
277.28manual restraints. The policy and procedures must comply with the requirements of this
277.29section and must specify the following:
277.30(1) a description of the positive support strategies and techniques staff must use to
277.31attempt to de-escalate a person's behavior before it poses an imminent risk of physical
277.32harm to self or others;
277.33(2) a description of the types of manual restraints the license holder allows staff to
277.34use on an emergency basis, if any. If the license holder will not allow the emergency use
277.35of manual restraint, the policy and procedure must identify the alternative measures the
278.1license holder will require staff to use when a person's conduct poses an imminent risk of
278.2physical harm to self or others and less restrictive strategies would not achieve safety;
278.3(3) instructions for safe and correct implementation of the allowed manual restraint
278.4procedures;
278.5(4) the training that staff must complete and the timelines for completion, before they
278.6may implement an emergency use of manual restraint. In addition to the training on this
278.7policy and procedure and the orientation and annual training required in section 245D.09,
278.8subdivision 4, the training for emergency use of manual restraint must incorporate the
278.9following subjects:
278.10(i) alternatives to manual restraint procedures, including techniques to identify
278.11events and environmental factors that may escalate conduct that poses an imminent risk of
278.12physical harm to self or others;
278.13(ii) de-escalation methods, positive support strategies, and how to avoid power
278.14struggles;
278.15(iii) simulated experiences of administering and receiving manual restraint
278.16procedures allowed by the license holder on an emergency basis;
278.17(iv) how to properly identify thresholds for implementing and ceasing restrictive
278.18procedures;
278.19(v) how to recognize, monitor, and respond to the person's physical signs of distress,
278.20including positional asphyxia;
278.21(vi) the physiological and psychological impact on the person and the staff when
278.22restrictive procedures are used;
278.23(vii) the communicative intent of behaviors; and
278.24(viii) relationship building;
278.25(5) the procedures and forms to be used to monitor the emergency use of manual
278.26restraints, including what must be monitored and the frequency of monitoring per
278.27each incident of emergency use of manual restraint, and the person or position who is
278.28responsible for monitoring the use;
278.29(6) the instructions, forms, and timelines required for completing and submitting an
278.30incident report by the person or persons who implemented the manual restraint; and
278.31(7) the procedures and timelines for conducting the internal review and the expanded
278.32support team review, and the person or position responsible for completing the reviews and
278.33who is responsible for ensuring that corrective action is taken or the person's coordinated
278.34service and support plan addendum is revised, when determined necessary.
278.35EFFECTIVE DATE.This section is effective January 1, 2014.

279.1    Sec. 24. Minnesota Statutes 2012, section 245D.07, is amended to read:
279.2245D.07 SERVICE NEEDS PLANNING AND DELIVERY.
279.3    Subdivision 1. Provision of services. The license holder must provide services as
279.4specified assigned in the coordinated service and support plan and assigned to the license
279.5holder. The provision of services must comply with the requirements of this chapter and
279.6the federal waiver plans.
279.7    Subd. 1a. Person-centered planning and service delivery. (a) The license holder
279.8must provide services in response to the person's identified needs, interests, preferences,
279.9and desired outcomes as specified in the coordinated service and support plan, the
279.10coordinated service and support plan addendum, and in compliance with the requirements
279.11of this chapter. License holders providing intensive support services must also provide
279.12outcome-based services according to the requirements in section 245D.071.
279.13(b) Services must be provided in a manner that supports the person's preferences,
279.14daily needs, and activities and accomplishment of the person's personal goals and service
279.15outcomes, consistent with the principles of:
279.16(1) person-centered service planning and delivery that:
279.17(i) identifies and supports what is important to the person as well as what is
279.18important for the person, including preferences for when, how, and by whom direct
279.19support service is provided;
279.20(ii) uses that information to identify outcomes the person desires; and
279.21(iii) respects each person's history, dignity, and cultural background;
279.22(2) self-determination that supports and provides:
279.23(i) opportunities for the development and exercise of functional and age-appropriate
279.24skills, decision making and choice, personal advocacy, and communication; and
279.25(ii) the affirmation and protection of each person's civil and legal rights;
279.26(3) providing the most integrated setting and inclusive service delivery that supports,
279.27promotes, and allows:
279.28(i) inclusion and participation in the person's community as desired by the person
279.29in a manner that enables the person to interact with nondisabled persons to the fullest
279.30extent possible and supports the person in developing and maintaining a role as a valued
279.31community member;
279.32(ii) opportunities for self-sufficiency as well as developing and maintaining social
279.33relationships and natural supports; and
279.34(iii) a balance between risk and opportunity, meaning the least restrictive supports or
279.35interventions necessary are provided in the most integrated settings in the most inclusive
280.1manner possible to support the person to engage in activities of the person's own choosing
280.2that may otherwise present a risk to the person's health, safety, or rights.
280.3    Subd. 2. Service planning requirements for basic support services. (a) License
280.4holders providing basic support services must meet the requirements of this subdivision.
280.5(b) Within 15 days of service initiation the license holder must complete a
280.6preliminary coordinated service and support plan addendum based on the coordinated
280.7service and support plan.
280.8(c) Within 60 days of service initiation the license holder must review and revise as
280.9needed the preliminary coordinated service and support plan addendum to document the
280.10services that will be provided including how, when, and by whom services will be provided,
280.11and the person responsible for overseeing the delivery and coordination of services.
280.12(d) The license holder must participate in service planning and support team
280.13meetings related to for the person following stated timelines established in the person's
280.14 coordinated service and support plan or as requested by the support team, the person, or
280.15the person's legal representative, the support team or the expanded support team.
280.16    Subd. 3. Reports. The license holder must provide written reports regarding the
280.17person's progress or status as requested by the person, the person's legal representative, the
280.18case manager, or the team.
280.19EFFECTIVE DATE.This section is effective January 1, 2014.

280.20    Sec. 25. [245D.071] SERVICE PLANNING AND DELIVERY; INTENSIVE
280.21SUPPORT SERVICES.
280.22    Subdivision 1. Requirements for intensive support services. A license holder
280.23providing intensive support services identified in section 245D.03, subdivision 1,
280.24paragraph (c), must comply with the requirements in section 245D.07, subdivisions 1
280.25and 3, and this section.
280.26    Subd. 2. Abuse prevention. Prior to or upon initiating services, the license holder
280.27must develop, document, and implement an abuse prevention plan according to section
280.28245A.65, subdivision 2.
280.29    Subd. 3. Assessment and initial service planning. (a) Within 15 days of service
280.30initiation the license holder must complete a preliminary coordinated service and support
280.31plan addendum based on the coordinated service and support plan.
280.32(b) Within 45 days of service initiation the license holder must meet with the person,
280.33the person's legal representative, the case manager, and other members of the support team
280.34or expanded support team to assess and determine the following based on the person's
281.1coordinated service and support plan and the requirements in subdivision 4 and section
281.2245D.07, subdivision 1a:
281.3(1) the scope of the services to be provided to support the person's daily needs
281.4and activities;
281.5(2) the person's desired outcomes and the supports necessary to accomplish the
281.6person's desired outcomes;
281.7(3) the person's preferences for how services and supports are provided;
281.8(4) whether the current service setting is the most integrated setting available and
281.9appropriate for the person; and
281.10(5) how services must be coordinated across other providers licensed under this
281.11chapter serving the same person to ensure continuity of care for the person.
281.12(c) Within the scope of services, the license holder must, at a minimum, assess
281.13the following areas:
281.14(1) the person's ability to self-manage health and medical needs to maintain or
281.15improve physical, mental, and emotional well-being, including, when applicable, allergies,
281.16seizures, choking, special dietary needs, chronic medical conditions, self-administration
281.17of medication or treatment orders, preventative screening, and medical and dental
281.18appointments;
281.19(2) the person's ability to self-manage personal safety to avoid injury or accident in
281.20the service setting, including, when applicable, risk of falling, mobility, regulating water
281.21temperature, community survival skills, water safety skills, and sensory disabilities; and
281.22(3) the person's ability to self-manage symptoms or behavior that may otherwise
281.23result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to
281.24(7), suspension or termination of services by the license holder, or other symptoms
281.25or behaviors that may jeopardize the health and safety of the person or others. The
281.26assessments must produce information about the person that is descriptive of the person's
281.27overall strengths, functional skills and abilities, and behaviors or symptoms.
281.28    Subd. 4. Service outcomes and supports. (a) Within ten working days of the
281.2945-day meeting, the license holder must develop and document the service outcomes and
281.30supports based on the assessments completed under subdivision 3 and the requirements
281.31in section 245D.07, subdivision 1a. The outcomes and supports must be included in the
281.32coordinated service and support plan addendum.
281.33(b) The license holder must document the supports and methods to be implemented
281.34to support the accomplishment of outcomes related to acquiring, retaining, or improving
281.35skills. The documentation must include:
282.1(1) the methods or actions that will be used to support the person and to accomplish
282.2the service outcomes, including information about:
282.3(i) any changes or modifications to the physical and social environments necessary
282.4when the service supports are provided;
282.5(ii) any equipment and materials required; and
282.6(iii) techniques that are consistent with the person's communication mode and
282.7learning style;
282.8(2) the measurable and observable criteria for identifying when the desired outcome
282.9has been achieved and how data will be collected;
282.10(3) the projected starting date for implementing the supports and methods and
282.11the date by which progress towards accomplishing the outcomes will be reviewed and
282.12evaluated; and
282.13(4) the names of the staff or position responsible for implementing the supports
282.14and methods.
282.15(c) Within 20 working days of the 45-day meeting, the license holder must obtain
282.16dated signatures from the person or the person's legal representative and case manager
282.17to document completion and approval of the assessment and coordinated service and
282.18support plan addendum.
282.19    Subd. 5. Progress reviews. (a) The license holder must give the person or the
282.20person's legal representative and case manager an opportunity to participate in the ongoing
282.21review and development of the methods used to support the person and accomplish
282.22outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
282.23the person's support team or expanded support team, must meet with the person, the
282.24person's legal representative, and the case manager, and participate in progress review
282.25meetings following stated timelines established in the person's coordinated service and
282.26support plan or coordinated service and support plan addendum or within 30 days of a
282.27written request by the person, the person's legal representative, or the case manager,
282.28at a minimum of once per year.
282.29(b) The license holder must summarize the person's progress toward achieving the
282.30identified outcomes and make recommendations and identify the rationale for changing,
282.31continuing, or discontinuing implementation of supports and methods identified in
282.32subdivision 4 in a written report sent to the person or the person's legal representative
282.33and case manager five working days prior to the review meeting, unless the person, the
282.34person's legal representative, or the case manager request to receive the report at the
282.35time of the meeting.
283.1(c) Within ten working days of the progress review meeting, the license holder
283.2must obtain dated signatures from the person or the person's legal representative and
283.3the case manager to document approval of any changes to the coordinated service and
283.4support plan addendum.
283.5EFFECTIVE DATE.This section is effective January 1, 2014.

283.6    Sec. 26. [245D.081] PROGRAM COORDINATION, EVALUATION, AND
283.7OVERSIGHT.
283.8    Subdivision 1. Program coordination and evaluation. (a) The license holder
283.9is responsible for:
283.10(1) coordination of service delivery and evaluation for each person served by the
283.11program as identified in subdivision 2; and
283.12(2) program management and oversight that includes evaluation of the program
283.13quality and program improvement for services provided by the license holder as identified
283.14in subdivision 3.
283.15(b) The same person may perform the functions in paragraph (a) if the work and
283.16education qualifications are met in subdivisions 2 and 3.
283.17    Subd. 2. Coordination and evaluation of individual service delivery. (a) Delivery
283.18and evaluation of services provided by the license holder must be coordinated by a
283.19designated staff person. The designated coordinator must provide supervision, support,
283.20and evaluation of activities that include:
283.21(1) oversight of the license holder's responsibilities assigned in the person's
283.22coordinated service and support plan and the coordinated service and support plan
283.23addendum;
283.24(2) taking the action necessary to facilitate the accomplishment of the outcomes
283.25according to the requirements in section 245D.07;
283.26(3) instruction and assistance to direct support staff implementing the coordinated
283.27service and support plan and the service outcomes, including direct observation of service
283.28delivery sufficient to assess staff competency; and
283.29(4) evaluation of the effectiveness of service delivery, methodologies, and progress on
283.30the person's outcomes based on the measurable and observable criteria for identifying when
283.31the desired outcome has been achieved according to the requirements in section 245D.07.
283.32(b) The license holder must ensure that the designated coordinator is competent to
283.33perform the required duties identified in paragraph (a) through education and training in
283.34human services and disability-related fields, and work experience in providing direct care
283.35services and supports to persons with disabilities. The designated coordinator must have
284.1the skills and ability necessary to develop effective plans and to design and use data
284.2systems to measure effectiveness of services and supports. The license holder must verify
284.3and document competence according to the requirements in section 245D.09, subdivision
284.43. The designated coordinator must minimally have:
284.5(1) a baccalaureate degree in a field related to human services, and one year of
284.6full-time work experience providing direct care services to persons with disabilities or
284.7persons age 65 and older;
284.8(2) an associate degree in a field related to human services, and two years of
284.9full-time work experience providing direct care services to persons with disabilities or
284.10persons age 65 and older;
284.11(3) a diploma in a field related to human services from an accredited postsecondary
284.12institution and three years of full-time work experience providing direct care services to
284.13persons with disabilities or persons age 65 and older; or
284.14(4) a minimum of 50 hours of education and training related to human services
284.15and disabilities; and
284.16(5) four years of full-time work experience providing direct care services to persons
284.17with disabilities or persons age 65 and older under the supervision of a staff person who
284.18meets the qualifications identified in clauses (1) to (3).
284.19    Subd. 3. Program management and oversight. (a) The license holder must
284.20designate a managerial staff person or persons to provide program management and
284.21oversight of the services provided by the license holder. The designated manager is
284.22responsible for the following:
284.23(1) maintaining a current understanding of the licensing requirements sufficient to
284.24ensure compliance throughout the program as identified in section 245A.04, subdivision
284.251, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21,
284.26paragraph (b);
284.27(2) ensuring the duties of the designated coordinator are fulfilled according to the
284.28requirements in subdivision 2;
284.29(3) ensuring the program implements corrective action identified as necessary
284.30by the program following review of incident and emergency reports according to the
284.31requirements in section 245D.11, subdivision 2, clause (7). An internal review of
284.32incident reports of alleged or suspected maltreatment must be conducted according to the
284.33requirements in section 245A.65, subdivision 1, paragraph (b);
284.34(4) evaluation of satisfaction of persons served by the program, the person's legal
284.35representative, if any, and the case manager, with the service delivery and progress
285.1towards accomplishing outcomes identified in sections 245D.07 and 245D.071, and
285.2ensuring and protecting each person's rights as identified in section 245D.04;
285.3(5) ensuring staff competency requirements are met according to the requirements in
285.4section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
285.5according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
285.6(6) ensuring corrective action is taken when ordered by the commissioner and that
285.7the terms and condition of the license and any variances are met; and
285.8(7) evaluating the information identified in clauses (1) to (6) to develop, document,
285.9and implement ongoing program improvements.
285.10(b) The designated manager must be competent to perform the duties as required and
285.11must minimally meet the education and training requirements identified in subdivision
285.122, paragraph (b), and have a minimum of three years of supervisory level experience in
285.13a program providing direct support services to persons with disabilities or persons age
285.1465 and older.
285.15EFFECTIVE DATE.This section is effective January 1, 2014.

285.16    Sec. 27. Minnesota Statutes 2012, section 245D.09, is amended to read:
285.17245D.09 STAFFING STANDARDS.
285.18    Subdivision 1. Staffing requirements. The license holder must provide the level of
285.19 direct service support staff sufficient supervision, assistance, and training necessary:
285.20(1) to ensure the health, safety, and protection of rights of each person; and
285.21(2) to be able to implement the responsibilities assigned to the license holder in each
285.22person's coordinated service and support plan or identified in the coordinated service and
285.23support plan addendum, according to the requirements of this chapter.
285.24    Subd. 2. Supervision of staff having direct contact. Except for a license holder
285.25who is the sole direct service support staff, the license holder must provide adequate
285.26supervision of staff providing direct service support to ensure the health, safety, and
285.27protection of rights of each person and implementation of the responsibilities assigned to
285.28the license holder in each person's service plan coordinated service and support plan or
285.29coordinated service and support plan addendum.
285.30    Subd. 3. Staff qualifications. (a) The license holder must ensure that staff providing
285.31direct support, or staff who have responsibilities related to supervising or managing the
285.32provision of direct support service, is competent as demonstrated through skills and
285.33knowledge training, experience, and education to meet the person's needs and additional
285.34requirements as written in the coordinated service and support plan or coordinated
286.1service and support plan addendum, or when otherwise required by the case manager or
286.2the federal waiver plan. The license holder must verify and maintain evidence of staff
286.3competency, including documentation of:
286.4(1) education and experience qualifications relevant to the job responsibilities
286.5assigned to the staff and the needs of the general population of persons served by the
286.6program, including a valid degree and transcript, or a current license, registration, or
286.7certification, when a degree or licensure, registration, or certification is required by this
286.8chapter or in the coordinated service and support plan or coordinated service and support
286.9plan addendum;
286.10(2) completion of required demonstrated competency in the orientation and training
286.11 areas required under this chapter, including and when applicable, completion of continuing
286.12education required to maintain professional licensure, registration, or certification
286.13requirements. Competency in these areas is determined by the license holder through
286.14knowledge testing and observed skill assessment conducted by the trainer or instructor; and
286.15(3) except for a license holder who is the sole direct service support staff, periodic
286.16 performance evaluations completed by the license holder of the direct service support staff
286.17person's ability to perform the job functions based on direct observation.
286.18(b) Staff under 18 years of age may not perform overnight duties or administer
286.19medication.
286.20    Subd. 4. Orientation to program requirements. (a) Except for a license holder
286.21who does not supervise any direct service support staff, within 90 days of hiring direct
286.22service staff 60 days of hire, unless stated otherwise, the license holder must provide
286.23and ensure completion of 30 hours of orientation for direct support staff that combines
286.24supervised on-the-job training with review of and instruction on in the following areas:
286.25(1) the job description and how to complete specific job functions, including:
286.26(i) responding to and reporting incidents as required under section 245D.06,
286.27subdivision 1; and
286.28(ii) following safety practices established by the license holder and as required in
286.29section 245D.06, subdivision 2;
286.30(2) the license holder's current policies and procedures required under this chapter,
286.31including their location and access, and staff responsibilities related to implementation
286.32of those policies and procedures;
286.33(3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the
286.34federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
286.35responsibilities related to complying with data privacy practices;
287.1(4) the service recipient rights under section 245D.04, and staff responsibilities
287.2related to ensuring the exercise and protection of those rights according to the requirements
287.3in section 245D.04;
287.4(5) sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment
287.5reporting and service planning for children and vulnerable adults, and staff responsibilities
287.6related to protecting persons from maltreatment and reporting maltreatment. This
287.7orientation must be provided within 72 hours of first providing direct contact services and
287.8annually thereafter according to section 245A.65, subdivision 3;
287.9(6) what constitutes use of restraints, seclusion, and psychotropic medications,
287.10and staff responsibilities related to the prohibitions of their use the principles of
287.11person-centered service planning and delivery as identified in section 245D.07, subdivision
287.121a, and how they apply to direct support service provided by the staff person; and
287.13(7) other topics as determined necessary in the person's coordinated service and
287.14support plan by the case manager or other areas identified by the license holder.
287.15(b) License holders who provide direct service themselves must complete the
287.16orientation required in paragraph (a), clauses (3) to (7).
287.17    Subd. 4a. Orientation to individual service recipient needs. (c) (a) Before
287.18providing having unsupervised direct service to contact with a person served by the
287.19program, or for whom the staff person has not previously provided direct service support,
287.20or any time the plans or procedures identified in clauses (1) and (2) paragraphs (b) to
287.21(f) are revised, the staff person must review and receive instruction on the following
287.22as it relates requirements in paragraphs (b) to (f) as they relate to the staff person's job
287.23functions for that person:.
287.24(b)Training and competency evaluations must include the following:
287.25(1) appropriate and safe techniques in personal hygiene and grooming, including
287.26hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of
287.27daily living (ADLs) as defined under section 256B.0659, subdivision 1;
287.28(2) an understanding of what constitutes a healthy diet according to data from the
287.29Centers for Disease Control and the skills necessary to prepare that diet;
287.30(3) skills necessary to provide appropriate support in instrumental activities of daily
287.31living (IADLs) as defined under section 256B.0659, subdivision 1; and
287.32(4) demonstrated competence in providing first aid.
287.33(1) (c) The staff person must review and receive instruction on the person's
287.34 coordinated service and support plan or coordinated service and support plan addendum as
287.35it relates to the responsibilities assigned to the license holder, and when applicable, the
287.36person's individual abuse prevention plan according to section 245A.65, to achieve and
288.1demonstrate an understanding of the person as a unique individual, and how to implement
288.2those plans; and.
288.3(2) (d) The staff person must review and receive instruction on medication
288.4administration procedures established for the person when medication administration is
288.5 assigned to the license holder according to section 245D.05, subdivision 1, paragraph
288.6(b). Unlicensed staff may administer medications only after successful completion of a
288.7medication administration training, from a training curriculum developed by a registered
288.8nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
288.9practitioner, physician's assistant, or physician incorporating. The training curriculum
288.10must incorporate an observed skill assessment conducted by the trainer to ensure staff
288.11demonstrate the ability to safely and correctly follow medication procedures.
288.12Medication administration must be taught by a registered nurse, clinical nurse
288.13specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
288.14service initiation or any time thereafter, the person has or develops a health care condition
288.15that affects the service options available to the person because the condition requires:
288.16(i) (1) specialized or intensive medical or nursing supervision; and
288.17(ii) (2) nonmedical service providers to adapt their services to accommodate the
288.18health and safety needs of the person; and.
288.19(iii) necessary training in order to meet the health service needs of the person as
288.20determined by the person's physician.
288.21(e) The staff person must review and receive instruction on the safe and correct
288.22operation of medical equipment used by the person to sustain life, including but not
288.23limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
288.24by a licensed health care professional or a manufacturer's representative and incorporate
288.25an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
288.26operate the equipment according to the treatment orders and the manufacturer's instructions.
288.27(f) The staff person must review and receive instruction on what constitutes use of
288.28restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
288.29related to the prohibitions of their use according to the requirements in section 245D.06,
288.30subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
288.31or undesired behavior and why they are not safe, and the safe and correct use of manual
288.32restraint on an emergency basis according to the requirements in section 245D.061.
288.33(g) In the event of an emergency service initiation, the license holder must ensure
288.34the training required in this subdivision occurs within 72 hours of the direct support staff
288.35person first having unsupervised contact with the person receiving services. The license
289.1holder must document the reason for the unplanned or emergency service initiation and
289.2maintain the documentation in the person's service recipient record.
289.3(h) License holders who provide direct support services themselves must complete
289.4the orientation required in subdivision 4, clauses (3) to (7).
289.5    Subd. 5. Annual training. (a) A license holder must provide annual training to
289.6direct service support staff on the topics identified in subdivision 4, paragraph (a), clauses
289.7(3) to (6) (7), and subdivision 4a, paragraphs (a) to (h). A license holder must provide a
289.8minimum of 24 hours of annual training to direct service staff with fewer than five years
289.9of documented experience and 12 hours of annual training to direct service staff with five
289.10or more years of documented experience in topics described in subdivisions 4, clauses (1)
289.11to (7), and 4a, paragraphs (a) to (h). Training on relevant topics received from sources
289.12other than the license holder may count toward training requirements.
289.13(b) A license holder providing behavioral programming, specialist services, personal
289.14support, 24-hour emergency assistance, night supervision, independent living skills,
289.15structured day, prevocational, or supported employment services must provide a minimum
289.16of eight hours of annual training to direct service staff that addresses:
289.17(1) topics related to the general health, safety, and service needs of the population
289.18served by the license holder; and
289.19(2) other areas identified by the license holder or in the person's current service plan.
289.20Training on relevant topics received from sources other than the license holder
289.21may count toward training requirements.
289.22(c) When the license holder is the owner, lessor, or tenant of the service site and
289.23whenever a person receiving services is present at the site, the license holder must have
289.24a staff person available on site who is trained in basic first aid and, when required in a
289.25person's service plan, cardiopulmonary resuscitation.
289.26    Subd. 5a. Alternative sources of training. Orientation or training received by the
289.27staff person from sources other than the license holder in the same subjects as identified
289.28in subdivision 4 may count toward the orientation and annual training requirements if
289.29received in the 12-month period before the staff person's date of hire. The license holder
289.30must maintain documentation of the training received from other sources and of each staff
289.31person's competency in the required area according to the requirements in subdivision 3.
289.32    Subd. 6. Subcontractors and temporary staff. If the license holder uses a
289.33subcontractor or temporary staff to perform services licensed under this chapter on the
289.34license holder's behalf, the license holder must ensure that the subcontractor or temporary
289.35staff meets and maintains compliance with all requirements under this chapter that apply
289.36to the services to be provided, including training, orientation, and supervision necessary
290.1to fulfill their responsibilities. The license holder must ensure that a background study
290.2has been completed according to the requirements in sections 245C.03, subdivision 1,
290.3and 245C.04. Subcontractors and temporary staff hired by the license holder must meet
290.4the Minnesota licensing requirements applicable to the disciplines in which they are
290.5providing services. The license holder must maintain documentation that the applicable
290.6requirements have been met.
290.7    Subd. 7. Volunteers. The license holder must ensure that volunteers who provide
290.8direct support services to persons served by the program receive the training, orientation,
290.9and supervision necessary to fulfill their responsibilities. The license holder must ensure
290.10that a background study has been completed according to the requirements in sections
290.11245C.03, subdivision 1, and 245C.04. The license holder must maintain documentation
290.12that the applicable requirements have been met.
290.13    Subd. 8. Staff orientation and training plan. The license holder must develop
290.14a staff orientation and training plan documenting when and how compliance with
290.15subdivisions 4, 4a, and 5 will be met.
290.16EFFECTIVE DATE.This section is effective January 1, 2014.

290.17    Sec. 28. [245D.091] INTERVENTION SERVICES.
290.18    Subdivision 1. Licensure requirements. An individual meeting the staff
290.19qualification requirements of this section who is an employee of a program licensed
290.20according to this chapter and providing behavioral support services, specialist services,
290.21or crisis respite services is not required to hold a separate license under this chapter.
290.22An individual meeting the staff qualifications of this section who is not providing these
290.23services as an employee of a program licensed according to this chapter must obtain a
290.24license according to this chapter.
290.25    Subd. 2. Behavior professional qualifications. A behavior professional, as defined
290.26in the brain injury and community alternatives for disabled individuals waiver plans or
290.27successor plans, must have competencies in areas related to:
290.28(1) ethical considerations;
290.29(2) functional assessment;
290.30(3) functional analysis;
290.31(4) measurement of behavior and interpretation of data;
290.32(5) selecting intervention outcomes and strategies;
290.33(6) behavior reduction and elimination strategies that promote least restrictive
290.34approved alternatives;
290.35(7) data collection;
291.1(8) staff and caregiver training;
291.2(9) support plan monitoring;
291.3(10) co-occurring mental disorders or neuro-cognitive disorder;
291.4(11) demonstrated expertise with populations being served; and
291.5(12) must be a:
291.6(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the
291.7Board of Psychology competencies in the above identified areas;
291.8(ii) clinical social worker licensed as an independent clinical social worker under
291.9chapter 148D, or a person with a master's degree in social work from an accredited college
291.10or university, with at least 4,000 hours of post-master's supervised experience in the
291.11delivery of clinical services in the areas identified in clauses (1) to (11);
291.12(iii) physician licensed under chapter 147 and certified by the American Board
291.13of Psychiatry and Neurology or eligible for board certification in psychiatry with
291.14competencies in the areas identified in clauses (1) to (11);
291.15(iv) licensed professional clinical counselor licensed under sections 148B.29 to
291.16148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery
291.17of clinical services who has demonstrated competencies in the areas identified in clauses
291.18(1) to (11);
291.19(v) person with a master's degree from an accredited college or university in one
291.20of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
291.21supervised experience in the delivery of clinical services with demonstrated competencies
291.22in the areas identified in clauses (1) to (11); or
291.23(vi) registered nurse who is licensed under sections 148.171 to 148.285, and who is
291.24certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and
291.25mental health nursing by a national nurse certification organization, or who has a master's
291.26degree in nursing or one of the behavioral sciences or related fields from an accredited
291.27college or university or its equivalent, with at least 4,000 hours of post-master's supervised
291.28experience in the delivery of clinical services.
291.29    Subd. 3. Behavior analyst qualifications. (a) A behavior analyst, as defined in
291.30the brain injury and community alternatives for disabled individuals waiver plans or
291.31successor plans, must:
291.32(1) have obtained a baccalaureate degree, master's degree, or a PhD in a social
291.33services discipline; or
291.34(2) meet the qualifications of a mental health practitioner as defined in section
291.35245.462, subdivision 17.
291.36(b) In addition, a behavior analyst must:
292.1(1) have four years of supervised experience working with individuals who exhibit
292.2challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder;
292.3(2) have received ten hours of instruction in functional assessment and functional
292.4analysis;
292.5(3) have received 20 hours of instruction in the understanding of the function of
292.6behavior;
292.7(4) have received ten hours of instruction on design of positive practices behavior
292.8support strategies;
292.9(5) have received 20 hours of instruction on the use of behavior reduction approved
292.10strategies used only in combination with behavior positive practices strategies;
292.11(6) be determined by a behavior professional to have the training and prerequisite
292.12skills required to provide positive practice strategies as well as behavior reduction
292.13approved and permitted intervention to the person who receives behavioral support; and
292.14(7) be under the direct supervision of a behavior professional.
292.15    Subd. 4. Behavior specialist qualifications. (a) A behavior specialist, as defined
292.16in the brain injury and community alternatives for disabled individuals waiver plans or
292.17successor plans, must meet the following qualifications:
292.18(1) have an associate's degree in a social services discipline; or
292.19(2) have two years of supervised experience working with individuals who exhibit
292.20challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder.
292.21(b) In addition, a behavior specialist must:
292.22(1) have received a minimum of four hours of training in functional assessment;
292.23(2) have received 20 hours of instruction in the understanding of the function of
292.24behavior;
292.25(3) have received ten hours of instruction on design of positive practices behavioral
292.26support strategies;
292.27(4) be determined by a behavior professional to have the training and prerequisite
292.28skills required to provide positive practices strategies as well as behavior reduction
292.29approved intervention to the person who receives behavioral support; and
292.30(5) be under the direct supervision of a behavior professional.
292.31    Subd. 5. Specialist services qualifications. An individual providing specialist
292.32services, as defined in the developmental disabilities waiver plan or successor plan, must
292.33have:
292.34(1) the specific experience and skills required of the specialist to meet the needs of
292.35the person identified by the person's service planning team; and
293.1(2) the qualifications of the specialist identified in the person's coordinated service
293.2and support plan.
293.3EFFECTIVE DATE.This section is effective January 1, 2014.

293.4    Sec. 29. [245D.095] RECORD REQUIREMENTS.
293.5    Subdivision 1. Record-keeping systems. The license holder must ensure that the
293.6content and format of service recipient, personnel, and program records are uniform and
293.7legible according to the requirements of this chapter.
293.8    Subd. 2. Admission and discharge register. The license holder must keep a written
293.9or electronic register, listing in chronological order the dates and names of all persons
293.10served by the program who have been admitted, discharged, or transferred, including
293.11service terminations initiated by the license holder and deaths.
293.12    Subd. 3. Service recipient record. (a) The license holder must maintain a record of
293.13current services provided to each person on the premises where the services are provided
293.14or coordinated. When the services are provided in a licensed facility, the records must
293.15be maintained at the facility, otherwise the records must be maintained at the license
293.16holder's program office. The license holder must protect service recipient records against
293.17loss, tampering, or unauthorized disclosure according to the requirements in sections
293.1813.01 to 13.10 and 13.46.
293.19(b) The license holder must maintain the following information for each person:
293.20(1) an admission form signed by the person or the person's legal representative
293.21that includes:
293.22(i) identifying information, including the person's name, date of birth, address,
293.23and telephone number; and
293.24(ii) the name, address, and telephone number of the person's legal representative, if
293.25any, and a primary emergency contact, the case manager, and family members or others as
293.26identified by the person or case manager;
293.27(2) service information, including service initiation information, verification of the
293.28person's eligibility for services, documentation verifying that services have been provided
293.29as identified in the coordinated service and support plan or coordinated service and support
293.30plan addendum according to paragraph (a), and date of admission or readmission;
293.31(3) health information, including medical history, special dietary needs, and
293.32allergies, and when the license holder is assigned responsibility for meeting the person's
293.33health service needs according to section 245D.05:
294.1(i) current orders for medication, treatments, or medical equipment and a signed
294.2authorization from the person or the person's legal representative to administer or assist in
294.3administering the medication or treatments, if applicable;
294.4(ii) a signed statement authorizing the license holder to act in a medical emergency
294.5when the person's legal representative, if any, cannot be reached or is delayed in arriving;
294.6(iii) medication administration procedures;
294.7(iv) a medication administration record documenting the implementation of the
294.8medication administration procedures, the medication administration record reviews, and
294.9including any agreements for administration of injectable medications by the license
294.10holder according to the requirements in section 245D.05; and
294.11(v) a medical appointment schedule when the license holder is assigned
294.12responsibility for assisting with medical appointments;
294.13(4) the person's current coordinated service and support plan or that portion of the
294.14plan assigned to the license holder;
294.15(5) copies of the individual abuse prevention plan and assessments as required under
294.16section 245D.071, subdivisions 2 and 3;
294.17(6) a record of other service providers serving the person when the person's
294.18coordinated service and support plan or coordinated service and support plan addendum
294.19identifies the need for coordination between the service providers, that includes a contact
294.20person and telephone numbers, services being provided, and names of staff responsible for
294.21coordination;
294.22(7) documentation of orientation to service recipient rights according to section
294.23245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
294.24section 245A.65, subdivision 1, paragraph (c);
294.25(8) copies of authorizations to handle a person's funds, according to section 245D.06,
294.26subdivision 4, paragraph (a);
294.27(9) documentation of complaints received and grievance resolution;
294.28(10) incident reports involving the person, required under section 245D.06,
294.29subdivision 1;
294.30(11) copies of written reports regarding the person's status when requested according
294.31to section 245D.07, subdivision 3, progress review reports as required under section
294.32245D.071, subdivision 5, progress or daily log notes that are recorded by the program,
294.33and reports received from other agencies involved in providing services or care to the
294.34person; and
294.35(12) discharge summary, including service termination notice and related
294.36documentation, when applicable.
295.1    Subd. 4. Access to service recipient records. The license holder must ensure that
295.2the following people have access to the information in subdivision 1 in accordance with
295.3applicable state and federal law, regulation, or rule:
295.4(1) the person, the person's legal representative, and anyone properly authorized
295.5by the person;
295.6(2) the person's case manager;
295.7(3) staff providing services to the person unless the information is not relevant to
295.8carrying out the coordinated service and support plan or coordinated service and support
295.9plan addendum; and
295.10(4) the county child or adult foster care licensor, when services are also licensed as
295.11child or adult foster care.
295.12    Subd. 5. Personnel records. (a) The license holder must maintain a personnel
295.13record of each employee to document and verify staff qualifications, orientation, and
295.14training. The personnel record must include:
295.15(1) the employee's date of hire, completed application, an acknowledgement signed
295.16by the employee that job duties were reviewed with the employee and the employee
295.17understands those duties, and documentation that the employee meets the position
295.18requirements as determined by the license holder;
295.19 (2) documentation of staff qualifications, orientation, training, and performance
295.20evaluations as required under section 245D.09, subdivisions 3 to 5, including the date
295.21the training was completed, the number of hours per subject area, and the name of the
295.22trainer or instructor; and
295.23(3) a completed background study as required under chapter 245C.
295.24(b) For employees hired after January 1, 2014, the license holder must maintain
295.25documentation in the personnel record or elsewhere, sufficient to determine the date of the
295.26employee's first supervised direct contact with a person served by the program, and the
295.27date of first unsupervised direct contact with a person served by the program.
295.28EFFECTIVE DATE.This section is effective January 1, 2014.

295.29    Sec. 30. Minnesota Statutes 2012, section 245D.10, is amended to read:
295.30245D.10 POLICIES AND PROCEDURES.
295.31    Subdivision 1. Policy and procedure requirements. The A license holder
295.32 providing either basic or intensive supports and services must establish, enforce, and
295.33maintain policies and procedures as required in this chapter, chapter 245A, and other
296.1applicable state and federal laws and regulations governing the provision of home and
296.2community-based services licensed according to this chapter.
296.3    Subd. 2. Grievances. The license holder must establish policies and procedures
296.4that provide promote service recipient rights by providing a simple complaint process for
296.5persons served by the program and their authorized representatives to bring a grievance that:
296.6(1) provides staff assistance with the complaint process when requested, and the
296.7addresses and telephone numbers of outside agencies to assist the person;
296.8(2) allows the person to bring the complaint to the highest level of authority in the
296.9program if the grievance cannot be resolved by other staff members, and that provides
296.10the name, address, and telephone number of that person;
296.11(3) requires the license holder to promptly respond to all complaints affecting a
296.12person's health and safety. For all other complaints, the license holder must provide an
296.13initial response within 14 calendar days of receipt of the complaint. All complaints must
296.14be resolved within 30 calendar days of receipt or the license holder must document the
296.15reason for the delay and a plan for resolution;
296.16(4) requires a complaint review that includes an evaluation of whether:
296.17(i) related policies and procedures were followed and adequate;
296.18(ii) there is a need for additional staff training;
296.19(iii) the complaint is similar to past complaints with the persons, staff, or services
296.20involved; and
296.21(iv) there is a need for corrective action by the license holder to protect the health
296.22and safety of persons receiving services;
296.23(5) based on the review in clause (4), requires the license holder to develop,
296.24document, and implement a corrective action plan designed to correct current lapses and
296.25prevent future lapses in performance by staff or the license holder, if any;
296.26(6) provides a written summary of the complaint and a notice of the complaint
296.27resolution to the person and case manager that:
296.28(i) identifies the nature of the complaint and the date it was received;
296.29(ii) includes the results of the complaint review;
296.30(iii) identifies the complaint resolution, including any corrective action; and
296.31(7) requires that the complaint summary and resolution notice be maintained in the
296.32service recipient record.
296.33    Subd. 3. Service suspension and service termination. (a) The license holder must
296.34establish policies and procedures for temporary service suspension and service termination
296.35that promote continuity of care and service coordination with the person and the case
296.36manager and with other licensed caregivers, if any, who also provide support to the person.
297.1(b) The policy must include the following requirements:
297.2(1) the license holder must notify the person or the person's legal representative and
297.3case manager in writing of the intended termination or temporary service suspension, and
297.4the person's right to seek a temporary order staying the termination of service according to
297.5the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);
297.6(2) notice of the proposed termination of services, including those situations
297.7that began with a temporary service suspension, must be given at least 60 days before
297.8the proposed termination is to become effective when a license holder is providing
297.9independent living skills training, structured day, prevocational or supported employment
297.10services to the person intensive supports and services identified in section 245D.03,
297.11subdivision 1, paragraph (c), and 30 days prior to termination for all other services
297.12licensed under this chapter;
297.13(3) the license holder must provide information requested by the person or case
297.14manager when services are temporarily suspended or upon notice of termination;
297.15(4) prior to giving notice of service termination or temporary service suspension,
297.16the license holder must document actions taken to minimize or eliminate the need for
297.17service suspension or termination;
297.18(5) during the temporary service suspension or service termination notice period,
297.19the license holder will work with the appropriate county agency to develop reasonable
297.20alternatives to protect the person and others;
297.21(6) the license holder must maintain information about the service suspension or
297.22termination, including the written termination notice, in the service recipient record; and
297.23(7) the license holder must restrict temporary service suspension to situations in
297.24which the person's behavior causes immediate and serious danger to the health and safety
297.25of the person or others conduct poses an imminent risk of physical harm to self or others
297.26and less restrictive or positive support strategies would not achieve safety.
297.27    Subd. 4. Availability of current written policies and procedures. (a) The license
297.28holder must review and update, as needed, the written policies and procedures required
297.29under this chapter.
297.30(b)(1) The license holder must inform the person and case manager of the policies
297.31and procedures affecting a person's rights under section 245D.04, and provide copies of
297.32those policies and procedures, within five working days of service initiation.
297.33(2) If a license holder only provides basic services and supports, this includes the:
297.34(i) grievance policy and procedure required under subdivision 2; and
297.35(ii) service suspension and termination policy and procedure required under
297.36subdivision 3.
298.1(3) For all other license holders this includes the:
298.2(i) policies and procedures in clause (2);
298.3(ii) emergency use of manual restraints policy and procedure required under
298.4subdivision 3a; and
298.5(iii) data privacy requirements under section 245D.11, subdivision 3.
298.6(c) The license holder must provide a written notice at least 30 days before
298.7implementing any revised policies and procedures procedural revisions to policies
298.8 affecting a person's service-related or protection-related rights under section 245D.04 and
298.9maltreatment reporting policies and procedures. The notice must explain the revision that
298.10was made and include a copy of the revised policy and procedure. The license holder
298.11must document the reason reasonable cause for not providing the notice at least 30 days
298.12before implementing the revisions.
298.13(d) Before implementing revisions to required policies and procedures, the license
298.14holder must inform all employees of the revisions and provide training on implementation
298.15of the revised policies and procedures.
298.16(e) The license holder must annually notify all persons, or their legal representatives,
298.17and case managers of any procedural revisions to policies required under this chapter,
298.18other than those in paragraph (c). Upon request, the license holder must provide the
298.19person, or the person's legal representative, and case manager with copies of the revised
298.20policies and procedures.
298.21EFFECTIVE DATE.This section is effective January 1, 2014.

298.22    Sec. 31. [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT
298.23SERVICES.
298.24    Subdivision 1. Policy and procedure requirements. A license holder providing
298.25intensive support services as identified in section 245D.03, subdivision 1, paragraph (c),
298.26must establish, enforce, and maintain policies and procedures as required in this section.
298.27    Subd. 2. Health and safety. The license holder must establish policies and
298.28procedures that promote health and safety by ensuring:
298.29(1) use of universal precautions and sanitary practices in compliance with section
298.30245D.06, subdivision 2, clause (5);
298.31(2) if the license holder operates a residential program, health service coordination
298.32and care according to the requirements in section 245D.05, subdivision 1;
298.33(3) safe medication assistance and administration according to the requirements
298.34in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
298.35consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
299.1doctor and require completion of medication administration training according to the
299.2requirements in section 245D.09, subdivision 4a, paragraph (c). Medication assistance
299.3and administration includes, but is not limited to:
299.4(i) providing medication-related services for a person;
299.5(ii) medication setup;
299.6(iii) medication administration;
299.7(iv) medication storage and security;
299.8(v) medication documentation and charting;
299.9(vi) verification and monitoring of effectiveness of systems to ensure safe medication
299.10handling and administration;
299.11(vii) coordination of medication refills;
299.12(viii) handling changes to prescriptions and implementation of those changes;
299.13(ix) communicating with the pharmacy; and
299.14(x) coordination and communication with prescriber;
299.15(4) safe transportation, when the license holder is responsible for transportation of
299.16persons, with provisions for handling emergency situations according to the requirements
299.17in section 245D.06, subdivision 2, clauses (2) to (4);
299.18(5) a plan for ensuring the safety of persons served by the program in emergencies as
299.19defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
299.20to the license holder. A license holder with a community residential setting or a day service
299.21facility license must ensure the policy and procedures comply with the requirements in
299.22section 245D.22, subdivision 4;
299.23(6) a plan for responding to all incidents as defined in section 245D.02, subdivision
299.2411; and reporting all incidents required to be reported according to section 245D.06,
299.25subdivision 1. The plan must:
299.26(i) provide the contact information of a source of emergency medical care and
299.27transportation; and
299.28(ii) require staff to first call 911 when the staff believes a medical emergency may be
299.29life threatening, or to call the mental health crisis intervention team when the person is
299.30experiencing a mental health crisis; and
299.31(7) a procedure for the review of incidents and emergencies to identify trends or
299.32patterns, and corrective action if needed. The license holder must establish and maintain
299.33a record-keeping system for the incident and emergency reports. Each incident and
299.34emergency report file must contain a written summary of the incident. The license holder
299.35must conduct a review of incident reports for identification of incident patterns, and
300.1implementation of corrective action as necessary to reduce occurrences. Each incident
300.2report must include:
300.3(i) the name of the person or persons involved in the incident. It is not necessary
300.4to identify all persons affected by or involved in an emergency unless the emergency
300.5resulted in an incident;
300.6(ii) the date, time, and location of the incident or emergency;
300.7(iii) a description of the incident or emergency;
300.8(iv) a description of the response to the incident or emergency and whether a person's
300.9coordinated service and support plan addendum or program policies and procedures were
300.10implemented as applicable;
300.11(v) the name of the staff person or persons who responded to the incident or
300.12emergency; and
300.13(vi) the determination of whether corrective action is necessary based on the results
300.14of the review.
300.15    Subd. 3. Data privacy. The license holder must establish policies and procedures that
300.16promote service recipient rights by ensuring data privacy according to the requirements in:
300.17(1) the Minnesota Government Data Practices Act, section 13.46, and all other
300.18applicable Minnesota laws and rules in handling all data related to the services provided;
300.19and
300.20(2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the
300.21extent that the license holder performs a function or activity involving the use of protected
300.22health information as defined under Code of Federal Regulations, title 45, section 164.501,
300.23including, but not limited to, providing health care services; health care claims processing
300.24or administration; data analysis, processing, or administration; utilization review; quality
300.25assurance; billing; benefit management; practice management; repricing; or as otherwise
300.26provided by Code of Federal Regulations, title 45, section 160.103. The license holder
300.27must comply with the Health Insurance Portability and Accountability Act of 1996 and
300.28its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164,
300.29and all applicable requirements.
300.30    Subd. 4. Admission criteria. The license holder must establish policies and
300.31procedures that promote continuity of care by ensuring that admission or service initiation
300.32criteria:
300.33(1) is consistent with the license holder's registration information identified in the
300.34requirements in section 245D.031, subdivision 2, and with the service-related rights
300.35identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);
301.1(2) identifies the criteria to be applied in determining whether the license holder
301.2can develop services to meet the needs specified in the person's coordinated service and
301.3support plan;
301.4(3) requires a license holder providing services in a health care facility to comply
301.5with the requirements in section 243.166, subdivision 4b, to provide notification to
301.6residents when a registered predatory offender is admitted into the program or to a
301.7potential admission when the facility was already serving a registered predatory offender.
301.8For purposes of this clause, "health care facility" means a facility licensed by the
301.9commissioner as a residential facility under chapter 245A to provide adult foster care or
301.10residential services to persons with disabilities; and
301.11(4) requires that when a person or the person's legal representative requests services
301.12from the license holder, a refusal to admit the person must be based on an evaluation of
301.13the person's assessed needs and the license holder's lack of capacity to meet the needs of
301.14the person. The license holder must not refuse to admit a person based solely on the
301.15type of residential services the person is receiving, or solely on the person's severity of
301.16disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of
301.17communication skills, physical disabilities, toilet habits, behavioral disorders, or past
301.18failure to make progress. Documentation of the basis for refusal must be provided to the
301.19person or the person's legal representative and case manager upon request.
301.20EFFECTIVE DATE.This section is effective January 1, 2014.

301.21    Sec. 32. [245D.21] FACILITY LICENSURE REQUIREMENTS AND
301.22APPLICATION PROCESS.
301.23    Subdivision 1. Community residential settings and day service facilities. For
301.24purposes of this section, "facility" means both a community residential setting and day
301.25service facility and the physical plant.
301.26    Subd. 2. Inspections and code compliance. (a) Physical plants must comply with
301.27applicable state and local fire, health, building, and zoning codes.
301.28(b)(1) The facility must be inspected by a fire marshal or their delegate within
301.2912 months before initial licensure to verify that it meets the applicable occupancy
301.30requirements as defined in the State Fire Code and that the facility complies with the fire
301.31safety standards for that occupancy code contained in the State Fire Code.
301.32(2) The fire marshal inspection of a community residential setting must verify the
301.33residence is a dwelling unit within a residential occupancy as defined in section 9.117 of
301.34the State Fire Code. A home safety checklist, approved by the commissioner, must be
302.1completed for a community residential setting by the license holder and the commissioner
302.2before the satellite license is reissued.
302.3(3) The facility shall be inspected according to the facility capacity specified on the
302.4initial application form.
302.5(4) If the commissioner has reasonable cause to believe that a potentially hazardous
302.6condition may be present or the licensed capacity is increased, the commissioner shall
302.7request a subsequent inspection and written report by a fire marshal to verify the absence
302.8of hazard.
302.9(5) Any condition cited by a fire marshal, building official, or health authority as
302.10hazardous or creating an immediate danger of fire or threat to health and safety must be
302.11corrected before a license is issued by the department, and for community residential
302.12settings, before a license is reissued.
302.13(c) The facility must maintain in a permanent file the reports of health, fire, and
302.14other safety inspections.
302.15(d) The facility's plumbing, ventilation, heating, cooling, lighting, and other
302.16fixtures and equipment, including elevators or food service, if provided, must conform to
302.17applicable health, sanitation, and safety codes and regulations.
302.18EFFECTIVE DATE.This section is effective January 1, 2014.

302.19    Sec. 33. [245D.22] FACILITY SANITATION AND HEALTH.
302.20    Subdivision 1. General maintenance. The license holder must maintain the interior
302.21and exterior of buildings, structures, or enclosures used by the facility, including walls,
302.22floors, ceilings, registers, fixtures, equipment, and furnishings in good repair and in a
302.23sanitary and safe condition. The facility must be clean and free from accumulations of
302.24dirt, grease, garbage, peeling paint, mold, vermin, and insects. The license holder must
302.25correct building and equipment deterioration, safety hazards, and unsanitary conditions.
302.26    Subd. 2. Hazards and toxic substances. (a) The license holder must ensure that
302.27service sites owned or leased by the license holder are free from hazards that would
302.28threaten the health or safety of a person receiving services by ensuring the requirements
302.29in paragraphs (b) to (h) are met.
302.30(b) Chemicals, detergents, and other hazardous or toxic substances must not be
302.31stored with food products or in any way that poses a hazard to persons receiving services.
302.32(c) The license holder must install handrails and nonslip surfaces on interior and
302.33exterior runways, stairways, and ramps according to the applicable building code.
303.1(d) If there are elevators in the facility, the license holder must have elevators
303.2inspected each year. The date of the inspection, any repairs needed, and the date the
303.3necessary repairs were made must be documented.
303.4(e) The license holder must keep stairways, ramps, and corridors free of obstructions.
303.5(f) Outside property must be free from debris and safety hazards. Exterior stairs and
303.6walkways must be kept free of ice and snow.
303.7(g) Heating, ventilation, air conditioning units, and other hot surfaces and moving
303.8parts of machinery must be shielded or enclosed.
303.9(h) Use of dangerous items or equipment by persons served by the program must be
303.10allowed in accordance with the person's coordinated service and support plan addendum
303.11or the program abuse prevention plan, if not addressed in the coordinated service and
303.12support plan addendum.
303.13    Subd. 3. Storage and disposal of medication. Schedule II controlled substances in
303.14the facility that are named in section 152.02, subdivision 3, must be stored in a locked
303.15storage area permitting access only by persons and staff authorized to administer the
303.16medication. This must be incorporated into the license holder's medication administration
303.17policy and procedures required under section 245D.11, subdivision 2, clause (3).
303.18Medications must be disposed of according to the Environmental Protection Agency
303.19recommendations.
303.20    Subd. 4. First aid must be available on site. (a) A staff person trained in first aid
303.21must be available on site and, when required in a person's coordinated service and support
303.22plan or coordinated service and support plan addendum, cardiopulmonary resuscitation,
303.23whenever persons are present and staff are required to be at the site to provide direct
303.24service. The training must include in-person instruction, hands-on practice, and an
303.25observed skills assessment under the direct supervision of a first aid instructor.
303.26(b) A facility must have first aid kits readily available for use by, and that meets
303.27the needs of, persons receiving services and staff. At a minimum, the first aid kit must
303.28be equipped with accessible first aid supplies including bandages, sterile compresses,
303.29scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
303.30adhesive tape, and first aid manual.
303.31    Subd. 5. Emergencies. (a) The license holder must have a written plan for
303.32responding to emergencies as defined in section 245D.02, subdivision 8, to ensure the
303.33safety of persons served in the facility. The plan must include:
303.34(1) procedures for emergency evacuation and emergency sheltering, including:
303.35(i) how to report a fire or other emergency;
304.1(ii) procedures to notify, relocate, and evacuate occupants, including use of adaptive
304.2procedures or equipment to assist with the safe evacuation of persons with physical or
304.3sensory disabilities; and
304.4(iii) instructions on closing off the fire area, using fire extinguishers, and activating
304.5and responding to alarm systems;
304.6(2) a floor plan that identifies:
304.7(i) the location of fire extinguishers;
304.8(ii) the location of audible or visual alarm systems, including but not limited to
304.9manual fire alarm boxes, smoke detectors, fire alarm enunciators and controls, and
304.10sprinkler systems;
304.11(iii) the location of exits, primary and secondary evacuation routes, and accessible
304.12egress routes, if any; and
304.13(iv) the location of emergency shelter within the facility;
304.14(3) a site plan that identifies:
304.15(i) designated assembly points outside the facility;
304.16(ii) the locations of fire hydrants; and
304.17(iii) the routes of fire department access;
304.18(4) the responsibilities each staff person must assume in case of emergency;
304.19(5) procedures for conducting quarterly drills each year and recording the date of
304.20each drill in the file of emergency plans;
304.21(6) procedures for relocation or service suspension when services are interrupted
304.22for more than 24 hours;
304.23(7) for a community residential setting with three or more dwelling units, a floor
304.24plan that identifies the location of enclosed exit stairs; and
304.25(8) an emergency escape plan for each resident.
304.26(b) The license holder must:
304.27(1) maintain a log of quarterly fire drills on file in the facility;
304.28(2) provide an emergency response plan that is readily available to staff and persons
304.29receiving services;
304.30(3) inform each person of a designated area within the facility where the person
304.31should go to for emergency shelter during severe weather and the designated assembly
304.32points outside the facility; and
304.33(4) maintain emergency contact information for persons served at the facility that
304.34can be readily accessed in an emergency.
305.1    Subd. 6. Emergency equipment. The facility must have a flashlight and a portable
305.2radio or television set that do not require electricity and can be used if a power failure
305.3occurs.
305.4    Subd. 7. Telephone and posted numbers. A facility must have a non-coin operated
305.5telephone that is readily accessible. A list of emergency numbers must be posted in a
305.6prominent location. When an area has a 911 number or a mental health crisis intervention
305.7team number, both numbers must be posted and the emergency number listed must be
305.8911. In areas of the state without a 911 number, the numbers listed must be those of the
305.9local fire department, police department, emergency transportation, and poison control
305.10center. The names and telephone numbers of each person's representative, physician, and
305.11dentist must be readily available.
305.12EFFECTIVE DATE.This section is effective January 1, 2014.

305.13    Sec. 34. [245D.23] COMMUNITY RESIDENTIAL SETTINGS; SATELLITE
305.14LICENSURE REQUIREMENTS AND APPLICATION PROCESS.
305.15    Subdivision 1. Separate satellite license required for separate sites. (a) A license
305.16holder providing residential support services must obtain a separate satellite license for
305.17each community residential setting located at separate addresses when the community
305.18residential settings are to be operated by the same license holder. For purposes of this
305.19chapter, a community residential setting is a satellite of the home and community-based
305.20services license.
305.21(b) Community residential settings are permitted single-family use homes. After a
305.22license has been issued, the commissioner shall notify the local municipality where the
305.23residence is located of the approved license.
305.24    Subd. 2. Notification to local agency. The license holder must notify the local
305.25agency within 24 hours of the onset of changes in a residence resulting from construction,
305.26remodeling, or damages requiring repairs that require a building permit or may affect a
305.27licensing requirement in this chapter.
305.28    Subd. 3. Alternate overnight supervision. A license holder granted an alternate
305.29overnight supervision technology adult foster care license according to section 245A.11,
305.30subdivision 7a, that converts to a community residential setting satellite license according
305.31to this chapter must retain that designation.
305.32EFFECTIVE DATE.This section is effective January 1, 2014.

306.1    Sec. 35. [245D.24] COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL
306.2PLANT AND ENVIRONMENT.
306.3    Subdivision 1. Occupancy. The residence must meet the definition of a dwelling
306.4unit in a residential occupancy.
306.5    Subd. 2. Common area requirements. The living area must be provided with an
306.6adequate number of furnishings for the usual functions of daily living and social activities.
306.7The dining area must be furnished to accommodate meals shared by all persons living in
306.8the residence. These furnishings must be in good repair and functional to meet the daily
306.9needs of the persons living in the residence.
306.10    Subd. 3. Bedrooms. (a) People receiving services must mutually consent, in
306.11writing, to sharing a bedroom with one another. No more than two people receiving
306.12services may share one bedroom.
306.13(b) A single occupancy bedroom must have at least 80 square feet of floor space with
306.14a 7-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor
306.15space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and
306.16other habitable rooms by floor to ceiling walls containing no openings except doorways
306.17and must not serve as a corridor to another room used in daily living.
306.18(c) A person's personal possessions and items for the person's own use are the only
306.19items permitted to be stored in a person's bedroom.
306.20(d) Unless otherwise documented through assessment as a safety concern for the
306.21person, each person must be provided with the following furnishings:
306.22(1) a separate bed of proper size and height for the convenience and comfort of the
306.23person, with a clean mattress in good repair;
306.24(2) clean bedding appropriate for the season for each person;
306.25(3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal
306.26possessions and clothing; and
306.27(4) a mirror for grooming.
306.28(e) When possible, a person must be allowed to have items of furniture that the
306.29person personally owns in the bedroom, unless doing so would interfere with safety
306.30precautions, violate a building or fire code, or interfere with another person's use of the
306.31bedroom. A person may choose to not have a cabinet, dresser, shelves, or a mirror in the
306.32bedroom, as otherwise required under paragraph (d), clause (3) or (4). A person may
306.33choose to use a mattress other than an innerspring mattress and may choose to not have
306.34the mattress on a mattress frame or support. If a person chooses not to have a piece of
306.35required furniture, the license holder must document this choice and is not required to
306.36provide the item. If a person chooses to use a mattress other than an innerspring mattress
307.1or chooses to not have a mattress frame or support, the license holder must document this
307.2choice and allow the alternative desired by the person.
307.3(f) A person must be allowed to bring personal possessions into the bedroom
307.4and other designated storage space, if such space is available, in the residence. The
307.5person must be allowed to accumulate possessions to the extent the residence is able to
307.6accommodate them, unless doing so is contraindicated for the person's physical or mental
307.7health, would interfere with safety precautions or another person's use of the bedroom, or
307.8would violate a building or fire code. The license holder must allow for locked storage
307.9of personal items. Any restriction on the possession or locked storage of personal items,
307.10including requiring a person to use a lock provided by the license holder, must comply
307.11with section 245D.04, subdivision 3, paragraph (c), and allow the person to be present if
307.12and when the license holder opens the lock.
307.13EFFECTIVE DATE.This section is effective January 1, 2014.

307.14    Sec. 36. [245D.25] COMMUNITY RESIDENTIAL SETTINGS; FOOD AND
307.15WATER.
307.16    Subdivision 1. Water. Potable water from privately owned wells must be tested
307.17annually by a Department of Health-certified laboratory for coliform bacteria and nitrate
307.18nitrogens to verify safety. The health authority may require retesting and corrective
307.19measures if results exceed state water standards in Minnesota Rules, chapter 4720, or in
307.20the event of a flooding or incident which may put the well at risk of contamination. To
307.21prevent scalding, the water temperature of faucets must not exceed 120 degrees Fahrenheit.
307.22    Subd. 2. Food. Food served must meet any special dietary needs of a person as
307.23prescribed by the person's physician or dietitian. Three nutritionally balanced meals a day
307.24must be served or made available to persons, and nutritious snacks must be available
307.25between meals.
307.26    Subd. 3. Food safety. Food must be obtained, handled, and properly stored to
307.27prevent contamination, spoilage, or a threat to the health of a person.
307.28EFFECTIVE DATE.This section is effective January 1, 2014.

307.29    Sec. 37. [245D.26] COMMUNITY RESIDENTIAL SETTINGS; SANITATION
307.30AND HEALTH.
307.31    Subdivision 1. Goods provided by the license holder. Individual clean bed linens
307.32appropriate for the season and the person's comfort, including towels and wash cloths,
307.33must be available for each person. Usual or customary goods for the operation of a
308.1residence which are communally used by all persons receiving services living in the
308.2residence must be provided by the license holder, including household items for meal
308.3preparation, cleaning supplies to maintain the cleanliness of the residence, window
308.4coverings on windows for privacy, toilet paper, and hand soap.
308.5    Subd. 2. Personal items. Personal health and hygiene items must be stored in a
308.6safe and sanitary manner.
308.7    Subd. 3. Pets and service animals. Pets and service animals housed within
308.8the residence must be immunized and maintained in good health as required by local
308.9ordinances and state law. The license holder must ensure that the person and the person's
308.10representative is notified before admission of the presence of pets in the residence.
308.11    Subd. 4. Smoking in the residence. License holders must comply with the
308.12requirements of the Minnesota Clean Indoor Air Act, sections 144.411 to 144.417, when
308.13smoking is permitted in the residence.
308.14    Subd. 5. Weapons. Weapons and ammunition must be stored separately in locked
308.15areas that are inaccessible to a person receiving services. For purposes of this subdivision,
308.16"weapons" means firearms and other instruments or devices designed for and capable of
308.17producing bodily harm.
308.18EFFECTIVE DATE.This section is effective January 1, 2014.

308.19    Sec. 38. [245D.27] DAY SERVICES FACILITIES; SATELLITE LICENSURE
308.20REQUIREMENTS AND APPLICATION PROCESS.
308.21Except for day service facilities on the same or adjoining lot, the license holder
308.22providing day services must apply for a separate license for each facility-based service
308.23site when the license holder is the owner, lessor, or tenant of the service site at which
308.24persons receive day services and the license holder's employees who provide day services
308.25are present for a cumulative total of more than 30 days within any 12-month period. For
308.26purposes of this chapter, a day services facility license is a satellite license of the day
308.27services program. A day services program may operate multiple licensed day service
308.28facilities in one or more counties in the state. For the purposes of this section, "adjoining
308.29lot" means day services facilities that are next door to or across the street from one another.
308.30EFFECTIVE DATE.This section is effective January 1, 2014.

308.31    Sec. 39. [245D.28] DAY SERVICES FACILITIES; PHYSICAL PLANT AND
308.32SPACE REQUIREMENTS.
309.1    Subdivision 1. Facility capacity and useable space requirements. (a) The facility
309.2capacity of each day service facility must be determined by the amount of primary space
309.3available, the scheduling of activities at other service sites, and the space requirements of
309.4all persons receiving services at the facility, not just the licensed services. The facility
309.5capacity must specify the maximum number of persons that may receive services on
309.6site at any one time.
309.7(b) When a facility is located in a multifunctional organization, the facility may
309.8share common space with the multifunctional organization if the required available
309.9primary space for use by persons receiving day services is maintained while the facility is
309.10operating. The license holder must comply at all times with all applicable fire and safety
309.11codes under section 245A.04, subdivision 2a, and adequate supervision requirements
309.12under section 245D.31 for all persons receiving day services.
309.13(c) A day services facility must have a minimum of 40 square feet of primary
309.14space available for each consumer who is present at the site at any one time. Primary
309.15space does not include:
309.16(1) common areas, such as hallways, stairways, closets, utility areas, bathrooms,
309.17and kitchens;
309.18(2) floor areas beneath stationary equipment; or
309.19(3) any space occupied by persons associated with the multifunctional organization
309.20while persons receiving day services are using common space.
309.21    Subd. 2. Individual personal articles. Each person must be provided space in a
309.22closet, cabinet, on a shelf, or a coat hook for storage of personal items for the person's own
309.23use while receiving services at the facility, unless doing so would interfere with safety
309.24precautions, another person's work space, or violate a building or fire code.
309.25EFFECTIVE DATE.This section is effective January 1, 2014.

309.26    Sec. 40. [245D.29] DAY SERVICES FACILITIES; HEALTH AND SAFETY
309.27REQUIREMENTS.
309.28    Subdivision 1. Refrigeration. If the license holder provides refrigeration at service
309.29sites owned or leased by the license holder for storing perishable foods and perishable
309.30portions of bag lunches, whether the foods are supplied by the license holder or the
309.31persons receiving services, the refrigeration must have a temperature of 40 degrees
309.32Fahrenheit or less.
309.33    Subd. 2. Drinking water. Drinking water must be available to all persons
309.34receiving services. If a person is unable to request or obtain drinking water, it must be
310.1provided according to that person's individual needs. Drinking water must be provided in
310.2single-service containers or from drinking fountains accessible to all persons.
310.3    Subd. 3. Individuals who become ill during the day. There must be an area in
310.4which a person receiving services can rest if:
310.5(1) the person becomes ill during the day;
310.6(2) the person does not live in a licensed residential site;
310.7(3) the person requires supervision; and
310.8(4) there is not a caretaker immediately available. Supervision must be provided
310.9until the caretaker arrives to bring the person home.
310.10    Subd. 4. Safety procedures. The license holder must establish general written
310.11safety procedures that include criteria for selecting, training, and supervising persons who
310.12work with hazardous machinery, tools, or substances. Safety procedures specific to each
310.13person's activities must be explained and be available in writing to all staff members
310.14and persons receiving services.
310.15EFFECTIVE DATE.This section is effective January 1, 2014.

310.16    Sec. 41. [245D.31] DAY SERVICES FACILITIES; STAFF RATIO AND
310.17FACILITY COVERAGE.
310.18    Subdivision 1. Scope. This section applies only to facility-based day services.
310.19    Subd. 2. Factors. (a) The number of direct support service staff members that a
310.20license holder must have on duty at the facility at a given time to meet the minimum
310.21staffing requirements established in this section varies according to:
310.22(1) the number of persons who are enrolled and receiving direct support services
310.23at that given time;
310.24(2) the staff ratio requirement established under subdivision 3 for each person who
310.25is present; and
310.26(3) whether the conditions described in subdivision 8 exist and warrant additional
310.27staffing beyond the number determined to be needed under subdivision 7.
310.28(b) The commissioner must consider the factors in paragraph (a) in determining a
310.29license holder's compliance with the staffing requirements and must further consider
310.30whether the staff ratio requirement established under subdivision 3 for each person
310.31receiving services accurately reflects the person's need for staff time.
310.32    Subd. 3. Staff ratio requirement for each person receiving services. The case
310.33manager, in consultation with the interdisciplinary team, must determine at least once each
310.34year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
310.35services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
311.1assigned each person and the documentation of how the ratio was arrived at must be kept
311.2in each person's individual service plan. Documentation must include an assessment of the
311.3person with respect to the characteristics in subdivisions 4, 5, and 6 recorded on a standard
311.4assessment form required by the commissioner.
311.5    Subd. 4. Person requiring staff ratio of one to four. A person must be assigned a
311.6staff ratio requirement of one to four if:
311.7(1) on a daily basis the person requires total care and monitoring or constant
311.8hand-over-hand physical guidance to successfully complete at least three of the following
311.9activities: toileting, communicating basic needs, eating, ambulating; or is not capable of
311.10taking appropriate action for self-preservation under emergency conditions; or
311.11(2) the person engages in conduct that poses an imminent risk of physical harm to
311.12self or others at a documented level of frequency, intensity, or duration requiring frequent
311.13daily ongoing intervention and monitoring as established in the person's coordinated
311.14service and support plan or coordinated service and support plan addendum.
311.15    Subd. 5. Person requiring staff ratio of one to eight. A person must be assigned a
311.16staff ratio requirement of one to eight if:
311.17(1) the person does not meet the requirements in subdivision 4; and
311.18(2) on a daily basis the person requires verbal prompts or spot checks and minimal
311.19or no physical assistance to successfully complete at least four of the following activities:
311.20toileting, communicating basic needs, eating, ambulating, or taking appropriate action for
311.21self-preservation under emergency conditions.
311.22    Subd. 6. Person requiring staff ratio of one to six. A person who does not have
311.23any of the characteristics described in subdivision 4 or 5 must be assigned a staff ratio
311.24requirement of one to six.
311.25    Subd. 7. Determining number of direct support service staff required. The
311.26minimum number of direct support service staff members required at any one time to
311.27meet the combined staff ratio requirements of the persons present at that time can be
311.28determined by the following steps:
311.29(1) assign each person in attendance the three-digit decimal below that corresponds
311.30to the staff ratio requirement assigned to that person. A staff ratio requirement of one to
311.31four equals 0.250. A staff ratio requirement of one to eight equals 0.125. A staff ratio
311.32requirement of one to six equals 0.166. A staff ratio requirement of one to ten equals 0.100;
311.33(2) add all of the three-digit decimals (one three-digit decimal for every person in
311.34attendance) assigned in clause (1);
311.35(3) when the sum in clause (2) falls between two whole numbers, round off the sum
311.36to the larger of the two whole numbers; and
312.1(4) the larger of the two whole numbers in clause (3) equals the number of direct
312.2support service staff members needed to meet the staff ratio requirements of the persons
312.3in attendance.
312.4    Subd. 8. Staff to be included in calculating minimum staffing requirement.
312.5Only staff providing direct support must be counted as staff members in calculating the
312.6staff-to-participant ratio. A volunteer may be counted as a staff providing direct support
312.7in calculating the staff-to-participant ratio if the volunteer meets the same standards
312.8and requirements as paid staff. No person receiving services must be counted as or be
312.9substituted for a staff member in calculating the staff-to-participant ratio.
312.10    Subd. 9. Conditions requiring additional direct support staff. The license holder
312.11must increase the number of direct support staff members present at any one time beyond
312.12the number arrived at in subdivision 4 if necessary when any one or combination of the
312.13following circumstances can be documented by the commissioner as existing:
312.14(1) the health and safety needs of the persons receiving services cannot be met by
312.15the number of staff members available under the staffing pattern in effect even though the
312.16number has been accurately calculated under subdivision 7; or
312.17(2) the person's conduct frequently presents an imminent risk of physical harm to
312.18self or others.
312.19    Subd. 10. Supervision requirements. (a) At no time must one direct support
312.20staff member be assigned responsibility for supervision and training of more than ten
312.21persons receiving supervision and training, except as otherwise stated in each person's risk
312.22management plan.
312.23(b) In the temporary absence of the director or a supervisor, a direct support staff
312.24member must be designated to supervise the center.
312.25    Subd. 11. Multifunctional programs. A multifunctional program may count other
312.26employees of the organization besides direct support staff of the day service facility in
312.27calculating the staff to participant ratio if the employee is assigned to the day services
312.28facility for a specified amount of time, during which the employee is not assigned to
312.29another organization or program.
312.30EFFECTIVE DATE.This section is effective January 1, 2014.

312.31    Sec. 42. [245D.32] ALTERNATIVE LICENSING INSPECTIONS.
312.32    Subdivision 1. Eligibility for an alternative licensing inspection. (a) A license
312.33holder providing services licensed under this chapter, with a qualifying accreditation and
312.34meeting the eligibility criteria in paragraphs (b) and (c) may request approval for an
312.35alternative licensing inspection when all services provided under the license holder's
313.1license are accredited. A license holder with a qualifying accreditation and meeting
313.2the eligibility criteria in paragraphs (b) and (c) may request approval for an alternative
313.3licensing inspection for individual community residential settings or day services facilities
313.4licensed under this chapter.
313.5(b) In order to be eligible for an alternative licensing inspection, the program must
313.6have had at least one inspection by the commissioner following issuance of the initial
313.7license. For programs operating a day services facility, each facility must have had at least
313.8one on-site inspection by the commissioner following issuance of the initial license.
313.9(c) In order to be eligible for an alternative licensing inspection, the program must
313.10have been in "substantial and consistent compliance" at the time of the last licensing
313.11inspection and during the current licensing period. For purposes of this section, substantial
313.12and consistent compliance means:
313.13(1) the license holder's license was not made conditional, suspended, or revoked;
313.14(2) there have been no substantiated allegations of maltreatment against the license
313.15holder;
313.16(3) there were no program deficiencies identified that would jeopardize the health,
313.17safety, or rights of persons being served; and
313.18(4) the license holder maintained substantial compliance with the other requirements
313.19of chapters 245A and 245C and other applicable laws and rules.
313.20(d) For the purposes of this section, the license holder's license includes services
313.21licensed under this chapter that were previously licensed under chapter 245B until
313.22December 31, 2013.
313.23    Subd. 2. Qualifying accreditation. The commissioner must accept a three-year
313.24accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF)
313.25as a qualifying accreditation.
313.26    Subd. 3. Request for approval of an alternative inspection status. (a) A request
313.27for an alternative inspection must be made on the forms and in the manner prescribed
313.28by the commissioner. When submitting the request, the license holder must submit all
313.29documentation issued by the accrediting body verifying that the license holder has obtained
313.30and maintained the qualifying accreditation and has complied with recommendations
313.31or requirements from the accrediting body during the period of accreditation. Based
313.32on the request and the additional required materials, the commissioner may approve
313.33an alternative inspection status.
313.34(b) The commissioner must notify the license holder in writing that the request for
313.35an alternative inspection status has been approved. Approval must be granted until the
313.36end of the qualifying accreditation period.
314.1(c) The license holder must submit a written request for approval to be renewed
314.2one month before the end of the current approval period according to the requirements
314.3in paragraph (a). If the license holder does not submit a request to renew approval as
314.4required, the commissioner must conduct a licensing inspection.
314.5    Subd. 4. Programs approved for alternative licensing inspection; deemed
314.6compliance licensing requirements. (a) A license holder approved for alternative
314.7licensing inspection under this section is required to maintain compliance with all
314.8licensing standards according to this chapter.
314.9(b) A license holder approved for alternative licensing inspection under this section
314.10must be deemed to be in compliance with all the requirements of this chapter, and the
314.11commissioner must not perform routine licensing inspections.
314.12(c) Upon receipt of a complaint regarding the services of a license holder approved
314.13for alternative licensing inspection under this section, the commissioner must investigate
314.14the complaint and may take any action as provided under section 245A.06 or 245A.07.
314.15    Subd. 5. Investigations of alleged or suspected maltreatment. Nothing in this
314.16section changes the commissioner's responsibilities to investigate alleged or suspected
314.17maltreatment of a minor under section 626.556 or a vulnerable adult under section 626.557.
314.18    Subd. 6. Termination or denial of subsequent approval. Following approval of
314.19an alternative licensing inspection, the commissioner may terminate or deny subsequent
314.20approval of an alternative licensing inspection if the commissioner determines that:
314.21(1) the license holder has not maintained the qualifying accreditation;
314.22(2) the commissioner has substantiated maltreatment for which the license holder or
314.23facility is determined to be responsible during the qualifying accreditation period; or
314.24(3) during the qualifying accreditation period, the license holder has been issued
314.25an order for conditional license, fine, suspension, or license revocation that has not been
314.26reversed upon appeal.
314.27    Subd. 7. Appeals. The commissioner's decision that the conditions for approval for
314.28an alternative licensing inspection have not been met is final and not subject to appeal
314.29under the provisions of chapter 14.
314.30    Subd. 8. Commissioner's programs. Home and community-based services licensed
314.31under this chapter for which the commissioner is the license holder with a qualifying
314.32accreditation are excluded from being approved for an alternative licensing inspection.
314.33EFFECTIVE DATE.This section is effective January 1, 2014.

314.34    Sec. 43. [245D.33] ADULT MENTAL HEALTH CERTIFICATION STANDARDS.
315.1(a) The commissioner of human services shall issue a mental health certification
315.2for services licensed under this chapter, when a license holder is determined to have met
315.3the requirements under paragraph (b). This certification is voluntary for license holders.
315.4The certification shall be printed on the license and identified on the commissioner's
315.5public Web site.
315.6(b) The requirements for certification are:
315.7(1) all staff have received at least seven hours of annual training covering all of
315.8the following topics:
315.9(i) mental health diagnoses;
315.10(ii) mental health crisis response and de-escalation techniques;
315.11(iii) recovery from mental illness;
315.12(iv) treatment options, including evidence-based practices;
315.13(v) medications and their side effects;
315.14(vi) co-occurring substance abuse and health conditions; and
315.15(vii) community resources;
315.16(2) a mental health professional, as defined in section 245.462, subdivision 18, or a
315.17mental health practitioner as defined in section 245.462, subdivision 17, is available
315.18for consultation and assistance;
315.19(3) there is a plan and protocol in place to address a mental health crisis; and
315.20(4) each person's individual service and support plan identifies who is providing
315.21clinical services and their contact information, and includes an individual crisis prevention
315.22and management plan developed with the person.
315.23(c) License holders seeking certification under this section must request this
315.24certification on forms and in the manner prescribed by the commissioner.
315.25(d) If the commissioner finds that the license holder has failed to comply with the
315.26certification requirements under paragraph (b), the commissioner may issue a correction
315.27order and an order of conditional license in accordance with section 245A.06 or may
315.28issue a sanction in accordance with section 245A.07, including and up to removal of
315.29the certification.
315.30(e) A denial of the certification or the removal of the certification based on a
315.31determination that the requirements under paragraph (b) have not been met is not subject to
315.32appeal. A license holder that has been denied a certification or that has had a certification
315.33removed may again request certification when the license holder is in compliance with the
315.34requirements of paragraph (b).
315.35EFFECTIVE DATE.This section is effective January 1, 2014.

316.1    Sec. 44. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
316.2    Subd. 11. Residential support services. (a) Upon federal approval, there is
316.3established a new service called residential support that is available on the community
316.4alternative care, community alternatives for disabled individuals, developmental
316.5disabilities, and brain injury waivers. Existing waiver service descriptions must be
316.6modified to the extent necessary to ensure there is no duplication between other services.
316.7Residential support services must be provided by vendors licensed as a community
316.8residential setting as defined in section 245A.11, subdivision 8, a foster care setting
316.9licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or an adult foster care
316.10setting licensed under Minnesota Rules, parts 9555.5105 to 9555.6265.
316.11    (b) Residential support services must meet the following criteria:
316.12    (1) providers of residential support services must own or control the residential site;
316.13    (2) the residential site must not be the primary residence of the license holder;
316.14    (3) (1) the residential site must have a designated program supervisor person
316.15 responsible for program management, oversight, development, and implementation of
316.16policies and procedures;
316.17    (4) (2) the provider of residential support services must provide supervision, training,
316.18and assistance as described in the person's coordinated service and support plan; and
316.19    (5) (3) the provider of residential support services must meet the requirements of
316.20licensure and additional requirements of the person's coordinated service and support plan.
316.21    (c) Providers of residential support services that meet the definition in paragraph (a)
316.22must be registered using a process determined by the commissioner beginning July 1, 2009
316.23 must be licensed according to chapter 245D. Providers licensed to provide child foster care
316.24under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult foster care licensed under
316.25Minnesota Rules, parts 9555.5105 to 9555.6265, and that meet the requirements in section
316.26245A.03, subdivision 7 , paragraph (g), are considered registered under this section.

316.27    Sec. 45. Minnesota Statutes 2012, section 256B.4912, subdivision 1, is amended to read:
316.28    Subdivision 1. Provider qualifications. (a) For the home and community-based
316.29waivers providing services to seniors and individuals with disabilities under sections
316.30256B.0913, 256B.0915, 256B.092, and 256B.49, the commissioner shall establish:
316.31(1) agreements with enrolled waiver service providers to ensure providers meet
316.32Minnesota health care program requirements;
316.33(2) regular reviews of provider qualifications, and including requests of proof of
316.34documentation; and
316.35(3) processes to gather the necessary information to determine provider qualifications.
317.1    (b) Beginning July 1, 2012, staff that provide direct contact, as defined in section
317.2245C.02, subdivision 11 , for services specified in the federally approved waiver plans
317.3must meet the requirements of chapter 245C prior to providing waiver services and as
317.4part of ongoing enrollment. Upon federal approval, this requirement must also apply to
317.5consumer-directed community supports.
317.6    (c) Beginning January 1, 2014, service owners and managerial officials overseeing
317.7the management or policies of services that provide direct contact as specified in the
317.8federally approved waiver plans must meet the requirements of chapter 245C prior to
317.9reenrollment or, for new providers, prior to initial enrollment if they have not already done
317.10so as a part of service licensure requirements.

317.11    Sec. 46. Minnesota Statutes 2012, section 256B.4912, subdivision 7, is amended to read:
317.12    Subd. 7. Applicant and license holder training. An applicant or license holder
317.13for the home and community-based waivers providing services to seniors and individuals
317.14with disabilities under sections 256B.0913, 256B.0915, 256B.092, and 256B.49 that is
317.15not enrolled as a Minnesota health care program home and community-based services
317.16waiver provider at the time of application must ensure that at least one controlling
317.17individual completes a onetime training on the requirements for providing home and
317.18community-based services from a qualified source as determined by the commissioner,
317.19before a provider is enrolled or license is issued. Within six months of enrollment, a newly
317.20enrolled home and community-based waiver service provider must ensure that at least one
317.21controlling individual has completed training on waiver and related program billing.

317.22    Sec. 47. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
317.23subdivision to read:
317.24    Subd. 8. Data on use of emergency use of manual restraint. Beginning July 1,
317.252013, facilities and services to be licensed under chapter 245D shall submit data regarding
317.26the use of emergency use of manual restraint as identified in section 245D.061 in a format
317.27and at a frequency identified by the commissioner.

317.28    Sec. 48. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
317.29subdivision to read:
317.30    Subd. 9. Definitions. (a) For the purposes of this section the following terms have
317.31the meanings given them.
318.1(b) "Controlling individual" means a public body, governmental agency, business
318.2entity, officer, owner, or managerial official whose responsibilities include the direction of
318.3the management or policies of a program.
318.4(c) "Managerial official" means an individual who has decision-making authority
318.5related to the operation of the program and responsibility for the ongoing management of
318.6or direction of the policies, services, or employees of the program.
318.7(d) "Owner" means an individual who has direct or indirect ownership interest in
318.8a corporation or partnership, or business association enrolling with the Department of
318.9Human Services as a provider of waiver services.

318.10    Sec. 49. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
318.11subdivision to read:
318.12    Subd. 10. Enrollment requirements. All home and community-based waiver
318.13providers must provide, at the time of enrollment and within 30 days of a request, in a
318.14format determined by the commissioner, information and documentation that includes, but
318.15is not limited to, the following:
318.16(1) proof of surety bond coverage in the amount of $50,000 or ten percent of the
318.17provider's payments from Medicaid in the previous calendar year, whichever is greater;
318.18(2) proof of fidelity bond coverage in the amount of $20,000; and
318.19(3) proof of liability insurance.

318.20    Sec. 50. Minnesota Statutes 2012, section 626.557, subdivision 9a, is amended to read:
318.21    Subd. 9a. Evaluation and referral of reports made to common entry point unit.
318.22    The common entry point must screen the reports of alleged or suspected maltreatment for
318.23immediate risk and make all necessary referrals as follows:
318.24    (1) if the common entry point determines that there is an immediate need for
318.25adult protective services, the common entry point agency shall immediately notify the
318.26appropriate county agency;
318.27    (2) if the report contains suspected criminal activity against a vulnerable adult, the
318.28common entry point shall immediately notify the appropriate law enforcement agency;
318.29    (3) the common entry point shall refer all reports of alleged or suspected
318.30maltreatment to the appropriate lead investigative agency as soon as possible, but in any
318.31event no longer than two working days; and
318.32    (4) if the report involves services licensed by the Department of Human Services
318.33and subject to chapter 245D, the common entry point shall refer the report to the county as
319.1the lead agency according to clause (3), but shall also notify the Department of Human
319.2Services of the report; and
319.3    (5) (4) if the report contains information about a suspicious death, the common
319.4entry point shall immediately notify the appropriate law enforcement agencies, the local
319.5medical examiner, and the ombudsman for mental health and developmental disabilities
319.6established under section 245.92. Law enforcement agencies shall coordinate with the
319.7local medical examiner and the ombudsman as provided by law.

319.8    Sec. 51. Minnesota Statutes 2012, section 626.5572, subdivision 13, is amended to read:
319.9    Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary
319.10administrative agency responsible for investigating reports made under section 626.557.
319.11(a) The Department of Health is the lead investigative agency for facilities or
319.12services licensed or required to be licensed as hospitals, home care providers, nursing
319.13homes, boarding care homes, hospice providers, residential facilities that are also federally
319.14certified as intermediate care facilities that serve people with developmental disabilities,
319.15or any other facility or service not listed in this subdivision that is licensed or required to
319.16be licensed by the Department of Health for the care of vulnerable adults. "Home care
319.17provider" has the meaning provided in section 144A.43, subdivision 4, and applies when
319.18care or services are delivered in the vulnerable adult's home, whether a private home or a
319.19housing with services establishment registered under chapter 144D, including those that
319.20offer assisted living services under chapter 144G.
319.21(b) Except as provided under paragraph (c), for services licensed according to
319.22chapter 245D, The Department of Human Services is the lead investigative agency for
319.23facilities or services licensed or required to be licensed as adult day care, adult foster care,
319.24programs for people with developmental disabilities, family adult day services, mental
319.25health programs, mental health clinics, chemical dependency programs, the Minnesota
319.26sex offender program, or any other facility or service not listed in this subdivision that is
319.27licensed or required to be licensed by the Department of Human Services.
319.28(c) The county social service agency or its designee is the lead investigative agency
319.29for all other reports, including, but not limited to, reports involving vulnerable adults
319.30receiving services from a personal care provider organization under section 256B.0659,
319.31or receiving home and community-based services licensed by the Department of Human
319.32Services and subject to chapter 245D.

319.33    Sec. 52. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
319.34AND COMMUNITY-BASED SERVICES.
320.1(a) The Department of Health Compliance Monitoring Division and the Department
320.2of Human Services Licensing Division shall jointly develop an integrated licensing system
320.3for providers of both home care services subject to licensure under Minnesota Statutes,
320.4chapter 144A, and for home and community-based services subject to licensure under
320.5Minnesota Statutes, chapter 245D. The integrated licensing system shall:
320.6(1) require only one license of any provider of services under Minnesota Statutes,
320.7sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
320.8(2) promote quality services that recognize a person's individual needs and protect
320.9the person's health, safety, rights, and well-being;
320.10(3) promote provider accountability through application requirements, compliance
320.11inspections, investigations, and enforcement actions;
320.12(4) reference other applicable requirements in existing state and federal laws,
320.13including the federal Affordable Care Act;
320.14(5) establish internal procedures to facilitate ongoing communications between the
320.15agencies, and with providers and services recipients about the regulatory activities;
320.16(6) create a link between the agency Web sites so that providers and the public can
320.17access the same information regardless of which Web site is accessed initially; and
320.18(7) collect data on identified outcome measures as necessary for the agencies to
320.19report to the Centers for Medicare and Medicaid Services.
320.20(b) The joint recommendations for legislative changes to implement the integrated
320.21licensing system are due to the legislature by February 15, 2014.
320.22(c) Before implementation of the integrated licensing system, providers licensed as
320.23home care providers under Minnesota Statutes, chapter 144A, may also provide home
320.24and community-based services subject to licensure under Minnesota Statutes, chapter
320.25245D, without obtaining a home and community-based services license under Minnesota
320.26Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
320.27apply to these providers:
320.28(1) the provider must comply with all requirements under Minnesota Statutes, chapter
320.29245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
320.30(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
320.31enforced by the Department of Health under the enforcement authority set forth in
320.32Minnesota Statutes, section 144A.475; and
320.33(3) the Department of Health will provide information to the Department of Human
320.34Services about each provider licensed under this section, including the provider's license
320.35application, licensing documents, inspections, information about complaints received, and
320.36investigations conducted for possible violations of Minnesota Statutes, chapter 245D.

321.1    Sec. 53. REPEALER.
321.2(a) Minnesota Statutes 2012, sections 245B.01; 245B.02; 245B.03; 245B.031;
321.3245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, and 7; 245B.055; 245B.06; 245B.07; and
321.4245B.08, are repealed effective January 1, 2014.
321.5(b) Minnesota Statutes 2012, section 245D.08, is repealed.


321.8    Section 1. Minnesota Statutes 2012, section 16C.10, subdivision 5, is amended to read:
321.9    Subd. 5. Specific purchases. The solicitation process described in this chapter is
321.10not required for acquisition of the following:
321.11(1) merchandise for resale purchased under policies determined by the commissioner;
321.12(2) farm and garden products which, as determined by the commissioner, may be
321.13purchased at the prevailing market price on the date of sale;
321.14(3) goods and services from the Minnesota correctional facilities;
321.15(4) goods and services from rehabilitation facilities and extended employment
321.16providers that are certified by the commissioner of employment and economic
321.17development, and day training and habilitation services licensed under sections 245B.01
321.18to 245B.08 chapter 245D;
321.19(5) goods and services for use by a community-based facility operated by the
321.20commissioner of human services;
321.21(6) goods purchased at auction or when submitting a sealed bid at auction provided
321.22that before authorizing such an action, the commissioner consult with the requesting
321.23agency to determine a fair and reasonable value for the goods considering factors
321.24including, but not limited to, costs associated with submitting a bid, travel, transportation,
321.25and storage. This fair and reasonable value must represent the limit of the state's bid;
321.26(7) utility services where no competition exists or where rates are fixed by law or
321.27ordinance; and
321.28(8) goods and services from Minnesota sex offender program facilities.
321.29EFFECTIVE DATE.This section is effective January 1, 2014.

321.30    Sec. 2. Minnesota Statutes 2012, section 16C.155, subdivision 1, is amended to read:
321.31    Subdivision 1. Service contracts. The commissioner of administration shall
321.32ensure that a portion of all contracts for janitorial services; document imaging;
321.33document shredding; and mailing, collating, and sorting services be awarded by the
322.1state to rehabilitation programs and extended employment providers that are certified
322.2by the commissioner of employment and economic development, and day training and
322.3habilitation services licensed under sections 245B.01 to 245B.08 chapter 245D. The
322.4amount of each contract awarded under this section may exceed the estimated fair market
322.5price as determined by the commissioner for the same goods and services by up to six
322.6percent. The aggregate value of the contracts awarded to eligible providers under this
322.7section in any given year must exceed 19 percent of the total value of all contracts for
322.8janitorial services; document imaging; document shredding; and mailing, collating, and
322.9sorting services entered into in the same year. For the 19 percent requirement to be
322.10applicable in any given year, the contract amounts proposed by eligible providers must be
322.11within six percent of the estimated fair market price for at least 19 percent of the contracts
322.12awarded for the corresponding service area.
322.13EFFECTIVE DATE.This section is effective January 1, 2014.

322.14    Sec. 3. Minnesota Statutes 2012, section 144D.01, subdivision 4, is amended to read:
322.15    Subd. 4. Housing with services establishment or establishment. (a) "Housing
322.16with services establishment" or "establishment" means:
322.17(1) an establishment providing sleeping accommodations to one or more adult
322.18residents, at least 80 percent of which are 55 years of age or older, and offering or
322.19providing, for a fee, one or more regularly scheduled health-related services or two or
322.20more regularly scheduled supportive services, whether offered or provided directly by the
322.21establishment or by another entity arranged for by the establishment; or
322.22(2) an establishment that registers under section 144D.025.
322.23(b) Housing with services establishment does not include:
322.24(1) a nursing home licensed under chapter 144A;
322.25(2) a hospital, certified boarding care home, or supervised living facility licensed
322.26under sections 144.50 to 144.56;
322.27(3) a board and lodging establishment licensed under chapter 157 and Minnesota
322.28Rules, parts 9520.0500 to 9520.0670, 9525.0215 to 9525.0355, 9525.0500 to 9525.0660,
322.29or 9530.4100 to 9530.4450, or under chapter 245B 245D;
322.30(4) a board and lodging establishment which serves as a shelter for battered women
322.31or other similar purpose;
322.32(5) a family adult foster care home licensed by the Department of Human Services;
322.33(6) private homes in which the residents are related by kinship, law, or affinity with
322.34the providers of services;
323.1(7) residential settings for persons with developmental disabilities in which the
323.2services are licensed under Minnesota Rules, parts 9525.2100 to 9525.2140, or applicable
323.3successor rules or laws;
323.4(8) a home-sharing arrangement such as when an elderly or disabled person or
323.5single-parent family makes lodging in a private residence available to another person
323.6in exchange for services or rent, or both;
323.7(9) a duly organized condominium, cooperative, common interest community, or
323.8owners' association of the foregoing where at least 80 percent of the units that comprise the
323.9condominium, cooperative, or common interest community are occupied by individuals
323.10who are the owners, members, or shareholders of the units; or
323.11(10) services for persons with developmental disabilities that are provided under
323.12a license according to Minnesota Rules, parts 9525.2000 to 9525.2140 in effect until
323.13January 1, 1998, or under chapter 245B 245D.
323.14EFFECTIVE DATE.This section is effective January 1, 2014.

323.15    Sec. 4. Minnesota Statutes 2012, section 174.30, subdivision 1, is amended to read:
323.16    Subdivision 1. Applicability. (a) The operating standards for special transportation
323.17service adopted under this section do not apply to special transportation provided by:
323.18(1) a common carrier operating on fixed routes and schedules;
323.19(2) a volunteer driver using a private automobile;
323.20(3) a school bus as defined in section 169.011, subdivision 71; or
323.21(4) an emergency ambulance regulated under chapter 144.
323.22(b) The operating standards adopted under this section only apply to providers
323.23of special transportation service who receive grants or other financial assistance from
323.24either the state or the federal government, or both, to provide or assist in providing that
323.25service; except that the operating standards adopted under this section do not apply
323.26to any nursing home licensed under section 144A.02, to any board and care facility
323.27licensed under section 144.50, or to any day training and habilitation services, day care,
323.28or group home facility licensed under sections 245A.01 to 245A.19 unless the facility or
323.29program provides transportation to nonresidents on a regular basis and the facility receives
323.30reimbursement, other than per diem payments, for that service under rules promulgated
323.31by the commissioner of human services.
323.32(c) Notwithstanding paragraph (b), the operating standards adopted under this
323.33section do not apply to any vendor of services licensed under chapter 245B 245D that
323.34provides transportation services to consumers or residents of other vendors licensed under
324.1chapter 245B 245D and transports 15 or fewer persons, including consumers or residents
324.2and the driver.
324.3EFFECTIVE DATE.This section is effective January 1, 2014.

324.4    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 1, is amended to read:
324.5    Subdivision 1. Scope. The terms used in this chapter and chapter 245B have the
324.6meanings given them in this section.
324.7EFFECTIVE DATE.This section is effective January 1, 2014.

324.8    Sec. 6. Minnesota Statutes 2012, section 245A.02, subdivision 9, is amended to read:
324.9    Subd. 9. License holder. "License holder" means an individual, corporation,
324.10partnership, voluntary association, or other organization that is legally responsible for the
324.11operation of the program, has been granted a license by the commissioner under this chapter
324.12or chapter 245B 245D and the rules of the commissioner, and is a controlling individual.
324.13EFFECTIVE DATE.This section is effective January 1, 2014.

324.14    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 9, is amended to read:
324.15    Subd. 9. Permitted services by an individual who is related. Notwithstanding
324.16subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
324.17person receiving supported living services may provide licensed services to that person if:
324.18(1) the person who receives supported living services received these services in a
324.19residential site on July 1, 2005;
324.20(2) the services under clause (1) were provided in a corporate foster care setting for
324.21adults and were funded by the developmental disabilities home and community-based
324.22services waiver defined in section 256B.092;
324.23(3) the individual who is related obtains and maintains both a license under chapter
324.24245B 245D and an adult foster care license under Minnesota Rules, parts 9555.5105
324.25to 9555.6265; and
324.26(4) the individual who is related is not the guardian of the person receiving supported
324.27living services.
324.28EFFECTIVE DATE.This section is effective January 1, 2014.

324.29    Sec. 8. Minnesota Statutes 2012, section 245A.04, subdivision 13, is amended to read:
325.1    Subd. 13. Funds and property; other requirements. (a) A license holder must
325.2ensure that persons served by the program retain the use and availability of personal funds
325.3or property unless restrictions are justified in the person's individual plan. This subdivision
325.4does not apply to programs governed by the provisions in section 245B.07, subdivision 10.
325.5(b) The license holder must ensure separation of funds of persons served by the
325.6program from funds of the license holder, the program, or program staff.
325.7(c) Whenever the license holder assists a person served by the program with the
325.8safekeeping of funds or other property, the license holder must:
325.9(1) immediately document receipt and disbursement of the person's funds or other
325.10property at the time of receipt or disbursement, including the person's signature, or the
325.11signature of the conservator or payee; and
325.12(2) return to the person upon the person's request, funds and property in the license
325.13holder's possession subject to restrictions in the person's treatment plan, as soon as
325.14possible, but no later than three working days after the date of request.
325.15(d) License holders and program staff must not:
325.16(1) borrow money from a person served by the program;
325.17(2) purchase personal items from a person served by the program;
325.18(3) sell merchandise or personal services to a person served by the program;
325.19(4) require a person served by the program to purchase items for which the license
325.20holder is eligible for reimbursement; or
325.21(5) use funds of persons served by the program to purchase items for which the
325.22facility is already receiving public or private payments.
325.23EFFECTIVE DATE.This section is effective January 1, 2014.

325.24    Sec. 9. Minnesota Statutes 2012, section 245A.07, subdivision 3, is amended to read:
325.25    Subd. 3. License suspension, revocation, or fine. (a) The commissioner may
325.26suspend or revoke a license, or impose a fine if:
325.27(1) a license holder fails to comply fully with applicable laws or rules;
325.28(2) a license holder, a controlling individual, or an individual living in the household
325.29where the licensed services are provided or is otherwise subject to a background study has
325.30a disqualification which has not been set aside under section 245C.22;
325.31(3) a license holder knowingly withholds relevant information from or gives false
325.32or misleading information to the commissioner in connection with an application for
325.33a license, in connection with the background study status of an individual, during an
325.34investigation, or regarding compliance with applicable laws or rules; or
326.1(4) after July 1, 2012, and upon request by the commissioner, a license holder fails
326.2to submit the information required of an applicant under section 245A.04, subdivision 1,
326.3paragraph (f) or (g).
326.4A license holder who has had a license suspended, revoked, or has been ordered
326.5to pay a fine must be given notice of the action by certified mail or personal service. If
326.6mailed, the notice must be mailed to the address shown on the application or the last
326.7known address of the license holder. The notice must state the reasons the license was
326.8suspended, revoked, or a fine was ordered.
326.9    (b) If the license was suspended or revoked, the notice must inform the license
326.10holder of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
326.111400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
326.12a license. The appeal of an order suspending or revoking a license must be made in writing
326.13by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
326.14the commissioner within ten calendar days after the license holder receives notice that the
326.15license has been suspended or revoked. If a request is made by personal service, it must be
326.16received by the commissioner within ten calendar days after the license holder received
326.17the order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits
326.18a timely appeal of an order suspending or revoking a license, the license holder may
326.19continue to operate the program as provided in section 245A.04, subdivision 7, paragraphs
326.20(g) and (h), until the commissioner issues a final order on the suspension or revocation.
326.21    (c)(1) If the license holder was ordered to pay a fine, the notice must inform the
326.22license holder of the responsibility for payment of fines and the right to a contested case
326.23hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal
326.24of an order to pay a fine must be made in writing by certified mail or personal service. If
326.25mailed, the appeal must be postmarked and sent to the commissioner within ten calendar
326.26days after the license holder receives notice that the fine has been ordered. If a request is
326.27made by personal service, it must be received by the commissioner within ten calendar
326.28days after the license holder received the order.
326.29    (2) The license holder shall pay the fines assessed on or before the payment date
326.30specified. If the license holder fails to fully comply with the order, the commissioner
326.31may issue a second fine or suspend the license until the license holder complies. If the
326.32license holder receives state funds, the state, county, or municipal agencies or departments
326.33responsible for administering the funds shall withhold payments and recover any payments
326.34made while the license is suspended for failure to pay a fine. A timely appeal shall stay
326.35payment of the fine until the commissioner issues a final order.
327.1    (3) A license holder shall promptly notify the commissioner of human services,
327.2in writing, when a violation specified in the order to forfeit a fine is corrected. If upon
327.3reinspection the commissioner determines that a violation has not been corrected as
327.4indicated by the order to forfeit a fine, the commissioner may issue a second fine. The
327.5commissioner shall notify the license holder by certified mail or personal service that a
327.6second fine has been assessed. The license holder may appeal the second fine as provided
327.7under this subdivision.
327.8    (4) Fines shall be assessed as follows: the license holder shall forfeit $1,000 for
327.9each determination of maltreatment of a child under section 626.556 or the maltreatment
327.10of a vulnerable adult under section 626.557 for which the license holder is determined
327.11responsible for the maltreatment under section 626.556, subdivision 10e, paragraph (i),
327.12or 626.557, subdivision 9c, paragraph (c); the license holder shall forfeit $200 for each
327.13occurrence of a violation of law or rule governing matters of health, safety, or supervision,
327.14including but not limited to the provision of adequate staff-to-child or adult ratios, and
327.15failure to comply with background study requirements under chapter 245C; and the license
327.16holder shall forfeit $100 for each occurrence of a violation of law or rule other than
327.17those subject to a $1,000 or $200 fine above. For purposes of this section, "occurrence"
327.18means each violation identified in the commissioner's fine order. Fines assessed against a
327.19license holder that holds a license to provide the residential-based habilitation home and
327.20community-based services, as defined under identified in section 245B.02, subdivision
327.2120 245D.03, subdivision 1, and a community residential setting or day services facility
327.22license to provide foster care under chapter 245D where the services are provided, may be
327.23assessed against both licenses for the same occurrence, but the combined amount of the
327.24fines shall not exceed the amount specified in this clause for that occurrence.
327.25    (5) When a fine has been assessed, the license holder may not avoid payment by
327.26closing, selling, or otherwise transferring the licensed program to a third party. In such an
327.27event, the license holder will be personally liable for payment. In the case of a corporation,
327.28each controlling individual is personally and jointly liable for payment.
327.29(d) Except for background study violations involving the failure to comply with an
327.30order to immediately remove an individual or an order to provide continuous, direct
327.31supervision, the commissioner shall not issue a fine under paragraph (c) relating to a
327.32background study violation to a license holder who self-corrects a background study
327.33violation before the commissioner discovers the violation. A license holder who has
327.34previously exercised the provisions of this paragraph to avoid a fine for a background
327.35study violation may not avoid a fine for a subsequent background study violation unless at
328.1least 365 days have passed since the license holder self-corrected the earlier background
328.2study violation.
328.3EFFECTIVE DATE.This section is effective January 1, 2014.

328.4    Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 19c, is amended to
328.5read:
328.6    Subd. 19c. Personal care. Medical assistance covers personal care assistance
328.7services provided by an individual who is qualified to provide the services according to
328.8subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
328.9plan, and supervised by a qualified professional.
328.10"Qualified professional" means a mental health professional as defined in section
328.11245.462, subdivision 18 , clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6);
328.12or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker
328.13as defined in sections 148E.010 and 148E.055, or a qualified developmental disabilities
328.14specialist under section 245B.07, subdivision 4 designated coordinator under section
328.15245D.081, subdivision 2. The qualified professional shall perform the duties required in
328.16section 256B.0659.
328.17EFFECTIVE DATE.This section is effective January 1, 2014.

328.18    Sec. 11. Minnesota Statutes 2012, section 256B.5011, subdivision 2, is amended to read:
328.19    Subd. 2. Contract provisions. (a) The service contract with each intermediate
328.20care facility must include provisions for:
328.21(1) modifying payments when significant changes occur in the needs of the
328.22consumers;
328.23(2) appropriate and necessary statistical information required by the commissioner;
328.24(3) annual aggregate facility financial information; and
328.25(4) additional requirements for intermediate care facilities not meeting the standards
328.26set forth in the service contract.
328.27(b) The commissioner of human services and the commissioner of health, in
328.28consultation with representatives from counties, advocacy organizations, and the provider
328.29community, shall review the consolidated standards under chapter 245B and the home and
328.30community-based services standards under chapter 245D and the supervised living facility
328.31rule under Minnesota Rules, chapter 4665, to determine what provisions in Minnesota
328.32Rules, chapter 4665, may be waived by the commissioner of health for intermediate care
328.33facilities in order to enable facilities to implement the performance measures in their
329.1contract and provide quality services to residents without a duplication of or increase in
329.2regulatory requirements.
329.3EFFECTIVE DATE.This section is effective January 1, 2014.

329.4    Sec. 12. Minnesota Statutes 2012, section 471.59, subdivision 1, is amended to read:
329.5    Subdivision 1. Agreement. Two or more governmental units, by agreement entered
329.6into through action of their governing bodies, may jointly or cooperatively exercise
329.7any power common to the contracting parties or any similar powers, including those
329.8which are the same except for the territorial limits within which they may be exercised.
329.9The agreement may provide for the exercise of such powers by one or more of the
329.10participating governmental units on behalf of the other participating units. The term
329.11"governmental unit" as used in this section includes every city, county, town, school
329.12district, independent nonprofit firefighting corporation, other political subdivision of
329.13this or another state, another state, federally recognized Indian tribe, the University
329.14of Minnesota, the Minnesota Historical Society, nonprofit hospitals licensed under
329.15sections 144.50 to 144.56, rehabilitation facilities and extended employment providers
329.16that are certified by the commissioner of employment and economic development, day
329.17training and habilitation services licensed under sections 245B.01 to 245B.08, day and
329.18supported employment services licensed under chapter 245D, and any agency of the state
329.19of Minnesota or the United States, and includes any instrumentality of a governmental
329.20unit. For the purpose of this section, an instrumentality of a governmental unit means an
329.21instrumentality having independent policy-making and appropriating authority.
329.22EFFECTIVE DATE.This section is effective January 1, 2014.

329.23    Sec. 13. Minnesota Statutes 2012, section 626.556, subdivision 2, is amended to read:
329.24    Subd. 2. Definitions. As used in this section, the following terms have the meanings
329.25given them unless the specific content indicates otherwise:
329.26    (a) "Family assessment" means a comprehensive assessment of child safety, risk
329.27of subsequent child maltreatment, and family strengths and needs that is applied to a
329.28child maltreatment report that does not allege substantial child endangerment. Family
329.29assessment does not include a determination as to whether child maltreatment occurred
329.30but does determine the need for services to address the safety of family members and the
329.31risk of subsequent maltreatment.
329.32    (b) "Investigation" means fact gathering related to the current safety of a child
329.33and the risk of subsequent maltreatment that determines whether child maltreatment
330.1occurred and whether child protective services are needed. An investigation must be used
330.2when reports involve substantial child endangerment, and for reports of maltreatment in
330.3facilities required to be licensed under chapter 245A or 245B; under sections 144.50 to
330.4144.58 and 241.021; in a school as defined in sections 120A.05, subdivisions 9, 11, and
330.513, and 124D.10; or in a nonlicensed personal care provider association as defined in
330.6sections 256B.04, subdivision 16, and 256B.0625, subdivision 19a.
330.7    (c) "Substantial child endangerment" means a person responsible for a child's care,
330.8and in the case of sexual abuse includes a person who has a significant relationship to the
330.9child as defined in section 609.341, or a person in a position of authority as defined in
330.10section 609.341, who by act or omission commits or attempts to commit an act against a
330.11child under their care that constitutes any of the following:
330.12    (1) egregious harm as defined in section 260C.007, subdivision 14;
330.13    (2) sexual abuse as defined in paragraph (d);
330.14    (3) abandonment under section 260C.301, subdivision 2;
330.15    (4) neglect as defined in paragraph (f), clause (2), that substantially endangers the
330.16child's physical or mental health, including a growth delay, which may be referred to as
330.17failure to thrive, that has been diagnosed by a physician and is due to parental neglect;
330.18    (5) murder in the first, second, or third degree under section 609.185, 609.19, or
330.19609.195 ;
330.20    (6) manslaughter in the first or second degree under section 609.20 or 609.205;
330.21    (7) assault in the first, second, or third degree under section 609.221, 609.222, or
330.22609.223 ;
330.23    (8) solicitation, inducement, and promotion of prostitution under section 609.322;
330.24    (9) criminal sexual conduct under sections 609.342 to 609.3451;
330.25    (10) solicitation of children to engage in sexual conduct under section 609.352;
330.26    (11) malicious punishment or neglect or endangerment of a child under section
330.27609.377 or 609.378;
330.28    (12) use of a minor in sexual performance under section 617.246; or
330.29    (13) parental behavior, status, or condition which mandates that the county attorney
330.30file a termination of parental rights petition under section 260C.301, subdivision 3,
330.31paragraph (a).
330.32    (d) "Sexual abuse" means the subjection of a child by a person responsible for the
330.33child's care, by a person who has a significant relationship to the child, as defined in
330.34section 609.341, or by a person in a position of authority, as defined in section 609.341,
330.35subdivision 10, to any act which constitutes a violation of section 609.342 (criminal sexual
330.36conduct in the first degree), 609.343 (criminal sexual conduct in the second degree),
331.1609.344 (criminal sexual conduct in the third degree), 609.345 (criminal sexual conduct
331.2in the fourth degree), or 609.3451 (criminal sexual conduct in the fifth degree). Sexual
331.3abuse also includes any act which involves a minor which constitutes a violation of
331.4prostitution offenses under sections 609.321 to 609.324 or 617.246. Sexual abuse includes
331.5threatened sexual abuse which includes the status of a parent or household member
331.6who has committed a violation which requires registration as an offender under section
331.7243.166, subdivision 1b, paragraph (a) or (b), or required registration under section
331.8243.166, subdivision 1b, paragraph (a) or (b).
331.9    (e) "Person responsible for the child's care" means (1) an individual functioning
331.10within the family unit and having responsibilities for the care of the child such as a
331.11parent, guardian, or other person having similar care responsibilities, or (2) an individual
331.12functioning outside the family unit and having responsibilities for the care of the child
331.13such as a teacher, school administrator, other school employees or agents, or other lawful
331.14custodian of a child having either full-time or short-term care responsibilities including,
331.15but not limited to, day care, babysitting whether paid or unpaid, counseling, teaching,
331.16and coaching.
331.17    (f) "Neglect" means the commission or omission of any of the acts specified under
331.18clauses (1) to (9), other than by accidental means:
331.19    (1) failure by a person responsible for a child's care to supply a child with necessary
331.20food, clothing, shelter, health, medical, or other care required for the child's physical or
331.21mental health when reasonably able to do so;
331.22    (2) failure to protect a child from conditions or actions that seriously endanger the
331.23child's physical or mental health when reasonably able to do so, including a growth delay,
331.24which may be referred to as a failure to thrive, that has been diagnosed by a physician and
331.25is due to parental neglect;
331.26    (3) failure to provide for necessary supervision or child care arrangements
331.27appropriate for a child after considering factors as the child's age, mental ability, physical
331.28condition, length of absence, or environment, when the child is unable to care for the
331.29child's own basic needs or safety, or the basic needs or safety of another child in their care;
331.30    (4) failure to ensure that the child is educated as defined in sections 120A.22 and
331.31260C.163, subdivision 11 , which does not include a parent's refusal to provide the parent's
331.32child with sympathomimetic medications, consistent with section 125A.091, subdivision 5;
331.33    (5) nothing in this section shall be construed to mean that a child is neglected solely
331.34because the child's parent, guardian, or other person responsible for the child's care in
331.35good faith selects and depends upon spiritual means or prayer for treatment or care of
331.36disease or remedial care of the child in lieu of medical care; except that a parent, guardian,
332.1or caretaker, or a person mandated to report pursuant to subdivision 3, has a duty to report
332.2if a lack of medical care may cause serious danger to the child's health. This section does
332.3not impose upon persons, not otherwise legally responsible for providing a child with
332.4necessary food, clothing, shelter, education, or medical care, a duty to provide that care;
332.5    (6) prenatal exposure to a controlled substance, as defined in section 253B.02,
332.6subdivision 2, used by the mother for a nonmedical purpose, as evidenced by withdrawal
332.7symptoms in the child at birth, results of a toxicology test performed on the mother at
332.8delivery or the child at birth, medical effects or developmental delays during the child's
332.9first year of life that medically indicate prenatal exposure to a controlled substance, or the
332.10presence of a fetal alcohol spectrum disorder;
332.11    (7) "medical neglect" as defined in section 260C.007, subdivision 6, clause (5);
332.12    (8) chronic and severe use of alcohol or a controlled substance by a parent or
332.13person responsible for the care of the child that adversely affects the child's basic needs
332.14and safety; or
332.15    (9) emotional harm from a pattern of behavior which contributes to impaired
332.16emotional functioning of the child which may be demonstrated by a substantial and
332.17observable effect in the child's behavior, emotional response, or cognition that is not
332.18within the normal range for the child's age and stage of development, with due regard to
332.19the child's culture.
332.20    (g) "Physical abuse" means any physical injury, mental injury, or threatened injury,
332.21inflicted by a person responsible for the child's care on a child other than by accidental
332.22means, or any physical or mental injury that cannot reasonably be explained by the child's
332.23history of injuries, or any aversive or deprivation procedures, or regulated interventions,
332.24that have not been authorized under section 121A.67 or 245.825.
332.25    Abuse does not include reasonable and moderate physical discipline of a child
332.26administered by a parent or legal guardian which does not result in an injury. Abuse does
332.27not include the use of reasonable force by a teacher, principal, or school employee as
332.28allowed by section 121A.582. Actions which are not reasonable and moderate include,
332.29but are not limited to, any of the following that are done in anger or without regard to the
332.30safety of the child:
332.31    (1) throwing, kicking, burning, biting, or cutting a child;
332.32    (2) striking a child with a closed fist;
332.33    (3) shaking a child under age three;
332.34    (4) striking or other actions which result in any nonaccidental injury to a child
332.35under 18 months of age;
332.36    (5) unreasonable interference with a child's breathing;
333.1    (6) threatening a child with a weapon, as defined in section 609.02, subdivision 6;
333.2    (7) striking a child under age one on the face or head;
333.3    (8) purposely giving a child poison, alcohol, or dangerous, harmful, or controlled
333.4substances which were not prescribed for the child by a practitioner, in order to control or
333.5punish the child; or other substances that substantially affect the child's behavior, motor
333.6coordination, or judgment or that results in sickness or internal injury, or subjects the
333.7child to medical procedures that would be unnecessary if the child were not exposed
333.8to the substances;
333.9    (9) unreasonable physical confinement or restraint not permitted under section
333.10609.379 , including but not limited to tying, caging, or chaining; or
333.11    (10) in a school facility or school zone, an act by a person responsible for the child's
333.12care that is a violation under section 121A.58.
333.13    (h) "Report" means any report received by the local welfare agency, police
333.14department, county sheriff, or agency responsible for assessing or investigating
333.15maltreatment pursuant to this section.
333.16    (i) "Facility" means:
333.17    (1) a licensed or unlicensed day care facility, residential facility, agency, hospital,
333.18sanitarium, or other facility or institution required to be licensed under sections 144.50 to
333.19144.58 , 241.021, or 245A.01 to 245A.16, or chapter 245B 245D;
333.20    (2) a school as defined in sections 120A.05, subdivisions 9, 11, and 13; and
333.21124D.10 ; or
333.22    (3) a nonlicensed personal care provider organization as defined in sections 256B.04,
333.23subdivision 16, and 256B.0625, subdivision 19a.
333.24    (j) "Operator" means an operator or agency as defined in section 245A.02.
333.25    (k) "Commissioner" means the commissioner of human services.
333.26    (l) "Practice of social services," for the purposes of subdivision 3, includes but is
333.27not limited to employee assistance counseling and the provision of guardian ad litem and
333.28parenting time expeditor services.
333.29    (m) "Mental injury" means an injury to the psychological capacity or emotional
333.30stability of a child as evidenced by an observable or substantial impairment in the child's
333.31ability to function within a normal range of performance and behavior with due regard to
333.32the child's culture.
333.33    (n) "Threatened injury" means a statement, overt act, condition, or status that
333.34represents a substantial risk of physical or sexual abuse or mental injury. Threatened
333.35injury includes, but is not limited to, exposing a child to a person responsible for the
333.36child's care, as defined in paragraph (e), clause (1), who has:
334.1    (1) subjected a child to, or failed to protect a child from, an overt act or condition
334.2that constitutes egregious harm, as defined in section 260C.007, subdivision 14, or a
334.3similar law of another jurisdiction;
334.4    (2) been found to be palpably unfit under section 260C.301, paragraph (b), clause
334.5(4), or a similar law of another jurisdiction;
334.6    (3) committed an act that has resulted in an involuntary termination of parental rights
334.7under section 260C.301, or a similar law of another jurisdiction; or
334.8    (4) committed an act that has resulted in the involuntary transfer of permanent
334.9legal and physical custody of a child to a relative under Minnesota Statutes 2010, section
334.10260C.201, subdivision 11 , paragraph (d), clause (1), section 260C.515, subdivision 4, or a
334.11similar law of another jurisdiction.
334.12A child is the subject of a report of threatened injury when the responsible social
334.13services agency receives birth match data under paragraph (o) from the Department of
334.14Human Services.
334.15(o) Upon receiving data under section 144.225, subdivision 2b, contained in a
334.16birth record or recognition of parentage identifying a child who is subject to threatened
334.17injury under paragraph (n), the Department of Human Services shall send the data to the
334.18responsible social services agency. The data is known as "birth match" data. Unless the
334.19responsible social services agency has already begun an investigation or assessment of the
334.20report due to the birth of the child or execution of the recognition of parentage and the
334.21parent's previous history with child protection, the agency shall accept the birth match
334.22data as a report under this section. The agency may use either a family assessment or
334.23investigation to determine whether the child is safe. All of the provisions of this section
334.24apply. If the child is determined to be safe, the agency shall consult with the county
334.25attorney to determine the appropriateness of filing a petition alleging the child is in need
334.26of protection or services under section 260C.007, subdivision 6, clause (16), in order to
334.27deliver needed services. If the child is determined not to be safe, the agency and the county
334.28attorney shall take appropriate action as required under section 260C.301, subdivision 3.
334.29    (p) Persons who conduct assessments or investigations under this section shall take
334.30into account accepted child-rearing practices of the culture in which a child participates
334.31and accepted teacher discipline practices, which are not injurious to the child's health,
334.32welfare, and safety.
334.33    (q) "Accidental" means a sudden, not reasonably foreseeable, and unexpected
334.34occurrence or event which:
334.35    (1) is not likely to occur and could not have been prevented by exercise of due
334.36care; and
335.1    (2) if occurring while a child is receiving services from a facility, happens when the
335.2facility and the employee or person providing services in the facility are in compliance
335.3with the laws and rules relevant to the occurrence or event.
335.4(r) "Nonmaltreatment mistake" means:
335.5(1) at the time of the incident, the individual was performing duties identified in the
335.6center's child care program plan required under Minnesota Rules, part 9503.0045;
335.7(2) the individual has not been determined responsible for a similar incident that
335.8resulted in a finding of maltreatment for at least seven years;
335.9(3) the individual has not been determined to have committed a similar
335.10nonmaltreatment mistake under this paragraph for at least four years;
335.11(4) any injury to a child resulting from the incident, if treated, is treated only with
335.12remedies that are available over the counter, whether ordered by a medical professional or
335.13not; and
335.14(5) except for the period when the incident occurred, the facility and the individual
335.15providing services were both in compliance with all licensing requirements relevant to the
335.16incident.
335.17This definition only applies to child care centers licensed under Minnesota
335.18Rules, chapter 9503. If clauses (1) to (5) apply, rather than making a determination of
335.19substantiated maltreatment by the individual, the commissioner of human services shall
335.20determine that a nonmaltreatment mistake was made by the individual.
335.21EFFECTIVE DATE.This section is effective January 1, 2014.

335.22    Sec. 14. Minnesota Statutes 2012, section 626.556, subdivision 3, is amended to read:
335.23    Subd. 3. Persons mandated to report. (a) A person who knows or has reason
335.24to believe a child is being neglected or physically or sexually abused, as defined in
335.25subdivision 2, or has been neglected or physically or sexually abused within the preceding
335.26three years, shall immediately report the information to the local welfare agency, agency
335.27responsible for assessing or investigating the report, police department, or the county
335.28sheriff if the person is:
335.29    (1) a professional or professional's delegate who is engaged in the practice of
335.30the healing arts, social services, hospital administration, psychological or psychiatric
335.31treatment, child care, education, correctional supervision, probation and correctional
335.32services, or law enforcement; or
335.33    (2) employed as a member of the clergy and received the information while
335.34engaged in ministerial duties, provided that a member of the clergy is not required by
336.1this subdivision to report information that is otherwise privileged under section 595.02,
336.2subdivision 1 , paragraph (c).
336.3    The police department or the county sheriff, upon receiving a report, shall
336.4immediately notify the local welfare agency or agency responsible for assessing or
336.5investigating the report, orally and in writing. The local welfare agency, or agency
336.6responsible for assessing or investigating the report, upon receiving a report, shall
336.7immediately notify the local police department or the county sheriff orally and in writing.
336.8The county sheriff and the head of every local welfare agency, agency responsible
336.9for assessing or investigating reports, and police department shall each designate a
336.10person within their agency, department, or office who is responsible for ensuring that
336.11the notification duties of this paragraph and paragraph (b) are carried out. Nothing in
336.12this subdivision shall be construed to require more than one report from any institution,
336.13facility, school, or agency.
336.14    (b) Any person may voluntarily report to the local welfare agency, agency responsible
336.15for assessing or investigating the report, police department, or the county sheriff if the
336.16person knows, has reason to believe, or suspects a child is being or has been neglected or
336.17subjected to physical or sexual abuse. The police department or the county sheriff, upon
336.18receiving a report, shall immediately notify the local welfare agency or agency responsible
336.19for assessing or investigating the report, orally and in writing. The local welfare agency or
336.20agency responsible for assessing or investigating the report, upon receiving a report, shall
336.21immediately notify the local police department or the county sheriff orally and in writing.
336.22    (c) A person mandated to report physical or sexual child abuse or neglect occurring
336.23within a licensed facility shall report the information to the agency responsible for
336.24licensing the facility under sections 144.50 to 144.58; 241.021; 245A.01 to 245A.16; or
336.25chapter 245B 245D; or a nonlicensed personal care provider organization as defined in
336.26sections 256B.04, subdivision 16; and 256B.0625, subdivision 19. A health or corrections
336.27agency receiving a report may request the local welfare agency to provide assistance
336.28pursuant to subdivisions 10, 10a, and 10b. A board or other entity whose licensees
336.29perform work within a school facility, upon receiving a complaint of alleged maltreatment,
336.30shall provide information about the circumstances of the alleged maltreatment to the
336.31commissioner of education. Section 13.03, subdivision 4, applies to data received by the
336.32commissioner of education from a licensing entity.
336.33    (d) Any person mandated to report shall receive a summary of the disposition of
336.34any report made by that reporter, including whether the case has been opened for child
336.35protection or other services, or if a referral has been made to a community organization,
336.36unless release would be detrimental to the best interests of the child. Any person who is
337.1not mandated to report shall, upon request to the local welfare agency, receive a concise
337.2summary of the disposition of any report made by that reporter, unless release would be
337.3detrimental to the best interests of the child.
337.4    (e) For purposes of this section, "immediately" means as soon as possible but in
337.5no event longer than 24 hours.
337.6EFFECTIVE DATE.This section is effective January 1, 2014.

337.7    Sec. 15. Minnesota Statutes 2012, section 626.556, subdivision 10d, is amended to read:
337.8    Subd. 10d. Notification of neglect or abuse in facility. (a) When a report is
337.9received that alleges neglect, physical abuse, sexual abuse, or maltreatment of a child while
337.10in the care of a licensed or unlicensed day care facility, residential facility, agency, hospital,
337.11sanitarium, or other facility or institution required to be licensed according to sections
337.12144.50 to 144.58; 241.021; or 245A.01 to 245A.16; or chapter 245B 245D, or a school as
337.13defined in sections 120A.05, subdivisions 9, 11, and 13; and 124D.10; or a nonlicensed
337.14personal care provider organization as defined in section 256B.04, subdivision 16, and
337.15256B.0625, subdivision 19a , the commissioner of the agency responsible for assessing
337.16or investigating the report or local welfare agency investigating the report shall provide
337.17the following information to the parent, guardian, or legal custodian of a child alleged to
337.18have been neglected, physically abused, sexually abused, or the victim of maltreatment
337.19of a child in the facility: the name of the facility; the fact that a report alleging neglect,
337.20physical abuse, sexual abuse, or maltreatment of a child in the facility has been received;
337.21the nature of the alleged neglect, physical abuse, sexual abuse, or maltreatment of a child
337.22in the facility; that the agency is conducting an assessment or investigation; any protective
337.23or corrective measures being taken pending the outcome of the investigation; and that a
337.24written memorandum will be provided when the investigation is completed.
337.25(b) The commissioner of the agency responsible for assessing or investigating the
337.26report or local welfare agency may also provide the information in paragraph (a) to the
337.27parent, guardian, or legal custodian of any other child in the facility if the investigative
337.28agency knows or has reason to believe the alleged neglect, physical abuse, sexual
337.29abuse, or maltreatment of a child in the facility has occurred. In determining whether
337.30to exercise this authority, the commissioner of the agency responsible for assessing
337.31or investigating the report or local welfare agency shall consider the seriousness of the
337.32alleged neglect, physical abuse, sexual abuse, or maltreatment of a child in the facility; the
337.33number of children allegedly neglected, physically abused, sexually abused, or victims of
337.34maltreatment of a child in the facility; the number of alleged perpetrators; and the length
337.35of the investigation. The facility shall be notified whenever this discretion is exercised.
338.1(c) When the commissioner of the agency responsible for assessing or investigating
338.2the report or local welfare agency has completed its investigation, every parent, guardian,
338.3or legal custodian previously notified of the investigation by the commissioner or
338.4local welfare agency shall be provided with the following information in a written
338.5memorandum: the name of the facility investigated; the nature of the alleged neglect,
338.6physical abuse, sexual abuse, or maltreatment of a child in the facility; the investigator's
338.7name; a summary of the investigation findings; a statement whether maltreatment was
338.8found; and the protective or corrective measures that are being or will be taken. The
338.9memorandum shall be written in a manner that protects the identity of the reporter and
338.10the child and shall not contain the name, or to the extent possible, reveal the identity of
338.11the alleged perpetrator or of those interviewed during the investigation. If maltreatment
338.12is determined to exist, the commissioner or local welfare agency shall also provide the
338.13written memorandum to the parent, guardian, or legal custodian of each child in the facility
338.14who had contact with the individual responsible for the maltreatment. When the facility is
338.15the responsible party for maltreatment, the commissioner or local welfare agency shall also
338.16provide the written memorandum to the parent, guardian, or legal custodian of each child
338.17who received services in the population of the facility where the maltreatment occurred.
338.18This notification must be provided to the parent, guardian, or legal custodian of each child
338.19receiving services from the time the maltreatment occurred until either the individual
338.20responsible for maltreatment is no longer in contact with a child or children in the facility
338.21or the conclusion of the investigation. In the case of maltreatment within a school facility,
338.22as defined in sections 120A.05, subdivisions 9, 11, and 13, and 124D.10, the commissioner
338.23of education need not provide notification to parents, guardians, or legal custodians of
338.24each child in the facility, but shall, within ten days after the investigation is completed,
338.25provide written notification to the parent, guardian, or legal custodian of any student
338.26alleged to have been maltreated. The commissioner of education may notify the parent,
338.27guardian, or legal custodian of any student involved as a witness to alleged maltreatment.
338.28EFFECTIVE DATE.This section is effective January 1, 2014.

338.29    Sec. 16. REPEALER.
338.30Minnesota Statutes 2012, section 256B.49, subdivision 16a, is repealed effective
338.31January 1, 2014.


339.3    Section 1. [3.0995] LEGISLATORS; DRUG TESTING.
339.4(a) To be eligible for compensation and expense reimbursements, a legislator must
339.5undergo drug and alcohol screening, to the extent practicable, following the established
339.6procedures and reliability safeguards provided for screening in sections 181.951, 181.953,
339.7and 181.954. Legislators may be required to undergo random drug screening. Legislators
339.8must provide evidence of a negative test result to the house controller for members of the
339.9house of representatives or the secretary of the senate for members of the senate prior to
339.10receipt of any compensation or expense reimbursement.
339.11(b) A laboratory must report to the house controller for members of the house of
339.12representatives or the secretary of the senate for members of the senate any positive test
339.13results returned on a legislator. Upon receipt of a positive test result, the house controller
339.14for members of the house of representatives and the secretary of the senate for members of
339.15the senate must deny or discontinue compensation and expense reimbursement until the
339.16legislator demonstrates a pattern of negative test results that satisfy the house controller or
339.17the secretary of the senate that the person is no longer a drug user.
339.18(c) A legislator who undergoes testing under this section shall pay a fee to the
339.19laboratory for the cost of the test prior to testing.
339.20EFFECTIVE DATE.This section is effective July 1, 2013.

339.21    Sec. 2. Minnesota Statutes 2012, section 62A.65, subdivision 2, is amended to read:
339.22    Subd. 2. Guaranteed renewal. (a) No individual health plan may be offered, sold,
339.23issued, or renewed to a Minnesota resident unless the health plan provides that the plan
339.24is guaranteed renewable at a premium rate that does not take into account the claims
339.25experience or any change in the health status of any covered person that occurred after
339.26the initial issuance of the health plan to the person. The premium rate upon renewal
339.27must also otherwise comply with this section. A health carrier must not refuse to renew
339.28an individual health plan, except for nonpayment of premiums, fraud, or intentional
339.29 misrepresentation of a material fact.
339.30    (b) A health carrier may elect to discontinue health plan coverage of an individual in
339.31the individual market only, excluding a grandfathered plan as defined in section 62A.011,
339.32subdivision 1c, in one or more of the following situations:
340.1    (1) the health carrier is ceasing to offer individual health plan coverage in the
340.2individual market in accordance with sections 62A.65, subdivision 8, 62E.11, subdivision
340.39, and federal law;
340.4    (2) for network plans, the individual no longer resides, lives, or works in the
340.5service area of the health carrier, or the area for which the health carrier is authorized to
340.6do business, but only if coverage is terminated uniformly without regard to any health
340.7status-related factor of covered individuals; or
340.8    (3) a decision by the health carrier to discontinue offering a particular type of
340.9individual health plan if it meets the following requirements:
340.10    (i) provides notice in writing to each individual provided coverage of that type of
340.11health plan at least 90 days before the date coverage will be discontinued;
340.12    (ii) provides notice to the commissioner of commerce at least 30 business days
340.13before the issuer or health carrier gives notice to the individuals;
340.14    (iii) offers to each covered individual information about products currently offered
340.15that are closest in actuarial equivalence;
340.16    (iv) offers to each covered individual, on a guaranteed issue basis, the option to
340.17purchase any other individual health plan currently being offered by the health carrier or
340.18related health carrier for individuals in the market; and
340.19    (v) acts uniformly without regard to any health status-related factor of covered
340.20individuals or dependents of covered individuals who may become eligible for coverage.

340.21    Sec. 3. Minnesota Statutes 2012, section 62A.65, is amended by adding a subdivision
340.22to read:
340.23    Subd. 2a. Modification of plan. At the time of coverage renewal, an issuer or
340.24health carrier may modify the health plan, excluding a grandfathered plan as defined under
340.25section 62A.011, subdivision 1c, providing individual health plan coverage offered to
340.26individuals in the individual market, so long as the modification is consistent with state
340.27law and is effective on a uniform basis for individuals with that coverage.

340.28    Sec. 4. Minnesota Statutes 2012, section 119B.13, subdivision 7, is amended to read:
340.29    Subd. 7. Absent days. (a) Licensed child care providers and license-exempt centers
340.30must not be reimbursed for more than ten 25 full-day absent days per child, excluding
340.31holidays, in a fiscal year, or for more than ten consecutive full-day absent days. Legal
340.32nonlicensed family child care providers must not be reimbursed for absent days. If a child
340.33attends for part of the time authorized to be in care in a day, but is absent for part of the
340.34time authorized to be in care in that same day, the absent time must be reimbursed but
341.1the time must not count toward the ten absent day days limit. Child care providers must
341.2only be reimbursed for absent days if the provider has a written policy for child absences
341.3and charges all other families in care for similar absences.
341.4(b) Notwithstanding paragraph (a), children with documented medical conditions
341.5that cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
341.6full-day absent days limit. Absences due to a documented medical condition of a parent
341.7or sibling who lives in the same residence as the child receiving child care assistance
341.8do not count against the absent days limit in a fiscal year. Documentation of medical
341.9conditions must be on the forms and submitted according to the timelines established by
341.10the commissioner. A public health nurse or school nurse may verify the illness in lieu of
341.11a medical practitioner. If a provider sends a child home early due to a medical reason,
341.12including, but not limited to, fever or contagious illness, the child care center director or
341.13lead teacher may verify the illness in lieu of a medical practitioner.
341.14(b) (c) Notwithstanding paragraph (a), children in families may exceed the ten absent
341.15days limit if at least one parent: (1) is under the age of 21; (2) does not have a high school
341.16or general equivalency diploma; and (3) is a student in a school district or another similar
341.17program that provides or arranges for child care, parenting support, social services, career
341.18and employment supports, and academic support to achieve high school graduation, upon
341.19request of the program and approval of the county. If a child attends part of an authorized
341.20day, payment to the provider must be for the full amount of care authorized for that day.
341.21    (c) (d) Child care providers must be reimbursed for up to ten federal or state holidays
341.22or designated holidays per year when the provider charges all families for these days and the
341.23holiday or designated holiday falls on a day when the child is authorized to be in attendance.
341.24Parents may substitute other cultural or religious holidays for the ten recognized state and
341.25federal holidays. Holidays do not count toward the ten absent day days limit.
341.26    (d) (e) A family or child care provider must not be assessed an overpayment for an
341.27absent day payment unless (1) there was an error in the amount of care authorized for the
341.28family, (2) all of the allowed full-day absent payments for the child have been paid, or (3)
341.29the family or provider did not timely report a change as required under law.
341.30    (e) (f) The provider and family shall receive notification of the number of absent
341.31days used upon initial provider authorization for a family and ongoing notification of the
341.32number of absent days used as of the date of the notification.
341.33(g) For purposes of this subdivision, "absent days limit" means 25 full-day absent
341.34days per child, excluding holidays, in a fiscal year; and ten consecutive full-day absent days.

342.1    Sec. 5. [214.075] HEALTH-RELATED LICENSING BOARDS; CRIMINAL
342.2BACKGROUND CHECKS.
342.3    Subdivision 1. Applications. (a) By January 1, 2018, each health-related licensing
342.4board, as defined in section 214.01, subdivision 2, shall require applicants for initial
342.5licensure, licensure by endorsement, or reinstatement or other relicensure after a lapse
342.6in licensure, as defined by the individual health-related licensing boards to submit to
342.7a criminal history records check of state data completed by the Bureau of Criminal
342.8Apprehension (BCA) and a national criminal history records check, including a search of
342.9the records of the Federal Bureau of Investigation (FBI).
342.10(b) An applicant must complete a criminal background check if more than one year
342.11has elapsed since the applicant last submitted a background check to the board.
342.12    Subd. 2. Investigations. If a health-related licensing board has reasonable cause
342.13to believe a licensee has been charged with or convicted of a crime in this or any other
342.14jurisdiction, the health-related licensing board may require the licensee to submit to a
342.15criminal history records check of state data completed by the BCA and a national criminal
342.16history records check, including a search of the records of the FBI.
342.17    Subd. 3. Consent form; fees; fingerprints. In order to effectuate the federal
342.18and state level, fingerprint-based criminal background check, the applicant or licensee
342.19must submit a completed criminal history records check consent form and a full set of
342.20fingerprints to the respective health-related licensing board or a designee in the manner
342.21and form specified by the board. The applicant or licensee is responsible for all fees
342.22associated with preparation of the fingerprints, the criminal records check consent form,
342.23and the criminal background check. The fees for the criminal records background check
342.24shall be set by the BCA and the FBI and are not refundable.
342.25    Subd. 4. Refusal to consent. (a) The health-related licensing boards shall not issue
342.26a license to any applicant who refuses to consent to a criminal background check or fails
342.27to submit fingerprints within 90 days after submission of an application for licensure. Any
342.28fees paid by the applicant to the board shall be forfeited if the applicant refuses to consent
342.29to the criminal background check or fails to submit the required fingerprints.
342.30(b) The failure of a licensee to submit to a criminal background check as provided in
342.31subdivision 3 is grounds for disciplinary action by the respective health licensing board.
342.32    Subd. 5. Submission of fingerprints to BCA. The health-related licensing board
342.33or designee shall submit applicant or licensee fingerprints to the BCA. The BCA shall
342.34perform a check for state criminal justice information and shall forward the applicant's
342.35or licensee's fingerprints to the FBI to perform a check for national criminal justice
343.1information regarding the applicant or licensee. The BCA shall report to the board the
343.2results of the state and national criminal justice information checks.
343.3    Subd. 6. Alternatives to fingerprint-based criminal background checks. The
343.4health-related licensing board may require an alternative method of criminal history
343.5checks for an applicant or licensee who has submitted at least three sets of fingerprints in
343.6accordance with this section that have been unreadable by the BCA or FBI.
343.7    Subd. 7. Opportunity to challenge accuracy of report. Prior to taking disciplinary
343.8action against an applicant or a licensee based on a criminal conviction, the health-related
343.9licensing board shall provide the applicant or licensee an opportunity to complete or
343.10challenge the accuracy of the criminal history information reported to the board. The
343.11applicant or licensee shall have 30 calendar days following notice from the board of the
343.12intent to deny licensure or take disciplinary action to request an opportunity to correct or
343.13complete the record prior to the board taking disciplinary action based on the information
343.14reported to the board. The board shall provide the applicant up to 180 days to challenge
343.15the accuracy or completeness of the report with the agency responsible for the record. This
343.16subdivision does not affect the right of the subject of the data to contest the accuracy or
343.17completeness under section 13.04, subdivision 4.
343.18    Subd. 8. Instructions to the board; plans. The health-related licensing boards, in
343.19collaboration with the commissioner of human services and the BCA, shall establish a
343.20plan for completing criminal background checks of all licensees who were licensed before
343.21the effective date requirement under subdivision 1. The plan must seek to minimize
343.22duplication of requirements for background checks of licensed health professionals. The
343.23plan for background checks of current licensees shall be developed no later than January
343.241, 2017, and may be contingent upon the implementation of a system by the BCA or FBI
343.25in which any new crimes that an applicant or licensee commits after an initial background
343.26check are flagged in the BCA's or FBI's database and reported back to the board. The plan
343.27shall include recommendations for any necessary statutory changes.

343.28    Sec. 6. Minnesota Statutes 2012, section 214.40, subdivision 1, is amended to read:
343.29    Subdivision 1. Definitions. (a) The definitions in this subdivision apply to this
343.30section.
343.31(b) "Administrative services unit" means the administrative services unit for the
343.32health-related licensing boards.
343.33(c) "Charitable organization" means a charitable organization within the meaning of
343.34section 501(c)(3) of the Internal Revenue Code that has as a purpose the sponsorship or
344.1support of programs designed to improve the quality, awareness, and availability of health
344.2care services and that serves as a funding mechanism for providing those services.
344.3(d) "Health care facility or organization" means a health care facility licensed under
344.4chapter 144 or 144A, or a charitable organization.
344.5(e) "Health care provider" means a physician licensed under chapter 147, physician
344.6assistant registered and practicing under chapter 147A, nurse licensed and registered to
344.7practice under chapter 148, or dentist or, dental hygienist, dental therapist, or advanced
344.8dental therapist licensed under chapter 150A.
344.9(f) "Health care services" means health promotion, health monitoring, health
344.10education, diagnosis, treatment, minor surgical procedures, the administration of local
344.11anesthesia for the stitching of wounds, and primary dental services, including preventive,
344.12diagnostic, restorative, and emergency treatment. Health care services do not include the
344.13administration of general anesthesia or surgical procedures other than minor surgical
344.14procedures.
344.15(g) "Medical professional liability insurance" means medical malpractice insurance
344.16as defined in section 62F.03.
344.17EFFECTIVE DATE.This section is effective the day following final enactment.

344.18    Sec. 7. Minnesota Statutes 2012, section 245A.07, subdivision 2a, is amended to read:
344.19    Subd. 2a. Immediate suspension expedited hearing. (a) Within five working days
344.20of receipt of the license holder's timely appeal, the commissioner shall request assignment
344.21of an administrative law judge. The request must include a proposed date, time, and place
344.22of a hearing. A hearing must be conducted by an administrative law judge within 30
344.23calendar days of the request for assignment, unless an extension is requested by either
344.24party and granted by the administrative law judge for good cause. The commissioner shall
344.25issue a notice of hearing by certified mail or personal service at least ten working days
344.26before the hearing. The scope of the hearing shall be limited solely to the issue of whether
344.27the temporary immediate suspension should remain in effect pending the commissioner's
344.28final order under section 245A.08, regarding a licensing sanction issued under subdivision
344.293 following the immediate suspension. The burden of proof in expedited hearings under
344.30this subdivision shall be limited to the commissioner's demonstration that reasonable
344.31cause exists to believe that the license holder's actions or failure to comply with applicable
344.32law or rule poses, or if the actions of other individuals or conditions in the program
344.33poses an imminent risk of harm to the health, safety, or rights of persons served by the
344.34program. "Reasonable cause" means there exist specific articulable facts or circumstances
344.35which provide the commissioner with a reasonable suspicion that there is an imminent
345.1risk of harm to the health, safety, or rights of persons served by the program. When the
345.2commissioner has determined there is reasonable cause to order the temporary immediate
345.3suspension of a license based on a violation of safe sleep requirements, as defined in
345.4section 245A.1435, the commissioner is not required to demonstrate that an infant died or
345.5was injured as a result of the safe sleep violations.
345.6    (b) The administrative law judge shall issue findings of fact, conclusions, and a
345.7recommendation within ten working days from the date of hearing. The parties shall have
345.8ten calendar days to submit exceptions to the administrative law judge's report. The
345.9record shall close at the end of the ten-day period for submission of exceptions. The
345.10commissioner's final order shall be issued within ten working days from the close of the
345.11record. Within 90 calendar days after a final order affirming an immediate suspension, the
345.12commissioner shall make a determination regarding whether a final licensing sanction
345.13shall be issued under subdivision 3. The license holder shall continue to be prohibited
345.14from operation of the program during this 90-day period.
345.15    (c) When the final order under paragraph (b) affirms an immediate suspension, and a
345.16final licensing sanction is issued under subdivision 3 and the license holder appeals that
345.17sanction, the license holder continues to be prohibited from operation of the program
345.18pending a final commissioner's order under section 245A.08, subdivision 5, regarding the
345.19final licensing sanction.

345.20    Sec. 8. Minnesota Statutes 2012, section 245A.1435, is amended to read:
345.21245A.1435 REDUCTION OF RISK OF SUDDEN UNEXPECTED INFANT
345.22DEATH SYNDROME IN LICENSED PROGRAMS.
345.23    (a) When a license holder is placing an infant to sleep, the license holder must
345.24place the infant on the infant's back, unless the license holder has documentation from
345.25the infant's parent physician directing an alternative sleeping position for the infant. The
345.26parent physician directive must be on a form approved by the commissioner and must
345.27include a statement that the parent or legal guardian has read the information provided by
345.28the Minnesota Sudden Infant Death Center, related to the risk of SIDS and the importance
345.29of placing an infant or child on its back to sleep to reduce the risk of SIDS. remain on file
345.30at the licensed location. An infant who independently rolls onto its stomach after being
345.31placed to sleep on its back may be allowed to remain sleeping on its stomach if the infant
345.32is at least six months of age or the license holder has a signed statement from the parent
345.33indicating that the infant regularly rolls over at home.
345.34(b) The license holder must place the infant in a crib directly on a firm mattress with
345.35a fitted crib sheet that fits tightly on the mattress and overlaps the mattress so it cannot be
346.1dislodged by pulling on the corner of the sheet. The license holder must not place pillows,
346.2quilts, comforters, sheepskin, pillow-like stuffed toys, or other soft products in the crib
346.3with the infant The license holder must place the infant in a crib directly on a firm mattress
346.4with a fitted sheet that is appropriate to the mattress size, that fits tightly on the mattress,
346.5and that overlaps the underside of the mattress so it cannot be dislodged by pulling on the
346.6corner of the sheet with reasonable effort. The license holder must not place anything in
346.7the crib with the infant except for the infant's pacifier. For the purposes of this section, a
346.8pacifier is defined as a synthetic nipple designed for infant sucking with nothing attached
346.9to it. The requirements of this section apply to license holders serving infants up to and
346.10including 12 months younger than one year of age. Licensed child care providers must
346.11meet the crib requirements under section 245A.146.
346.12(c) If an infant falls asleep before being placed in a crib, the license holder must
346.13move the infant to a crib as soon as practicable, and must keep the infant within sight of
346.14the license holder until the infant is placed in a crib. When an infant falls asleep while
346.15being held, the license holder must consider the supervision needs of other children in
346.16care when determining how long to hold the infant before placing the infant in a crib to
346.17sleep. The sleeping infant must not be in a position where the airway may be blocked or
346.18with anything covering the infant's face.
346.19(d) Placing a swaddled infant down to sleep in a licensed setting is not recommended
346.20for an infant of any age and is prohibited for any infant who has begun to roll over
346.21independently. However, with the written consent of a parent or guardian according to this
346.22paragraph, a license holder may place the infant who has not yet begun to roll over on its
346.23own down to sleep in a one-piece sleeper equipped with an attached system that fastens
346.24securely only across the upper torso, with no constriction of the hips or legs, to create a
346.25swaddle. Prior to any use of swaddling for sleep by a provider licensed under this chapter,
346.26the license holder must obtain informed written consent for the use of swaddling from the
346.27parent or guardian of the infant on a form provided by the commissioner and prepared in
346.28partnership with the Minnesota Sudden Infant Death Center.

346.29    Sec. 9. Minnesota Statutes 2012, section 245A.144, is amended to read:
346.30245A.144 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
346.31DEATH AND SHAKEN BABY SYNDROME ABUSIVE HEAD TRAUMA FOR
346.32CHILD FOSTER CARE PROVIDERS.
346.33    (a) Licensed child foster care providers that care for infants or children through five
346.34years of age must document that before staff persons and caregivers assist in the care
346.35of infants or children through five years of age, they are instructed on the standards in
347.1section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
347.2death syndrome and shaken baby syndrome for abusive head trauma from shaking infants
347.3and young children. This section does not apply to emergency relative placement under
347.4section 245A.035. The training on reducing the risk of sudden unexpected infant death
347.5syndrome and shaken baby syndrome abusive head trauma may be provided as:
347.6    (1) orientation training to child foster care providers, who care for infants or children
347.7through five years of age, under Minnesota Rules, part 2960.3070, subpart 1; or
347.8    (2) in-service training to child foster care providers, who care for infants or children
347.9through five years of age, under Minnesota Rules, part 2960.3070, subpart 2.
347.10    (b) Training required under this section must be at least one hour in length and must
347.11be completed at least once every five years. At a minimum, the training must address
347.12the risk factors related to sudden unexpected infant death syndrome and shaken baby
347.13syndrome abusive head trauma, means of reducing the risk of sudden unexpected infant
347.14death syndrome and shaken baby syndrome abusive head trauma, and license holder
347.15communication with parents regarding reducing the risk of sudden unexpected infant
347.16death syndrome and shaken baby syndrome abusive head trauma.
347.17    (c) Training for child foster care providers must be approved by the county or
347.18private licensing agency that is responsible for monitoring the child foster care provider
347.19under section 245A.16. The approved training fulfills, in part, training required under
347.20Minnesota Rules, part 2960.3070.

347.21    Sec. 10. Minnesota Statutes 2012, section 245A.1444, is amended to read:
347.22245A.1444 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
347.23DEATH SYNDROME AND SHAKEN BABY SYNDROME ABUSIVE HEAD
347.24TRAUMA BY OTHER PROGRAMS.
347.25    A licensed chemical dependency treatment program that serves clients with infants
347.26or children through five years of age, who sleep at the program and a licensed children's
347.27residential facility that serves infants or children through five years of age, must document
347.28that before program staff persons or volunteers assist in the care of infants or children
347.29through five years of age, they are instructed on the standards in section 245A.1435 and
347.30receive training on reducing the risk of sudden unexpected infant death syndrome and
347.31shaken baby syndrome abusive head trauma from shaking infants and young children. The
347.32training conducted under this section may be used to fulfill training requirements under
347.33Minnesota Rules, parts 2960.0100, subpart 3; and 9530.6490, subpart 4, item B.
347.34    This section does not apply to child care centers or family child care programs
347.35governed by sections 245A.40 and 245A.50.

348.1    Sec. 11. [245A.1446] FAMILY CHILD CARE DIAPERING AREA
348.2DISINFECTION.
348.3Notwithstanding Minnesota Rules, part 9502.0435, a family child care provider may
348.4disinfect the diaper changing surface with either a solution of at least two teaspoons
348.5of chlorine bleach to one quart of water or with a surface disinfectant that meets the
348.6following criteria:
348.7(1) the manufacturer's label or instructions state that the product is registered with
348.8the United States Environmental Protection Agency;
348.9(2) the manufacturer's label or instructions state that the disinfectant is effective
348.10against Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa;
348.11(3) the manufacturer's label or instructions state that the disinfectant is effective with
348.12a ten minute or less contact time;
348.13(4) the disinfectant is clearly labeled by the manufacturer with directions for mixing
348.14and use;
348.15(5) the disinfectant is used only in accordance with the manufacturer's directions; and
348.16(6) the product does not include triclosan or derivatives of triclosan.

348.17    Sec. 12. [245A.147] FAMILY CHILD CARE INFANT SLEEP SUPERVISION
348.18REQUIREMENTS.
348.19    Subdivision 1. In-person checks on infants. (a) License holders that serve infants
348.20are encouraged to monitor sleeping infants by conducting in-person checks on each infant
348.21in their care every 30 minutes.
348.22(b) Upon enrollment of an infant in a family child care program, the license holder is
348.23encouraged to conduct in-person checks on the sleeping infant every 15 minutes during
348.24the first four months of care.
348.25(c) When an infant has an upper respiratory infection, the license holder is
348.26encouraged to conduct in-person checks on the sleeping infant every 15 minutes
348.27throughout the hours of sleep.
348.28    Subd. 2. Use of audio or visual monitoring devices. In addition to conducting
348.29the in-person checks encouraged under subdivision 1, license holders serving infants are
348.30encouraged to use and maintain an audio or visual monitoring device to monitor each
348.31sleeping infant in care during all hours of sleep.

348.32    Sec. 13. [245A.152] CHILD CARE LICENSE HOLDER INSURANCE.
348.33(a) A license holder must provide a written notice to all parents or guardians of all
348.34children to be accepted for care prior to admission stating whether the license holder has
349.1liability insurance. This notice may be incorporated into and provided on the admission
349.2form used by the license holder.
349.3(b) If the license holder has liability insurance:
349.4(1) the license holder shall inform parents in writing that a current certificate of
349.5coverage for insurance is available for inspection to all parents or guardians of children
349.6receiving services and to all parents seeking services from the family child care program;
349.7(2) the notice must provide the parent or guardian with the date of expiration or
349.8next renewal of the policy; and
349.9(3) upon the expiration date of the policy, the license holder must provide a new
349.10written notice indicating whether the insurance policy has lapsed or whether the license
349.11holder has renewed the policy.
349.12If the policy was renewed, the license holder must provide the new expiration date of the
349.13policy in writing to the parents or guardians.
349.14(c) If the license holder does not have liability insurance, the license holder must
349.15provide an annual notice, on a form developed and made available by the commissioner,
349.16to the parents or guardians of children in care indicating that the license holder does not
349.17carry liability insurance.
349.18(d) The license holder must notify all parents and guardians in writing immediately
349.19of any change in insurance status.
349.20(e) The license holder must make available upon request the certificate of liability
349.21insurance to the parents of children in care, to the commissioner, and to county licensing
349.22agents.
349.23(f) The license holder must document, with the signature of the parent or guardian,
349.24that the parent or guardian received the notices required by this section.

349.25    Sec. 14. Minnesota Statutes 2012, section 245A.40, subdivision 5, is amended to read:
349.26    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome
349.27 abusive head trauma training. (a) License holders must document that before staff
349.28persons and volunteers care for infants, they are instructed on the standards in section
349.29245A.1435 and receive training on reducing the risk of sudden unexpected infant death
349.30syndrome. In addition, license holders must document that before staff persons care for
349.31infants or children under school age, they receive training on the risk of shaken baby
349.32syndrome abusive head trauma from shaking infants and young children. The training
349.33in this subdivision may be provided as orientation training under subdivision 1 and
349.34in-service training under subdivision 7.
350.1    (b) Sudden unexpected infant death syndrome reduction training required under
350.2this subdivision must be at least one-half hour in length and must be completed at least
350.3once every five years year. At a minimum, the training must address the risk factors
350.4related to sudden unexpected infant death syndrome, means of reducing the risk of sudden
350.5unexpected infant death syndrome in child care, and license holder communication with
350.6parents regarding reducing the risk of sudden unexpected infant death syndrome.
350.7    (c) Shaken baby syndrome Abusive head trauma training under this subdivision
350.8must be at least one-half hour in length and must be completed at least once every five
350.9years year. At a minimum, the training must address the risk factors related to shaken
350.10baby syndrome for shaking infants and young children, means to reduce the risk of shaken
350.11baby syndrome abusive head trauma in child care, and license holder communication with
350.12parents regarding reducing the risk of shaken baby syndrome abusive head trauma.
350.13(d) The commissioner shall make available for viewing a video presentation on the
350.14dangers associated with shaking infants and young children. The video presentation must
350.15be part of the orientation and annual in-service training of licensed child care center
350.16staff persons caring for children under school age. The commissioner shall provide to
350.17child care providers and interested individuals, at cost, copies of a video approved by the
350.18commissioner of health under section 144.574 on the dangers associated with shaking
350.19infants and young children.

350.20    Sec. 15. Minnesota Statutes 2012, section 245A.50, is amended to read:
350.21245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.
350.22    Subdivision 1. Initial training. (a) License holders, caregivers, and substitutes must
350.23comply with the training requirements in this section.
350.24    (b) Helpers who assist with care on a regular basis must complete six hours of
350.25training within one year after the date of initial employment.
350.26    Subd. 2. Child growth and development and behavior guidance training. (a) For
350.27purposes of family and group family child care, the license holder and each adult caregiver
350.28who provides care in the licensed setting for more than 30 days in any 12-month period
350.29shall complete and document at least two four hours of child growth and development
350.30and behavior guidance training within the first year of prior to initial licensure, and before
350.31caring for children. For purposes of this subdivision, "child growth and development
350.32training" means training in understanding how children acquire language and develop
350.33physically, cognitively, emotionally, and socially. "Behavior guidance training" means
350.34training in the understanding of the functions of child behavior and strategies for managing
350.35challenging situations. Child growth and development and behavior guidance training
351.1must be repeated annually. Training curriculum shall be developed or approved by the
351.2commissioner of human services by January 1, 2014.
351.3    (b) Notwithstanding paragraph (a), individuals are exempt from this requirement if
351.4they:
351.5    (1) have taken a three-credit course on early childhood development within the
351.6past five years;
351.7    (2) have received a baccalaureate or master's degree in early childhood education or
351.8school-age child care within the past five years;
351.9    (3) are licensed in Minnesota as a prekindergarten teacher, an early childhood
351.10educator, a kindergarten to grade 6 teacher with a prekindergarten specialty, an early
351.11childhood special education teacher, or an elementary teacher with a kindergarten
351.12endorsement; or
351.13    (4) have received a baccalaureate degree with a Montessori certificate within the
351.14past five years.
351.15    Subd. 3. First aid. (a) When children are present in a family child care home
351.16governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person
351.17must be present in the home who has been trained in first aid. The first aid training must
351.18have been provided by an individual approved to provide first aid instruction. First aid
351.19training may be less than eight hours and persons qualified to provide first aid training
351.20include individuals approved as first aid instructors. First aid training must be repeated
351.21every two years.
351.22    (b) A family child care provider is exempt from the first aid training requirements
351.23under this subdivision related to any substitute caregiver who provides less than 30 hours
351.24of care during any 12-month period.
351.25    (c) Video training reviewed and approved by the county licensing agency satisfies
351.26the training requirement of this subdivision.
351.27    Subd. 4. Cardiopulmonary resuscitation. (a) When children are present in a family
351.28child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least
351.29one staff person must be present in the home who has been trained in cardiopulmonary
351.30resuscitation (CPR) and in the treatment of obstructed airways that includes CPR
351.31techniques for infants and children. The CPR training must have been provided by an
351.32individual approved to provide CPR instruction, must be repeated at least once every three
351.33 two years, and must be documented in the staff person's records.
351.34    (b) A family child care provider is exempt from the CPR training requirement in
351.35this subdivision related to any substitute caregiver who provides less than 30 hours of
351.36care during any 12-month period.
352.1    (c) Video training reviewed and approved by the county licensing agency satisfies
352.2the training requirement of this subdivision. Persons providing CPR training must use
352.3CPR training that has been developed:
352.4    (1) by the American Heart Association or the American Red Cross and incorporates
352.5psychomotor skills to support the instruction; or
352.6    (2) using nationally recognized, evidence-based guidelines for CPR training and
352.7incorporates psychomotor skills to support the instruction.
352.8    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome
352.9 abusive head trauma training. (a) License holders must document that before staff
352.10persons, caregivers, and helpers assist in the care of infants, they are instructed on the
352.11standards in section 245A.1435 and receive training on reducing the risk of sudden
352.12unexpected infant death syndrome. In addition, license holders must document that before
352.13staff persons, caregivers, and helpers assist in the care of infants and children under
352.14school age, they receive training on reducing the risk of shaken baby syndrome abusive
352.15head trauma from shaking infants and young children. The training in this subdivision
352.16may be provided as initial training under subdivision 1 or ongoing annual training under
352.17subdivision 7.
352.18    (b) Sudden unexpected infant death syndrome reduction training required under this
352.19subdivision must be at least one-half hour in length and must be completed in person
352.20 at least once every five years two years. On the years when the license holder is not
352.21receiving the in-person training on sudden unexpected infant death reduction, the license
352.22holder must receive sudden unexpected infant death reduction training through a video
352.23of no more than one hour in length developed or approved by the commissioner. At a
352.24minimum, the training must address the risk factors related to sudden unexpected infant
352.25death syndrome, means of reducing the risk of sudden unexpected infant death syndrome
352.26 in child care, and license holder communication with parents regarding reducing the risk
352.27of sudden unexpected infant death syndrome.
352.28    (c) Shaken baby syndrome Abusive head trauma training required under this
352.29subdivision must be at least one-half hour in length and must be completed at least once
352.30every five years year. At a minimum, the training must address the risk factors related
352.31to shaken baby syndrome shaking infants and young children, means of reducing the
352.32risk of shaken baby syndrome abusive head trauma in child care, and license holder
352.33communication with parents regarding reducing the risk of shaken baby syndrome abusive
352.34head trauma.
352.35(d) Training for family and group family child care providers must be developed
352.36by the commissioner in conjunction with the Minnesota Sudden Infant Death Center
353.1and approved by the county licensing agency by the Minnesota Center for Professional
353.2Development.
353.3    (e) The commissioner shall make available for viewing by all licensed child care
353.4providers a video presentation on the dangers associated with shaking infants and young
353.5children. The video presentation shall be part of the initial and ongoing annual training of
353.6licensed child care providers, caregivers, and helpers caring for children under school age.
353.7The commissioner shall provide to child care providers and interested individuals, at cost,
353.8copies of a video approved by the commissioner of health under section 144.574 on the
353.9dangers associated with shaking infants and young children.
353.10    Subd. 6. Child passenger restraint systems; training requirement. (a) A license
353.11holder must comply with all seat belt and child passenger restraint system requirements
353.12under section 169.685.
353.13    (b) Family and group family child care programs licensed by the Department of
353.14Human Services that serve a child or children under nine years of age must document
353.15training that fulfills the requirements in this subdivision.
353.16    (1) Before a license holder, staff person, caregiver, or helper transports a child or
353.17children under age nine in a motor vehicle, the person placing the child or children in a
353.18passenger restraint must satisfactorily complete training on the proper use and installation
353.19of child restraint systems in motor vehicles. Training completed under this subdivision may
353.20be used to meet initial training under subdivision 1 or ongoing training under subdivision 7.
353.21    (2) Training required under this subdivision must be at least one hour in length,
353.22completed at initial training, and repeated at least once every five years. At a minimum,
353.23the training must address the proper use of child restraint systems based on the child's
353.24size, weight, and age, and the proper installation of a car seat or booster seat in the motor
353.25vehicle used by the license holder to transport the child or children.
353.26    (3) Training under this subdivision must be provided by individuals who are certified
353.27and approved by the Department of Public Safety, Office of Traffic Safety. License holders
353.28may obtain a list of certified and approved trainers through the Department of Public
353.29Safety Web site or by contacting the agency.
353.30    (c) Child care providers that only transport school-age children as defined in section
353.31245A.02, subdivision 19 , paragraph (f), in child care buses as defined in section 169.448,
353.32subdivision 1, paragraph (e), are exempt from this subdivision.
353.33    Subd. 7. Training requirements for family and group family child care. For
353.34purposes of family and group family child care, the license holder and each primary
353.35caregiver must complete eight 16 hours of ongoing training each year. For purposes
353.36of this subdivision, a primary caregiver is an adult caregiver who provides services in
354.1the licensed setting for more than 30 days in any 12-month period. Repeat of topical
354.2training requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
354.3requirement. Additional ongoing training subjects to meet the annual 16-hour training
354.4requirement must be selected from the following areas:
354.5    (1) "child growth and development training" has the meaning given in under
354.6 subdivision 2, paragraph (a);
354.7    (2) "learning environment and curriculum" includes, including training in
354.8establishing an environment and providing activities that provide learning experiences to
354.9meet each child's needs, capabilities, and interests;
354.10    (3) "assessment and planning for individual needs" includes, including training in
354.11observing and assessing what children know and can do in order to provide curriculum
354.12and instruction that addresses their developmental and learning needs, including children
354.13with special needs and bilingual children or children for whom English is not their
354.14primary language;
354.15    (4) "interactions with children" includes, including training in establishing
354.16supportive relationships with children, guiding them as individuals and as part of a group;
354.17    (5) "families and communities" includes, including training in working
354.18collaboratively with families and agencies or organizations to meet children's needs and to
354.19encourage the community's involvement;
354.20    (6) "health, safety, and nutrition" includes, including training in establishing and
354.21maintaining an environment that ensures children's health, safety, and nourishment,
354.22including child abuse, maltreatment, prevention, and reporting; home and fire safety; child
354.23injury prevention; communicable disease prevention and control; first aid; and CPR; and
354.24    (7) "program planning and evaluation" includes, including training in establishing,
354.25implementing, evaluating, and enhancing program operations.; and
354.26(8) behavior guidance, including training in the understanding of the functions of
354.27child behavior and strategies for managing behavior.
354.28    Subd. 8. Other required training requirements. (a) The training required of
354.29family and group family child care providers and staff must include training in the cultural
354.30dynamics of early childhood development and child care. The cultural dynamics and
354.31disabilities training and skills development of child care providers must be designed to
354.32achieve outcomes for providers of child care that include, but are not limited to:
354.33    (1) an understanding and support of the importance of culture and differences in
354.34ability in children's identity development;
354.35    (2) understanding the importance of awareness of cultural differences and
354.36similarities in working with children and their families;
355.1    (3) understanding and support of the needs of families and children with differences
355.2in ability;
355.3    (4) developing skills to help children develop unbiased attitudes about cultural
355.4differences and differences in ability;
355.5    (5) developing skills in culturally appropriate caregiving; and
355.6    (6) developing skills in appropriate caregiving for children of different abilities.
355.7    The commissioner shall approve the curriculum for cultural dynamics and disability
355.8training.
355.9    (b) The provider must meet the training requirement in section 245A.14, subdivision
355.1011 , paragraph (a), clause (4), to be eligible to allow a child cared for at the family child
355.11care or group family child care home to use the swimming pool located at the home.
355.12    Subd. 9. Supervising for safety; training requirement. Effective July 1, 2014,
355.13all family child care license holders and each adult caregiver who provides care in the
355.14licensed family child care home for more than 30 days in any 12-month period shall
355.15complete and document at least six hours of approved training on supervising for safety
355.16prior to initial licensure, and before caring for children. At least two hours of training
355.17on supervising for safety must be repeated annually. For purposes of this subdivision,
355.18"supervising for safety" includes supervision basics, supervision outdoors, equipment and
355.19materials, illness, injuries, and disaster preparedness. The commissioner shall develop
355.20the supervising for safety curriculum by January 1, 2014.
355.21    Subd. 10. Approved training. County licensing staff must accept training approved
355.22by the Minnesota Center for Professional Development, including:
355.23(1) face-to-face or classroom training;
355.24(2) online training; and
355.25(3) relationship-based professional development, such as mentoring, coaching,
355.26and consulting.
355.27    Subd. 11. Provider training. New and increased training requirements under this
355.28section must not be imposed on providers until the commissioner establishes statewide
355.29accessibility to the required provider training.

355.30    Sec. 16. Minnesota Statutes 2012, section 246.54, is amended to read:
355.31246.54 LIABILITY OF COUNTY; REIMBURSEMENT.
355.32    Subdivision 1. County portion for cost of care. (a) Except for chemical
355.33dependency services provided under sections 254B.01 to 254B.09, the client's county
355.34shall pay to the state of Minnesota a portion of the cost of care provided in a regional
355.35treatment center or a state nursing facility to a client legally settled in that county. A
356.1county's payment shall be made from the county's own sources of revenue and payments
356.2shall equal a percentage of the cost of care, as determined by the commissioner, for each
356.3day, or the portion thereof, that the client spends at a regional treatment center or a state
356.4nursing facility according to the following schedule:
356.5    (1) zero percent for the first 30 days;
356.6    (2) 20 percent for days 31 to 60; and
356.7    (3) 50 75 percent for any days over 60.
356.8    (b) The increase in the county portion for cost of care under paragraph (a), clause
356.9(3), shall be imposed when the treatment facility has determined that it is clinically
356.10appropriate for the client to be discharged.
356.11    (c) If payments received by the state under sections 246.50 to 246.53 exceed 80
356.12percent of the cost of care for days 31 to 60, or 50 25 percent for days over 60, the county
356.13shall be responsible for paying the state only the remaining amount. The county shall
356.14not be entitled to reimbursement from the client, the client's estate, or from the client's
356.15relatives, except as provided in section 246.53.
356.16    Subd. 2. Exceptions. (a) Subdivision 1 does not apply to services provided at the
356.17Minnesota Security Hospital or the Minnesota extended treatment options program. For
356.18services at these facilities the Minnesota Security Hospital, a county's payment shall be
356.19made from the county's own sources of revenue and payments shall be paid as follows:.
356.20Excluding the state-operated forensic transition service, payments to the state from the
356.21county shall equal ten percent of the cost of care, as determined by the commissioner, for
356.22each day, or the portion thereof, that the client spends at the facility. For the state-operated
356.23forensic transition service, payments to the state from the county shall equal 50 percent of
356.24the cost of care, as determined by the commissioner, for each day, or the portion thereof,
356.25that the client spends in the program. If payments received by the state under sections
356.26246.50 to 246.53 for services provided at the Minnesota Security Hospital, excluding the
356.27state-operated forensic transition service, exceed 90 percent of the cost of care, the county
356.28shall be responsible for paying the state only the remaining amount. If payments received
356.29by the state under sections 246.50 to 246.53 for the state-operated forensic transition service
356.30exceed 50 percent of the cost of care, the county shall be responsible for paying the state
356.31only the remaining amount. The county shall not be entitled to reimbursement from the
356.32client, the client's estate, or from the client's relatives, except as provided in section 246.53.
356.33    (b) Regardless of the facility to which the client is committed, subdivision 1 does
356.34not apply to the following individuals:
356.35    (1) clients who are committed as mentally ill and dangerous under section 253B.02,
356.36subdivision 17;
357.1    (2) (1) clients who are committed as sexual psychopathic personalities under section
357.2253B.02, subdivision 18b ; and
357.3    (3) (2) clients who are committed as sexually dangerous persons under section
357.4253B.02 , subdivision 18c.
357.5    For each of the individuals in clauses (1) to (3), the payment by the county to the state
357.6shall equal ten percent of the cost of care for each day as determined by the commissioner.

357.7    Sec. 17. [256.999] CULTURAL AND ETHNIC COMMUNITIES LEADERSHIP
357.8COUNCIL.
357.9    Subdivision 1. Establishment; purpose. There is hereby established the Cultural
357.10and Ethnic Communities Leadership Council for the Department of Human Services. The
357.11purpose of the council is to advise the commissioner of human services on reducing
357.12disparities that affect racial and ethnic groups.
357.13    Subd. 2. Members. (a) The council must consist of no fewer than 15 and no more
357.14than 25 members appointed by the commissioner of human services, in consultation with
357.15county, tribal, cultural, and ethnic communities; diverse program participants; and parent
357.16representatives from these communities. The commissioner shall direct the development
357.17of guidelines defining the membership of the council; setting out definitions; and
357.18developing duties of the commissioner, the council, and council members regarding racial
357.19and ethnic disparities reduction. The guidelines must be developed in consultation with:
357.20(1) the chairs of relevant committees; and
357.21(2) county, tribal, and cultural communities and program participants from these
357.22communities.
357.23(b) Members must be appointed to allow for representation of the following groups:
357.24(1) racial and ethnic minority groups;
357.25(2) tribal service providers;
357.26(3) culturally and linguistically specific advocacy groups and service providers;
357.27(4) human services program participants;
357.28(5) public and private institutions;
357.29(6) parents of human services program participants;
357.30(7) members of the faith community;
357.31(8) Department of Human Services employees;
357.32(9) chairs of relevant legislative committees; and
357.33(10) any other group the commissioner deems appropriate to facilitate the goals
357.34and duties of the council.
358.1(c) Each member of the council must be appointed to either a one-year or two-year
358.2term. The commissioner shall appoint one member as chair.
358.3(d) Notwithstanding section 15.059, members of the council shall receive no
358.4compensation for their services.
358.5    Subd. 3. Duties of commissioner. (a) The commissioner of human services or the
358.6commissioner's designee shall:
358.7(1) maintain the council established in this section;
358.8(2) supervise and coordinate policies for persons from racial, ethnic, cultural,
358.9linguistic, and tribal communities who experience disparities in access and outcomes;
358.10(3) identify human services rules or statutes affecting persons from racial, ethnic,
358.11cultural, linguistic, and tribal communities that may need to be revised;
358.12(4) investigate and implement cost-effective models of service delivery such as
358.13careful adaptation of clinically proven services that constitute one strategy for increasing
358.14the number of culturally relevant services available to currently underserved populations;
358.15(5) based on recommendations of the council, review identified department
358.16policies that maintain racial, ethnic, cultural, linguistic, and tribal disparities, and make
358.17adjustments to ensure those disparities are not perpetuated; and
358.18(6) based on recommendations of the council, submit legislation to reduce disparities
358.19affecting racial and ethnic groups, increase access to programs, and promote better
358.20outcomes.
358.21(b) The commissioner of human services or the commissioner's designee shall
358.22consult with the council and receive recommendations from the council when meeting
358.23the requirements of this section.
358.24    Subd. 4. Duties of council. The Cultural and Ethnic Communities Leadership
358.25Council shall:
358.26(1) recommend to the commissioner for review identified policies in the Department
358.27of Human Services that maintain racial, ethnic, cultural, linguistic, and tribal disparities;
358.28(2) identify issues regarding disparities by engaging diverse populations in human
358.29services programs;
358.30(3) engage in mutual learning essential for achieving human services parity and
358.31optimal wellness for service recipients;
358.32(4) raise awareness about human services disparities to the legislature and media;
358.33(5) provide technical assistance and consultation support to counties, private
358.34nonprofit agencies, and other service providers to build their capacity to provide equitable
358.35human services for persons from racial, ethnic, cultural, linguistic, and tribal communities
358.36who experience disparities in access and outcomes;
359.1(6) provide technical assistance to promote statewide development of culturally
359.2and linguistically appropriate, accessible, and cost-effective human services and related
359.3policies;
359.4(7) provide training and outreach to facilitate access to culturally and linguistically
359.5appropriate, accessible, and cost-effective human services to prevent disparities;
359.6(8) facilitate culturally appropriate and culturally sensitive admissions, continued
359.7services, discharges, and utilization review for human services agencies and institutions;
359.8(9) form work groups to help carry out the duties of the council that include, but are
359.9not limited to, persons who provide and receive services and representatives of advocacy
359.10groups, and provide the work groups with clear guidelines, standardized parameters, and
359.11tasks for the work groups to accomplish; and
359.12(10) promote information-sharing in the human services community and statewide.
359.13    Subd. 5. Duties of council members. The members of the council shall:
359.14(1) attend and participate in scheduled meetings and be prepared by reviewing
359.15meeting notes;
359.16(2) maintain open communication channels with respective constituencies;
359.17(3) identify and communicate issues and risks that could impact the timely
359.18completion of tasks;
359.19(4) collaborate on disparity reduction efforts;
359.20(5) communicate updates of the council's work progress and status on the
359.21Department of Human Services Web site; and
359.22(6) participate in any activities the council or chair deem appropriate and necessary
359.23to facilitate the goals and duties of the council.
359.24    Subd. 6. Expiration. Notwithstanding section 15.059, the council does not expire
359.25unless directed by the commissioner.

359.26    Sec. 18. Minnesota Statutes 2012, section 256D.024, is amended by adding a
359.27subdivision to read:
359.28    Subd. 5. Person convicted of certain crimes of violence. An individual convicted
359.29of one of the following crimes is disqualified from receiving general assistance:
359.30(1) murder in the first degree, as defined in section 609.185, or as defined under the
359.31laws of the jurisdiction in which the crime was committed;
359.32(2) murder in the second degree as defined in section 609.19, or as defined under the
359.33laws of the jurisdiction in which the crime was committed; or
359.34(3) criminal sexual conduct in the first degree, as defined in section 609.342, or as
359.35defined under the laws of the jurisdiction in which the crime was committed.
360.1EFFECTIVE DATE.This section is effective July 1, 2013.

360.2    Sec. 19. Minnesota Statutes 2012, section 256I.04, subdivision 3, is amended to read:
360.3    Subd. 3. Moratorium on development of group residential housing beds. (a)
360.4County agencies shall not enter into agreements for new group residential housing beds
360.5with total rates in excess of the MSA equivalent rate except:
360.6(1) for group residential housing establishments licensed under Minnesota Rules,
360.7parts 9525.0215 to 9525.0355, provided the facility is needed to meet the census reduction
360.8targets for persons with developmental disabilities at regional treatment centers;
360.9(2) to ensure compliance with the federal Omnibus Budget Reconciliation Act
360.10alternative disposition plan requirements for inappropriately placed persons with
360.11developmental disabilities or mental illness;
360.12(3) up to 80 beds in a single, specialized facility located in Hennepin County that will
360.13provide housing for chronic inebriates who are repetitive users of detoxification centers
360.14and are refused placement in emergency shelters because of their state of intoxication,
360.15and planning for the specialized facility must have been initiated before July 1, 1991,
360.16in anticipation of receiving a grant from the Housing Finance Agency under section
360.17462A.05, subdivision 20a , paragraph (b);
360.18(4) notwithstanding the provisions of subdivision 2a, for up to 190 supportive
360.19housing units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a
360.20mental illness, a history of substance abuse, or human immunodeficiency virus or acquired
360.21immunodeficiency syndrome. For purposes of this section, "homeless adult" means a
360.22person who is living on the street or in a shelter or discharged from a regional treatment
360.23center, community hospital, or residential treatment program and has no appropriate
360.24housing available and lacks the resources and support necessary to access appropriate
360.25housing. At least 70 percent of the supportive housing units must serve homeless adults
360.26with mental illness, substance abuse problems, or human immunodeficiency virus or
360.27acquired immunodeficiency syndrome who are about to be or, within the previous six
360.28months, has been discharged from a regional treatment center, or a state-contracted
360.29psychiatric bed in a community hospital, or a residential mental health or chemical
360.30dependency treatment program. If a person meets the requirements of subdivision 1,
360.31paragraph (a), and receives a federal or state housing subsidy, the group residential housing
360.32rate for that person is limited to the supplementary rate under section 256I.05, subdivision
360.331a , and is determined by subtracting the amount of the person's countable income that
360.34exceeds the MSA equivalent rate from the group residential housing supplementary rate.
360.35A resident in a demonstration project site who no longer participates in the demonstration
361.1program shall retain eligibility for a group residential housing payment in an amount
361.2determined under section 256I.06, subdivision 8, using the MSA equivalent rate. Service
361.3funding under section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching
361.4funds are available and the services can be provided through a managed care entity. If
361.5federal matching funds are not available, then service funding will continue under section
361.6256I.05, subdivision 1a ;
361.7(5) for group residential housing beds in settings meeting the requirements of
361.8subdivision 2a, clauses (1) and (3), which are used exclusively for recipients receiving
361.9home and community-based waiver services under sections 256B.0915, 256B.092,
361.10subdivision 5 , 256B.093, and 256B.49, and who resided in a nursing facility for the six
361.11months immediately prior to the month of entry into the group residential housing setting.
361.12The group residential housing rate for these beds must be set so that the monthly group
361.13residential housing payment for an individual occupying the bed when combined with the
361.14nonfederal share of services delivered under the waiver for that person does not exceed the
361.15nonfederal share of the monthly medical assistance payment made for the person to the
361.16nursing facility in which the person resided prior to entry into the group residential housing
361.17establishment. The rate may not exceed the MSA equivalent rate plus $426.37 for any case;
361.18(6) for an additional two beds, resulting in a total of 32 beds, for a facility located in
361.19Hennepin County providing services for recovering and chemically dependent men that
361.20has had a group residential housing contract with the county and has been licensed as a
361.21board and lodge facility with special services since 1980;
361.22(7) for a group residential housing provider located in the city of St. Cloud, or a county
361.23contiguous to the city of St. Cloud, that operates a 40-bed facility, that received financing
361.24through the Minnesota Housing Finance Agency Ending Long-Term Homelessness
361.25Initiative and serves chemically dependent clientele, providing 24-hour-a-day supervision;
361.26(8) for a new 65-bed facility in Crow Wing County that will serve chemically
361.27dependent persons, operated by a group residential housing provider that currently
361.28operates a 304-bed facility in Minneapolis, and a 44-bed facility in Duluth;
361.29(9) for a group residential housing provider that operates two ten-bed facilities, one
361.30located in Hennepin County and one located in Ramsey County, that provide community
361.31support and 24-hour-a-day supervision to serve the mental health needs of individuals
361.32who have chronically lived unsheltered; and
361.33(10) for a group residential facility in Hennepin County with a capacity of up to 48
361.34beds that has been licensed since 1978 as a board and lodging facility and that until August
361.351, 2007, operated as a licensed chemical dependency treatment program.
362.1    (b) A county agency may enter into a group residential housing agreement for beds
362.2with rates in excess of the MSA equivalent rate in addition to those currently covered
362.3under a group residential housing agreement if the additional beds are only a replacement
362.4of beds with rates in excess of the MSA equivalent rate which have been made available
362.5due to closure of a setting, a change of licensure or certification which removes the beds
362.6from group residential housing payment, or as a result of the downsizing of a group
362.7residential housing setting. The transfer of available beds from one county to another can
362.8only occur by the agreement of both counties.
362.9(c) Effective July 1, 2013, 35 beds with rates in excess of the MSA-equivalent rate
362.10must be designated for youth victims of sex trafficking.

362.11    Sec. 20. Minnesota Statutes 2012, section 256I.05, subdivision 1e, is amended to read:
362.12    Subd. 1e. Supplementary rate for certain facilities. (a) Notwithstanding the
362.13provisions of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall
362.14negotiate a supplementary rate in addition to the rate specified in subdivision 1, not to
362.15exceed $700 per month, including any legislatively authorized inflationary adjustments,
362.16for a group residential housing provider that:
362.17(1) is located in Hennepin County and has had a group residential housing contract
362.18with the county since June 1996;
362.19(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a
362.2026-bed facility; and
362.21(3) serves a chemically dependent clientele, providing 24 hours per day supervision
362.22and limiting a resident's maximum length of stay to 13 months out of a consecutive
362.2324-month period.
362.24(b) Notwithstanding subdivisions 1a and 1c, a county agency shall negotiate a
362.25supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700
362.26per month, including any legislatively authorized inflationary adjustments, of a group
362.27residential provider that:
362.28(1) is located in St. Louis County and has had a group residential housing contract
362.29with the county since 2006;
362.30(2) operates a 62-bed facility; and
362.31(3) serves a chemically dependent adult male clientele, providing 24 hours per
362.32day supervision and limiting a resident's maximum length of stay to 13 months out of
362.33a consecutive 24-month period.
362.34(c) Notwithstanding subdivisions 1a and 1c, beginning July 1, 2013, a county agency
362.35shall negotiate a supplementary rate in addition to the rate specified in subdivision 1, not
363.1to exceed $700 per month, including any legislatively authorized inflationary adjustments,
363.2for the group residential provider described under paragraphs (a) and (b), not to exceed
363.3an additional 115 beds.

363.4    Sec. 21. Minnesota Statutes 2012, section 256J.15, is amended by adding a subdivision
363.5to read:
363.6    Subd. 3. Eligibility; drug testing. (a) To be eligible for MFIP, a person must
363.7undergo drug and alcohol screening, the extent practicable, following the established
363.8procedures and reliability safeguards provided for screening in sections 181.951, 181.953,
363.9and 181.954. A county agency may require a recipient of benefits to undergo random
363.10drug screening. An applicant must provide evidence of a negative test result to the
363.11appropriate county agency prior to being accepted for MFIP benefits and prior to receiving
363.12an extension of benefits under section 256J.425.
363.13(b) A laboratory must report to the appropriate county agency any positive test results
363.14returned on an applicant or recipient of MFIP benefits. Upon receipt of a positive test result,
363.15a county agency must deny or discontinue benefits until the person demonstrates a pattern
363.16of negative test results that satisfy the agency that the person is no longer a drug user.
363.17(c) A person who undergoes testing under this subdivision shall pay a fee to the
363.18laboratory for the cost of the test prior to testing.
363.19EFFECTIVE DATE.This section is effective July 1, 2013.

363.20    Sec. 22. Minnesota Statutes 2012, section 256J.26, subdivision 3, is amended to read:
363.21    Subd. 3. Fleeing felons. An individual who is fleeing to avoid prosecution, or
363.22custody, or confinement after conviction for a crime that is a felony under the laws of
363.23the jurisdiction from which the individual flees, or in the case of New Jersey, is a high
363.24misdemeanor, is disqualified from receiving MFIP. The county agency must cooperate
363.25with law enforcement agencies to determine if an applicant is a fleeing felon under this
363.26subdivision.

363.27    Sec. 23. Minnesota Statutes 2012, section 256J.26, is amended by adding a subdivision
363.28to read:
363.29    Subd. 6. Persons convicted of certain crimes of violence. An individual convicted
363.30of one of the following crimes is disqualified from receiving MFIP:
363.31(1) murder in the first degree, as defined in section 609.185, or as defined under the
363.32laws of the jurisdiction in which the crime was committed;
364.1(2) murder in the second degree as defined in section 609.19, or as defined under the
364.2laws of the jurisdiction in which the crime was committed; or
364.3(3) criminal sexual conduct in the first degree, as defined in section 609.342, or as
364.4defined under the laws of the jurisdiction in which the crime was committed.

364.5    Sec. 24. Minnesota Statutes 2012, section 256J.35, is amended to read:
364.6256J.35 AMOUNT OF ASSISTANCE PAYMENT.
364.7Except as provided in paragraphs (a) to (c) (d), the amount of an assistance payment
364.8is equal to the difference between the MFIP standard of need or the Minnesota family
364.9wage level in section 256J.24 and countable income.
364.10(a) When MFIP eligibility exists for the month of application, the amount of the
364.11assistance payment for the month of application must be prorated from the date of
364.12application or the date all other eligibility factors are met for that applicant, whichever is
364.13later. This provision applies when an applicant loses at least one day of MFIP eligibility.
364.14(b) MFIP overpayments to an assistance unit must be recouped according to section
364.15256J.38, subdivision 4 .
364.16(c) An initial assistance payment must not be made to an applicant who is not
364.17eligible on the date payment is made.
364.18(d) MFIP assistance units whose housing costs exceed 50 percent of their monthly
364.19cash grant are eligible for an additional cash amount in the form of a housing assistance
364.20grant. The housing assistance grant must be equal to 50 percent of the difference between
364.21the assistance unit's cash grant and its housing costs, with a maximum housing assistance
364.22grant of $250 per month. MFIP assistance units must report their housing costs to the lead
364.23agency on the forms and according to the timelines established by the commissioner.
364.24EFFECTIVE DATE.This section is effective December 1, 2013.

364.25    Sec. 25. Minnesota Statutes 2012, section 256K.45, is amended to read:
364.26256K.45 RUNAWAY AND HOMELESS YOUTH ACT.
364.27    Subdivision 1. Mission. The mission of the Homeless Youth Act is to reduce
364.28the incidence of homelessness among youth by providing integrated and supportive
364.29services and housing to homeless youth, youth at risk of homelessness, and runaways.
364.30The commissioner shall establish a Homeless Youth Act fund and award grants to
364.31providers who are committed to serving homeless youth, to provide street and community
364.32outreach and drop-in programs, emergency shelter programs, and supportive housing and
364.33transitional living programs, consistent with the program descriptions in this act.
365.1    Subd. 1a. Definitions. (a) The definitions in this subdivision apply to this section.
365.2(b) "Commissioner" means the commissioner of human services.
365.3(c) "Homeless youth" means a person 21 years of age or younger who is
365.4unaccompanied by a parent or guardian and is without shelter where appropriate care and
365.5supervision are available, whose parent or legal guardian is unable or unwilling to provide
365.6shelter and care, or who lacks a fixed, regular, and adequate nighttime residence. The
365.7following are not fixed, regular, or adequate nighttime residences:
365.8(1) a supervised publicly or privately operated shelter designed to provide temporary
365.9living accommodations;
365.10(2) an institution or a publicly or privately operated shelter designed to provide
365.11temporary living accommodations;
365.12(3) transitional housing;
365.13(4) a temporary placement with a peer, friend, or family member that has not offered
365.14permanent residence, a residential lease, or temporary lodging for more than 30 days; or
365.15(5) a public or private place not designed for, nor ordinarily used as, a regular
365.16sleeping accommodation for human beings.
365.17Homeless youth does not include persons incarcerated or otherwise detained under
365.18federal or state law.
365.19(d) "Youth at risk of homelessness" means a person 21 years of age or younger
365.20whose status or circumstances indicate a significant danger of experiencing homelessness
365.21in the near future. Status or circumstances that indicate a significant danger may include:
365.22(1) youth exiting out-of-home placements; (2) youth who previously were homeless; (3)
365.23youth whose parents or primary caregivers are or were previously homeless; (4) youth
365.24who are exposed to abuse and neglect in their homes; (5) youth who experience conflict
365.25with parents due to chemical or alcohol dependency, mental health disabilities, or other
365.26disabilities; and (6) runaways.
365.27(e) "Runaway" means an unmarried child under the age of 18 years who is absent
365.28from the home of a parent or guardian or other lawful placement without the consent of
365.29the parent, guardian, or lawful custodian.
365.30    Subd. 2. Homeless and runaway youth report. The commissioner shall develop a
365.31report for homeless youth, youth at risk of homelessness, and runaways. The report shall
365.32include coordination of services as defined under subdivisions 3 to 5.
365.33    Subd. 3. Street and community outreach and drop-in program. Youth drop-in
365.34centers must provide walk-in access to crisis intervention and ongoing supportive services
365.35including one-to-one case management services on a self-referral basis. Street and
365.36community outreach programs must locate, contact, and provide information, referrals,
366.1and services to homeless youth, youth at risk of homelessness, and runaways. Information,
366.2referrals, and services provided may include, but are not limited to:
366.3(1) family reunification services;
366.4(2) conflict resolution or mediation counseling;
366.5(3) assistance in obtaining temporary emergency shelter;
366.6(4) assistance in obtaining food, clothing, medical care, or mental health counseling;
366.7(5) counseling regarding violence, prostitution sexual exploitation, substance abuse,
366.8sexually transmitted diseases, and pregnancy;
366.9(6) referrals to other agencies that provide support services to homeless youth,
366.10youth at risk of homelessness, and runaways;
366.11(7) assistance with education, employment, and independent living skills;
366.12(8) aftercare services;
366.13(9) specialized services for highly vulnerable runaways and homeless youth,
366.14including teen parents, emotionally disturbed and mentally ill youth, and sexually
366.15exploited youth; and
366.16(10) homelessness prevention.
366.17    Subd. 4. Emergency shelter program. (a) Emergency shelter programs must
366.18provide homeless youth and runaways with referral and walk-in access to emergency,
366.19short-term residential care. The program shall provide homeless youth and runaways with
366.20safe, dignified shelter, including private shower facilities, beds, and at least one meal each
366.21day; and shall assist a runaway and homeless youth with reunification with the family or
366.22legal guardian when required or appropriate.
366.23(b) The services provided at emergency shelters may include, but are not limited to:
366.24(1) family reunification services;
366.25(2) individual, family, and group counseling;
366.26(3) assistance obtaining clothing;
366.27(4) access to medical and dental care and mental health counseling;
366.28(5) education and employment services;
366.29(6) recreational activities;
366.30(7) advocacy and referral services;
366.31(8) independent living skills training;
366.32(9) aftercare and follow-up services;
366.33(10) transportation; and
366.34(11) homelessness prevention.
366.35    Subd. 5. Supportive housing and transitional living programs. Transitional
366.36living programs must help homeless youth and youth at risk of homelessness to find and
367.1maintain safe, dignified housing. The program may also provide rental assistance and
367.2related supportive services, or refer youth to other organizations or agencies that provide
367.3such services. Services provided may include, but are not limited to:
367.4(1) educational assessment and referrals to educational programs;
367.5(2) career planning, employment, work skill training, and independent living skills
367.6training;
367.7(3) job placement;
367.8(4) budgeting and money management;
367.9(5) assistance in securing housing appropriate to needs and income;
367.10(6) counseling regarding violence, prostitution sexual exploitation, substance abuse,
367.11sexually transmitted diseases, and pregnancy;
367.12(7) referral for medical services or chemical dependency treatment;
367.13(8) parenting skills;
367.14(9) self-sufficiency support services or life skill training;
367.15(10) aftercare and follow-up services; and
367.16(11) homelessness prevention.
367.17    Subd. 6. Funding. Any Funds appropriated for this section may be expended on
367.18programs described under subdivisions 3 to 5, technical assistance, and capacity building.
367.19Up to four percent of funds appropriated may be used for the purpose of monitoring and
367.20evaluating runaway and homeless youth programs receiving funding under this section.
367.21Funding shall be directed to meet the greatest need, with a significant share of the funding
367.22focused on homeless youth providers in greater Minnesota to meet the greatest need on
367.23a statewide basis. Programs funded under this section must submit demographic and
367.24outcome information to the commissioner. The commissioner must submit a report
367.25regarding program demographic and outcome information to the legislature upon request.

367.26    Sec. 26. Minnesota Statutes 2012, section 257.0755, subdivision 1, is amended to read:
367.27    Subdivision 1. Creation. One Each ombudsperson shall operate independently from
367.28but in collaboration with each of the following groups the community-specific board that
367.29appointed the ombudsperson under section 257.0768: the Indian Affairs Council, the
367.30Council on Affairs of Chicano/Latino people, the Council on Black Minnesotans, and
367.31the Council on Asian-Pacific Minnesotans.

367.32    Sec. 27. Minnesota Statutes 2012, section 260B.007, subdivision 6, is amended to read:
367.33    Subd. 6. Delinquent child. (a) Except as otherwise provided in paragraphs (b)
367.34and (c), "delinquent child" means a child:
368.1    (1) who has violated any state or local law, except as provided in section 260B.225,
368.2subdivision 1 , and except for juvenile offenders as described in subdivisions 16 to 18;
368.3    (2) who has violated a federal law or a law of another state and whose case has been
368.4referred to the juvenile court if the violation would be an act of delinquency if committed
368.5in this state or a crime or offense if committed by an adult;
368.6    (3) who has escaped from confinement to a state juvenile correctional facility after
368.7being committed to the custody of the commissioner of corrections; or
368.8    (4) who has escaped from confinement to a local juvenile correctional facility after
368.9being committed to the facility by the court.
368.10    (b) The term delinquent child does not include a child alleged to have committed
368.11murder in the first degree after becoming 16 years of age, but the term delinquent child
368.12does include a child alleged to have committed attempted murder in the first degree.
368.13    (c) The term delinquent child does not include a child under the age of 16 years
368.14 alleged to have engaged in conduct which would, if committed by an adult, violate any
368.15federal, state, or local law relating to being hired, offering to be hired, or agreeing to be
368.16hired by another individual to engage in sexual penetration or sexual conduct.
368.17EFFECTIVE DATE.This section is effective August 1, 2014, and applies to
368.18offenses committed on or after that date.

368.19    Sec. 28. Minnesota Statutes 2012, section 260B.007, subdivision 16, is amended to read:
368.20    Subd. 16. Juvenile petty offender; juvenile petty offense. (a) "Juvenile petty
368.21offense" includes a juvenile alcohol offense, a juvenile controlled substance offense,
368.22a violation of section 609.685, or a violation of a local ordinance, which by its terms
368.23prohibits conduct by a child under the age of 18 years which would be lawful conduct if
368.24committed by an adult.
368.25    (b) Except as otherwise provided in paragraph (c), "juvenile petty offense" also
368.26includes an offense that would be a misdemeanor if committed by an adult.
368.27    (c) "Juvenile petty offense" does not include any of the following:
368.28    (1) a misdemeanor-level violation of section 518B.01, 588.20, 609.224, 609.2242,
368.29609.324 , subdivision 2 or 3, 609.5632, 609.576, 609.66, 609.746, 609.748, 609.79,
368.30or 617.23;
368.31    (2) a major traffic offense or an adult court traffic offense, as described in section
368.32260B.225 ;
368.33    (3) a misdemeanor-level offense committed by a child whom the juvenile court
368.34previously has found to have committed a misdemeanor, gross misdemeanor, or felony
368.35offense; or
369.1    (4) a misdemeanor-level offense committed by a child whom the juvenile court
369.2has found to have committed a misdemeanor-level juvenile petty offense on two or
369.3more prior occasions, unless the county attorney designates the child on the petition
369.4as a juvenile petty offender notwithstanding this prior record. As used in this clause,
369.5"misdemeanor-level juvenile petty offense" includes a misdemeanor-level offense that
369.6would have been a juvenile petty offense if it had been committed on or after July 1, 1995.
369.7    (d) A child who commits a juvenile petty offense is a "juvenile petty offender." The
369.8term juvenile petty offender does not include a child under the age of 16 years alleged
369.9to have violated any law relating to being hired, offering to be hired, or agreeing to be
369.10hired by another individual to engage in sexual penetration or sexual conduct which, if
369.11committed by an adult, would be a misdemeanor.
369.12EFFECTIVE DATE.This section is effective August 1, 2014, and applies to
369.13offenses committed on or after that date.

369.14    Sec. 29. Minnesota Statutes 2012, section 260C.007, subdivision 6, is amended to read:
369.15    Subd. 6. Child in need of protection or services. "Child in need of protection or
369.16services" means a child who is in need of protection or services because the child:
369.17    (1) is abandoned or without parent, guardian, or custodian;
369.18    (2)(i) has been a victim of physical or sexual abuse as defined in section 626.556,
369.19subdivision 2, (ii) resides with or has resided with a victim of child abuse as defined in
369.20subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or
369.21would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or
369.22child abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment
369.23as defined in subdivision 15;
369.24    (3) is without necessary food, clothing, shelter, education, or other required care
369.25for the child's physical or mental health or morals because the child's parent, guardian,
369.26or custodian is unable or unwilling to provide that care;
369.27    (4) is without the special care made necessary by a physical, mental, or emotional
369.28condition because the child's parent, guardian, or custodian is unable or unwilling to
369.29provide that care;
369.30    (5) is medically neglected, which includes, but is not limited to, the withholding of
369.31medically indicated treatment from a disabled infant with a life-threatening condition. The
369.32term "withholding of medically indicated treatment" means the failure to respond to the
369.33infant's life-threatening conditions by providing treatment, including appropriate nutrition,
369.34hydration, and medication which, in the treating physician's or physicians' reasonable
369.35medical judgment, will be most likely to be effective in ameliorating or correcting all
370.1conditions, except that the term does not include the failure to provide treatment other
370.2than appropriate nutrition, hydration, or medication to an infant when, in the treating
370.3physician's or physicians' reasonable medical judgment:
370.4    (i) the infant is chronically and irreversibly comatose;
370.5    (ii) the provision of the treatment would merely prolong dying, not be effective in
370.6ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be
370.7futile in terms of the survival of the infant; or
370.8    (iii) the provision of the treatment would be virtually futile in terms of the survival
370.9of the infant and the treatment itself under the circumstances would be inhumane;
370.10    (6) is one whose parent, guardian, or other custodian for good cause desires to be
370.11relieved of the child's care and custody, including a child who entered foster care under a
370.12voluntary placement agreement between the parent and the responsible social services
370.13agency under section 260C.227;
370.14    (7) has been placed for adoption or care in violation of law;
370.15    (8) is without proper parental care because of the emotional, mental, or physical
370.16disability, or state of immaturity of the child's parent, guardian, or other custodian;
370.17    (9) is one whose behavior, condition, or environment is such as to be injurious or
370.18dangerous to the child or others. An injurious or dangerous environment may include, but
370.19is not limited to, the exposure of a child to criminal activity in the child's home;
370.20    (10) is experiencing growth delays, which may be referred to as failure to thrive, that
370.21have been diagnosed by a physician and are due to parental neglect;
370.22    (11) has engaged in prostitution as defined in section 609.321, subdivision 9 is a
370.23sexually exploited youth;
370.24    (12) has committed a delinquent act or a juvenile petty offense before becoming
370.25ten years old;
370.26    (13) is a runaway;
370.27    (14) is a habitual truant;
370.28    (15) has been found incompetent to proceed or has been found not guilty by reason
370.29of mental illness or mental deficiency in connection with a delinquency proceeding, a
370.30certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a
370.31proceeding involving a juvenile petty offense; or
370.32    (16) has a parent whose parental rights to one or more other children were
370.33involuntarily terminated or whose custodial rights to another child have been involuntarily
370.34transferred to a relative and there is a case plan prepared by the responsible social services
370.35agency documenting a compelling reason why filing the termination of parental rights
370.36petition under section 260C.301, subdivision 3, is not in the best interests of the child; or.
371.1    (17) is a sexually exploited youth.
371.2EFFECTIVE DATE.This section is effective August 1, 2014.

371.3    Sec. 30. Minnesota Statutes 2012, section 260C.007, subdivision 31, is amended to read:
371.4    Subd. 31. Sexually exploited youth. "Sexually exploited youth" means an
371.5individual who:
371.6    (1) is alleged to have engaged in conduct which would, if committed by an adult,
371.7violate any federal, state, or local law relating to being hired, offering to be hired, or
371.8agreeing to be hired by another individual to engage in sexual penetration or sexual conduct;
371.9    (2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
371.10609.3451 , 609.3453, 609.352, 617.246, or 617.247;
371.11    (3) is a victim of a crime described in United States Code, title 18, section 2260;
371.122421; 2422; 2423; 2425; 2425A; or 2256; or
371.13    (4) is a sex trafficking victim as defined in section 609.321, subdivision 7b.
371.14EFFECTIVE DATE.This section is effective the day following final enactment.

371.15    Sec. 31. Laws 1998, chapter 407, article 6, section 116, is amended to read:
371.16    Sec. 116. EBT TRANSACTION COSTS; APPROVAL FROM LEGISLATURE.
371.17    The commissioner of human services shall request and receive approval from the
371.18legislature before adjusting the payment to not subsidize retailers for electronic benefit
371.19transfer transaction costs Supplemental Nutrition Assistance Program transactions.
371.20EFFECTIVE DATE.This section is effective 30 days after the commissioner
371.21notifies retailers of the termination of their agreement with the state. The commissioner of
371.22human services must notify the revisor of statutes of that date.

371.23    Sec. 32. Laws 2011, First Special Session chapter 9, article 1, section 3, the effective
371.24date, is amended to read:
371.25EFFECTIVE DATE.This section is effective January 1, 2013 July 1, 2014.
371.26EFFECTIVE DATE.This section is effective retroactively from January 1, 2013.

371.27    Sec. 33. INCLUSION OF OTHER HEALTH-RELATED OCCUPATIONS TO
371.28CRIMINAL BACKGROUND CHECKS.
371.29(a) If the Department of Health is not reviewed by the Sunset Advisory Commission
371.30according to the schedule in Minnesota Statutes, section 3D.21, the commissioner
372.1of health, as the regulator for occupational therapy practitioners, speech-language
372.2pathologists, audiologists, and hearing instrument dispensers, shall require applicants
372.3for licensure or renewal to submit to a criminal history records check as required under
372.4Minnesota Statutes, section 214.075, for other health-related licensed occupations
372.5regulated by the health-related licensing boards.
372.6(b) Any statutory changes necessary to include the commissioner of health to
372.7Minnesota Statutes, section 214.075, shall be included in the plan required in Minnesota
372.8Statutes, section 214.075, subdivision 8.

372.9    Sec. 34. DIRECTION TO COMMISSIONERS; INCOME AND ASSET
372.10EXCLUSION.
372.11(a) The commissioner of human services shall not count conditional cash transfers
372.12made to families participating in a family independence demonstration as income or
372.13assets for purposes of determining or redetermining eligibility for child care assistance
372.14programs under Minnesota Statutes, chapter 119B; general assistance under Minnesota
372.15Statutes, chapter 256D; group residential housing under Minnesota Statutes, chapter 256I;
372.16the Minnesota family investment program, work benefit program, or diversionary work
372.17program under Minnesota Statutes, chapter 256J; or the MinnesotaCare program under
372.18Minnesota Statutes, chapter 256L, during the duration of the demonstration.
372.19(b) The commissioner of human services shall not count conditional cash transfers
372.20made to families participating in a family independence demonstration as income or assets
372.21for purposes of determining or redetermining eligibility for medical assistance under
372.22Minnesota Statutes, chapter 256B, and MinnesotaCare under Minnesota Statutes, chapter
372.23256L, except that for enrollees subject to a modified adjusted gross income calculation to
372.24determine eligibility, the conditional cash transfer payments shall be counted as income if
372.25they are included on the enrollee's federal tax return as income, or if the payments can be
372.26taken into account in the month of receipt as a lump sum payment.
372.27(c) The commissioner of the Minnesota Housing Finance Agency shall not count
372.28conditional cash transfers made to families participating in a family independence
372.29demonstration as income or assets for purposes of determining or redetermining eligibility
372.30for housing assistance programs under Minnesota Statutes, section 462A.201, during
372.31the duration of the demonstration.
372.32    (d) For the purposes of this section:
372.33(1) "conditional cash transfer" means a payment made to a participant in a family
372.34independence demonstration by a sponsoring organization to incent, support, or facilitate
372.35participation; and
373.1(2) "family independence demonstration" means an initiative sponsored or
373.2cosponsored by a governmental or nongovernmental organization, the goal of which is
373.3to facilitate individualized goal-setting and peer support for cohorts of no more than 12
373.4families each toward the development of financial and nonfinancial assets that enable the
373.5participating families to achieve financial independence.

373.6    Sec. 35. MINNESOTA INSURANCE MARKETPLACE.
373.7No employee of the Minnesota Insurance Marketplace, including navigators, as
373.8defined in Minnesota Statutes, section 62V.02, subdivision 9, may request, solicit or
373.9offer information related to voter registration to persons seeking to purchase insurance
373.10through the exchange.

373.11    Sec. 36. REDUCTION OF YOUTH HOMELESSNESS.
373.12(a) The Minnesota Interagency Council on Homelessness established under the
373.13authority of Minnesota Statutes, section 462A.29, as it updates its statewide plan to
373.14prevent and end homelessness, shall make recommendations on strategies to reduce the
373.15number of youth experiencing homelessness and to prevent homelessness for youth who
373.16are at risk of becoming homeless.
373.17(b) Recommended strategies must take into consideration, to the extent feasible,
373.18issues that contribute to or reduce youth homelessness including, but not limited to, mental
373.19health, chemical dependency, trafficking of youth for sex or other purposes, exiting foster
373.20care, and involvement in gangs. The recommended strategies must include supportive
373.21services as outlined in Minnesota Statutes, section 256K.45, subdivision 5.
373.22(c) The council shall provide an update on the status of its work by December 1,
373.232014, to the legislative committees with jurisdiction over housing, homelessness, and
373.24matters pertaining to youth. If the council determines legislative action is required to
373.25implement recommended strategies, the council shall submit proposals to the legislature at
373.26the earliest possible opportunity.

373.27    Sec. 37. REPEALER.
373.28(a) Minnesota Statutes 2012, sections 256J.24, subdivision 6; and 256K.45,
373.29subdivision 2, are repealed.
373.30(b) Minnesota Statutes 2012, section 609.093, is repealed.
373.31EFFECTIVE DATE.Paragraph (b) is effective the day following final enactment.


374.3    Section 1. Minnesota Statutes 2012, section 144.051, is amended by adding a
374.4subdivision to read:
374.5    Subd. 3. Data classification; private data. For providers regulated pursuant to
374.6sections 144A.43 to 144A.482, the following data collected, created, or maintained by the
374.7commissioner are classified as "private data" as defined in section 13.02, subdivision 12:
374.8(1) data submitted by or on behalf of applicants for licenses prior to issuance of
374.9the license;
374.10(2) the identity of complainants who have made reports concerning licensees or
374.11applicants unless the complainant consents to the disclosure;
374.12(3) the identity of individuals who provide information as part of surveys and
374.13investigations;
374.14(4) Social Security numbers; and
374.15(5) health record data.

374.16    Sec. 2. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
374.17to read:
374.18    Subd. 4. Data classification; public data. For providers regulated pursuant to
374.19sections 144A.43 to 144A.482, the following data collected, created, or maintained by the
374.20commissioner are classified as "public data" as defined in section 13.02, subdivision 15:
374.21(1) all application data on licensees, license numbers, license status;
374.22(2) licensing information about licenses previously held under this chapter;
374.23(3) correction orders, including information about compliance with the order and
374.24whether the fine was paid;
374.25(4) final enforcement actions pursuant to chapter 14;
374.26(5) orders for hearing, findings of fact and conclusions of law; and
374.27(6) when the licensee and department agree to resolve the matter without a hearing,
374.28the agreement and specific reasons for the agreement are public data.

374.29    Sec. 3. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
374.30to read:
374.31    Subd. 5. Data classification; confidential data. For providers regulated pursuant to
374.32sections 144A.43 to 144A.482, the following data collected, created, or maintained by
374.33the Department of Health are classified as "confidential data" as defined in section 13.02,
375.1subdivision 3: active investigative data relating to the investigation of potential violations
375.2of law by licensee including data from the survey process before the correction order is
375.3issued by the department.

375.4    Sec. 4. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
375.5to read:
375.6    Subd. 6. Release of private or confidential data. For providers regulated pursuant
375.7to sections 144A.43 to 144A.482, the department may release private or confidential
375.8data, except Social Security numbers, to the appropriate state, federal, or local agency
375.9and law enforcement office to enhance investigative or enforcement efforts or further
375.10public health protective process. Types of offices include, but are not limited to, Adult
375.11Protective Services, Office of the Ombudsmen for Long-Term Care and Office of the
375.12Ombudsmen for Mental Health and Developmental Disabilities, the health licensing
375.13boards, Department of Human Services, county or city attorney's offices, police, and local
375.14or county public health offices.

375.15    Sec. 5. Minnesota Statutes 2012, section 144A.43, is amended to read:
375.16144A.43 DEFINITIONS.
375.17    Subdivision 1. Applicability. The definitions in this section apply to sections
375.18144.699, subdivision 2 , and 144A.43 to 144A.47 144A.482.
375.19    Subd. 1a. Agent. "Agent" means the person upon whom all notices and orders shall
375.20be served and who is authorized to accept service of notices and orders on behalf of
375.21the home care provider.
375.22    Subd. 1b. Applicant. "Applicant" means an individual, organization, association,
375.23corporation, unit of government, or other entity that applies for a temporary license,
375.24license, or renewal of their home care provider license under section 144A.472.
375.25    Subd. 1c. Client. "Client" means a person to whom home care services are provided.
375.26    Subd. 1d. Client record. "Client record" means all records that document
375.27information about the home care services provided to the client by the home care provider.
375.28    Subd. 1e. Client representative. "Client representative" means a person who,
375.29because of the client's needs, makes decisions about the client's care on behalf of the
375.30client. A client representative may be a guardian, health care agent, family member, or
375.31other agent of the client. Nothing in this section expands or diminishes the rights of
375.32persons to act on behalf of clients under other law.
375.33    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.
376.1    Subd. 2a. Controlled substance. "Controlled substance" has the meaning given
376.2in section 152.01, subdivision 4.
376.3    Subd. 2b. Department. "Department" means the Minnesota Department of Health.
376.4    Subd. 2c. Dietary supplement. "Dietary supplement" means a product taken by
376.5mouth that contains a "dietary ingredient" intended to supplement the diet. Dietary
376.6ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and
376.7substances such as enzymes, organ tissue, glandulars, or metabolites.
376.8    Subd. 2d. Dietitian. "Dietitian" is a person licensed under sections 148.621 to
376.9148.633.
376.10    Subd. 2e. Dietetics or nutrition practice. "Dietetics or nutrition practice" is
376.11performed by a licensed dietician or licensed nutritionist and includes the activities of
376.12assessment, setting priorities and objectives, providing nutrition counseling, developing
376.13and implementing nutrition care services, and evaluating and maintaining appropriate
376.14standards of quality of nutrition care under sections 148.621 to 148.633.
376.15    Subd. 3. Home care service. "Home care service" means any of the following
376.16services when delivered in a place of residence to the home of a person whose illness,
376.17disability, or physical condition creates a need for the service:
376.18(1) nursing services, including the services of a home health aide;
376.19(2) personal care services not included under sections 148.171 to 148.285;
376.20(3) physical therapy;
376.21(4) speech therapy;
376.22(5) respiratory therapy;
376.23(6) occupational therapy;
376.24(7) nutritional services;
376.25(8) home management services when provided to a person who is unable to perform
376.26these activities due to illness, disability, or physical condition. Home management
376.27services include at least two of the following services: housekeeping, meal preparation,
376.28and shopping;
376.29(9) medical social services;
376.30(10) the provision of medical supplies and equipment when accompanied by the
376.31provision of a home care service; and
376.32(11) other similar medical services and health-related support services identified by
376.33the commissioner in rule.
376.34"Home care service" does not include the following activities conducted by the
376.35commissioner of health or a board of health as defined in section 145A.02, subdivision 2:
376.36communicable disease investigations or testing; administering or monitoring a prescribed
377.1therapy necessary to control or prevent a communicable disease; or the monitoring
377.2of an individual's compliance with a health directive as defined in section 144.4172,
377.3subdivision 6 .
377.4(1) assistive tasks provided by unlicensed personnel;
377.5(2) services provided by a registered nurse or licensed practical nurse, physical
377.6therapist, respiratory therapist, occupational therapist, speech-language pathologist,
377.7dietitian or nutritionist, or social worker;
377.8(3) medication and treatment management services; or
377.9(4) the provision of durable medical equipment services when provided with any of
377.10the home care services listed in clauses (1) to (3).
377.11    Subd. 3a. Hands-on-assistance. "Hands-on-assistance" means physical help by
377.12another person without which the client is not able to perform the activity.
377.13    Subd. 3b. Home. "Home" means the client's temporary or permanent place of
377.14residence.
377.15    Subd. 4. Home care provider. "Home care provider" means an individual,
377.16organization, association, corporation, unit of government, or other entity that is regularly
377.17engaged in the delivery of at least one home care service, directly or by contractual
377.18arrangement, of home care services in a client's home for a fee and who has a valid current
377.19temporary license or license issued under sections 144A.43 to 144A.482. At least one
377.20home care service must be provided directly, although additional home care services may
377.21be provided by contractual arrangements. "Home care provider" does not include:
377.22(1) any home care or nursing services conducted by and for the adherents of any
377.23recognized church or religious denomination for the purpose of providing care and
377.24services for those who depend upon spiritual means, through prayer alone, for healing;
377.25(2) an individual who only provides services to a relative;
377.26(3) an individual not connected with a home care provider who provides assistance
377.27with home management services or personal care needs if the assistance is provided
377.28primarily as a contribution and not as a business;
377.29(4) an individual not connected with a home care provider who shares housing with
377.30and provides primarily housekeeping or homemaking services to an elderly or disabled
377.31person in return for free or reduced-cost housing;
377.32(5) an individual or agency providing home-delivered meal services;
377.33(6) an agency providing senior companion services and other older American
377.34volunteer programs established under the Domestic Volunteer Service Act of 1973,
377.35Public Law 98-288;
378.1(7) an employee of a nursing home licensed under this chapter or an employee of a
378.2boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
378.3emergency calls from individuals residing in a residential setting that is attached to or
378.4located on property contiguous to the nursing home or boarding care home;
378.5(8) a member of a professional corporation organized under chapter 319B that does
378.6not regularly offer or provide home care services as defined in subdivision 3;
378.7(9) the following organizations established to provide medical or surgical services
378.8that do not regularly offer or provide home care services as defined in subdivision 3:
378.9a business trust organized under sections 318.01 to 318.04, a nonprofit corporation
378.10organized under chapter 317A, a partnership organized under chapter 323, or any other
378.11entity determined by the commissioner;
378.12(10) an individual or agency that provides medical supplies or durable medical
378.13equipment, except when the provision of supplies or equipment is accompanied by a
378.14home care service;
378.15(11) an individual licensed under chapter 147; or
378.16(12) an individual who provides home care services to a person with a developmental
378.17disability who lives in a place of residence with a family, foster family, or primary caregiver.
378.18    Subd. 5. Medication reminder. "Medication reminder" means providing a verbal
378.19or visual reminder to a client to take medication. This includes bringing the medication
378.20to the client and providing liquids or nutrition to accompany medication that a client is
378.21self-administering.
378.22    Subd. 6. License. "License" means a basic or comprehensive home care license
378.23issued by the commissioner to a home care provider.
378.24    Subd. 7. Licensed health professional. "Licensed health professional" means a
378.25person, other than a registered nurse or licensed practical nurse, who provides home care
378.26services within the scope of practice of the person's health occupation license, registration,
378.27or certification as regulated and who is licensed by the appropriate Minnesota state board
378.28or agency.
378.29    Subd. 8. Licensee. "Licensee" means a home care provider that is licensed under
378.30this chapter.
378.31    Subd. 9. Managerial official. "Managerial official" means an administrator,
378.32director, officer, trustee, or employee of a home care provider, however designated, who
378.33has the authority to establish or control business policy.
378.34    Subd. 10. Medication. "Medication" means a prescription or over-the-counter drug.
378.35For purposes of this chapter only, medication includes dietary supplements.
379.1    Subd. 11. Medication administration. "Medication administration" means
379.2performing a set of tasks to ensure a client takes medications, and includes the following:
379.3(1) checking the client's medication record;
379.4(2) preparing the medication as necessary;
379.5(3) administering the medication to the client;
379.6(4) documenting the administration or reason for not administering the medication;
379.7and
379.8(5) reporting to a nurse any concerns about the medication, the client, or the client's
379.9refusal to take the medication.
379.10    Subd. 12. Medication management. "Medication management" means the
379.11provision of any of the following medication-related services to a client:
379.12(1) performing medication setup;
379.13(2) administering medication;
379.14(3) storing and securing medications;
379.15(4) documenting medication activities;
379.16(5) verifying and monitoring effectiveness of systems to ensure safe handling and
379.17administration;
379.18(6) coordinating refills;
379.19(7) handling and implementing changes to prescriptions;
379.20(8) communicating with the pharmacy about the client's medications; and
379.21(9) coordinating and communicating with the prescriber.
379.22    Subd. 13. Medication setup. "Medication setup" means arranging medications by a
379.23nurse, pharmacy, or authorized prescriber for later administration by the client or by
379.24comprehensive home care staff.
379.25    Subd. 14. Nurse. "Nurse" means a person who is licensed under sections 148.171 to
379.26148.285.
379.27    Subd. 15. Occupational therapist. "Occupational therapist" means a person who is
379.28licensed under sections 148.6401 to 148.6450.
379.29    Subd. 16. Over-the-counter drug. "Over-the-counter drug" means a drug that is
379.30not required by federal law to bear the symbol "Rx only."
379.31    Subd. 17. Owner. "Owner" means a proprietor, general partner, limited partner who
379.32has five percent or more of equity interest in a limited partnership, a person who owns or
379.33controls voting stock in a corporation in an amount equal to or greater than five percent of
379.34the shares issued and outstanding, or a corporation that owns equity interest in a licensee
379.35or applicant for a license.
380.1    Subd. 18. Pharmacist. "Pharmacist" has the meaning given in section 151.01,
380.2subdivision 3.
380.3    Subd. 19. Physical therapist. "Physical therapist" means a person who is licensed
380.4under sections 148.65 to 148.78.
380.5    Subd. 20. Physician. "Physician" means a person who is licensed under chapter 147.
380.6    Subd. 21. Prescriber. "Prescriber" means a person who is authorized by sections
380.7148.235; 151.01, subdivision 23; and 151.37, to prescribe prescription drugs.
380.8    Subd. 22. Prescription. "Prescription" has the meaning given in section 151.01,
380.9subdivision 16.
380.10    Subd. 23. Regularly scheduled. "Regularly scheduled" means ordered or planned
380.11to be completed at predetermined times or according to a predetermined routine.
380.12    Subd. 24. Reminder. "Reminder" means providing a verbal or visual reminder
380.13to a client.
380.14    Subd. 25. Respiratory therapist. "Respiratory therapist" means a person who
380.15is licensed under chapter 147C.
380.16    Subd. 26. Revenues. "Revenues" means all money received by a licensee derived
380.17from the provision of home care services, including fees for services and appropriations
380.18of public money for home care services.
380.19    Subd. 27. Service plan. "Service plan" means the written plan between the client or
380.20client's representative and the temporary licensee or licensee about the services that will
380.21be provided to the client.
380.22    Subd. 28. Social worker. "Social worker" means a person who is licensed under
380.23chapter 148D or 148E.
380.24    Subd. 29. Speech language pathologist. "Speech language pathologist" has the
380.25meaning given in section 148.512.
380.26    Subd. 30. Standby assistance. "Standby assistance" means the presence of another
380.27person within arm's reach to minimize the risk of injury while performing daily activities
380.28through physical intervention or cuing.
380.29    Subd. 31. Substantial compliance. "Substantial compliance" means complying
380.30with the requirements in this chapter sufficiently to prevent unacceptable health or safety
380.31risks to the home care client.
380.32    Subd. 32. Survey. "Survey" means an inspection of a licensee or applicant for
380.33licensure for compliance with this chapter.
380.34    Subd. 33. Surveyor. "Surveyor" means a staff person of the department authorized
380.35to conduct surveys of home care providers and applicants.
381.1    Subd. 34. Temporary license. "Temporary license" means the initial basic or
381.2comprehensive home care license the department issues after approval of a complete
381.3written application and before the department completes the temporary license survey and
381.4determines that the temporary licensee is in substantial compliance.
381.5    Subd. 35. Treatment or therapy. "Treatment" or "therapy" means the provision
381.6of care, other than medications, ordered or prescribed by a licensed health professional
381.7provided to a client to cure, rehabilitate, or ease symptoms.
381.8    Subd. 36. Unit of government. "Unit of government" means every city, county,
381.9town, school district, other political subdivisions of the state, and any agency of the state
381.10or federal government, which includes any instrumentality of a unit of government.
381.11    Subd. 37. Unlicensed personnel. "Unlicensed personnel" are individuals not
381.12otherwise licensed or certified by a governmental health board or agency who provide
381.13home care services in the client's home.
381.14    Subd. 38. Verbal. "Verbal" means oral and not in writing.

381.15    Sec. 6. Minnesota Statutes 2012, section 144A.44, is amended to read:
381.16144A.44 HOME CARE BILL OF RIGHTS.
381.17    Subdivision 1. Statement of rights. A person who receives home care services
381.18has these rights:
381.19(1) the right to receive written information about rights in advance of before
381.20receiving care or during the initial evaluation visit before the initiation of treatment
381.21 services, including what to do if rights are violated;
381.22(2) the right to receive care and services according to a suitable and up-to-date plan,
381.23and subject to accepted health care, medical or nursing standards, to take an active part
381.24in creating and changing the plan developing, modifying, and evaluating care the plan
381.25 and services;
381.26(3) the right to be told in advance of before receiving care about the services that will
381.27be provided, the disciplines that will furnish care the type and disciplines of staff who will
381.28be providing the services, the frequency of visits proposed to be furnished, other choices
381.29that are available for addressing home care needs, and the consequences of these choices
381.30including the potential consequences of refusing these services;
381.31(4) the right to be told in advance of any change recommended changes by the
381.32provider in the service plan of care and to take an active part in any change decisions
381.33about changes to the service plan;
381.34(5) the right to refuse services or treatment;
382.1(6) the right to know, in advance before receiving services or during the initial
382.2visit, any limits to the services available from a home care provider, and the provider's
382.3grounds for a termination of services;
382.4(7) the right to know in advance of receiving care whether the services are covered
382.5by health insurance, medical assistance, or other health programs, the charges for services
382.6that will not be covered by Medicare, and the charges that the individual may have to pay;
382.7(8) (7) the right to know be told before services are initiated what the provider
382.8charges are for the services, no matter who will be paying the bill and if known to what
382.9extent payment may be expected from health insurance, public programs or other sources,
382.10and what charges the client may be responsible for paying;
382.11(9) (8) the right to know that there may be other services available in the community,
382.12including other home care services and providers, and to know where to go for find
382.13 information about these services;
382.14(10) (9) the right to choose freely among available providers and to change providers
382.15after services have begun, within the limits of health insurance, long-term care insurance,
382.16medical assistance, or other health programs;
382.17(11) (10) the right to have personal, financial, and medical information kept private,
382.18and to be advised of the provider's policies and procedures regarding disclosure of such
382.19information;
382.20(12) (11) the right to be allowed access to the client's own records and written
382.21information from those records in accordance with sections 144.291 to 144.298;
382.22(13) (12) the right to be served by people who are properly trained and competent
382.23to perform their duties;
382.24(14) (13) the right to be treated with courtesy and respect, and to have the patient's
382.25 client's property treated with respect;
382.26(15) (14) the right to be free from physical and verbal abuse, neglect, financial
382.27exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and
382.28the Maltreatment of Minors Act;
382.29(16) (15) the right to reasonable, advance notice of changes in services or charges,
382.30including;
382.31(16) the right to know the provider's reason for termination of services;
382.32(17) the right to at least ten days' advance notice of the termination of a service by a
382.33provider, except in cases where:
382.34(i) the recipient of services client engages in conduct that significantly alters the
382.35conditions of employment as specified in the employment contract between terms of
383.1the service plan with the home care provider and the individual providing home care
383.2services, or creates;
383.3(ii) the client, person who lives with the client, or others create an abusive or unsafe
383.4work environment for the individual person providing home care services; or
383.5(ii) (iii) an emergency for the informal caregiver or a significant change in the
383.6recipient's client's condition has resulted in service needs that exceed the current service
383.7provider agreement plan and that cannot be safely met by the home care provider;
383.8(17) (18) the right to a coordinated transfer when there will be a change in the
383.9provider of services;
383.10(18) (19) the right to voice grievances regarding treatment or care that is complain
383.11about services that are provided, or fails to be, furnished, or regarding fail to be provided,
383.12and the lack of courtesy or respect to the patient client or the patient's client's property;
383.13(19) (20) the right to know how to contact an individual associated with the home
383.14care provider who is responsible for handling problems and to have the home care provider
383.15investigate and attempt to resolve the grievance or complaint;
383.16(20) (21) the right to know the name and address of the state or county agency to
383.17contact for additional information or assistance; and
383.18(21) (22) the right to assert these rights personally, or have them asserted by
383.19the patient's family or guardian when the patient has been judged incompetent, client's
383.20representative or by anyone on behalf of the client, without retaliation.
383.21    Subd. 2. Interpretation and enforcement of rights. These rights are established
383.22for the benefit of persons clients who receive home care services. "Home care services"
383.23means home care services as defined in section 144A.43, subdivision 3, and unlicensed
383.24personal care assistance services, including services covered by medical assistance under
383.25section 256B.0625, subdivision 19a. All home care providers, including those exempted
383.26under section 144A.471, must comply with this section. The commissioner shall enforce
383.27this section and the home care bill of rights requirement against home care providers
383.28exempt from licensure in the same manner as for licensees. A home care provider may
383.29not request or require a person client to surrender any of these rights as a condition of
383.30receiving services. A guardian or conservator or, when there is no guardian or conservator,
383.31a designated person, may seek to enforce these rights. This statement of rights does not
383.32replace or diminish other rights and liberties that may exist relative to persons clients
383.33 receiving home care services, persons providing home care services, or providers licensed
383.34under Laws 1987, chapter 378. A copy of these rights must be provided to an individual
383.35at the time home care services, including personal care assistance services, are initiated.
383.36The copy shall also contain the address and phone number of the Office of Health Facility
384.1Complaints and the Office of Ombudsman for Long-Term Care and a brief statement
384.2describing how to file a complaint with these offices. Information about how to contact
384.3the Office of Ombudsman for Long-Term Care shall be included in notices of change in
384.4client fees and in notices where home care providers initiate transfer or discontinuation of
384.5services sections 144A.43 to 144A.482.

384.6    Sec. 7. Minnesota Statutes 2012, section 144A.45, is amended to read:
384.7144A.45 REGULATION OF HOME CARE SERVICES.
384.8    Subdivision 1. Rules Regulations. The commissioner shall adopt rules for the
384.9regulation of regulate home care providers pursuant to sections 144A.43 to 144A.47
384.10 144A.482. The rules regulations shall include the following:
384.11    (1) provisions to assure, to the extent possible, the health, safety and well-being,
384.12and appropriate treatment of persons who receive home care services while respecting
384.13clients' autonomy and choice;
384.14    (2) requirements that home care providers furnish the commissioner with specified
384.15information necessary to implement sections 144A.43 to 144A.47 144A.482;
384.16    (3) standards of training of home care provider personnel, which may vary according
384.17to the nature of the services provided or the health status of the consumer;
384.18(4) standards for provision of home care services;
384.19    (4) (5) standards for medication management which may vary according to the
384.20nature of the services provided, the setting in which the services are provided, or the
384.21status of the consumer. Medication management includes the central storage, handling,
384.22distribution, and administration of medications;
384.23    (5) (6) standards for supervision of home care services requiring supervision by a
384.24registered nurse or other appropriate health care professional which must occur on site
384.25at least every 62 days, or more frequently if indicated by a clinical assessment, and in
384.26accordance with sections 148.171 to 148.285 and rules adopted thereunder, except that a
384.27person performing home care aide tasks for a class B licensee providing paraprofessional
384.28services does not require nursing supervision;
384.29    (6) (7) standards for client evaluation or assessment which may vary according to
384.30the nature of the services provided or the status of the consumer;
384.31    (7) (8) requirements for the involvement of a consumer's physician client's health
384.32care provider, the documentation of physicians' health care providers' orders, if required,
384.33and the consumer's treatment client's service plan, and;
384.34(9) the maintenance of accurate, current clinical client records;
385.1    (8) (10) the establishment of different classes basic and comprehensive levels of
385.2licenses for different types of providers and different standards and requirements for
385.3different kinds of home care based on services provided; and
385.4    (9) operating procedures required to implement (11) provisions to enforce these
385.5regulations and the home care bill of rights.
385.6    Subd. 1a. Home care aide tasks. Notwithstanding the provisions of Minnesota
385.7Rules, part 4668.0110, subpart 1, item E, home care aide tasks also include assisting
385.8toileting, transfers, and ambulation if the client is ambulatory and if the client has no
385.9serious acute illness or infectious disease.
385.10    Subd. 1b. Home health aide qualifications. Notwithstanding the provisions of
385.11Minnesota Rules, part 4668.0100, subpart 5, a person may perform home health aide tasks
385.12if the person maintains current registration as a nursing assistant on the Minnesota nursing
385.13assistant registry. Maintaining current registration on the Minnesota nursing assistant
385.14registry satisfies the documentation requirements of Minnesota Rules, part 4668.0110,
385.15subpart 3.
385.16    Subd. 2. Regulatory functions. (a) The commissioner shall:
385.17(1) evaluate, monitor, and license, survey, and monitor without advance notice, home
385.18care providers in accordance with sections 144A.45 to 144A.47 144A.43 to 144A.482;
385.19(2) inspect the office and records of a provider during regular business hours without
385.20advance notice to the home care provider;
385.21(2) survey every temporary licensee within one year of the temporary license issuance
385.22date subject to the temporary licensee providing home care services to a client or clients;
385.23(3) survey all licensed home care providers on an interval that will promote the
385.24health and safety of clients;
385.25(3) (4) with the consent of the consumer client, visit the home where services are
385.26being provided;
385.27(4) (5) issue correction orders and assess civil penalties in accordance with section
385.28144.653, subdivisions 5 to 8 , for violations of sections 144A.43 to 144A.47 or the rules
385.29adopted under those sections 144A.482;
385.30(5) (6) take action as authorized in section 144A.46, subdivision 3 144A.475; and
385.31(6) (7) take other action reasonably required to accomplish the purposes of sections
385.32144A.43 to 144A.47 144A.482.
385.33(b) In the exercise of the authority granted in sections 144A.43 to 144A.47, the
385.34commissioner shall comply with the applicable requirements of section 144.122, the
385.35Government Data Practices Act, and the Administrative Procedure Act.
386.1    Subd. 4. Medicaid reimbursement. Notwithstanding the provisions of section
386.2256B.37 or state plan requirements to the contrary, certification by the federal Medicare
386.3program must not be a requirement of Medicaid payment for services delivered under
386.4section 144A.4605.
386.5    Subd. 5. Home care providers; services for Alzheimer's disease or related
386.6disorder. (a) If a home care provider licensed under section 144A.46 or 144A.4605 markets
386.7or otherwise promotes services for persons with Alzheimer's disease or related disorders,
386.8the facility's direct care staff and their supervisors must be trained in dementia care.
386.9(b) Areas of required training include:
386.10(1) an explanation of Alzheimer's disease and related disorders;
386.11(2) assistance with activities of daily living;
386.12(3) problem solving with challenging behaviors; and
386.13(4) communication skills.
386.14(c) The licensee shall provide to consumers in written or electronic form a
386.15description of the training program, the categories of employees trained, the frequency
386.16of training, and the basic topics covered.

386.17    Sec. 8. [144A.471] HOME CARE PROVIDER AND HOME CARE SERVICES.
386.18    Subdivision 1. License required. A home care provider may not open, operate,
386.19manage, conduct, maintain, or advertise itself as a home care provider or provide home
386.20care services in Minnesota without a temporary or current home care provider license
386.21issued by the commissioner of health.
386.22    Subd. 2. Determination of direct home care service. "Direct home care service"
386.23means a home care service provided to a client by the home care provider or its employees,
386.24and not by contract. Factors that must be considered in determining whether an individual
386.25or a business entity provides at least one home care service directly include, but are not
386.26limited to, whether the individual or business entity:
386.27    (1) has the right to control, and does control, the types of services provided;
386.28(2) has the right to control, and does control, when and how the services are provided;
386.29    (3) establishes the charges;
386.30(4) collects fees from the clients or receives payment from third-party payers on
386.31the clients' behalf;
386.32(5) pays individuals providing services compensation on an hourly, weekly, or
386.33similar basis;
386.34(6) treats the individuals providing services as employees for the purposes of payroll
386.35taxes and workers' compensation insurance; and
387.1(7) holds itself out as a provider of home care services or acts in a manner that
387.2leads clients or potential clients to believe that it is a home care provider providing home
387.3care services.
387.4    None of the factors listed in this subdivision is solely determinative.
387.5    Subd. 3. Determination of regularly engaged. "Regularly engaged" means
387.6providing, or offering to provide, home care services as a regular part of a business. The
387.7following factors must be considered by the commissioner in determining whether an
387.8individual or a business entity is regularly engaged in providing home care services:
387.9    (1) whether the individual or business entity states or otherwise promotes that the
387.10individual or business entity provides home care services;
387.11    (2) whether persons receiving home care services constitute a substantial part of the
387.12individual's or the business entity's clientele; and
387.13(3) whether the home care services provided are other than occasional or incidental
387.14to the provision of services other than home care services.
387.15    None of the factors listed in this subdivision is solely determinative.
387.16    Subd. 4. Penalties for operating without license. A person involved in the
387.17management, operation, or control of a home care provider that operates without an
387.18appropriate license is guilty of a misdemeanor. This section does not apply to a person
387.19who has no legal authority to affect or change decisions related to the management,
387.20operation, or control of a home care provider.
387.21    Subd. 5. Basic and comprehensive levels of licensure. An applicant seeking
387.22to become a home care provider must apply for either a basic or comprehensive home
387.23care license.
387.24    Subd. 6. Basic home care license provider. Home care services that can be
387.25provided with a basic home care license are assistive tasks provided by licensed or
387.26unlicensed personnel that include:
387.27(1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting,
387.28and bathing;
387.29(2) providing standby assistance;
387.30(3) providing verbal or visual reminders to the client to take regularly scheduled
387.31medication which includes bringing the client previously set-up medication, medication in
387.32original containers, or liquid or food to accompany the medication;
387.33(4) providing verbal or visual reminders to the client to perform regularly scheduled
387.34treatments and exercises;
387.35(5) preparing modified diets ordered by a licensed health professional; and
388.1(6) assisting with laundry, housekeeping, meal preparation, shopping, or other
388.2household chores and services if the provider is also providing at least one of the activities
388.3in clauses (1) to (5)
388.4    Subd. 7. Comprehensive home care license provider. Home care services that
388.5may be provided with a comprehensive home care license include any of the basic home
388.6care services listed in subdivision 6, and one or more of the following:
388.7(1) services of an advanced practice nurse, registered nurse, licensed practical
388.8nurse, physical therapist, respiratory therapist, occupational therapist, speech-language
388.9pathologist, dietician or nutritionist, or social worker;
388.10(2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a
388.11licensed health professional within the person's scope of practice;
388.12(3) medication management services;
388.13(4) hands-on assistance with transfers and mobility;
388.14(5) assisting clients with eating when the clients have complicating eating problems
388.15as identified in the client record or through an assessment such as difficulty swallowing,
388.16recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous
388.17instruments to be fed; or
388.18(6) providing other complex or specialty health care services.
388.19    Subd. 8. Exemptions from home care services licensure. (a) Except as otherwise
388.20provided in this chapter, home care services that are provided by the state, counties, or
388.21other units of government must be licensed under this chapter.
388.22(b) An exemption under this subdivision does not excuse the exempted individual or
388.23organization from complying with applicable provisions of the home care bill of rights
388.24in section 144A.44. The following individuals or organizations are exempt from the
388.25requirement to obtain a home care provider license:
388.26(1) an individual or organization that offers, provides, or arranges for personal care
388.27assistance services under the medical assistance program as authorized under sections
388.28256B.04, subdivision 16; 256B.0625, subdivision 19a; and 256B.0659;
388.29(2) a provider that is licensed by the commissioner of human services to provide
388.30semi-independent living services for persons with developmental disabilities under section
388.31252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020;
388.32(3) a provider that is licensed by the commissioner of human services to provide
388.33home and community-based services for persons with developmental disabilities under
388.34section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930;
388.35(4) an individual or organization that provides only home management services, if
388.36the individual or organization is registered under section 144A.482; or
389.1(5) an individual who is licensed in this state as a nurse, dietitian, social worker,
389.2occupational therapist, physical therapist, or speech-language pathologist who provides
389.3health care services in the home independently and not through any contractual or
389.4employment relationship with a home care provider or other organization.
389.5    Subd. 9. Exclusions from home care licensure. The following are excluded from
389.6home care licensure and are not required to provide the home care bill of rights:
389.7(1) an individual or business entity providing only coordination of home care that
389.8includes one or more of the following:
389.9(i) determination of whether a client needs home care services, or assisting a client
389.10in determining what services are needed;
389.11(ii) referral of clients to a home care provider;
389.12(iii) administration of payments for home care services; or
389.13(iv) administration of a health care home established under section 256B.0751;
389.14(2) an individual who is not an employee of a licensed home care provider if the
389.15individual:
389.16(i) only provides services as an independent contractor to one or more licensed
389.17home care providers;
389.18(ii) provides no services under direct agreements or contracts with clients; and
389.19(iii) is contractually bound to perform services in compliance with the contracting
389.20home care provider's policies and service plans;
389.21(3) a business that provides staff to home care providers, such as a temporary
389.22employment agency, if the business:
389.23(i) only provides staff under contract to licensed or exempt providers;
389.24(ii) provides no services under direct agreements with clients; and
389.25(iii) is contractually bound to perform services under the contracting home care
389.26provider's direction and supervision;
389.27(4) any home care services conducted by and for the adherents of any recognized
389.28church or religious denomination for its members through spiritual means, or by prayer
389.29for healing;
389.30(5) an individual who only provides home care services to a relative;
389.31(6) an individual not connected with a home care provider that provides assistance
389.32with basic home care needs if the assistance is provided primarily as a contribution and
389.33not as a business;
389.34(7) an individual not connected with a home care provider that shares housing with
389.35and provides primarily housekeeping or homemaking services to an elderly or disabled
389.36person in return for free or reduced-cost housing;
390.1(8) an individual or provider providing home-delivered meal services;
390.2(9) an individual providing senior companion services and other Older American
390.3Volunteer Programs (OAVP) established under the Domestic Volunteer Service Act of
390.41973, United States Code, title 42, chapter 66;
390.5(10) an employee of a nursing home licensed under this chapter or an employee of a
390.6boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
390.7emergency calls from individuals residing in a residential setting that is attached to or
390.8located on property contiguous to the nursing home or boarding care home;
390.9(11) a member of a professional corporation organized under chapter 319B that
390.10does not regularly offer or provide home care services as defined in section 144A.43,
390.11subdivision 3;
390.12(12) the following organizations established to provide medical or surgical services
390.13that do not regularly offer or provide home care services as defined in section 144A.43,
390.14subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit
390.15corporation organized under chapter 317A, a partnership organized under chapter 323, or
390.16any other entity determined by the commissioner;
390.17(13) an individual or agency that provides medical supplies or durable medical
390.18equipment, except when the provision of supplies or equipment is accompanied by a
390.19home care service;
390.20(14) a physician licensed under chapter 147;
390.21(15) an individual who provides home care services to a person with a developmental
390.22disability who lives in a place of residence with a family, foster family, or primary caregiver;
390.23(16) a business that only provides services that are primarily instructional and not
390.24medical services or health-related support services;
390.25(17) an individual who performs basic home care services for no more than 14 hours
390.26each calendar week to no more than one client;
390.27(18) an individual or business licensed as hospice as defined in sections 144A.75 to
390.28144A.755 who is not providing home care services independent of hospice service;
390.29(19) activities conducted by the commissioner of health or a board of health as
390.30defined in section 145A.02, subdivision 2, including communicable disease investigations
390.31or testing; or
390.32(20) administering or monitoring a prescribed therapy necessary to control or
390.33prevent a communicable disease, or the monitoring of an individual's compliance with a
390.34health directive as defined in section 144.4172, subdivision 6.

391.1    Sec. 9. [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION AND
391.2RENEWAL.
391.3    Subdivision 1. License applications. Each application for a home care provider
391.4license must include information sufficient to show that the applicant meets the
391.5requirements of licensure, including:
391.6    (1) the applicant's name, e-mail address, physical address, and mailing address,
391.7including the name of the county in which the applicant resides and has a principal
391.8place of business;
391.9(2) the initial license fee in the amount specified in subdivision 7;
391.10(3) e-mail address, physical address, mailing address, and telephone number of the
391.11principal administrative office;
391.12(4) e-mail address, physical address, mailing address, and telephone number of
391.13each branch office, if any;
391.14(5) names, e-mail and mailing addresses, and telephone numbers of all owners
391.15and managerial officials;
391.16(6) documentation of compliance with the background study requirements of section
391.17144A.476 for all persons involved in the management, operation, or control of the home
391.18care provider;
391.19(7) documentation of a background study as required by section 144.057 for any
391.20individual seeking employment, paid or volunteer, with the home care provider;
391.21(8) evidence of workers' compensation coverage as required by sections 176.181
391.22and 176.182;
391.23(9) documentation of liability coverage, if the provider has it;
391.24(10) identification of the license level the provider is seeking;
391.25(11) documentation that identifies the managerial official who is in charge of
391.26day-to-day operations and attestation that the person has reviewed and understands the
391.27home care provider regulations;
391.28(12) documentation that the applicant has designated one or more owners,
391.29managerial officials, or employees as an agent or agents, which shall not affect the legal
391.30responsibility of any other owner or managerial official under this chapter;
391.31(13) the signature of the officer or managing agent on behalf of an entity, corporation,
391.32association, or unit of government;
391.33(14) verification that the applicant has the following policies and procedures in place
391.34so that if a license is issued, the applicant will implement the policies and procedures
391.35and keep them current:
392.1    (i) requirements in sections 626.556, reporting of maltreatment of minors, and
392.2626.557, reporting of maltreatment of vulnerable adults;
392.3(ii) conducting and handling background studies on employees;
392.4(iii) orientation, training, and competency evaluations of home care staff, and a
392.5process for evaluating staff performance;
392.6(iv) handling complaints from clients, family members, or client representatives
392.7regarding staff or services provided by staff;
392.8(v) conducting initial evaluation of clients' needs and the providers' ability to provide
392.9those services;
392.10(vi) conducting initial and ongoing client evaluations and assessments and how
392.11changes in a client's condition are identified, managed, and communicated to staff and
392.12other health care providers as appropriate;
392.13(vii) orientation to and implementation of the home care client bill of rights;
392.14(viii) infection control practices;
392.15(ix) reminders for medications, treatments, or exercises, if provided; and
392.16(x) conducting appropriate screenings, or documentation of prior screenings, to
392.17show that staff are free of tuberculosis, consistent with current United States Centers for
392.18Disease Control standards; and
392.19(15) other information required by the department.
392.20    Subd. 2. Comprehensive home care license applications. In addition to the
392.21information and fee required in subdivision 1, applicants applying for a comprehensive
392.22home care license must also provide verification that the applicant has the following
392.23policies and procedures in place so that if a license is issued, the applicant will implement
392.24the policies and procedures in this subdivision and keep them current:
392.25(1) conducting initial and ongoing assessments of the client's needs by a registered
392.26nurse or appropriate licensed health professional, including how changes in the client's
392.27conditions are identified, managed, and communicated to staff and other health care
392.28providers, as appropriate;
392.29(2) ensuring that nurses and licensed health professionals have current and valid
392.30licenses to practice;
392.31(3) medication and treatment management;
392.32(4) delegation of home care tasks by registered nurses or licensed health professionals;
392.33(5) supervision of registered nurses and licensed health professionals; and
392.34(6) supervision of unlicensed personnel performing delegated home care tasks.
392.35    Subd. 3. License renewal. (a) Except as provided in section 144A.475, a license
392.36may be renewed for a period of one year if the licensee satisfies the following:
393.1(1) submits an application for renewal in the format provided by the commissioner
393.2at least 30 days before expiration of the license;
393.3(2) submits the renewal fee in the amount specified in subdivision 7;
393.4(3) has provided home care services within the past 12 months;
393.5(4) complies with sections 144A.43 to 144A.4799;
393.6(5) provides information sufficient to show that the applicant meets the requirements
393.7of licensure, including items required under subdivision 1;
393.8(6) provides verification that all policies under subdivision 1, are current; and
393.9(7) provides any other information deemed necessary by the commissioner.
393.10(b) A renewal applicant who holds a comprehensive home care license must also
393.11provide verification that policies listed under subdivision 2 are current.
393.12    Subd. 4. Multiple units. Multiple units or branches of a licensee must be separately
393.13licensed if the commissioner determines that the units cannot adequately share supervision
393.14and administration of services from the main office.
393.15    Subd. 5. Transfers prohibited; changes in ownership. Any home care license
393.16issued by the commissioner may not be transferred to another party. Before acquiring
393.17ownership of a home care provider business, a prospective applicant must apply for a
393.18new temporary license. A change of ownership is a transfer of operational control to
393.19a different business entity, and includes:
393.20(1) transfer of the business to a different or new corporation;
393.21(2) in the case of a partnership, the dissolution or termination of the partnership under
393.22chapter 323A, with the business continuing by a successor partnership or other entity;
393.23(3) relinquishment of control of the provider to another party, including to a contract
393.24management firm that is not under the control of the owner of the business' assets;
393.25(4) transfer of the business by a sole proprietor to another party or entity; or
393.26(5) in the case of a privately held corporation, the change in ownership or control of
393.2750 percent or more of the outstanding voting stock.
393.28    Subd. 6. Notification of changes of information. The temporary licensee or
393.29licensee shall notify the commissioner in writing within ten working days after any
393.30change in the information required in subdivision 1, except the information required in
393.31subdivision 1, clause (5), is required at the time of license renewal.
393.32    Subd. 7. Fees; application, change of ownership, and renewal. (a) An initial
393.33applicant seeking a temporary home care licensure must submit the following application
393.34fee to the commissioner along with a completed application:
393.35(1) basic home care provider, $2,100; or
393.36(2) comprehensive home care provider, $4,200.
394.1(b) A home care provider who is filing a change of ownership as required under
394.2subdivision 5 must submit the following application fee to the commissioner, along with
394.3the documentation required for the change of ownership:
394.4(1) basic home care provider, $2,100; or
394.5(2) comprehensive home care provider, $4,200.
394.6(c) A home care provider who is seeking to renew the provider's license shall pay a
394.7fee to the commissioner based on revenues derived from the provision of home care
394.8services during the calendar year prior to the year in which the application is submitted,
394.9according to the following schedule:
394.10License Renewal Fee

394.11	Provider Annual Revenue	Fee
394.12	greater than $1,500,000	$6,625
394.13 394.14	greater than $1,275,000 and no more than $1,500,000	$5,797
394.15 394.16	greater than $1,100,000 and no more than $1,275,000	$4,969
394.17 394.18	greater than $950,000 and no more than $1,100,000	$4,141
394.19 394.20	greater than $850,000 and no more than $950,000	$3,727
394.21 394.22	greater than $750,000 and no more than $850,000	$3,313
394.23 394.24	greater than $650,000 and no more than $750,000	$2,898
394.25 394.26	greater than $550,000 and no more than $650,000	$2,485
394.27 394.28	greater than $450,000 and no more than $550,000	$2,070
394.29 394.30	greater than $350,000 and no more than $450,000	$1,656
394.31 394.32	greater than $250,000 and no more than $350,000	$1,242
394.33 394.34	greater than $100,000 and no more than $250,000	$828
394.35	greater than $50,000 and no more than $100,000	$500
394.36	greater than $25,000 and no more than $50,000	$400
394.37	no more than $25,000	$200

394.38(d) If requested, the home care provider shall provide the commissioner information
394.39to verify the provider's annual revenues or other information as needed, including copies
394.40of documents submitted to the Department of Revenue.
394.41(e) At each annual renewal, a home care provider may elect to pay the highest
394.42renewal fee for its license category, and not provide annual revenue information to the
394.43commissioner.
395.1(f) A temporary license or license applicant, or temporary licensee or licensee that
395.2knowingly provides the commissioner incorrect revenue amounts for the purpose of
395.3paying a lower license fee, shall be subject to a civil penalty in the amount of double the
395.4fee the provider should have paid.
395.5(g) Fees and penalties collected under this section shall be deposited in the state
395.6treasury and credited to the special state government revenue fund.
395.7(h) The license renewal fee schedule in this subdivision is effective July 1, 2016.

395.8    Sec. 10. [144A.473] ISSUANCE OF TEMPORARY LICENSE AND LICENSE
395.9RENEWAL.
395.10    Subdivision 1. Temporary license and renewal of license. (a) The department
395.11shall review each application to determine the applicant's knowledge of and compliance
395.12with Minnesota home care regulations. Before granting a temporary license or renewing a
395.13license, the commissioner may further evaluate the applicant or licensee by requesting
395.14additional information or documentation or by conducting an on-site survey of the
395.15applicant to determine compliance with sections 144A.43 to 144A.482.
395.16(b) Within 14 calendar days after receiving an application for a license,
395.17the commissioner shall acknowledge receipt of the application in writing. The
395.18acknowledgment must indicate whether the application appears to be complete or whether
395.19additional information is required before the application will be considered complete.
395.20(c) Within 90 days after receiving a complete application, the commissioner shall
395.21issue a temporary license, renew the license, or deny the license.
395.22(d) The commissioner shall issue a license that contains the home care provider's
395.23name, address, license level, expiration date of the license, and unique license number. All
395.24licenses are valid for one year from the date of issuance.
395.25    Subd. 2. Temporary license. (a) For new license applicants, the commissioner
395.26shall issue a temporary license for either the basic or comprehensive home care level. A
395.27temporary license is effective for one year from the date of issuance. Temporary licensees
395.28must comply with sections 144A.43 to 144A.482.
395.29(b) During the temporary license year, the commissioner shall survey the temporary
395.30licensee after the commissioner is notified or has evidence that the temporary licensee
395.31is providing home care services.
395.32(c) Within five days of beginning the provision of services, the temporary
395.33licensee must notify the commissioner that it is serving clients. The notification to the
395.34commissioner may be mailed or e-mailed to the commissioner at the address provided by
395.35the commissioner. If the temporary licensee does not provide home care services during
396.1the temporary license year, then the temporary license expires at the end of the year and
396.2the applicant must reapply for a temporary home care license.
396.3(d) A temporary licensee may request a change in the level of licensure prior to
396.4being surveyed and granted a license by notifying the commissioner in writing and
396.5providing additional documentation or materials required to update or complete the
396.6changed temporary license application. The applicant must pay the difference between the
396.7application fees when changing from the basic to the comprehensive level of licensure.
396.8No refund will be made if the provider chooses to change the license application to the
396.9basic level.
396.10(e) If the temporary licensee notifies the commissioner that the licensee has clients
396.11within 45 days prior to the temporary license expiration, the commissioner may extend the
396.12temporary license for up to 60 days in order to allow the commissioner to complete the
396.13on-site survey required under this section and follow-up survey visits.
396.14    Subd. 3. Temporary licensee survey. (a) If the temporary licensee is in substantial
396.15compliance with the survey, the commissioner shall issue either a basic or comprehensive
396.16home care license. If the temporary licensee is not in substantial compliance with the
396.17survey, the commissioner shall not issue a basic or comprehensive license and there will
396.18be no contested hearing right under chapter 14.
396.19(b) If the temporary licensee whose basic or comprehensive license has been denied
396.20disagrees with the conclusions of the commissioner, then the licensee may request a
396.21reconsideration by the commissioner or commissioner's designee. The reconsideration
396.22request process will be conducted internally by the commissioner or commissioner's
396.23designee, and chapter 14 does not apply.
396.24(c) The temporary licensee requesting reconsideration must make the request in
396.25writing and must list and describe the reasons why the licensee disagrees with the decision
396.26to deny the basic or comprehensive home care license.
396.27(d) A temporary licensee whose license is denied must comply with the requirements
396.28for notification and transfer of clients in section 144A.475, subdivision 5.

396.29    Sec. 11. [144A.474] SURVEYS AND INVESTIGATIONS.
396.30    Subdivision 1. Surveys. The commissioner shall conduct surveys of each home
396.31care provider. By June 30, 2016, the commissioner shall conduct a survey of home care
396.32providers on a frequency of at least once every three years. Survey frequency may be
396.33based on the license level, the provider's compliance history, number of clients served,
396.34or other factors as determined by the department deemed necessary to ensure the health,
396.35safety, and welfare of clients and compliance with the law.
397.1    Subd. 2. Types of home care surveys. (a) "Initial full survey" is the survey
397.2conducted of a new temporary licensee after the department is notified or has evidence that
397.3the licensee is providing home care services to determine if the provider is in compliance
397.4with home care requirements. Initial surveys must be completed within 14 months after
397.5the department's issuance of a temporary basic or comprehensive license.
397.6(b) "Core survey" means periodic inspection of home care providers to determine
397.7ongoing compliance with the home care requirements, focusing on the essential health and
397.8safety requirements. Core surveys are available to licensed home care providers who have
397.9been licensed for three years and surveyed at least once in the past three years with the
397.10latest survey having no widespread violations beyond Level 1 as provided in subdivision
397.1111. Providers must also not have had any substantiated licensing complaints, substantiated
397.12complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
397.13Act, or an enforcement action as authorized in section 144A.475 in the past three years.
397.14(1) The core survey for basic license-level providers reviews compliance in the
397.15following areas:
397.16(i) reporting of maltreatment;
397.17(ii) orientation to and implementation of Home Care Client Bill of Rights;
397.18(iii) statement of home care services;
397.19(iv) initial evaluation of clients and initiation of services;
397.20(v) basic-license level client review and monitoring;
397.21(vi) service plan implementation and changes to the service plan;
397.22(vii) client complaint and investigative process;
397.23(viii) competency of unlicensed personnel; and
397.24(ix) infection control.
397.25(2) For comprehensive license-level providers, the core survey will include
397.26everything in the basic license-level core survey plus these areas:
397.27(i) delegation to unlicensed personnel;
397.28(ii) assessment, monitoring, and reassessment of clients; and
397.29(iii) medication, treatment, and therapy management.
397.30(c) "Full survey" means the periodic inspection of home care providers to determine
397.31ongoing compliance with the home care requirements that cover the core survey areas
397.32and all the legal requirements for home care providers. A full survey is conducted for all
397.33temporary licensees and for providers who do not meet the requirements needed for a core
397.34survey, and when a surveyor identifies unacceptable client health or safety risks during a
397.35core survey. A full survey will include all the tasks identified as part of the core survey
398.1and any additional review deemed necessary by the department, including additional
398.2observation, interviewing, or records review of additional clients and staff.
398.3(d) "Follow-up surveys" are conducted to determine if a home care provider has
398.4corrected deficient issues and systems identified during a core survey, full survey, or
398.5complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax,
398.6mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be
398.7concluded with an exit conference and written information provided on the process for
398.8requesting a reconsideration of the survey results.
398.9(e) Upon receiving information that a home care provider has violated or is currently
398.10violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
398.11investigate the complaint according to sections 144A.51 to 144A.54.
398.12    Subd. 3. Survey process. (a) The survey process for core surveys shall include the
398.13following as applicable to the particular licensee and setting surveyed:
398.14(1) presurvey review of pertinent documents and notification to the ombudsman
398.15for long-term care;
398.16(2) an entrance conference with available staff;
398.17(3) communication with managerial officials or the registered nurse in charge, if
398.18available, and ongoing communication with key staff throughout the survey regarding
398.19information needed by the surveyor, clarifications regarding home care requirements, and
398.20applicable standards of practice;
398.21(4) presentation of written contact information to the provider about the survey staff
398.22conducting the survey, the supervisor, and the process for requesting a reconsideration of
398.23the survey results;
398.24(5) a brief tour of a sample of the housing with services establishments in which the
398.25provider is providing home care services;
398.26(6) a sample selection of home care clients;
398.27(7) information-gathering through client and staff observations, client and staff
398.28interviews, and reviews of records, policies, procedures, practices, and other agency
398.29information;
398.30(8) interviews of clients' family members, if available, with clients' consent when the
398.31client can legally give consent;
398.32(9) except for complaint surveys conducted by the Office of Health Facilities
398.33Complaints, exit conference, with preliminary findings shared and discussed with the
398.34provider and written information provided on the process for requesting a reconsideration
398.35of the survey results; and
399.1(10) postsurvey analysis of findings and formulation of survey results, including
399.2correction orders when applicable.
399.3    Subd. 4. Scheduling surveys. Surveys and investigations shall be conducted
399.4without advance notice to home care providers. Surveyors may contact the home care
399.5provider on the day of a survey to arrange for someone to be available at the survey site.
399.6The contact does not constitute advance notice.
399.7    Subd. 5. Information provided by home care provider. The home care provider
399.8shall provide accurate and truthful information to the department during a survey,
399.9investigation, or other licensing activities.
399.10    Subd. 6. Providing client records. Upon request of a surveyor, home care providers
399.11shall provide a list of current and past clients or client representatives that includes
399.12addresses and telephone numbers and any other information requested about the services
399.13to clients within a reasonable period of time.
399.14    Subd. 7. Contacting and visiting clients. Surveyors may contact or visit a home
399.15care provider's clients to gather information without notice to the home care provider.
399.16Before visiting a client, a surveyor shall obtain the client's or client's representative's
399.17permission by telephone, mail, or in person. Surveyors shall inform all clients or client's
399.18representatives of their right to decline permission for a visit.
399.19    Subd. 8. Correction orders. (a) A correction order may be issued whenever the
399.20commissioner finds upon survey or during a complaint investigation that a home care
399.21provider, a managerial official, or an employee of the provider is not in compliance with
399.22sections 144A.43 to 144A.482. The correction order shall cite the specific statute and
399.23document areas of noncompliance and the time allowed for correction.
399.24(b) The commissioner shall mail copies of any correction order within 30 calendar
399.25days after exit survey to the last known address of the home care provider. A copy of each
399.26correction order and copies of any documentation supplied to the commissioner shall be
399.27kept on file by the home care provider, and public documents shall be made available for
399.28viewing by any person upon request. Copies may be kept electronically.
399.29(c) By the correction order date, the home care provider must document in the
399.30provider's records any action taken to comply with the correction order. The commissioner
399.31may request a copy of this documentation and the home care provider's action to respond
399.32to the correction order in future surveys, upon a complaint investigation, and as otherwise
399.33needed.
399.34    Subd. 9. Follow-up surveys. For providers that have Level 3 or Level 4 violations
399.35or any violations determined to be widespread, the department shall conduct a follow-up
399.36survey within 90 calendar days of the survey. When conducting a follow-up survey, the
400.1surveyor will focus on whether the previous violations have been corrected and may also
400.2address any new violations that are observed while evaluating the corrections that have
400.3been made. If a new violation is identified on a follow-up survey, no fine will be imposed
400.4unless it is not corrected on the next follow-up survey.
400.5    Subd. 10. Performance incentive. A licensee is eligible for a performance
400.6incentive if there are no violations identified in a core or full survey. The performance
400.7incentive is a ten percent discount on the licensee's next home care renewal license fee.
400.8    Subd. 11. Fines. (a) Fines and enforcement actions under this subdivision may be
400.9assessed based on the level and scope of the violations described in paragraph (c) as follows:
400.10(1) Level 1, no fines or enforcement;
400.11(2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
400.12mechanisms authorized in section 144A.475 for widespread violations;
400.13(3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
400.14mechanisms authorized in section 144A.475; and
400.15(4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the
400.16enforcement mechanisms authorized in section 144A.475.
400.17(b) Correction orders for violations are categorized by both level and scope as
400.18follows and fines will be assessed accordingly:
400.19(1) Level of violation:
400.20(i) Level 1. A violation that has no potential to cause more than a minimal impact on
400.21the client and does not affect health or safety.
400.22(ii) Level 2. A violation that did not harm the client's health or safety, but had the
400.23potential to have harmed a client's health or safety, but was not likely to cause serious
400.24injury, impairment, or death.
400.25(iii) Level 3. A violation that harmed a client's health or safety, not including serious
400.26injury, impairment, or death, or a violation that has the potential to lead to serious injury,
400.27impairment, or death.
400.28(iv) Level 4. A violation that results in serious injury, impairment, or death.
400.29(2) Scope of violation:
400.30(i) Isolated. When one or a limited number of clients are affected, or one or a limited
400.31number of staff are involved, or the situation has occurred only occasionally.
400.32(ii) Pattern. When more than a limited number of clients are affected, more than
400.33a limited number of staff are involved, or the situation has occurred repeatedly but is
400.34not found to be pervasive.
400.35(iii) Widespread. When problems are pervasive or represent a systemic failure that
400.36has affected or has the potential to affect a large portion or all of the clients.
401.1(c) If the commissioner finds that the applicant or a home care provider required
401.2to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the
401.3date specified in the correction order or conditional license resulting from a survey or
401.4complaint investigation, the commissioner may impose a fine. A notice of noncompliance
401.5with a correction order must be mailed to the applicant's or provider's last known address.
401.6The noncompliance notice must list the violations not corrected.
401.7(d) The license holder must pay the fines assessed on or before the payment date
401.8specified. If the license holder fails to fully comply with the order, the commissioner
401.9may issue a second fine or suspend the license until the license holder complies by
401.10paying the fine. A timely appeal shall stay payment of the fine until the commissioner
401.11issues a final order.
401.12(e) A license holder shall promptly notify the commissioner in writing when a
401.13violation specified in the order is corrected. If upon reinspection the commissioner
401.14determines that a violation has not been corrected as indicated by the order, the
401.15commissioner may issue a second fine. The commissioner shall notify the license holder by
401.16mail to the last known address in the licensing record that a second fine has been assessed.
401.17The license holder may appeal the second fine as provided under this subdivision.
401.18(f) A home care provider that has been assessed a fine under this subdivision has a
401.19right to a reconsideration or a hearing under this section and chapter 14.
401.20(g) When a fine has been assessed, the license holder may not avoid payment by
401.21closing, selling, or otherwise transferring the licensed program to a third party. In such an
401.22event, the license holder shall be liable for payment of the fine.
401.23(h) In addition to any fine imposed under this section, the commissioner may assess
401.24costs related to an investigation that results in a final order assessing a fine or other
401.25enforcement action authorized by this chapter.
401.26(i) Fines collected under this subdivision shall be deposited in the state government
401.27special revenue fund and credited to an account separate from the revenue collected under
401.28section 144A.472. Subject to an appropriation by the legislature, the revenue from the
401.29fines collected may be used by the commissioner for special projects to improve home care
401.30in Minnesota as recommended by the advisory council established in section 144A.4799.
401.31    Subd. 12. Reconsideration. The commissioner shall make available to home
401.32care providers a correction order reconsideration process. This process may be used
401.33to challenge the correction order issued, including the level and scope described in
401.34subdivision 9, and any fine assessed. During the correction order reconsideration request,
401.35the issuance for the correction orders under reconsideration are not stayed, but the
402.1department will post in formation on the Web site with the correction order that the
402.2licensee has requested a reconsideration required and that the review is pending.
402.3(a) A licensed home care provider may request from the commissioner, in writing,
402.4a correction order reconsideration regarding any correction order issued to the provider.
402.5The correction order reconsideration shall not be reviewed by any surveyor, investigator,
402.6or supervisor that participated in the writing or reviewing of the correction order being
402.7disputed. The correction order reconsiderations may be conducted in person by telephone,
402.8by another electronic form, or in writing, as determined by the commissioner. The
402.9commissioner shall respond in writing to the request from a home care provider for
402.10a correction order reconsideration within 60 days of the date the provider requests a
402.11reconsideration. The commissioner's response shall identify the commissioner's decision
402.12regarding each citation challenged by the home care provider.
402.13The findings of a correction order reconsideration process shall be one or more of
402.14the following:
402.15(1) Supported in full. The correction order is supported in full, with no deletion of
402.16findings to the citation.
402.17(2) Supported in substance. The correction order is supported, but one or more
402.18findings are deleted or modified without any change in the citation.
402.19(3) Correction order cited an incorrect home care licensing requirement. The
402.20correction order is amended by changing the correction order to the appropriate statutory
402.21reference.
402.22(4) Correction order was issued under an incorrect citation. The correction order is
402.23amended to be issued under the more appropriate correction order citation.
402.24(5) The correction order is rescinded.
402.25(6) Fine is amended. It is determined the fine assigned to the correction order was
402.26applied incorrectly.
402.27(7) The level or scope of the citation is modified based on the reconsideration.
402.28(b) If the correction order findings are changed by the commissioner, the
402.29commissioner shall update the correction order Web site accordingly.
402.30    Subd. 13. Home care surveyor training. Before conducting a home care survey,
402.31each home care surveyor must receive training on the following topics:
402.32(1) Minnesota home care licensure requirements;
402.33(2) Minnesota Home Care Client Bill of Rights;
402.34(3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
402.35(4) principles of documentation;
402.36(5) survey protocol and processes;
403.1(6) Offices of the Ombudsman roles;
403.2(7) Office of Health Facility Complaints;
403.3(8) Minnesota landlord-tenant and housing with services laws;
403.4(9) types of payors for home care services; and
403.5(10) Minnesota Nurse Practice Act for nurse surveyors.
403.6Materials used for this training will be posted on the department Web site. Requisite
403.7understanding of these topics will be reviewed as part of the quality improvement plan
403.8in section 28.

403.9    Sec. 12. [144A.475] ENFORCEMENT.
403.10    Subdivision 1. Conditions. (a) The commissioner may refuse to grant a temporary
403.11license, renew a license, suspend or revoke a license, or impose a conditional license if the
403.12home care provider or owner or managerial official of the home care provider:
403.13(1) is in violation of, or during the term of the license has violated, any of the
403.14requirements in sections 144A.471 to 144A.482;
403.15(2) permits, aids, or abets the commission of any illegal act in the provision of
403.16home care;
403.17(3) performs any act detrimental to the health, safety, and welfare of a client;
403.18(4) obtains the license by fraud or misrepresentation;
403.19(5) knowingly made or makes a false statement of a material fact in the application
403.20for a license or in any other record or report required by this chapter;
403.21(6) denies representatives of the department access to any part of the home care
403.22provider's books, records, files, or employees;
403.23(7) interferes with or impedes a representative of the department in contacting the
403.24home care provider's clients;
403.25(8) interferes with or impedes a representative of the department in the enforcement
403.26of this chapter or has failed to fully cooperate with an inspection, survey, or investigation
403.27by the department;
403.28(9) destroys or makes unavailable any records or other evidence relating to the home
403.29care provider's compliance with this chapter;
403.30(10) refuses to initiate a background study under section 144.057 or 245A.04;
403.31(11) fails to timely pay any fines assessed by the department;
403.32(12) violates any local, city, or township ordinance relating to home care services;
403.33(13) has repeated incidents of personnel performing services beyond their
403.34competency level; or
403.35(14) has operated beyond the scope of the home care provider's license level.
404.1    (b) A violation by a contractor providing the home care services of the home care
404.2provider is a violation by the home care provider.
404.3    Subd. 2. Terms to suspension or conditional license. A suspension or conditional
404.4license designation may include terms that must be completed or met before a suspension
404.5or conditional license designation is lifted. A conditional license designation may include
404.6restrictions or conditions that are imposed on the provider. Terms for a suspension or
404.7conditional license may include one or more of the following and the scope of each will be
404.8determined by the commissioner:
404.9(1) requiring a consultant to review, evaluate, and make recommended changes to
404.10the home care provider's practices and submit reports to the commissioner at the cost of
404.11the home care provider;
404.12(2) requiring supervision of the home care provider or staff practices at the cost
404.13of the home care provider by an unrelated person who has sufficient knowledge and
404.14qualifications to oversee the practices and who will submit reports to the commissioner;
404.15(3) requiring the home care provider or employees to obtain training at the cost of
404.16the home care provider;
404.17(4) requiring the home care provider to submit reports to the commissioner;
404.18(5) prohibiting the home care provider from taking any new clients for a period
404.19of time; or
404.20(6) any other action reasonably required to accomplish the purpose of this
404.21subdivision and section 144A.45, subdivision 2.
404.22    Subd. 3. Notice. Prior to any suspension, revocation, or refusal to renew a license,
404.23the home care provider shall be entitled to notice and a hearing as provided by sections
404.2414.57 to 14.69. In addition to any other remedy provided by law, the commissioner may,
404.25without a prior contested case hearing, temporarily suspend a license or prohibit delivery
404.26of services by a provider for not more than 90 days if the commissioner determines that
404.27the health or safety of a consumer is in imminent danger, provided:
404.28(1) advance notice is given to the home care provider;
404.29(2) after notice, the home care provider fails to correct the problem;
404.30(3) the commissioner has reason to believe that other administrative remedies are not
404.31likely to be effective; and
404.32(4) there is an opportunity for a contested case hearing within the 90 days.
404.33    Subd. 4. Time limits for appeals. To appeal the assessment of civil penalties
404.34under section 144A.45, subdivision 2, clause (5), and an action against a license under
404.35this section, a provider must request a hearing no later than 15 days after the provider
404.36receives notice of the action.
405.1    Subd. 5. Plan required. (a) The process of suspending or revoking a license
405.2must include a plan for transferring affected clients to other providers by the home care
405.3provider, which will be monitored by the commissioner. Within three business days of
405.4being notified of the final revocation or suspension action, the home care provider shall
405.5provide the commissioner, the lead agencies as defined in section 256B.0911, and the
405.6ombudsman for long-term care with the following information:
405.7(1) a list of all clients, including full names and all contact information on file;
405.8(2) a list of each client's representative or emergency contact person, including full
405.9names and all contact information on file;
405.10(3) the location or current residence of each client;
405.11(4) the payor sources for each client, including payor source identification numbers;
405.12and
405.13(5) for each client, a copy of the client's service plan, and a list of the types of
405.14services being provided.
405.15(b) The revocation or suspension notification requirement is satisfied by mailing the
405.16notice to the address in the license record. The home care provider shall cooperate with
405.17the commissioner and the lead agencies during the process of transferring care of clients to
405.18qualified providers. Within three business days of being notified of the final revocation or
405.19suspension action, the home care provider must notify and disclose to each of the home
405.20care provider's clients, or the client's representative or emergency contact persons, that
405.21the commissioner is taking action against the home care provider's license by providing a
405.22copy of the revocation or suspension notice issued by the commissioner.
405.23    Subd. 6. Owners and managerial officials; refusal to grant license. (a) The
405.24owner and managerial officials of a home care provider whose Minnesota license has not
405.25been renewed or that has been revoked because of noncompliance with applicable laws or
405.26rules shall not be eligible to apply for nor will be granted a home care license, including
405.27other licenses under this chapter, or be given status as an enrolled personal care assistance
405.28provider agency or personal care assistant by the Department of Human Services under
405.29section 256B.0659 for five years following the effective date of the nonrenewal or
405.30revocation. If the owner and managerial officials already have enrollment status, their
405.31enrollment will be terminated by the Department of Human Services.
405.32(b) The commissioner shall not issue a license to a home care provider for five
405.33years following the effective date of license nonrenewal or revocation if the owner or
405.34managerial official, including any individual who was an owner or managerial official
405.35of another home care provider, had a Minnesota license that was not renewed or was
405.36revoked as described in paragraph (a).
406.1(c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall
406.2suspend or revoke, the license of any home care provider that includes any individual
406.3as an owner or managerial official who was an owner or managerial official of a home
406.4care provider whose Minnesota license was not renewed or was revoked as described in
406.5paragraph (a) for five years following the effective date of the nonrenewal or revocation.
406.6(d) The commissioner shall notify the home care provider 30 days in advance of
406.7the date of nonrenewal, suspension, or revocation of the license. Within ten days after
406.8the receipt of the notification, the home care provider may request, in writing, that the
406.9commissioner stay the nonrenewal, revocation, or suspension of the license. The home
406.10care provider shall specify the reasons for requesting the stay; the steps that will be taken
406.11to attain or maintain compliance with the licensure laws and regulations; any limits on the
406.12authority or responsibility of the owners or managerial officials whose actions resulted in
406.13the notice of nonrenewal, revocation, or suspension; and any other information to establish
406.14that the continuing affiliation with these individuals will not jeopardize client health, safety,
406.15or well-being. The commissioner shall determine whether the stay will be granted within
406.1630 days of receiving the provider's request. The commissioner may propose additional
406.17restrictions or limitations on the provider's license and require that the granting of the stay
406.18be contingent upon compliance with those provisions. The commissioner shall take into
406.19consideration the following factors when determining whether the stay should be granted:
406.20(1) the threat that continued involvement of the owners and managerial officials with
406.21the home care provider poses to client health, safety, and well-being;
406.22(2) the compliance history of the home care provider; and
406.23(3) the appropriateness of any limits suggested by the home care provider.
406.24    If the commissioner grants the stay, the order shall include any restrictions or
406.25limitation on the provider's license. The failure of the provider to comply with any
406.26restrictions or limitations shall result in the immediate removal of the stay and the
406.27commissioner shall take immediate action to suspend, revoke, or not renew the license.
406.28    Subd. 7. Request for hearing. A request for a hearing must be in writing and must:
406.29(1) be mailed or delivered to the department or the commissioner's designee;
406.30(2) contain a brief and plain statement describing every matter or issue contested; and
406.31(3) contain a brief and plain statement of any new matter that the applicant or home
406.32care provider believes constitutes a defense or mitigating factor.
406.33    Subd. 8. Informal conference. At any time, the applicant or home care provider
406.34and the commissioner may hold an informal conference to exchange information, clarify
406.35issues, or resolve issues.
407.1    Subd. 9. Injunctive relief. In addition to any other remedy provided by law, the
407.2commissioner may bring an action in district court to enjoin a person who is involved in
407.3the management, operation, or control of a home care provider or an employee of the
407.4home care provider from illegally engaging in activities regulated by sections 144A.43 to
407.5144A.482. The commissioner may bring an action under this subdivision in the district
407.6court in Ramsey County or in the district in which a home care provider is providing
407.7services. The court may grant a temporary restraining order in the proceeding if continued
407.8activity by the person who is involved in the management, operation, or control of a home
407.9care provider, or by an employee of the home care provider, would create an imminent
407.10risk of harm to a recipient of home care services.
407.11    Subd. 10. Subpoena. In matters pending before the commissioner under sections
407.12144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance
407.13of witnesses and the production of all necessary papers, books, records, documents, and
407.14other evidentiary material. If a person fails or refuses to comply with a subpoena or
407.15order of the commissioner to appear or testify regarding any matter about which the
407.16person may be lawfully questioned or to produce any papers, books, records, documents,
407.17or evidentiary materials in the matter to be heard, the commissioner may apply to the
407.18district court in any district, and the court shall order the person to comply with the
407.19commissioner's order or subpoena. The commissioner of health may administer oaths to
407.20witnesses or take their affirmation. Depositions may be taken in or outside the state in the
407.21manner provided by law for the taking of depositions in civil actions. A subpoena or other
407.22process or paper may be served on a named person anywhere in the state by an officer
407.23authorized to serve subpoenas in civil actions, with the same fees and mileage and in the
407.24same manner as prescribed by law for a process issued out of a district court. A person
407.25subpoenaed under this subdivision shall receive the same fees, mileage, and other costs
407.26that are paid in proceedings in district court.

407.27    Sec. 13. [144A.476] BACKGROUND STUDIES.
407.28    Subdivision 1. Prior criminal convictions; owner and managerial officials. (a)
407.29Before the commissioner issues a temporary license or renews a license, an owner or
407.30managerial official is required to complete a background study under section 144.057. No
407.31person may be involved in the management, operation, or control of a home care provider
407.32if the person has been disqualified under chapter 245C. If an individual is disqualified
407.33under section 144.057 or chapter 245C, the individual may request reconsideration of
407.34the disqualification. If the individual requests reconsideration and the commissioner
407.35sets aside or rescinds the disqualification, the individual is eligible to be involved in the
408.1management, operation, or control of the provider. If an individual has a disqualification
408.2under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's
408.3disqualification is barred from a set aside, and the individual must not be involved in the
408.4management, operation, or control of the provider.
408.5(b) For purposes of this section, owners of a home care provider subject to the
408.6background check requirement are those individuals whose ownership interest provides
408.7sufficient authority or control to affect or change decisions related to the operation of the
408.8home care provider. An owner includes a sole proprietor, a general partner, or any other
408.9individual whose individual ownership interest can affect the management and direction
408.10of the policies of the home care provider.
408.11(c) For the purposes of this section, managerial officials subject to the background
408.12check requirement are individuals who provide direct contact as defined in section 245C.02,
408.13subdivision 11, or individuals who have the responsibility for the ongoing management or
408.14direction of the policies, services, or employees of the home care provider. Data collected
408.15under this subdivision shall be classified as private data under section 13.02, subdivision 12.
408.16(d) The department shall not issue any license if the applicant or owner or managerial
408.17official has been unsuccessful in having a background study disqualification set aside
408.18under section 144.057 and chapter 245C; if the owner or managerial official, as an owner
408.19or managerial official of another home care provider, was substantially responsible for
408.20the other home care provider's failure to substantially comply with sections 144A.43 to
408.21144A.482; or if an owner that has ceased doing business, either individually or as an
408.22owner of a home care provider, was issued a correction order for failing to assist clients in
408.23violation of this chapter.
408.24    Subd. 2. Employees, contractors, and volunteers. (a) Employees, contractors,
408.25and volunteers of a home care provider are subject to the background study required by
408.26section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall
408.27be construed to prohibit a home care provider from requiring self-disclosure of criminal
408.28conviction information.
408.29(b) Termination of an employee in good faith reliance on information or records
408.30obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not
408.31subject the home care provider to civil liability or liability for unemployment benefits.

408.32    Sec. 14. [144A.477] COMPLIANCE.
408.33    Subdivision 1. Medicare-certified providers; coordination of surveys. If feasible,
408.34the commissioner shall survey licensees to determine compliance with this chapter at the
408.35same time as surveys for certification for Medicare if Medicare certification is based on
409.1compliance with the federal conditions of participation and on survey and enforcement
409.2by the Department of Health as agent for the United States Department of Health and
409.3Human Services.
409.4    Subd. 2. Medicare-certified providers; equivalent requirements. For home care
409.5providers licensed to provide comprehensive home care services that are also certified for
409.6participation in Medicare as a home health agency under Code of Federal Regulations,
409.7title 42, part 484, the following state licensure regulations are considered equivalent to
409.8the federal requirements:
409.9(1) quality management, section 144A.479, subdivision 3;
409.10(2) personnel records, section 144A.479, subdivision 7;
409.11(3) acceptance of clients, section 144A.4791, subdivision 4;
409.12(4) referrals, section 144A.4791, subdivision 5;
409.13(5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792,
409.14subdivisions 2 and 3;
409.15(6) individualized monitoring and reassessment, sections 144A.4791, subdivision
409.168, and 144A.4792, subdivisions 2 and 3;
409.17(7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792,
409.18subdivision 5, and 144A.4793, subdivision 3;
409.19(8) client complaint and investigation process, section 144A.4791, subdivision 11;
409.20(9) prescription orders, section 144A.4792, subdivisions 13 to 16;
409.21(10) client records, section 144A.4794, subdivisions 1 to 3;
409.22(11) qualifications for unlicensed personnel performing delegated tasks, section
409.23144A.4795;
409.24(12) training and competency staff, section 144A.4795;
409.25(13) training and competency for unlicensed personnel, section 144A.4795,
409.26subdivision 7;
409.27(14) delegation of home care services, section 144A.4795, subdivision 4;
409.28(15) availability of contact person, section 144A.4797, subdivision 1; and
409.29(16) supervision of staff, section 144A.4797, subdivisions 2 and 3.
409.30Violations of requirements in clauses (1) to (16) may lead to enforcement actions
409.31under section 144A.474.

409.32    Sec. 15. [144A.478] INNOVATION VARIANCE.
409.33    Subdivision 1. Definition. For purposes of this section, "innovation variance"
409.34means a specified alternative to a requirement of this chapter. An innovation variance
409.35may be granted to allow a home care provider to offer home care services of a type or
410.1in a manner that is innovative, will not impair the services provided, will not adversely
410.2affect the health, safety, or welfare of the clients, and is likely to improve the services
410.3provided. The innovative variance cannot change any of the client's rights under section
410.4144A.44, home care bill of rights.
410.5    Subd. 2. Conditions. The commissioner may impose conditions on the granting of
410.6an innovation variance that the commissioner considers necessary.
410.7    Subd. 3. Duration and renewal. The commissioner may limit the duration of any
410.8innovation variance and may renew a limited innovation variance.
410.9    Subd. 4. Applications; innovation variance. An application for innovation
410.10variance from the requirements of this chapter may be made at any time, must be made in
410.11writing to the commissioner, and must specify the following:
410.12(1) the statute or law from which the innovation variance is requested;
410.13(2) the time period for which the innovation variance is requested;
410.14(3) the specific alternative action that the licensee proposes;
410.15(4) the reasons for the request; and
410.16(5) justification that an innovation variance will not impair the services provided,
410.17will not adversely affect the health, safety, or welfare of clients, and is likely to improve
410.18the services provided.
410.19The commissioner may require additional information from the home care provider before
410.20acting on the request.
410.21    Subd. 5. Grants and denials. The commissioner shall grant or deny each request
410.22for an innovation variance in writing within 45 days of receipt of a complete request.
410.23Notice of a denial shall contain the reasons for the denial. The terms of a requested
410.24innovation variance may be modified upon agreement between the commissioner and
410.25the home care provider.
410.26    Subd. 6. Violation of innovation variances. A failure to comply with the terms of
410.27an innovation variance shall be deemed to be a violation of this chapter.
410.28    Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or
410.29deny renewal of an innovation variance if:
410.30(1) it is determined that the innovation variance is adversely affecting the health,
410.31safety, or welfare of the licensee's clients;
410.32(2) the home care provider has failed to comply with the terms of the innovation
410.33variance;
410.34(3) the home care provider notifies the commissioner in writing that it wishes to
410.35relinquish the innovation variance and be subject to the statute previously varied; or
410.36(4) the revocation or denial is required by a change in law.

411.1    Sec. 16. [144A.479] HOME CARE PROVIDER RESPONSIBILITIES;
411.2BUSINESS OPERATION.
411.3    Subdivision 1. Display of license. The original current license must be displayed
411.4in the home care providers' principal business office and copies must be displayed in
411.5any branch office. The home care provider must provide a copy of the license to any
411.6person who requests it.
411.7    Subd. 2. Advertising. Home care providers shall not use false, fraudulent,
411.8or misleading advertising in the marketing of services. For purposes of this section,
411.9advertising includes any verbal, written, or electronic means of communicating to
411.10potential clients about the availability, nature, or terms of home care services.
411.11    Subd. 3. Quality management. The home care provider shall engage in quality
411.12management appropriate to the size of the home care provider and relevant to the type
411.13of services the home care provider provides. The quality management activity means
411.14evaluating the quality of care by periodically reviewing client services, complaints made,
411.15and other issues that have occurred and determining whether changes in services, staffing,
411.16or other procedures need to be made in order to ensure safe and competent services to
411.17clients. Documentation about quality management activity must be available for two
411.18years. Information about quality management must be available to the commissioner at
411.19the time of the survey, investigation, or renewal.
411.20    Subd. 4. Provider restrictions. (a) This subdivision does not apply to licensees
411.21that are Minnesota counties or other units of government.
411.22(b) A home care provider or staff cannot accept powers-of-attorney from clients for
411.23any purpose, and may not accept appointments as guardians or conservators of clients.
411.24(c) A home care provider cannot serve as a client's representative.
411.25    Subd. 5. Handling of client's finances and property. (a) A home care provider
411.26may assist clients with household budgeting, including paying bills and purchasing
411.27household goods, but may not otherwise manage a client's property. A home care provider
411.28must provide a client with receipts for all transactions and purchases paid with the clients'
411.29funds. When receipts are not available, the transaction or purchase must be documented.
411.30A home care provider must maintain records of all such transactions.
411.31(b) A home care provider or staff may not borrow a client's funds or personal or
411.32real property, nor in any way convert a client's property to the home care provider's or
411.33staff's possession.
411.34(c) Nothing in this section precludes a home care provider or staff from accepting
411.35gifts of minimal value, or precludes the acceptance of donations or bequests made to a
412.1home care provider that are exempt from income tax under section 501(c) of the Internal
412.2Revenue Code of 1986.
412.3    Subd. 6. Reporting maltreatment of vulnerable adults and minors. (a) All
412.4home care providers must comply with requirements for the reporting of maltreatment
412.5of minors in section 626.556 and the requirements for the reporting of maltreatment
412.6of vulnerable adults in section 626.557. Home care providers must report suspected
412.7maltreatment of minors and vulnerable adults to the common entry point. Each home
412.8care provider must establish and implement a written procedure to ensure that all cases
412.9of suspected maltreatment are reported.
412.10(b) Each home care provider must develop and implement an individual abuse
412.11prevention plan for each vulnerable minor or adult for whom home care services are
412.12provided by a home care provider. The plan shall contain an individualized review or
412.13assessment of the person's susceptibility to abuse by another individual, including other
412.14vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors;
412.15and statements of the specific measures to be taken to minimize the risk of abuse to that
412.16person and other vulnerable adults or minors. For purposes of the abuse prevention plan,
412.17the term abuse includes self-abuse.
412.18    Subd. 7. Employee records. The home care provider must maintain current records
412.19of each paid employee, regularly scheduled volunteers providing home care services, and
412.20of each individual contractor providing home care services. The records must include
412.21the following information:
412.22(1) evidence of current professional licensure, registration, or certification, if
412.23licensure, registration, or certification is required by this statute, or other rules;
412.24(2) records of orientation, required annual training and infection control training,
412.25and competency evaluations;
412.26(3) current job description, including qualifications, responsibilities, and
412.27identification of staff providing supervision;
412.28(4) documentation of annual performance reviews which identify areas of
412.29improvement needed and training needs;
412.30(5) for individuals providing home care services, verification that required health
412.31screenings under section 144A.4798 have taken place and the dates of those screenings; and
412.32(6) documentation of the background study as required under section 144.057.
412.33Each employee record must be retained for at least three years after a paid employee,
412.34home care volunteer, or contractor ceases to be employed by or under contract with the
412.35home care provider. If a home care provider ceases operation, employee records must be
412.36maintained for three years.

413.1    Sec. 17. [144A.4791] HOME CARE PROVIDER RESPONSIBILITIES WITH
413.2RESPECT TO CLIENTS.
413.3    Subdivision 1. Home care bill of rights; notification to client. (a) The home
413.4care provider shall provide the client or the client's representative a written notice of the
413.5rights under section 144A.44 in a language that the client or the client's representative
413.6can understand before the initiation of services to that client. If a written version is not
413.7available, the home care bill of rights must be communicated to the client or client's
413.8representative in a language they can understand.
413.9(b) In addition to the text of the home care bill of rights in section 144A.44,
413.10subdivision 1, the notice shall also contain the following statement describing how to file
413.11a complaint with these offices.
413.12"If you have a complaint about the provider or the person providing your
413.13home care services, you may call, write, or visit the Office of Health Facility
413.14Complaints, Minnesota Department of Health. You may also contact the Office of
413.15Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health
413.16and Developmental Disabilities."
413.17The statement should include the telephone number, Web site address, e-mail
413.18address, mailing address, and street address of the Office of Health Facility Complaints at
413.19the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care,
413.20and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The
413.21statement should also include the home care provider's name, address, e-mail, telephone
413.22number, and name or title of the person at the provider to whom problems or complaints
413.23may be directed. It must also include a statement that the home care provider will not
413.24retaliate because of a complaint.
413.25(c) The home care provider shall obtain written acknowledgment of the client's
413.26receipt of the home care bill of rights or shall document why an acknowledgment cannot
413.27be obtained. The acknowledgment may be obtained from the client or the client's
413.28representative. Acknowledgment of receipt shall be retained in the client's record.
413.29    Subd. 2. Notice of services for dementia, Alzheimer's disease, or related
413.30disorders. The home care provider that provides services to clients with dementia shall
413.31provide in written or electronic form, to clients and families or other persons who request
413.32it, a description of the training program and related training it provides, including the
413.33categories of employees trained, the frequency of training, and the basic topics covered.
413.34This information satisfies the disclosure requirements in section 325F.72, subdivision
413.352, clause (4).
414.1    Subd. 3. Statement of home care services. Prior to the initiation of services,
414.2a home care provider must provide to the client or the client's representative a written
414.3statement which identifies if they have a basic or comprehensive home care license, the
414.4services they are authorized to provide, and which services they cannot provide under the
414.5scope of their license. The home care provider shall obtain written acknowledgment
414.6from the clients that they have provided the statement or must document why they could
414.7not obtain the acknowledgment.
414.8    Subd. 4. Acceptance of clients. No home care provider may accept a person as a
414.9client unless the home care provider has staff, sufficient in qualifications, competency,
414.10and numbers, to adequately provide the services agreed to in the service plan and that
414.11are within the provider's scope of practice.
414.12    Subd. 5. Referrals. If a home care provider reasonably believes that a client is in
414.13need of another medical or health service, including a licensed health professional, or
414.14social service provider, the home care provider shall:
414.15(1) determine the client's preferences with respect to obtaining the service; and
414.16(2) inform the client of resources available, if known, to assist the client in obtaining
414.17services.
414.18    Subd. 6. Initiation of services. When a provider initiates services and the
414.19individualized review or assessment required in subdivisions 7 and 8 has not been
414.20completed, the provider must complete a temporary plan and agreement with the client for
414.21services.
414.22    Subd. 7. Basic individualized client review and monitoring. (a) When services
414.23being provided are basic home care services, an individualized initial review of the client's
414.24needs and preferences must be conducted at the client's residence with the client or client's
414.25representative. This initial review must be completed within 30 days after the initiation of
414.26the home care services.
414.27(b) Client monitoring and review must be conducted as needed based on changes
414.28in the needs of the client and cannot exceed 90 days from the date of the last review.
414.29The monitoring and review may be conducted at the client's residence or through the
414.30utilization of telecommunication methods based on practice standards that meet the
414.31individual client's needs.
414.32    Subd. 8. Comprehensive assessment, monitoring, and reassessment. (a) When
414.33the services being provided are comprehensive home care services, an individualized
414.34initial assessment must be conducted in-person by a registered nurse. When the services
414.35are provided by other licensed health professionals, the assessment must be conducted by
415.1the appropriate health professional. This initial assessment must be completed within five
415.2days after initiation of home care services.
415.3(b) Client monitoring and reassessment must be conducted in the client's home no
415.4more than 14 days after initiation of services.
415.5(c) Ongoing client monitoring and reassessment must be conducted as needed based
415.6on changes in the needs of the client and cannot exceed 90 days from the last date of the
415.7assessment. The monitoring and reassessment may be conducted at the client's residence
415.8or through the utilization of telecommunication methods based on practice standards that
415.9meet the individual client's needs.
415.10    Subd. 9. Service plan, implementation, and revisions to service plan. (a) No later
415.11than 14 days after the initiation of services, a home care provider shall finalize a current
415.12written service plan.
415.13(b) The service plan and any revisions must include a signature or other
415.14authentication by the home care provider and by the client or the client's representative
415.15documenting agreement on the services to be provided. The service plan must be revised,
415.16if needed, based on client review or reassessment under subdivisions 7 and 8. The provider
415.17must provide information to the client about changes to the provider's fee for services and
415.18how to contact the Office of the Ombudsman for Long-Term Care.
415.19(c) The home care provider must implement and provide all services required by
415.20the current service plan.
415.21(d) The service plan and revised service plan must be entered into the client's record,
415.22including notice of a change in a client's fees when applicable.
415.23(e) Staff providing home care services must be informed of the current written
415.24service plan.
415.25(f) The service plan must include:
415.26(1) a description of the home care services to be provided, the fees for services, and
415.27the frequency of each service, according to the client's current review or assessment and
415.28client preferences;
415.29(2) the identification of the staff or categories of staff who will provide the services;
415.30(3) the schedule and methods of monitoring reviews or assessments of the client;
415.31(4) the frequency of sessions of supervision of staff and type of personnel who
415.32will supervise staff; and
415.33(5) a contingency plan that includes:
415.34(i) the action to be taken by the home care provider and by the client or client's
415.35representative if the scheduled service cannot be provided;
416.1(ii) information and method for a client or client's representative to contact the
416.2home care provider;
416.3(iii) names and contact information of persons the client wishes to have notified
416.4in an emergency or if there is a significant adverse change in the client's condition,
416.5including identification of and information as to who has authority to sign for the client in
416.6an emergency; and
416.7(iv) the circumstances in which emergency medical services are not to be summoned
416.8consistent with chapters 145B and 145C, and declarations made by the client under those
416.9chapters.
416.10    Subd. 10. Termination of service plan. (a) If a home care provider terminates a
416.11service plan with a client, and the client continues to need home care services, the home
416.12care provider shall provide the client and the client's representative, if any, with a written
416.13notice of termination which includes the following information:
416.14(1) the effective date of termination;
416.15(2) the reason for termination;
416.16(3) a list of known licensed home care providers in the client's immediate geographic
416.17area;
416.18(4) a statement that the home care provider will participate in a coordinated transfer
416.19of care of the client to another home care provider, health care provider, or caregiver, as
416.20required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
416.21(5) the name and contact information of a person employed by the home care
416.22provider with whom the client may discuss the notice of termination; and
416.23(6) if applicable, a statement that the notice of termination of home care services
416.24does not constitute notice of termination of the housing with services contract with a
416.25housing with services establishment.
416.26(b) When the home care provider voluntarily discontinues services to all clients, the
416.27home care provider must notify the commissioner, lead agencies, and the ombudsman for
416.28long-term care about its clients and comply with the requirements in this subdivision.
416.29    Subd. 11. Client complaint and investigative process. (a) The home care
416.30provider must have a written policy and system for receiving, investigating, reporting,
416.31and attempting to resolve complaints from its clients or clients' representatives. The
416.32policy should clearly identify the process by which clients may file a complaint or concern
416.33about home care services and an explicit statement that the home care provider will not
416.34discriminate or retaliate against a client for expressing concerns or complaints. A home
416.35care provider must have a process in place to conduct investigations of complaints made
416.36by the client or the client's representative about the services in the client's plan that are or
417.1are not being provided or other items covered in the client's home care bill of rights. This
417.2complaint system must provide reasonable accommodations for any special needs of the
417.3client or client's representative if requested.
417.4(b) The home care provider must document the complaint, name of the client,
417.5investigation, and resolution of each complaint filed. The home care provider must
417.6maintain a record of all activities regarding complaints received, including the date the
417.7complaint was received, and the home care provider's investigation and resolution of the
417.8complaint. This complaint record must be kept for each event for at least two years after
417.9the date of entry and must be available to the commissioner for review.
417.10(c) The required complaint system must provide for written notice to each client or
417.11client's representative that includes:
417.12(1) the client's right to complain to the home care provider about the services received;
417.13(2) the name or title of the person or persons with the home care provider to contact
417.14with complaints;
417.15(3) the method of submitting a complaint to the home care provider; and
417.16(4) a statement that the provider is prohibited against retaliation according to
417.17paragraph (d).
417.18(d) A home care provider must not take any action that negatively affects a client
417.19in retaliation for a complaint made or a concern expressed by the client or the client's
417.20representative.
417.21    Subd. 12. Disaster planning and emergency preparedness plan. The home care
417.22provider must have a written plan of action to facilitate the management of the client's care
417.23and services in response to a natural disaster, such as flood and storms, or other emergencies
417.24that may disrupt the home care provider's ability to provide care or services. The licensee
417.25must provide adequate orientation and training of staff on emergency preparedness.
417.26    Subd. 13. Request for discontinuation of life-sustaining treatment. (a) If a
417.27client, family member, or other caregiver of the client requests that an employee or other
417.28agent of the home care provider discontinue a life-sustaining treatment, the employee or
417.29agent receiving the request:
417.30(1) shall take no action to discontinue the treatment; and
417.31(2) shall promptly inform their supervisor or other agent of the home care provider
417.32of the client's request.
417.33(b) Upon being informed of a request for termination of treatment, the home care
417.34provider shall promptly:
417.35(1) inform the client that the request will be made known to the physician who
417.36ordered the client's treatment;
418.1(2) inform the physician of the client's request; and
418.2(3) work with the client and the client's physician to comply with the provisions of
418.3the Health Care Directive Act in chapter 145C.
418.4(c) This section does not require the home care provider to discontinue treatment,
418.5except as may be required by law or court order.
418.6(d) This section does not diminish the rights of clients to control their treatments,
418.7refuse services, or terminate their relationships with the home care provider.
418.8(e) This section shall be construed in a manner consistent with chapter 145B or
418.9145C, whichever applies, and declarations made by clients under those chapters.

418.10    Sec. 18. [144A.4792] MEDICATION MANAGEMENT.
418.11    Subdivision 1. Medication management services; comprehensive home care
418.12license. (a) This subdivision applies only to home care providers with a comprehensive
418.13home care license that provides medication management services to clients. Medication
418.14management services may not be provided by a home care provider that has a basic
418.15home care license.
418.16(b) A comprehensive home care provider who provides medication management
418.17services must develop, implement, and maintain current written medication management
418.18policies and procedures. The policies and procedures must be developed under the
418.19supervision and direction of a registered nurse, licensed health professional, or pharmacist
418.20consistent with current practice standards and guidelines.
418.21(c) The written policies and procedures must address requesting and receiving
418.22prescriptions for medications; preparing and giving medications; verifying that
418.23prescription drugs are administered as prescribed; documenting medication management
418.24activities; controlling and storing medications; monitoring and evaluating medication use;
418.25resolving medication errors; communicating with the prescriber, pharmacist, and client
418.26and client representative, if any; disposing of unused medications; and educating clients
418.27and client representatives about medications. When controlled substances are being
418.28managed, the policies and procedures must also identify how the provider will ensure
418.29security and accountability for the overall management, control, and disposition of those
418.30substances in compliance with state and federal regulations and with subdivision 22.
418.31    Subd. 2. Provision of medication management services. (a) For each client who
418.32requests medication management services, the comprehensive home care provider shall,
418.33prior to providing medication management services, have a registered nurse, licensed
418.34health professional, or authorized prescriber under section 151.37 conduct an assessment
418.35to determine what mediation management services will be provided and how the services
419.1will be provided. This assessment must be conducted face-to-face with the client. The
419.2assessment must include an identification and review of all medications the client is known
419.3to be taking. The review and identification must include indications for medications, side
419.4effects, contraindications, allergic or adverse reactions, and actions to address these issues.
419.5(b) The assessment must identify interventions needed in management of
419.6medications to prevent diversion of medication by the client or others who may have
419.7access to the medications. Diversion of medications means the misuse, theft, or illegal
419.8or improper disposition of medications.
419.9    Subd. 3. Individualized medication monitoring and reassessment. The
419.10comprehensive home care provider must monitor and reassess the client's medication
419.11management services as needed under subdivision 14 when the client presents with
419.12symptoms or other issues that may be medication-related and, at a minimum, annually.
419.13    Subd. 4. Client refusal. The home care provider must document in the client's
419.14record any refusal for an assessment for medication management by the client. The
419.15provider must discuss with the client the possible consequences of the client's refusal and
419.16document the discussion in the client's record.
419.17    Subd. 5. Individualized medication management plan. (a) For each client
419.18receiving medication management services, the comprehensive home care provider must
419.19prepare and include in the service plan a written statement of the medication management
419.20services that will be provided to the client. The provider must develop and maintain a
419.21current individualized medication management record for each client based on the client's
419.22assessment that must contain the following:
419.23(1) a statement describing the medication management services that will be provided;
419.24(2) a description of storage of medications based on the client's needs and
419.25preferences, risk of diversion, and consistent with the manufacturer's directions;
419.26(3) documentation of specific client instructions relating to the administration
419.27of medications;
419.28(4) identification of persons responsible for monitoring medication supplies and
419.29ensuring that medication refills are ordered on a timely basis;
419.30(5) identification of medication management tasks that may be delegated to
419.31unlicensed personnel;
419.32(6) procedures for staff notifying a registered nurse or appropriate licensed health
419.33professional when a problem arises with medication management services; and
419.34(7) any client-specific requirements relating to documenting medication
419.35administration, verifications that all medications are administered as prescribed, and
419.36monitoring of medication use to prevent possible complications or adverse reactions.
420.1(b) The medication management record must be current and updated when there are
420.2any changes.
420.3    Subd. 6. Administration of medication. Medications may be administered by a
420.4nurse, physician, or other licensed health practitioner authorized to administer medications
420.5or by unlicensed personnel who have been delegated medication administration tasks by
420.6a registered nurse.
420.7    Subd. 7. Delegation of medication administration. When administration of
420.8medications is delegated to unlicensed personnel, the comprehensive home care provider
420.9must ensure that the registered nurse has:
420.10(1) instructed the unlicensed personnel in the proper methods to administer the
420.11medications, and the unlicensed personnel has demonstrated ability to competently follow
420.12the procedures;
420.13(2) specified, in writing, specific instructions for each client and documented those
420.14instructions in the client's records; and
420.15(3) communicated with the unlicensed personnel about the individual needs of
420.16the client.
420.17    Subd. 8. Documentation of administration of medications. Each medication
420.18administered by comprehensive home care provider staff must be documented in the
420.19client's record. The documentation must include the signature and title of the person
420.20who administered the medication. The documentation must include the medication
420.21name, dosage, date and time administered, and method and route of administration. The
420.22staff must document the reason why medication administration was not completed as
420.23prescribed and document any follow-up procedures that were provided to meet the client's
420.24needs when medication was not administered as prescribed and in compliance with the
420.25client's medication management plan.
420.26    Subd. 9. Documentation of medication set up. Documentation of dates of
420.27medication set up, name of medication, quantity of dose, times to be administered, route
420.28of administration, and name of person completing medication set up must be done at
420.29time of set up.
420.30    Subd. 10. Medications management for clients who will be away from home. (a)
420.31A home care provider that is providing medication management services to the client and
420.32controls the client's access to the medications must develop and implement policies and
420.33procedures for giving accurate and current medications to clients for planned or unplanned
420.34times away from home according to the client's individualized medication management
420.35plan. The policy and procedures must state that:
421.1(1) for planned time away, the medications must be obtained from the pharmacy or
421.2set up by the registered nurse according to appropriate state and federal laws and nursing
421.3standards of practice;
421.4(2) for unplanned time away, when the pharmacy is not able to provide the
421.5medications, a licensed nurse or unlicensed personnel shall give the client or client's
421.6representative medications in amounts and dosages needed for the length of the anticipated
421.7absence, not to exceed 120 hours;
421.8(3) the client, or the client's representative, must be provided written information
421.9on medications, including any special instructions for administering or handling the
421.10medications, including controlled substances;
421.11(4) the medications must be placed in a medication container or containers
421.12appropriate to the provider's medication system and must be labeled with the client's name
421.13and the dates and times that the medications are scheduled; and
421.14(5) the client or client's representative must be provided in writing the home care
421.15provider's name and information on how to contact the home care provider.
421.16(b) For unplanned time away when the licensed nurse is not available, the registered
421.17nurse may delegate this task to unlicensed personnel if:
421.18(1) the registered nurse has trained the unlicensed staff and determined the
421.19unlicensed staff is competent to follow the procedures for giving medications to clients;
421.20(2) the registered nurse has developed written procedures for the unlicensed
421.21personnel, including any special instructions or procedures regarding controlled substances
421.22that are prescribed for the client. The procedures must address:
421.23(i) the type of container or containers to be used for the medications appropriate to
421.24the provider's medication system;
421.25(ii) how the container or containers must be labeled;
421.26(iii) the written information about the medications to be given to the client or client's
421.27representative;
421.28(iv) how the unlicensed staff will document in the client's record that medications
421.29have been given to the client or the client's representative, including documenting the date
421.30the medications were given to the client or the client's representative and who received the
421.31medications, the person who gave the medications to the client, the number of medications
421.32that were given to the client, and other required information;
421.33(v) how the registered nurse will be notified that medications have been given to
421.34the client or client's representative and whether the registered nurse needs to be contacted
421.35before the medications are given to the client or the client's representative; and
422.1(vi) a review by the registered nurse of the completion of this task to verify that this
422.2task was completed accurately by the unlicensed personnel.
422.3    Subd. 11. Prescribed and nonprescribed medication. The comprehensive home
422.4care provider must determine whether it will require a prescription for all medications it
422.5manages. The comprehensive home care provider must inform the client or the client's
422.6representative whether the comprehensive home care provider requires a prescription
422.7for all over-the-counter and dietary supplements before the comprehensive home care
422.8provider will agree to manage those medications.
422.9    Subd. 12. Medications; over-the-counter; dietary supplements not prescribed.
422.10A comprehensive home care provider providing medication management services for
422.11over-the-counter drugs or dietary supplements must retain those items in the original labeled
422.12container with directions for use prior to setting up for immediate or later administration.
422.13The provider must verify that the medications are up-to-date and stored as appropriate.
422.14    Subd. 13. Prescriptions. There must be a current written or electronically recorded
422.15prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed
422.16medications that the comprehensive home care provider is managing for the client.
422.17    Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least
422.18every 12 months or more frequently as indicated by the assessment in subdivision 2.
422.19Prescriptions for controlled substances must comply with chapter 152.
422.20    Subd. 15. Verbal prescription orders. Verbal prescription orders from an
422.21authorized prescriber must be received by a nurse or pharmacist. The order must be
422.22handled according to Minnesota Rules, part 6800.6200.
422.23    Subd. 16. Written or electronic prescription. When a written or electronic
422.24prescription is received, it must be communicated to the registered nurse in charge and
422.25recorded or placed in the client's record.
422.26    Subd. 17. Records confidential. A prescription or order received verbally, in
422.27writing, or electronically must be kept confidential according to sections 144.291 to
422.28144.298 and 144A.44.
422.29    Subd. 18. Medications provided by client or family members. When the
422.30comprehensive home care provider is aware of any medications or dietary supplements
422.31that are being used by the client and are not included in the assessment for medication
422.32management services, the staff must advise the registered nurse and document that in
422.33the client's record.
422.34    Subd. 19. Storage of drugs. A comprehensive home care provider providing
422.35storage of medications outside of the client's private living space must store all prescription
423.1drugs in securely locked and substantially constructed compartments according to the
423.2manufacturer's directions and permit only authorized personnel to have access.
423.3    Subd. 20. Prescription drugs. A prescription drug, prior to being set up for
423.4immediate or later administration, must be kept in the original container in which it was
423.5dispensed by the pharmacy bearing the original prescription label with legible information
423.6including the expiration or beyond-use date of a time-dated drug.
423.7    Subd. 21. Prohibitions. No prescription drug supply for one client may be used or
423.8saved for use by anyone other than the client.
423.9    Subd. 22. Disposition of drugs. (a) Any current medications being managed by the
423.10comprehensive home care provider must be given to the client or the client's representative
423.11when the client's service plan ends or medication management services are no longer part
423.12of the service plan. Medications that have been stored in the client's private living space
423.13for a client that is deceased or that have been discontinued or that have expired may be
423.14given to the client or the client's representative for disposal.
423.15(b) The comprehensive home care provider will dispose of any medications
423.16remaining with the comprehensive home care provider that are discontinued or expired or
423.17upon the termination of the service contract or the client's death according to state and
423.18federal regulations for disposition of drugs and controlled substances.
423.19(c) Upon disposition, the comprehensive home care provider must document in the
423.20client's record the disposition of the medications including the medication's name, strength,
423.21prescription number as applicable, quantity, to whom the medications were given, date of
423.22disposition, and names of staff and other individuals involved in the disposition.
423.23    Subd. 23. Loss or spillage. (a) Comprehensive home care providers providing
423.24medication management must develop and implement procedures for loss or spillage of all
423.25controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must
423.26require that when a spillage of a controlled substance occurs, a notation must be made
423.27in the client's record explaining the spillage and the actions taken. The notation must
423.28be signed by the person responsible for the spillage and include verification that any
423.29contaminated substance was disposed of according to state or federal regulations.
423.30(b) The procedures must require the comprehensive home care provider of
423.31medication management to investigate any known loss or unaccounted for prescription
423.32drugs and take appropriate action required under state or federal regulations and document
423.33the investigation in required records.

423.34    Sec. 19. [144A.4793] TREATMENT AND THERAPY MANAGEMENT
423.35SERVICES.
424.1    Subdivision 1. Providers with a comprehensive home care license. This section
424.2applies only to home care providers with a comprehensive home care license that provide
424.3treatment or therapy management services to clients. Treatment or therapy management
424.4services cannot be provided by a home care provider that has a basic home care license.
424.5    Subd. 2. Policies and procedures. (a) A comprehensive home care provider who
424.6provides treatment and therapy management services must develop, implement, and
424.7maintain up-to-date written treatment or therapy management policies and procedures.
424.8The policies and procedures must be developed under the supervision and direction of
424.9a registered nurse or appropriate licensed health professional consistent with current
424.10practice standards and guidelines.
424.11(b) The written policies and procedures must address requesting and receiving
424.12orders or prescriptions for treatments or therapies, providing the treatment or therapy,
424.13documenting of treatment or therapy activities, educating and communicating with clients
424.14about treatments or therapy they are receiving, monitoring and evaluating the treatment
424.15and therapy, and communicating with the prescriber.
424.16    Subd. 3. Individualized treatment or therapy management plan. For each
424.17client receiving management of ordered or prescribed treatments or therapy services, the
424.18comprehensive home care provider must prepare and include in the service plan a written
424.19statement of the treatment or therapy services that will be provided to the client. The
424.20provider must also develop and maintain a current individualized treatment and therapy
424.21management record for each client which must contain at least the following:
424.22(1) a statement of the type of services that will be provided;
424.23(2) documentation of specific client instructions relating to the treatments or therapy
424.24administration;
424.25(3) identification of treatment or therapy tasks that will be delegated to unlicensed
424.26personnel;
424.27(4) procedures for notifying a registered nurse or appropriate licensed health
424.28professional when a problem arises with treatments or therapy services; and
424.29(5) any client-specific requirements relating to documentation of treatment
424.30and therapy received, verification that all treatment and therapy was administered as
424.31prescribed, and monitoring of treatment or therapy to prevent possible complications or
424.32adverse reactions. The treatment or therapy management record must be current and
424.33updated when there are any changes.
424.34    Subd. 4. Administration of treatments and therapy. Ordered or prescribed
424.35treatments or therapies must be administered by a nurse, physician, or other licensed health
424.36professional authorized to perform the treatment or therapy, or may be delegated or assigned
425.1to unlicensed personnel by the licensed health professional according to the appropriate
425.2practice standards for delegation or assignment. When administration of a treatment or
425.3therapy is delegated or assigned to unlicensed personnel, the home care provider must
425.4ensure that the registered nurse or authorized licensed health professional has:
425.5(1) instructed the unlicensed personnel in the proper methods with respect to each
425.6client and has demonstrated their ability to competently follow the procedures;
425.7(2) specified, in writing, specific instructions for each client and documented those
425.8instructions in the client's record; and
425.9(3) communicated with the unlicensed personnel about the individual needs of
425.10the client.
425.11    Subd. 5. Documentation of administration of treatments and therapies. Each
425.12treatment or therapy administered by a comprehensive home care provider must be
425.13documented in the client's record. The documentation must include the signature and title
425.14of the person who administered the treatment or therapy and must include the date and
425.15time of administration. When treatment or therapies are not administered as ordered or
425.16prescribed, the provider must document the reason why it was not administered and any
425.17follow-up procedures that were provided to meet the client's needs.
425.18    Subd. 6. Orders or prescriptions. There must be an up-to-date written or
425.19electronically recorded order or prescription for all treatments and therapies. The order
425.20must contain the name of the client, description of the treatment or therapy to be provided,
425.21and the frequency and other information needed to administer the treatment or therapy.

425.22    Sec. 20. [144A.4794] CLIENT RECORD REQUIREMENTS.
425.23    Subdivision 1. Client record. (a) The home care provider must maintain records
425.24for each client for whom it is providing services. Entries in the client records must be
425.25current, legible, permanently recorded, dated, and authenticated with the name and title
425.26of the person making the entry.
425.27(b) Client records, whether written or electronic, must be protected against loss,
425.28tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable
425.29relevant federal and state laws. The home care provider shall establish and implement
425.30written procedures to control use, storage, and security of client's records and establish
425.31criteria for release of client information.
425.32(c) The home care provider may not disclose to any other person any personal,
425.33financial, medical, or other information about the client, except:
425.34(1) as may be required by law;
426.1(2) to employees or contractors of the home care provider, another home care
426.2provider, other health care practitioner or provider, or inpatient facility needing
426.3information in order to provide services to the client, but only such information that
426.4is necessary for the provision of services;
426.5(3) to persons authorized in writing by the client or the client's representative to
426.6receive the information, including third-party payers; and
426.7(4) to representatives of the commissioner authorized to survey or investigate home
426.8care providers under this chapter or federal laws.
426.9    Subd. 2. Access to records. The home care provider must ensure that the
426.10appropriate records are readily available to employees or contractors authorized to access
426.11the records. Client records must be maintained in a manner that allows for timely access,
426.12printing, or transmission of the records.
426.13    Subd. 3. Contents of client record. Contents of a client record include the
426.14following for each client:
426.15(1) identifying information, including the client's name, date of birth, address, and
426.16telephone number;
426.17(2) the name, address, and telephone number of an emergency contact, family
426.18members, client's representative, if any, or others as identified;
426.19(3) names, addresses, and telephone numbers of the client's health and medical
426.20service providers and other home care providers, if known;
426.21(4) health information, including medical history, allergies, and when the provider
426.22is managing medications, treatments or therapies that require documentation, and other
426.23relevant health records;
426.24(5) client's advance directives, if any;
426.25(6) the home care provider's current and previous assessments and service plans;
426.26(7) all records of communications pertinent to the client's home care services;
426.27(8) documentation of significant changes in the client's status and actions taken in
426.28response to the needs of the client including reporting to the appropriate supervisor or
426.29health care professional;
426.30(9) documentation of incidents involving the client and actions taken in response
426.31to the needs of the client including reporting to the appropriate supervisor or health
426.32care professional;
426.33(10) documentation that services have been provided as identified in the service plan;
426.34(11) documentation that the client has received and reviewed the home care bill
426.35of rights;
427.1(12) documentation that the client has been provided the statement of disclosure on
427.2limitations of services under section 144A.4791, subdivision 3;
427.3(13) documentation of complaints received and resolution;
427.4(14) discharge summary, including service termination notice and related
427.5documentation, when applicable; and
427.6(15) other documentation required under this chapter and relevant to the client's
427.7services or status.
427.8    Subd. 4. Transfer of client records. If a client transfers to another home care
427.9provider or other health care practitioner or provider, or is admitted to an inpatient facility,
427.10the home care provider, upon request of the client or the client's representative, shall take
427.11steps to ensure a coordinated transfer including sending a copy or summary of the client's
427.12record to the new home care provider, facility, or the client, as appropriate.
427.13    Subd. 5. Record retention. Following the client's discharge or termination of
427.14services, a home care provider must retain a client's record for at least five years, or as
427.15otherwise required by state or federal regulations. Arrangements must be made for secure
427.16storage and retrieval of client records if the home care provider ceases business.

427.17    Sec. 21. [144A.4795] HOME CARE PROVIDER RESPONSIBILITIES; STAFF.
427.18    Subdivision 1. Qualifications, training, and competency. All staff providing
427.19home care services must be trained and competent in the provision of home care services
427.20consistent with current practice standards appropriate to the client's needs.
427.21    Subd. 2. Licensed health professionals and nurses. (a) Licensed health
427.22professionals and nurses providing home care services as an employee of a licensed home
427.23care provider must possess current Minnesota license or registration to practice.
427.24(b) Licensed health professionals and registered nurses must be competent in
427.25assessing client needs, planning appropriate home care services to meet client needs,
427.26implementing services, and supervising staff if assigned.
427.27(c) Nothing in this section limits or expands the rights of nurses or licensed health
427.28professionals to provide services within the scope of their licenses or registrations, as
427.29provided by law.
427.30    Subd. 3. Unlicensed personnel. (a) Unlicensed personnel providing basic home
427.31care services must have:
427.32(1) successfully completed a training and competency evaluation appropriate to
427.33the services provided by the home care provider and the topics listed in subdivision 7,
427.34paragraph (b); or
428.1(2) demonstrated competency by satisfactorily completing a written or oral test on
428.2the tasks the unlicensed personnel will perform and in the topics listed in subdivision
428.37, paragraph (b); and successfully demonstrate competency of topics in subdivision 7,
428.4paragraph (b), clauses (5), (7), and (8), by a practical skills test.
428.5Unlicensed personnel providing home care services for a basic home care provider may
428.6not perform delegated nursing or therapy tasks.
428.7(b) Unlicensed personnel performing delegated nursing tasks for a comprehensive
428.8home care provider must:
428.9(1) have successfully completed training and demonstrated competency by
428.10successfully completing a written or oral test of the topics in subdivision 7, paragraphs (b)
428.11and (c), and a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5)
428.12and (7), and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform;
428.13(2) satisfy the current requirements of Medicare for training or competency of home
428.14health aides or nursing assistants, as provided by Code of Federal Regulations, title 42,
428.15section 483 or section 484.36; or
428.16(3) have, before April 19, 1993, completed a training course for nursing assistants
428.17that was approved by the commissioner.
428.18(c) Unlicensed personnel performing therapy or treatment tasks delegated or
428.19assigned by a licensed health professional must meet the requirements for delegated
428.20tasks in subdivision 4 and any other training or competency requirements within the
428.21licensed health professional scope of practice relating to delegation or assignment of tasks
428.22to unlicensed personnel.
428.23    Subd. 4. Delegation of home care tasks. A registered nurse or licensed health
428.24professional may delegate tasks only to staff that are competent and possess the knowledge
428.25and skills consistent with the complexity of the tasks and according to the appropriate
428.26Minnesota Practice Act. The comprehensive home care provider must establish and
428.27implement a system to communicate up-to-date information to the registered nurse or
428.28licensed health professional regarding the current available staff and their competency so
428.29the registered nurse or licensed health professional has sufficient information to determine
428.30the appropriateness of delegating tasks to meet individual client needs and preferences.
428.31    Subd. 5. Individual contractors. When a home care provider contracts with an
428.32individual contractor excluded from licensure under section 144A.471 to provide home
428.33care services, the contractor must meet the same requirements required by this section for
428.34personnel employed by the home care provider.
428.35    Subd. 6. Temporary staff. When a home care provider contracts with a temporary
428.36staffing agency excluded from licensure under section 144A.471, those individuals must
429.1meet the same requirements required by this section for personnel employed by the home
429.2care provider and shall be treated as if they are staff of the home care provider.
429.3    Subd. 7. Requirements for instructors, training content, and competency
429.4evaluations for unlicensed personnel. (a) Instructors and competency evaluators must
429.5meet the following requirements:
429.6(1) training and competency evaluations of unlicensed personnel providing basic
429.7home care services must be conducted by individuals with work experience and training in
429.8providing home care services listed in section 144A.471, subdivisions 6 and 7; and
429.9(2) training and competency evaluations of unlicensed personnel providing
429.10comprehensive home care services must be conducted by a registered nurse, or another
429.11instructor may provide training in conjunction with the registered nurse. If the home care
429.12provider is providing services by licensed health professionals only, then that specific
429.13training and competency evaluation may be conducted by the licensed health professionals
429.14as appropriate.
429.15(b) Training and competency evaluations for all unlicensed personnel must include
429.16the following:
429.17(1) documentation requirements for all services provided;
429.18(2) reports of changes in the client's condition to the supervisor designated by the
429.19home care provider;
429.20(3) basic infection control, including blood-borne pathogens;
429.21(4) maintenance of a clean and safe environment;
429.22(5) appropriate and safe techniques in personal hygiene and grooming, including:
429.23(i) hair care and bathing;
429.24(ii) care of teeth, gums, and oral prosthetic devices;
429.25(iii) care and use of hearing aids; and
429.26(iv) dressing and assisting with toileting;
429.27(6) training on the prevention of falls for providers working with the elderly or
429.28individuals at risk of falls;
429.29(7) standby assistance techniques and how to perform them;
429.30(8) medication, exercise, and treatment reminders;
429.31(9) basic nutrition, meal preparation, food safety, and assistance with eating;
429.32(10) preparation of modified diets as ordered by a licensed health professional;
429.33(11) communication skills that include preserving the dignity of the client and
429.34showing respect for the client and the client's preferences, cultural background, and family;
429.35(12) awareness of confidentiality and privacy;
430.1(13) understanding appropriate boundaries between staff and clients and the client's
430.2family;
430.3(14) procedures to utilize in handling various emergency situations; and
430.4(15) awareness of commonly used health technology equipment and assistive devices.
430.5(c) In addition to paragraph (b), training and competency evaluation for unlicensed
430.6personnel providing comprehensive home care services must include:
430.7(1) observation, reporting, and documenting of client status;
430.8(2) basic knowledge of body functioning and changes in body functioning, injuries,
430.9or other observed changes that must be reported to appropriate personnel;
430.10(3) reading and recording temperature, pulse, and respirations of the client;
430.11(4) recognizing physical, emotional, cognitive, and developmental needs of the client;
430.12(5) safe transfer techniques and ambulation;
430.13(6) range of motioning and positioning; and
430.14(7) administering medications or treatments as required.
430.15(d) When the registered nurse or licensed health professional delegates tasks, they
430.16must ensure that prior to the delegation the unlicensed personnel is trained in the proper
430.17methods to perform the tasks or procedures for each client and are able to demonstrate
430.18the ability to competently follow the procedures and perform the tasks. If an unlicensed
430.19personnel has not regularly performed the delegated home care task for a period of 24
430.20consecutive months, the unlicensed personnel must demonstrate competency in the task
430.21to the registered nurse or appropriate licensed health professional. The registered nurse
430.22or licensed health professional must document instructions for the delegated tasks in
430.23the client's record.

430.24    Sec. 22. [144A.4796] ORIENTATION AND ANNUAL TRAINING
430.25REQUIREMENTS.
430.26    Subdivision 1. Orientation of staff and supervisors to home care. All staff
430.27providing and supervising direct home care services must complete an orientation to home
430.28care licensing requirements and regulations before providing home care services to clients.
430.29The orientation may be incorporated into the training required under subdivision 6. The
430.30orientation need only be completed once for each staff person and is not transferable
430.31to another home care provider.
430.32    Subd. 2. Content. The orientation must contain the following topics:
430.33    (1) an overview of sections 144A.43 to 144A.4798;
430.34(2) introduction and review of all the provider's policies and procedures related to
430.35the provision of home care services;
431.1(3) handling of emergencies and use of emergency services;
431.2(4) compliance with and reporting the maltreatment of minors or vulnerable adults
431.3under sections 626.556 and 626.557;
431.4(5) home care bill of rights, under section 144A.44;
431.5(6) handling of clients' complaints; reporting of complaints and where to report
431.6complaints including information on the Office of Health Facility Complaints and the
431.7Common Entry Point;
431.8(7) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
431.9Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
431.10Ombudsman at the Department of Human Services, county managed care advocates,
431.11or other relevant advocacy services; and
431.12(8) review of the types of home care services the employee will be providing and
431.13the provider's scope of licensure.
431.14    Subd. 3. Verification and documentation of orientation. Each home care provider
431.15shall retain evidence in the employee record of each staff person having completed the
431.16orientation required by this section.
431.17    Subd. 4. Orientation to client. Staff providing home care services must be oriented
431.18specifically to each individual client and the services to be provided. This orientation may
431.19be provided in person, orally, in writing, or electronically.
431.20    Subd. 5. Training required relating to Alzheimer's disease and related disorders.
431.21For home care providers that provide services for persons with Alzheimer's or related
431.22disorders, all direct care staff and supervisors working with those clients must receive
431.23training that includes a current explanation of Alzheimer's disease and related disorders
431.24effective approaches to use to problem solve when working with a client's challenging
431.25behaviors, and how to communicate with clients who have Alzheimer's or related disorders.
431.26    Subd. 6. Required annual training. All staff that perform direct home care
431.27services must complete at least eight hours of annual training for each 12 months of
431.28employment. The training may be obtained from the home care provider or another source
431.29and must include topics relevant to the provision of home care services. The annual
431.30training must include:
431.31(1) training on reporting of maltreatment of minors under section 626.556 and
431.32maltreatment of vulnerable adults under section 626.557, whichever is applicable to the
431.33services provided;
431.34(2) review of the home care bill of rights in section 144A.44;
431.35(3) review of infection control techniques used in the home and implementation of
431.36infection control standards including a review of hand washing techniques; the need for
432.1and use of protective gloves, gowns, and masks; appropriate disposal of contaminated
432.2materials and equipment, such as dressings, needles, syringes, and razor blades;
432.3disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of
432.4communicable diseases; and
432.5(4) review of the provider's policies and procedures relating to the provision of home
432.6care services and how to implement those policies and procedures.
432.7    Subd. 7. Documentation. A home care provider must retain documentation in the
432.8employee records of the staff that have satisfied the orientation and training requirements
432.9of this section.

432.10    Sec. 23. [144A.4797] PROVISION OF SERVICES.
432.11    Subdivision 1. Availability of contact person to staff. (a) A home care provider
432.12with a basic home care license must have a person available to staff for consultation on
432.13items relating to the provision of services or about the client.
432.14(b) A home care provider with a comprehensive home care license must have a
432.15registered nurse available for consultation to staff performing delegated nursing tasks
432.16and must have an appropriate licensed health professional available if performing other
432.17delegated services such as therapies.
432.18(c) The appropriate contact person must be readily available either in person, by
432.19telephone, or by other means to the staff at times when the staff is providing services.
432.20    Subd. 2. Supervision of staff; basic home care services. (a) Staff who perform
432.21basic home care services must be supervised periodically where the services are being
432.22provided to verify that the work is being performed competently and to identify problems
432.23and solutions to address issues relating to the staff's ability to provide the services. The
432.24supervision of the unlicensed personnel must be done by staff of the home care provider
432.25having the authority, skills, and ability to provide the supervision of unlicensed personnel
432.26and who can implement changes as needed, and train staff.
432.27(b) Supervision includes direct observation of unlicensed personnel while they
432.28are providing the services and may also include indirect methods of gaining input such
432.29as gathering feedback from the client. Supervisory review of staff must be provided at a
432.30frequency based on the staff person's competency and performance.
432.31(c) For an individual who is licensed as a home care provider, this section does
432.32not apply.
432.33    Subd. 3. Supervision of staff providing delegated nursing or therapy home
432.34care tasks. (a) Staff who perform delegated nursing or therapy home care tasks must be
432.35supervised by an appropriate licensed health professional or a registered nurse periodically
433.1where the services are being provided to verify that the work is being performed
433.2competently and to identify problems and solutions related to the staff person's ability to
433.3perform the tasks. Supervision of staff performing medication or treatment administration
433.4shall be provided by a registered nurse or appropriate licensed health professional and
433.5must include observation of the staff administering the medication or treatment and the
433.6interaction with the client.
433.7(b) The direct supervision of staff performing delegated tasks must be provided
433.8within 30 days after the individual begins working for the home care provider and
433.9thereafter as needed based on performance. This requirement also applies to staff who
433.10have not performed delegated tasks for one year or longer.
433.11    Subd. 4. Documentation. A home care provider must retain documentation of
433.12supervision activities in the personnel records.
433.13    Subd. 5. Exemption. This section does not apply to an individual licensed under
433.14sections 144A.43 to 144A.4799.

433.15    Sec. 24. [144A.4798] EMPLOYEE HEALTH STATUS.
433.16    Subdivision 1. Tuberculosis (TB) prevention and control. A home care provider
433.17must establish and maintain a TB prevention and control program based on the most
433.18current guidelines issued by the Centers for Disease Control and Prevention (CDC).
433.19Components of a TB prevention and control program include screening all staff providing
433.20home care services, both paid and unpaid, at the time of hire for active TB disease and
433.21latent TB infection, and developing and implementing a written TB infection control plan.
433.22The commissioner shall make the most recent CDC standards available to home care
433.23providers on the department's Web site.
433.24    Subd. 2. Communicable diseases. A home care provider must follow
433.25current federal or state guidelines for prevention, control, and reporting of human
433.26immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other
433.27communicable diseases as defined in Minnesota Rules, part 4605.7040.

433.28    Sec. 25. [144A.4799] DEPARTMENT OF HEALTH LICENSED HOME CARE
433.29PROVIDER ADVISORY COUNCIL.
433.30    Subdivision 1. Membership. The commissioner of health shall appoint eight
433.31persons to a home care provider advisory council consisting of the following:
433.32(1) three public members as defined in section 214.02 who shall be either persons
433.33who are currently receiving home care services or have family members receiving home
434.1care services, or persons who have family members who have received home care services
434.2within five years of the application date;
434.3(2) three Minnesota home care licensees representing basic and comprehensive
434.4levels of licensure who may be a managerial official, an administrator, a supervising
434.5registered nurse, or an unlicensed personnel performing home care tasks;
434.6(3) one member representing the Minnesota Board of Nursing; and
434.7(4) one member representing the ombudsman for long-term care.
434.8    Subd. 2. Organizations and meetings. The advisory council shall be organized
434.9and administered under section 15.059 with per diems and costs paid within the limits of
434.10available appropriations. Meetings will be held quarterly and hosted by the department.
434.11Subcommittees may be developed as necessary by the commissioner. Advisory council
434.12meetings are subject to the Open Meeting Law under chapter 13D.
434.13    Subd. 3. Duties. At the commissioner's request, the advisory council shall provide
434.14advice regarding regulations of Department of Health licensed home care providers in
434.15this chapter such as:
434.16(1) advice to the commissioner regarding community standards for home care
434.17practices;
434.18(2) advice to the commissioner on enforcement of licensing standards and whether
434.19certain disciplinary actions are appropriate;
434.20(3) advice to the commissioner about ways of distributing information to licensees
434.21and consumers of home care;
434.22(4) advice to the commissioner about training standards;
434.23(5) identify emerging issues and opportunities in the home care field, including the
434.24use of technology in home and telehealth capabilities; and
434.25(6) perform other duties as directed by the commissioner.

434.26    Sec. 26. [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR
434.27NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.
434.28    Subdivision 1. Temporary home care licenses and changes of ownership. (a)
434.29Beginning January 1, 2014, all temporary license applicants must apply for either a
434.30temporary basic or comprehensive home care license.
434.31(b) Temporary home care temporary licenses issued beginning January 1, 2014,
434.32will be issued according to the provisions in sections 144A.43 to 144A.4799 and fees in
434.33section 144A.472 and will be required to comply with this chapter.
434.34(c) No temporary licenses or licenses will be accepted or issued between October 1,
434.352013, and December 31, 2013.
435.1(d) Beginning October 1, 2013, changes in ownership applications will require
435.2payment of the new fees listed in section 144A.472.
435.3    Subd. 2. Current home care licensees with licenses prior to July 1, 2013. (a)
435.4Beginning July 1, 2014, department licensed home care providers must apply for either
435.5the basic or comprehensive home care license on their regularly scheduled renewal date.
435.6(b) By June 30, 2015, all home care providers must either have a basic or
435.7comprehensive home care license or temporary license.
435.8    Subd. 3. Renewal application of home care licensure during transition period.
435.9Renewal of home care licenses issued beginning July 1, 2014, will be issued according to
435.10sections 144A.43 to 144A.4799 and, upon license renewal, providers must comply with
435.11sections 144A.43 to 144A.4799. Prior to renewal, providers must comply with the home
435.12care licensure law in effect on June 30, 2013.
435.13The fees charged for licenses renewed between July 1, 2014, and June 30, 2016,
435.14shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000
435.15increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
435.16For fiscal year 2014 only, the fees for providers with revenues greater than $25,000
435.17and no more than $100,000 will be $313 and for providers with revenues no more than
435.18$25,000 the fee will be $125.

435.19    Sec. 27. [144A.482] REGISTRATION OF HOME MANAGEMENT
435.20PROVIDERS.
435.21(a) For purposes of this section, a home management provider is an individual or
435.22organization that provides at least two of the following services: housekeeping, meal
435.23preparation, and shopping, to a person who is unable to perform these activities due to
435.24illness, disability, or physical condition.
435.25(b) A person or organization that provides only home management services may not
435.26operate in the state without a current certificate of registration issued by the commissioner
435.27of health. To obtain a certificate of registration, the person or organization must annually
435.28submit to the commissioner the name, mailing and physical address, e-mail address, and
435.29telephone number of the individual or organization and a signed statement declaring that
435.30the individual or organization is aware that the home care bill of rights applies to their
435.31clients and that the person or organization will comply with the home care bill of rights
435.32provisions contained in section 144A.44. An individual or organization applying for a
435.33certificate must also provide the name, business address, and telephone number of each of
435.34the individuals responsible for the management or direction of the organization.
436.1(c) The commissioner shall charge an annual registration fee of $20 for individuals
436.2and $50 for organizations. The registration fee shall be deposited in the state treasury and
436.3credited to the state government special revenue fund.
436.4(d) A home care provider that provides home management services and other home
436.5care services must be licensed, but licensure requirements other than the home care bill of
436.6rights do not apply to those employees or volunteers who provide only home management
436.7services to clients who do not receive any other home care services from the provider.
436.8A licensed home care provider need not be registered as a home management service
436.9provider, but must provide an orientation on the home care bill of rights to its employees
436.10or volunteers who provide home management services.
436.11(e) An individual who provides home management services under this section must,
436.12within 120 days after beginning to provide services, attend an orientation session approved
436.13by the commissioner that provides training on the home care bill of rights and an orientation
436.14on the aging process and the needs and concerns of elderly and disabled persons.
436.15(f) The commissioner may suspend or revoke a provider's certificate of registration
436.16or assess fines for violation of the home care bill of rights. Any fine assessed for a
436.17violation of the home care bill of rights by a provider registered under this section shall be
436.18in the amount established in the licensure rules for home care providers. As a condition
436.19of registration, a provider must cooperate fully with any investigation conducted by the
436.20commissioner, including providing specific information requested by the commissioner on
436.21clients served and the employees and volunteers who provide services. Fines collected
436.22under this paragraph shall be deposited in the state treasury and credited to the fund
436.23specified in the statute or rule in which the penalty was established.
436.24(g) The commissioner may use any of the powers granted in sections 144A.43 to
436.25144A.4799 to administer the registration system and enforce the home care bill of rights
436.26under this section.

436.27    Sec. 28. AGENCY QUALITY IMPROVEMENT PROGRAM.
436.28    Subdivision 1. Annual legislative report on home care licensing. The
436.29commissioner shall establish a quality improvement program for the home care survey
436.30and home care complaint investigation processes. The commissioner shall submit to the
436.31legislature an annual report, beginning October 1, 2015, and each October 1 thereafter.
436.32Each report will review the previous state fiscal year of home care licensing and regulatory
436.33activities. The report must include, but is not limited to, an analysis of:
437.1(1) the number of FTE's in the Division of Compliance Monitoring, including the
437.2Office of Health Facility Complaints units assigned to home care licensing, survey,
437.3investigation and enforcement process;
437.4(2) numbers of and descriptive information about licenses issued, complaints
437.5received and investigated, including allegations made and correction orders issued,
437.6surveys completed and timelines, and correction order reconsiderations and results;
437.7(3) descriptions of emerging trends in home care provision and areas of concern
437.8identified by the department in its regulation of home care providers;
437.9(4) information and data regarding performance improvement projects underway
437.10and planned by the commissioner in the area of home care surveys; and
437.11(5) work of the Department of Health Home Care Advisory Council.
437.12    Subd. 2. Study of correction order appeal process. Starting July 1, 2015, the
437.13commissioner shall study whether to add a correction order appeal process conducted by
437.14an independent reviewer such as an administrative law judge or other office and submit a
437.15report to the legislature by February 1, 2016. The commissioner shall review home care
437.16regulatory systems in other states as part of that study. The commissioner shall consult
437.17with the home care providers and representatives.

437.18    Sec. 29. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
437.19AND COMMUNITY-BASED SERVICES.
437.20(a) The Department of Health Compliance Monitoring Division and the Department
437.21of Human Services Licensing Division shall jointly develop an integrated licensing system
437.22for providers of both home care services subject to licensure under Minnesota Statutes,
437.23chapter 144A, and for home and community-based services subject to licensure under
437.24Minnesota Statutes, chapter 245D. The integrated licensing system shall:
437.25(1) require only one license of any provider of services under Minnesota Statutes,
437.26sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
437.27(2) promote quality services that recognize a person's individual needs and protect
437.28the person's health, safety, rights, and well-being;
437.29(3) promote provider accountability through application requirements, compliance
437.30inspections, investigations, and enforcement actions;
437.31(4) reference other applicable requirements in existing state and federal laws,
437.32including the federal Affordable Care Act;
437.33(5) establish internal procedures to facilitate ongoing communications between the
437.34agencies, and with providers and services recipients about the regulatory activities;
438.1(6) create a link between the agency Web sites so that providers and the public can
438.2access the same information regardless of which Web site is accessed initially; and
438.3(7) collect data on identified outcome measures as necessary for the agencies to
438.4report to the Centers for Medicare and Medicaid Services.
438.5(b) The joint recommendations for legislative changes to implement the integrated
438.6licensing system are due to the legislature by February 15, 2014.
438.7(c) Before implementation of the integrated licensing system, providers licensed as
438.8home care providers under Minnesota Statutes, chapter 144A, may also provide home
438.9and community-based services subject to licensure under Minnesota Statutes, chapter
438.10245D, without obtaining a home and community-based services license under Minnesota
438.11Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
438.12apply to these providers:
438.13(1) the provider must comply with all requirements under Minnesota Statutes, chapter
438.14245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
438.15(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
438.16enforced by the Department of Health under the enforcement authority set forth in
438.17Minnesota Statutes, section 144A.475; and
438.18(3) the Department of Health will provide information to the Department of Human
438.19Services about each provider licensed under this section, including the provider's license
438.20application, licensing documents, inspections, information about complaints received, and
438.21investigations conducted for possible violations of Minnesota Statutes, chapter 245D.

438.22    Sec. 30. REPEALER.
438.23(a) Minnesota Statutes 2012, sections 144A.46; and 144A.461, are repealed.
438.24(b) Minnesota Rules, parts 4668.0002; 4668.0003; 4668.0005; 4668.0008;
438.254668.0012; 4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040;
438.264668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100;
438.274668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160; 4668.0170;
438.284668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220; 4668.0230; 4668.0240;
438.294668.0800; 4668.0805; 4668.0810; 4668.0815; 4668.0820; 4668.0825; 4668.0830;
438.304668.0835; 4668.0840; 4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870;
438.314669.0001; 4669.0010; 4669.0020; 4669.0030; 4669.0040; and 4669.0050, are repealed.

438.32    Sec. 31. EFFECTIVE DATE.
438.33Sections 1 to 30 are effective the day following final enactment.


439.3    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 2, is amended to read:
439.4    Subd. 2. Transfers. (a) Notwithstanding section 295.581, to the extent available
439.5resources in the health care access fund exceed expenditures in that fund, effective for
439.6the biennium beginning July 1, 2007, the commissioner of management and budget shall
439.7transfer the excess funds from the health care access fund to the general fund on June 30
439.8of each year, provided that the amount transferred in any fiscal biennium shall not exceed
439.9$96,000,000. The purpose of this transfer is to meet the rate increase required under Laws
439.102003, First Special Session chapter 14, article 13C, section 2, subdivision 6.
439.11    (b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and,
439.12if necessary, the commissioner shall reduce these transfers from the health care access
439.13fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary,
439.14transfer sufficient funds from the general fund to the health care access fund to meet
439.15annual MinnesotaCare expenditures.
439.16(c) Notwithstanding section 295.581, to the extent available resources in the health
439.17care access fund exceed expenditures in that fund, effective for the biennium beginning
439.18July 1, 2013, the commissioner of management and budget shall transfer $1,000,000 each
439.19fiscal year from the health access fund to the medical education and research costs fund
439.20established under section 62J.692, for distribution under section 62J.692, subdivision 4,
439.21paragraph (b).

439.22    Sec. 2. [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
439.23    Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
439.24paragraphs (b) to (e) have the meanings given.
439.25    (b) "Autism spectrum disorders" means the conditions as determined by criteria
439.26set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental
439.27Disorders of the American Psychiatric Association.
439.28    (c) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
439.29    (d) "Medically necessary care" means health care services appropriate, in terms of
439.30type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
439.31testing and preventative services. Medically necessary care must be consistent with
439.32generally accepted practice parameters as determined by physicians and licensed
439.33psychologists who typically manage patients who have autism spectrum disorders.
440.1    (e) "Mental health professional" has the meaning given in section 245.4871,
440.2subdivision 27.
440.3    Subd. 2. Optional coverage required. (a) A health plan must provide:
440.4    (1) all health benefits related to the treatment of autism spectrum disorders required
440.5by the essential health benefits required under section 1302 of the Affordable Care Act;
440.6    (2) all health benefits required by this section or any other section of Minnesota
440.7Statutes as of December 31, 2012; and
440.8    (3) an offer of one or more options for the purchase of supplemental autism coverage
440.9for young children for children under age 18 for the diagnosis, evaluation, assessment,
440.10and medically necessary care of autism spectrum disorders, including but not limited to
440.11the following:
440.12    (i) early intensive behavioral and developmental therapy based in behavioral and
440.13developmental science, including but not limited to applied behavior analysis, intensive
440.14early intervention behavior therapy, intensive behavior intervention, and Lovaas therapy
440.15and developmental approaches;
440.16    (ii) neurodevelopmental and behavioral health treatments and management;
440.17    (iii) speech therapy;
440.18    (iv) occupational therapy;
440.19    (v) physical therapy; and
440.20    (vi) medications.
440.21    (b) The diagnosis, evaluation, and assessment must include an assessment of the
440.22child's developmental skills, functional behavior, needs, and capacities.
440.23    (c) The coverage option required under this section shall include treatment that is
440.24in accordance with an individualized treatment plan prescribed by the insured's treating
440.25physician or mental health professional.
440.26    (d) A health plan may not refuse to renew or reissue, or otherwise terminate or
440.27restrict, coverage of an individual solely because the individual is diagnosed with an
440.28autism spectrum disorder.
440.29    (e) A health plan may request an updated treatment plan only once every six months,
440.30unless the health plan and the treating physician or mental health professional agree that a
440.31more frequent review is necessary due to emerging circumstances.
440.32    (f) An independent progress evaluation conducted by a mental health professional
440.33with expertise and training in autism spectrum disorder and child development must
440.34be completed to determine if progress toward functional and generalizable gains, as
440.35determined in the treatment plan, is being made.
441.1    (g) A health plan may cap the dollar value of the supplemental coverage offered
441.2under this subdivision, but may not cap the value at less than $50,000 per calendar year
441.3per individual receiving a diagnosis of autism spectrum disorder.
441.4    Subd. 3. No effect on other law. Nothing in this section limits in any way the
441.5coverage required under section 62Q.47.
441.6    Subd. 4. State health care programs. This section does not affect benefits available
441.7under the medical assistance and MinnesotaCare programs and does not limit, restrict, or
441.8otherwise reduce coverage under these programs.
441.9EFFECTIVE DATE.This section is effective January 1, 2014, and sunsets effective
441.10December 31, 2015, and applies to coverage offered, issued, sold, renewed, or continued
441.11as defined in Minnesota Statutes, section 60A.02, subdivision 2a, on or after that date.

441.12    Sec. 3. [62D.0425] NET WORTH LIMIT.
441.13(a) Between July 1, 2013, and June 30, 2018, no health maintenance organization
441.14shall have a net worth of more than 25 percent of the sum of all expenses incurred during
441.15the most recent calendar year, except as provided in paragraph (b).
441.16(b) A health maintenance organization may have a net worth of more than 25 percent
441.17of the sum of all expenses incurred during the most recent calendar year if necessary to
441.18maintain capital reserves at the level of the product of 2.0 and its authorized control
441.19level risk-based capital, as required pursuant to sections 60A.50 to 60A.592 and 62D.04.
441.20Paragraphs (c) and (d) do not apply to health maintenance organizations permitted, under
441.21this paragraph, to have a net worth greater than 25 percent of the sum of all expenses
441.22incurred during the most recent calendar year.
441.23(c) By June 15, 2013, and annually thereafter until June 15, 2017, for a health
441.24maintenance organization that has a net worth of more than 25 percent of the sum of all
441.25expenses incurred during the most recent calendar year, the commissioner of health, in
441.26consultation with the commissioners of commerce and human services, shall determine:
441.27(1) capital reserves using the National Association of Insurance Commissioners
441.28definitions of admitted assets, which shall be used in clauses (2) to (5);
441.29(2) the proportion of capital reserves that are reasonably attributable to net
441.30underwriting gains in Minnesota public health care programs based on annual financial
441.31filings for calendar years 2003 through 2012;
441.32(3) the proportion of capital reserves that are reasonably attributable to investment
441.33gains associated with net underwriting gains in Minnesota public health care programs
441.34based on annual financial filings for calendar years 2003 through 2012;
442.1(4) any adjustments needed to clause (1) or (2) based on corporate reorganizations,
442.2since 2003; and
442.3(5) any adjustments needed to account for the impact of annual financial filings for
442.4calendar years 2013 through 2016.
442.5(d) A health maintenance organization that has a net worth of more than 25 percent
442.6of the sum of all expenses incurred during the most recent calendar year shall reduce its
442.7capital reserves as follows:
442.8(1) as determined by paragraph (c), the proportion of capital reserves that are greater
442.9than 25 percent of the sum of all expenses incurred during the most recent calendar
442.10year and that are reasonably attributable to net underwriting gains and investment gains
442.11associated with net underwriting gains in Minnesota public health care programs shall be
442.12spent down. The health maintenance organization shall place excess capital reserves in a
442.13special restricted account under the control of the health maintenance organization. The
442.14special restricted account may only be used to pay for a portion of the health maintenance
442.15organization's current public program enrollee premiums. The health maintenance
442.16organization shall spend no less than 50 percent of this special restricted account in any
442.17state fiscal year beginning on or after July 1, 2013; and
442.18(2) the proportion of capital reserves that are greater than 25 percent of the
442.19sum of all expenses incurred during the most recent calendar year and that are not
442.20reasonably attributable to net underwriting gains and investment gains associated with net
442.21underwriting gains in Minnesota public health care programs shall be spent down. The
442.22health maintenance organization shall place these excess capital reserves in a second
442.23special restricted account under the control of the health maintenance organization. The
442.24health maintenance organization may use this special restricted account to benefit current
442.25enrollees by moderating variation in premium increases, assisting enrollees in accessing
442.26new benefits, reducing health disparities, promoting health, wellness and preventive
442.27services, and improving care coordination. Prior to spending down excess reserves from
442.28this special revenue account, the health maintenance organization's spenddown plan must
442.29be approved by the commissioner of health. The health maintenance organization shall
442.30spend no less than 33 percent of this special restricted account in any state fiscal year
442.31beginning July 1, 2013.
442.32(e) The health maintenance organization must spend down all of the reserves placed
442.33in its special restricted accounts by July 1, 2018. All reserves placed in a special account
442.34must be spent according to paragraph (d), unless the reserves are necessary for the health
442.35maintenance organization to maintain capital reserves at the level of the product of 2.0 and
442.36its authorized control level risk-based capital, as required pursuant to sections 60A.50 to
443.160A.592 and 62D.04, in which case the health maintenance organization may transfer funds
443.2out of its special restricted accounts in a manner approved by the commissioner of health.
443.3(f) The commissioner of health must approve all health maintenance organization
443.4expenditures for the acquisition of any asset that is not an admitted asset under National
443.5Association of Insurance Commissioners definitions. The commissioner shall disapprove
443.6any acquisition unless the health maintenance organization demonstrates that the
443.7acquisition is: (1) consistent with its long-standing business practices; or (2) more
443.8beneficial to enrollees than benefits to enrollees under paragraph (d).

443.9    Sec. 4. Minnesota Statutes 2012, section 62J.692, subdivision 4, is amended to read:
443.10    Subd. 4. Distribution of funds. (a) The commissioner shall annually distribute the
443.11available medical education funds to all qualifying applicants based on a distribution
443.12formula that reflects a summation of two factors:
443.13    (1) a public program volume factor, which is determined by the total volume of
443.14public program revenue received by each training site as a percentage of all public
443.15program revenue received by all training sites in the fund pool; and
443.16    (2) a supplemental public program volume factor, which is determined by providing
443.17a supplemental payment of 20 percent of each training site's grant to training sites whose
443.18public program revenue accounted for at least 0.98 percent of the total public program
443.19revenue received by all eligible training sites. Grants to training sites whose public
443.20program revenue accounted for less than 0.98 percent of the total public program revenue
443.21received by all eligible training sites shall be reduced by an amount equal to the total
443.22value of the supplemental payment.
443.23    Public program revenue for the distribution formula includes revenue from medical
443.24assistance, prepaid medical assistance, general assistance medical care, and prepaid
443.25general assistance medical care. Training sites that receive no public program revenue
443.26are ineligible for funds available under this subdivision. For purposes of determining
443.27training-site level grants to be distributed under paragraph (a), total statewide average
443.28costs per trainee for medical residents is based on audited clinical training costs per trainee
443.29in primary care clinical medical education programs for medical residents. Total statewide
443.30average costs per trainee for dental residents is based on audited clinical training costs
443.31per trainee in clinical medical education programs for dental students. Total statewide
443.32average costs per trainee for pharmacy residents is based on audited clinical training costs
443.33per trainee in clinical medical education programs for pharmacy students. Training sites
443.34whose training site level grant is less than $1,000, based on the formula described in this
443.35paragraph, are ineligible for funds available under this subdivision.
444.1    (b) Of available medical education funds, $1,000,000 shall be distributed each year
444.2for grants to family medicine residency programs located outside of the seven-county
444.3metropolitan area, as defined in section 473.121, subdivision 4, focused on eduction and
444.4training of family medicine physicians to serve communities outside the metropolitan area.
444.5To be eligible for a grant under this paragraph, a family medicine residency program must
444.6demonstrate that over the most recent three calendar years, at least 25 percent of its residents
444.7practice in Minnesota communities outside of the metropolitan area. Grant funds must be
444.8allocated proportionally based on the number of residents per eligible residency program.
444.9    (c) Funds distributed shall not be used to displace current funding appropriations
444.10from federal or state sources.
444.11    (c) (d) Funds shall be distributed to the sponsoring institutions indicating the amount
444.12to be distributed to each of the sponsor's clinical medical education programs based on
444.13the criteria in this subdivision and in accordance with the commissioner's approval letter.
444.14Each clinical medical education program must distribute funds allocated under paragraph
444.15(a) to the training sites as specified in the commissioner's approval letter. Sponsoring
444.16institutions, which are accredited through an organization recognized by the Department
444.17of Education or the Centers for Medicare and Medicaid Services, may contract directly
444.18with training sites to provide clinical training. To ensure the quality of clinical training,
444.19those accredited sponsoring institutions must:
444.20    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical
444.21training conducted at sites; and
444.22    (2) take necessary action if the contract requirements are not met. Action may include
444.23the withholding of payments under this section or the removal of students from the site.
444.24    (d) (e) Any funds not distributed in accordance with the commissioner's approval
444.25letter must be returned to the medical education and research fund within 30 days of
444.26receiving notice from the commissioner. The commissioner shall distribute returned funds
444.27to the appropriate training sites in accordance with the commissioner's approval letter.
444.28    (e) (f) A maximum of $150,000 of the funds dedicated to the commissioner
444.29under section 297F.10, subdivision 1, clause (2), may be used by the commissioner for
444.30administrative expenses associated with implementing this section.

444.31    Sec. 5. Minnesota Statutes 2012, section 62Q.19, subdivision 1, is amended to read:
444.32    Subdivision 1. Designation. (a) The commissioner shall designate essential
444.33community providers. The criteria for essential community provider designation shall be
444.34the following:
445.1(1) a demonstrated ability to integrate applicable supportive and stabilizing services
445.2with medical care for uninsured persons and high-risk and special needs populations,
445.3underserved, and other special needs populations; and
445.4(2) a commitment to serve low-income and underserved populations by meeting the
445.5following requirements:
445.6(i) has nonprofit status in accordance with chapter 317A;
445.7(ii) has tax-exempt status in accordance with the Internal Revenue Service Code,
445.8section 501(c)(3);
445.9(iii) charges for services on a sliding fee schedule based on current poverty income
445.10guidelines; and
445.11(iv) does not restrict access or services because of a client's financial limitation;
445.12(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
445.13hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
445.14government, an Indian health service unit, or a community health board as defined in
445.15chapter 145A;
445.16(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
445.17bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
445.18conditions;
445.19(5) a sole community hospital. For these rural hospitals, the essential community
445.20provider designation applies to all health services provided, including both inpatient and
445.21outpatient services. For purposes of this section, "sole community hospital" means a
445.22rural hospital that:
445.23(i) is eligible to be classified as a sole community hospital according to Code
445.24of Federal Regulations, title 42, section 412.92, or is located in a community with a
445.25population of less than 5,000 and located more than 25 miles from a like hospital currently
445.26providing acute short-term services;
445.27(ii) has experienced net operating income losses in two of the previous three
445.28most recent consecutive hospital fiscal years for which audited financial information is
445.29available; and
445.30(iii) consists of 40 or fewer licensed beds; or
445.31(6) a birth center licensed under section 144.615.; or
445.32(7) a hospital, and its affiliated specialty clinics, whose inpatients are predominantly
445.33under 21 years of age and that meets the following criteria:
445.34(i) provides intensive specialty pediatric services that are routinely provided in
445.35only four or fewer hospitals in the state; and
445.36(ii) serves children from at least one-half of the counties in the state.
446.1(b) Prior to designation, the commissioner shall publish the names of all applicants
446.2in the State Register. The public shall have 30 days from the date of publication to submit
446.3written comments to the commissioner on the application. No designation shall be made
446.4by the commissioner until the 30-day period has expired.
446.5(c) The commissioner may designate an eligible provider as an essential community
446.6provider for all the services offered by that provider or for specific services designated by
446.7the commissioner.
446.8(d) For the purpose of this subdivision, supportive and stabilizing services include at
446.9a minimum, transportation, child care, cultural, and linguistic services where appropriate.

446.10    Sec. 6. Minnesota Statutes 2012, section 103I.005, is amended by adding a subdivision
446.11to read:
446.12    Subd. 1a. Bored geothermal heat exchanger. "Bored geothermal heat exchanger"
446.13means an earth-coupled heating or cooling device consisting of a sealed closed-loop
446.14piping system installed in a boring in the ground to transfer heat to or from the surrounding
446.15earth with no discharge.

446.16    Sec. 7. Minnesota Statutes 2012, section 103I.521, is amended to read:
446.17103I.521 FEES DEPOSITED WITH COMMISSIONER OF MANAGEMENT
446.18AND BUDGET.
446.19Unless otherwise specified, fees collected for licenses or registration by the
446.20commissioner under this chapter shall be deposited in the state treasury and credited to
446.21the state government special revenue fund.

446.22    Sec. 8. Minnesota Statutes 2012, section 144.0724, subdivision 6, is amended to read:
446.23    Subd. 6. Penalties for late or nonsubmission. A facility that fails to complete or
446.24submit an assessment for a RUG-III or RUG-IV classification within seven days of the
446.25time requirements in subdivisions 4 and 5 is subject to a reduced rate for that resident.
446.26The reduced rate shall be the lowest rate for that facility. The reduced rate is effective on
446.27the day of admission for new admission assessments or on the day that the assessment
446.28was due for all other assessments and continues in effect until the first day of the month
446.29following the date of submission of the resident's assessment. If loss of revenue due to
446.30penalties incurred by a facility for any period of 92 days are equal to or greater than 1.0
446.31percent of the total operating costs on the facility's most recent annual statistical and cost
446.32report, a facility may apply to the commissioner of human services for a reduction in
446.33the total penalty amount. The commissioner of human services in consultation with the
447.1commissioner of health may, at the sole discretion of the commissioner of human services,
447.2limit the penalty for residents covered by medical assistance to 15 days.

447.3    Sec. 9. Minnesota Statutes 2012, section 144.123, subdivision 1, is amended to read:
447.4    Subdivision 1. Who must pay. Except for the limitation contained in this section,
447.5the commissioner of health shall charge a handling fee may enter into a contractual
447.6agreement to recover costs incurred for analysis for diagnostic purposes for each specimen
447.7submitted to the Department of Health for analysis for diagnostic purposes by any hospital,
447.8private laboratory, private clinic, or physician. No fee shall be charged to any entity which
447.9receives direct or indirect financial assistance from state or federal funds administered by
447.10the Department of Health, including any public health department, nonprofit community
447.11clinic, sexually transmitted disease clinic, or similar entity. No fee will be charged The
447.12commissioner shall not charge for any biological materials submitted to the Department
447.13of Health as a requirement of Minnesota Rules, part 4605.7040, or for those biological
447.14materials requested by the department to gather information for disease prevention or
447.15control purposes. The commissioner of health may establish other exceptions to the
447.16handling fee as may be necessary to protect the public's health. All fees collected pursuant
447.17to this section shall be deposited in the state treasury and credited to the state government
447.18special revenue fund. Funds generated in a contractual agreement made pursuant to this
447.19section shall be deposited in a special account and are appropriated to the commissioner
447.20for purposes of providing the services specified in the contracts. All such contractual
447.21agreements shall be processed in accordance with the provisions of chapter 16C.
447.22EFFECTIVE DATE.This section is effective July 1, 2014.

447.23    Sec. 10. Minnesota Statutes 2012, section 144.125, subdivision 1, is amended to read:
447.24    Subdivision 1. Duty to perform testing. (a) It is the duty of (1) the administrative
447.25officer or other person in charge of each institution caring for infants 28 days or less
447.26of age, (2) the person required in pursuance of the provisions of section 144.215, to
447.27register the birth of a child, or (3) the nurse midwife or midwife in attendance at the
447.28birth, to arrange to have administered to every infant or child in its care tests for heritable
447.29and congenital disorders according to subdivision 2 and rules prescribed by the state
447.30commissioner of health.
447.31    (b) Testing and the, recording and of test results, reporting of test results, and
447.32follow-up of infants with heritable congenital disorders, including hearing loss detected
447.33through the early hearing detection and intervention program in section 144.966, shall be
447.34performed at the times and in the manner prescribed by the commissioner of health. The
448.1commissioner shall charge a fee so that the total of fees collected will approximate the
448.2costs of conducting the tests and implementing and maintaining a system to follow-up
448.3infants with heritable or congenital disorders, including hearing loss detected through the
448.4early hearing detection and intervention program under section 144.966.
448.5    (c) The fee is $101 per specimen. Effective July 1, 2010, the fee shall be increased
448.6to $106 to support the newborn screening program, including tests administered under
448.7this section and section 144.966, shall be $145 per specimen. The increased fee amount
448.8shall be deposited in the general fund. Costs associated with capital expenditures and
448.9the development of new procedures may be prorated over a three-year period when
448.10calculating the amount of the fees. This fee amount shall be deposited in the state treasury
448.11and credited to the state government special revenue fund.
448.12(d) The fee to offset the cost of the support services provided under section 144.966,
448.13subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury
448.14and credited to the general fund.

448.15    Sec. 11. [144.1251] NEWBORN SCREENING FOR CRITICAL CONGENITAL
448.16HEART DISEASE (CCHD).
448.17    Subdivision 1. Required testing and reporting. Each licensed hospital or
448.18state-licensed birthing center or facility that provides maternity and newborn care services
448.19shall provide screening for congenital heart disease to all newborns prior to discharge
448.20using pulse oximetry screening. This screening should occur before discharge from the
448.21nursery, after the infant turns 24 hours of age. If discharge prior to 24 hours after birth
448.22occurs, screening should occur as close as possible to the time of discharge. Results of this
448.23screening must be reported to the Department of Health.
448.24For premature infants (less than 36 weeks of gestation) and infants admitted to a
448.25higher-level nursery (special care or intensive care), pulse oximetry should be performed
448.26when medically appropriate, but always prior to discharge.
448.27    Subd. 2. Implementation. The Department of Health shall:
448.28(1) communicate the screening protocol requirements;
448.29(2) make information and forms available to the persons with a duty to perform
448.30testing and reporting, health care providers, parents of newborns, and the public on
448.31screening and parental options;
448.32(3) provide training to ensure compliance with and appropriate implementation of
448.33the screening;
449.1(4) establish the mechanism for the required data collection and reporting of
449.2screening and follow-up diagnostic results to the Department of Health according to the
449.3Department of Health's recommendations;
449.4(5) coordinate the implementation of universal standardized screening;
449.5(6) act as a resource for providers as the screening program is implemented, and in
449.6consultation with the Advisory Committee on Heritable and Congenital Disorders, develop
449.7and implement policies for early medical and developmental intervention services and
449.8long-term follow-up services for children and their families identified with a CCHD; and
449.9(7) comply with sections 144.125 to 144.128.

449.10    Sec. 12. [144.492] DEFINITIONS.
449.11    Subdivision 1. Applicability. For the purposes of sections 144.492 to 144.494, the
449.12terms defined in this section have the meanings given them.
449.13    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.
449.14    Subd. 3. Stroke. "Stroke" means the sudden death of brain cells in a localized
449.15area due to inadequate blood flow.

449.16    Sec. 13. [144.493] CRITERIA.
449.17    Subdivision 1. Comprehensive stroke center. A hospital meets the criteria for a
449.18comprehensive stroke center if the hospital has been certified as a comprehensive stroke
449.19center by the joint commission or another nationally recognized accreditation entity.
449.20    Subd. 2. Primary stroke center. A hospital meets the criteria for a primary stroke
449.21center if the hospital has been certified as a primary stroke center by the joint commission
449.22or another nationally recognized accreditation entity.
449.23    Subd. 3. Acute stroke ready hospital. A hospital meets the criteria for an acute
449.24stroke ready hospital if the hospital has the following elements of an acute stroke ready
449.25hospital:
449.26(1) an acute stroke team available and/or on-call 24 hours a days, seven days a week;
449.27(2) written stroke protocols, including triage, stabilization of vital functions, initial
449.28diagnostic tests, and use of medications;
449.29(3) a written plan and letter of cooperation with emergency medical services regarding
449.30triage and communication that are consistent with regional patient care procedures;
449.31(4) emergency department personnel who are trained in diagnosing and treating
449.32acute stroke;
449.33(5) the capacity to complete basic laboratory tests, electrocardiograms, and chest
449.34x-rays 24 hours a day, seven days a week;
450.1(6) the capacity to perform and interpret brain injury imaging studies 24 hours a
450.2days, seven days a week;
450.3(7) written protocols that detail available emergent therapies and reflect current
450.4treatment guidelines, which include performance measures and are revised at least annually;
450.5(8) a neurosurgery coverage plan, call schedule, and a triage and transportation plan;
450.6(9) transfer protocols and agreements for stroke patients; and
450.7(10) a designated medical director with experience and expertise in acute stroke care.

450.8    Sec. 14. [144.494] DESIGNATING STROKE CENTERS AND STROKE
450.9HOSPITALS.
450.10    Subdivision 1. Naming privileges. Unless it has been designated as a stroke center
450.11or stroke hospital pursuant to section 144.493, no hospital shall use the term "stroke
450.12center" or "stroke hospital" in its name or its advertising or shall otherwise indicate it
450.13has stroke treatment capabilities.
450.14    Subd. 2. Designation. A hospital that voluntarily meets the criteria for a
450.15comprehensive stroke center, primary stroke center, or acute stroke ready hospital may
450.16apply to the commissioner for designation, and upon the commissioner's review and
450.17approval of the application, shall be designated as a comprehensive stroke center, a
450.18primary stroke center, or an acute stroke ready hospital for a three-year period. If a hospital
450.19loses its certification as a comprehensive stroke center or primary stroke center from
450.20the joint commission or other nationally recognized accreditation entity, its Minnesota
450.21designation will be immediately withdrawn. Prior to the expiration of the three-year
450.22designation, a hospital seeking to remain part of the voluntary acute stroke system may
450.23reapply to the commissioner for designation.

450.24    Sec. 15. [144.554] HEALTH FACILITIES CONSTRUCTION PLAN
450.25SUBMITTAL AND FEES.
450.26For hospitals, nursing homes, boarding care homes, residential hospices, supervised
450.27living facilities, freestanding outpatient surgical centers, and end-stage renal disease
450.28facilities, the commissioner shall collect a fee for the review and approval of architectural,
450.29mechanical, and electrical plans and specifications submitted before construction begins
450.30for each project relative to construction of new buildings, additions to existing buildings,
450.31or for remodeling or alterations of existing buildings. All fees collected in this section
450.32shall be deposited in the state treasury and credited to the state government special revenue
450.33fund. Fees must be paid at the time of submission of final plans for review and are not
450.34refundable. The fee is calculated as follows:

451.1	Construction project total estimated cost	Fee
451.2	$0 - $10,000	$30
451.3	$10,001 - $50,000	$150
451.4	$50,001 - $100,000	$300
451.5	$100,001 - $150,000	$450
451.6	$150,001 - $200,000	$600
451.7	$200,001 - $250,000	$750
451.8	$250,001 - $300,000	$900
451.9	$300,001 - $350,000	$1,050
451.10	$350,001 - $400,000	$1,200
451.11	$400,001 - $450,000	$1,350
451.12	$450,001 - $500,000	$1,500
451.13	$500,001 - $550,000	$1,650
451.14	$550,001 - $600,000	$1,800
451.15	$600,001 - $650,000	$1,950
451.16	$650,001 - $700,000	$2,100
451.17	$700,001 - $750,000	$2,250
451.18	$750,001 - $800,000	$2,400
451.19	$800,001 - $850,000	$2,550
451.20	$850,001 - $900,000	$2,700
451.21	$900,001 - $950,000	$2,850
451.22	$950,001 - $1,000,000	$3,000
451.23	$1,000,001 - $1,050,000	$3,150
451.24	$1,050,001 - $1,100,000	$3,300
451.25	$1,100,001 - $1,150,000	$3,450
451.26	$1,150,001 - $1,200,000	$3,600
451.27	$1,200,001 - $1,250,000	$3,750
451.28	$1,250,001 - $1,300,000	$3,900
451.29	$1,300,001 - $1,350,000	$4,050
451.30	$1,350,001 - $1,400,000	$4,200
451.31	$1,400,001 - $1,450,000	$4,350
451.32	$1,450,001 - $1,500,000	$4,500
451.33	$1,500,001 and over	$4,800

451.34    Sec. 16. Minnesota Statutes 2012, section 144.966, subdivision 2, is amended to read:
451.35    Subd. 2. Newborn Hearing Screening Advisory Committee. (a) The
451.36commissioner of health shall establish a Newborn Hearing Screening Advisory Committee
451.37to advise and assist the Department of Health and the Department of Education in:
451.38    (1) developing protocols and timelines for screening, rescreening, and diagnostic
451.39audiological assessment and early medical, audiological, and educational intervention
451.40services for children who are deaf or hard-of-hearing;
452.1    (2) designing protocols for tracking children from birth through age three that may
452.2have passed newborn screening but are at risk for delayed or late onset of permanent
452.3hearing loss;
452.4    (3) designing a technical assistance program to support facilities implementing the
452.5screening program and facilities conducting rescreening and diagnostic audiological
452.6assessment;
452.7    (4) designing implementation and evaluation of a system of follow-up and tracking;
452.8and
452.9    (5) evaluating program outcomes to increase effectiveness and efficiency and ensure
452.10culturally appropriate services for children with a confirmed hearing loss and their families.
452.11    (b) The commissioner of health shall appoint at least one member from each of the
452.12following groups with no less than two of the members being deaf or hard-of-hearing:
452.13    (1) a representative from a consumer organization representing culturally deaf
452.14persons;
452.15    (2) a parent with a child with hearing loss representing a parent organization;
452.16    (3) a consumer from an organization representing oral communication options;
452.17    (4) a consumer from an organization representing cued speech communication
452.18options;
452.19    (5) an audiologist who has experience in evaluation and intervention of infants
452.20and young children;
452.21    (6) a speech-language pathologist who has experience in evaluation and intervention
452.22of infants and young children;
452.23    (7) two primary care providers who have experience in the care of infants and young
452.24children, one of which shall be a pediatrician;
452.25    (8) a representative from the early hearing detection intervention teams;
452.26    (9) a representative from the Department of Education resource center for the deaf
452.27and hard-of-hearing or the representative's designee;
452.28    (10) a representative of the Commission of Deaf, DeafBlind and Hard-of-Hearing
452.29Minnesotans;
452.30    (11) a representative from the Department of Human Services Deaf and
452.31Hard-of-Hearing Services Division;
452.32    (12) one or more of the Part C coordinators from the Department of Education, the
452.33Department of Health, or the Department of Human Services or the department's designees;
452.34    (13) the Department of Health early hearing detection and intervention coordinators;
452.35    (14) two birth hospital representatives from one rural and one urban hospital;
452.36    (15) a pediatric geneticist;
453.1    (16) an otolaryngologist;
453.2    (17) a representative from the Newborn Screening Advisory Committee under
453.3this subdivision; and
453.4    (18) a representative of the Department of Education regional low-incidence
453.5facilitators.
453.6The commissioner must complete the appointments required under this subdivision by
453.7September 1, 2007.
453.8    (c) The Department of Health member shall chair the first meeting of the committee.
453.9At the first meeting, the committee shall elect a chair from its membership. The committee
453.10shall meet at the call of the chair, at least four times a year. The committee shall adopt
453.11written bylaws to govern its activities. The Department of Health shall provide technical
453.12and administrative support services as required by the committee. These services shall
453.13include technical support from individuals qualified to administer infant hearing screening,
453.14rescreening, and diagnostic audiological assessments.
453.15    Members of the committee shall receive no compensation for their service, but
453.16shall be reimbursed as provided in section 15.059 for expenses incurred as a result of
453.17their duties as members of the committee.
453.18    (d) This subdivision expires June 30, 2013 2019.

453.19    Sec. 17. Minnesota Statutes 2012, section 144.966, subdivision 3a, is amended to read:
453.20    Subd. 3a. Support services to families. The commissioner shall contract with a
453.21nonprofit organization to provide support and assistance to families with children who are
453.22deaf or have a hearing loss. The family support provided must include:
453.23    (1) direct hearing loss specific parent-to-parent assistance and unbiased information
453.24on communication, educational, and medical options, preferably provided by a program
453.25that is part of a national organization; and
453.26    (2) individualized deaf or hard of hearing mentors who provide education, including
453.27instruction in American Sign Language.
453.28The commissioner shall give preference to a nonprofit organization that has the ability to
453.29provide these services throughout the state.

453.30    Sec. 18. Minnesota Statutes 2012, section 144.98, subdivision 3, is amended to read:
453.31    Subd. 3. Annual fees. (a) An application for accreditation under subdivision 6 must
453.32be accompanied by the annual fees specified in this subdivision. The annual fees include:
453.33(1) base accreditation fee, $1,500 $600;
453.34(2) sample preparation techniques fee, $200 per technique;
454.1(3) an administrative fee for laboratories located outside this state, $3,750 $2,000; and
454.2(4) test category fees.
454.3(b) For the programs in subdivision 3a, the commissioner may accredit laboratories
454.4for fields of testing under the categories listed in clauses (1) to (10) upon completion of
454.5the application requirements provided by subdivision 6 and receipt of the fees for each
454.6category under each program that accreditation is requested. The categories offered and
454.7related fees include:
454.8(1) microbiology, $450 $200;
454.9(2) inorganics, $450 $200;
454.10(3) metals, $1,000 $500;
454.11(4) volatile organics, $1,300 $1,000;
454.12(5) other organics, $1,300 $1,000;
454.13(6) radiochemistry, $1,500 $750;
454.14(7) emerging contaminants, $1,500 $1,000;
454.15(8) agricultural contaminants, $1,250 $1,000;
454.16(9) toxicity (bioassay), $1,000 $500; and
454.17(10) physical characterization, $250.
454.18(c) The total annual fee includes the base fee, the sample preparation techniques
454.19fees, the test category fees per program, and, when applicable, an administrative fee for
454.20out-of-state laboratories.
454.21EFFECTIVE DATE.This section is effective the day following final enactment.

454.22    Sec. 19. Minnesota Statutes 2012, section 144.98, subdivision 5, is amended to read:
454.23    Subd. 5. State government special revenue fund. Fees collected by the
454.24commissioner under this section must be deposited in the state treasury and credited to
454.25the state government special revenue fund.
454.26EFFECTIVE DATE.This section is effective the day following final enactment.

454.27    Sec. 20. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
454.28to read:
454.29    Subd. 10. Establishing a selection committee. (a) The commissioner shall
454.30establish a selection committee for the purpose of recommending approval of qualified
454.31laboratory assessors and assessment bodies. Committee members shall demonstrate
454.32competence in assessment practices. The committee shall initially consist of seven
454.33members appointed by the commissioner as follows:
455.1(1) one member from a municipal laboratory accredited by the commissioner;
455.2(2) one member from an industrial treatment laboratory accredited by the
455.3commissioner;
455.4(3) one member from a commercial laboratory located in this state and accredited by
455.5the commissioner;
455.6(4) one member from a commercial laboratory located outside the state and
455.7accredited by the commissioner;
455.8(5) one member from a nongovernmental client of environmental laboratories;
455.9(6) one member from a professional organization with a demonstrated interest in
455.10environmental laboratory data and accreditation; and
455.11(7) one employee of the laboratory accreditation program administered by the
455.12department.
455.13(b) Committee appointments begin on January 1 and end on December 31 of the
455.14same year.
455.15(c) The commissioner shall appoint persons to fill vacant committee positions,
455.16expand the total number of appointed positions, or change the designated positions upon
455.17the advice of the committee.
455.18(d) The commissioner shall rescind the appointment of a selection committee
455.19member for sufficient cause as the commissioner determines, such as:
455.20(1) neglect of duty;
455.21(2) failure to notify the commissioner of a real or perceived conflict of interest;
455.22(3) nonconformance with committee procedures;
455.23(4) failure to demonstrate competence in assessment practices; or
455.24(5) official misconduct.
455.25(e) Members of the selection committee shall be compensated according to the
455.26provisions in section 15.059, subdivision 3.

455.27    Sec. 21. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
455.28to read:
455.29    Subd. 11. Activities of the selection committee. (a) The selection committee
455.30will determine assessor and assessment body application requirements, the frequency
455.31of application submittal, and the application review schedule. The commissioner shall
455.32publish the application requirements and procedures on the accreditation program Web site.
455.33(b) In its selection process, the committee shall ensure its application requirements
455.34and review process:
455.35(1) meet the standards implemented in subdivision 2a;
456.1(2) ensure assessors have demonstrated competence in technical disciplines offered
456.2for accreditation by the commissioner; and
456.3(3) consider any history of repeated nonconformance or complaints regarding
456.4assessors or assessment bodies.
456.5(c) The selection committee shall consider an application received from qualified
456.6applicants and shall supply a list of recommended assessors and assessment bodies to
456.7the commissioner of health no later than 90 days after the commissioner notifies the
456.8committee of the need for review of applications.

456.9    Sec. 22. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
456.10to read:
456.11    Subd. 12. Commissioner approval of assessors and scheduling of assessments.
456.12(a) The commissioner shall approve assessors who:
456.13(1) are employed by the commissioner for the purpose of accrediting laboratories
456.14and demonstrate competence in assessment practices for environmental laboratories; or
456.15(2) are employed by a state or federal agency with established agreements for
456.16mutual assistance or recognition with the commissioner and demonstrate competence in
456.17assessment practices for environmental laboratories.
456.18(b) The commissioner may approve other assessors or assessment bodies who are
456.19recommended by the selection committee according to subdivision 11, paragraph (c). The
456.20commissioner shall publish the list of assessors and assessment bodies approved from the
456.21recommendations.
456.22(c) The commissioner shall rescind approval for an assessor or assessment body for
456.23sufficient cause as the commissioner determines, such as:
456.24(1) failure to meet the minimum qualifications for performing assessments;
456.25(2) lack of availability;
456.26(3) nonconformance with the applicable laws, rules, standards, policies, and
456.27procedures;
456.28(4) misrepresentation of application information regarding qualifications and
456.29training; or
456.30(5) excessive cost to perform the assessment activities.

456.31    Sec. 23. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
456.32to read:
456.33    Subd. 13. Laboratory requirements for assessor selection and scheduling
456.34assessments. (a) A laboratory accredited or seeking accreditation that requires an
457.1assessment by the commissioner must select an assessor, group of assessors, or an
457.2assessment body from the published list specified in subdivision 12, paragraph (b). An
457.3accredited laboratory must complete an assessment and make all corrective actions at least
457.4once every 24 months. Unless the commissioner grants interim accreditation, a laboratory
457.5seeking accreditation must complete an assessment and make all corrective actions
457.6prior to, but no earlier than, 18 months prior to the date the application is submitted to
457.7the commissioner.
457.8(b) A laboratory shall not select the same assessor more than twice in succession
457.9for assessments of the same facility unless the laboratory receives written approval
457.10from the commissioner for the selection. The laboratory must supply a written request
457.11to the commissioner for approval and must justify the reason for the request and provide
457.12the alternate options considered.
457.13(c) A laboratory must select assessors appropriate to the size and scope of the
457.14laboratory's application or existing accreditation.
457.15(d) A laboratory must enter into its own contract for direct payment of the assessors
457.16or assessment body. The contract must authorize the assessor, assessment body, or
457.17subcontractors to release all records to the commissioner regarding the assessment activity,
457.18when the assessment is performed in compliance with this statute.
457.19(e) A laboratory must agree to permit other assessors as selected by the commissioner
457.20to participate in the assessment activities.
457.21(f) If the laboratory determines no approved assessor is available to perform
457.22the assessment, the laboratory must notify the commissioner in writing and provide a
457.23justification for the determination. If the commissioner confirms no approved assessor
457.24is available, the commissioner may designate an alternate assessor from those approved
457.25in subdivision 12, paragraph (a), or the commissioner may delay the assessment until
457.26an assessor is available. If an approved alternate assessor performs the assessment, the
457.27commissioner may collect fees equivalent to the cost of performing the assessment
457.28activities.
457.29(g) Fees collected under this section are deposited in a special account and are
457.30annually appropriated to the commissioner for the purpose of performing assessment
457.31activities.
457.32EFFECTIVE DATE.This section is effective the day following final enactment.

457.33    Sec. 24. Minnesota Statutes 2012, section 144.99, subdivision 4, is amended to read:
457.34    Subd. 4. Administrative penalty orders. (a) The commissioner may issue an
457.35order requiring violations to be corrected and administratively assessing monetary
458.1penalties for violations of the statutes, rules, and other actions listed in subdivision 1. The
458.2procedures in section 144.991 must be followed when issuing administrative penalty
458.3orders. Except in the case of repeated or serious violations, the penalty assessed in the
458.4order must be forgiven if the person who is subject to the order demonstrates in writing
458.5to the commissioner before the 31st day after receiving the order that the person has
458.6corrected the violation or has developed a corrective plan acceptable to the commissioner.
458.7The maximum amount of an administrative penalty order is $10,000 for each violator for
458.8all violations by that violator identified in an inspection or review of compliance.
458.9(b) Notwithstanding paragraph (a), the commissioner may issue to a large public
458.10water supply, serving a population of more than 10,000 persons, an administrative penalty
458.11order imposing a penalty of at least $1,000 per day per violation, not to exceed $10,000
458.12for each violation of sections 144.381 to 144.385 and rules adopted thereunder.
458.13(c) Notwithstanding paragraph (a), the commissioner may issue to a certified lead
458.14firm or person performing regulated lead work, an administrative penalty order imposing a
458.15penalty of at least $5,000 per violation per day, not to exceed $10,000 for each violation of
458.16sections 144.9501 to 144.9512 and rules adopted thereunder. All revenue collected from
458.17monetary penalties in this section shall be deposited in the state treasury and credited to
458.18the state government special revenue fund.

458.19    Sec. 25. Minnesota Statutes 2012, section 144A.53, subdivision 2, is amended to read:
458.20    Subd. 2. Complaints. The director may receive a complaint from any source
458.21concerning an action of an administrative agency, a health care provider, a home care
458.22provider, a residential care home, or a health facility. The director may require a
458.23complainant to pursue other remedies or channels of complaint open to the complainant
458.24before accepting or investigating the complaint. Investigators are required to interview
458.25at least one family member of the vulnerable adult identified in the complaint. If the
458.26vulnerable adult is directing the vulnerable adult's own care and does not want the
458.27investigator to contact the family, this information shall be documented in the investigative
458.28file.
458.29The director shall keep written records of all complaints and any action upon
458.30them. After completing an investigation of a complaint, the director shall inform the
458.31complainant, the administrative agency having jurisdiction over the subject matter, the
458.32health care provider, the home care provider, the residential care home, and the health
458.33facility of the action taken. Complainants must be provided a copy of the public report
458.34upon completion of the investigation.

459.1    Sec. 26. [145.417] LICENSURE OF CERTAIN FACILITIES THAT PERFORM
459.2ABORTIONS.
459.3    Subdivision 1. License required for facilities that perform ten or more abortions
459.4per month. (a) A clinic, health center, or other facility in which the pregnancies of ten or
459.5more women known to be pregnant are willfully terminated or aborted each month shall
459.6be licensed by the commissioner of health and, notwithstanding Minnesota Rules, part
459.74675.0100, subparts 8 and 9, subject to the licensure requirements provided in Minnesota
459.8Rules, chapter 4675. The commissioner shall not require a facility licensed as a hospital or
459.9as an outpatient surgical center, pursuant to sections 144.50 to 144.56, to obtain a separate
459.10license under this section, but may subject these facilities to inspections and investigations
459.11as permitted under subdivision 2.
459.12(b) The establishment or operation of a facility described in this section without
459.13obtaining a license is a misdemeanor punishable by a fine of not more than $300. The
459.14commissioner of health, the attorney general, an appropriate county attorney, or a woman
459.15upon whom an abortion has been performed or attempted to be performed at an unlicensed
459.16facility may seek an injunction in district court against the continued operation of the
459.17facility. Proceedings for securing an injunction may be brought by the attorney general or
459.18by the appropriate county attorney.
459.19(c) Sanctions provided in this subdivision do not restrict other available sanctions.
459.20    Subd. 2. Inspections; no notice required. No more than two times per year,
459.21the commissioner of health shall perform routine and comprehensive inspections and
459.22investigations of facilities described under subdivision 1. Every clinic, health center,
459.23or other facility described under subdivision 1, and any other premise proposed to be
459.24conducted as a facility by an applicant for a license, shall be open at all reasonable times
459.25to inspection authorized in writing by the commissioner of health. No notice need be
459.26given to any person prior to any inspection.
459.27    Subd. 3. Licensure fee. (a) The annual license fee for facilities required to be
459.28licensed under this section is $3,712.
459.29(b) Fees shall be collected and deposited according to section 144.122.
459.30    Subd. 4. Suspension, revocation, and refusal to renew. The commissioner of
459.31health may refuse to grant or renew, or may suspend or revoke a license on any of the
459.32following grounds:
459.33(1) violation of any of the provisions of this section or Minnesota Rules, chapter 4675;
459.34(2) permitting, aiding, or abetting the commission of any illegal act in the facility;
459.35(3) conduct or practices detrimental to the welfare of the patient;
459.36(4) obtaining or attempting to obtain a license by fraud or misrepresentation; or
460.1(5) if there is a pattern of conduct that involves one or more physicians in the
460.2facility who have a financial or economic interest in the facility, as defined in section
460.3144.6521, subdivision 3, and who have not provided notice and disclosure of the financial
460.4or economic interest as required by section 144.6521.
460.5    Subd. 5. Hearing. Prior to any suspension, revocation, or refusal to renew a license,
460.6the licensee shall be entitled to notice and a hearing as provided by sections 14.57 to
460.714.69. At each hearing, the commissioner of health shall have the burden of establishing
460.8that a violation described in subdivision 4 has occurred. If a license is revoked, suspended,
460.9or not renewed, a new application for a license may be considered by the commissioner if
460.10the conditions upon which revocation, suspension, or refusal to renew was based have
460.11been corrected and evidence of this fact has been satisfactorily furnished. A new license
460.12may be granted after proper inspection has been made and all provisions of this section
460.13and Minnesota Rules, chapter 4675, have been complied with and a recommendation
460.14for licensure has been made by the commissioner or by an inspector as an agent of the
460.15commissioner.
460.16    Subd. 6. Severability. If any one or more provision, section, subdivision, sentence,
460.17clause, phrase, or word of this section or the application of it to any person or circumstance
460.18is found to be unconstitutional, it is declared to be severable and the balance of this section
460.19shall remain effective notwithstanding such unconstitutionality. The legislature intends
460.20that it would have passed this section, and each provision, section, subdivision, sentence,
460.21clause, phrase, or word, regardless of the fact that any one provision, section, subdivision,
460.22sentence, clause, phrase, or word is declared unconstitutional.

460.23    Sec. 27. [145.4716] SAFE HARBOR FOR SEXUALLY EXPLOITED YOUTH.
460.24    Subdivision 1. Director. The commissioner of health shall establish a position for a
460.25director of child sex trafficking prevention.
460.26    Subd. 2. Duties of director. The director of child sex trafficking prevention is
460.27responsible for the following:
460.28    (1) developing and providing comprehensive training on sexual exploitation of
460.29youth for social service professionals, medical professionals, public health workers, and
460.30criminal justice professionals;
460.31    (2) collecting, organizing, maintaining, and disseminating information on sexual
460.32exploitation and services across the state, including maintaining a list of resources on the
460.33Department of Health Web site;
460.34    (3) monitoring and applying for federal funding for antitrafficking efforts that may
460.35benefit victims in the state;
461.1    (4) managing grant programs established under this act;
461.2    (5) identifying best practices in serving sexually exploited youth, as defined in
461.3section 260C.007, subdivision 31;
461.4    (6) providing oversight of and technical support to regional navigators pursuant to
461.5section 145.4717;
461.6    (7) conducting a comprehensive evaluation of the statewide program for safe harbor
461.7of sexually exploited youth; and
461.8    (8) developing a policy, consistent with the requirements of chapter 13, for sharing
461.9data related to sexually exploited youth, as defined in section 260C.007, subdivision 31,
461.10among regional navigators and community-based advocates.

461.11    Sec. 28. [145.4717] REGIONAL NAVIGATOR GRANTS.
461.12    The commissioner of health, through its director of child sex trafficking prevention,
461.13established in section 145.4716, shall provide grants to regional navigators serving six
461.14regions of the state to be determined by the commissioner. Each regional navigator must
461.15develop and annually submit a work plan to the director of child sex trafficking prevention.
461.16The work plans must include, but are not limited to, the following information:
461.17    (1) a needs statement specific to the region, including an examination of the
461.18population at risk;
461.19    (2) regional resources available to sexually exploited youth, as defined in section
461.20260C.007, subdivision 31;
461.21    (3) grant goals and measurable outcomes; and
461.22    (4) grant activities including timelines.

461.23    Sec. 29. [145.4718] PROGRAM EVALUATION.
461.24    (a) The director of child sex trafficking prevention, established under section
461.25145.4716, must conduct, or contract for, comprehensive evaluation of the statewide
461.26program for safe harbor for sexually exploited youth. The first evaluation must be
461.27completed by June 30, 2015, and must be submitted to the commissioner of health by
461.28September 1, 2015, and every two years thereafter. The evaluation must consider whether
461.29the program is reaching intended victims and whether support services are available,
461.30accessible, and adequate for sexually exploited youth, as defined in section 260C.007,
461.31subdivision 31.
461.32    (b) In conducting the evaluation, the director of child sex trafficking prevention must
461.33consider evaluation of outcomes, including whether the program increases identification
461.34of sexually exploited youth, coordination of investigations, access to services and housing
462.1available for sexually exploited youth, and improved effectiveness of services. The
462.2evaluation must also include examination of the ways in which penalties under section
462.3609.3241 are assessed, collected, and distributed to ensure funding for investigation,
462.4prosecution, and victim services to combat sexual exploitation of youth.

462.5    Sec. 30. Minnesota Statutes 2012, section 145.986, is amended to read:
462.6145.986 STATEWIDE HEALTH IMPROVEMENT PROGRAM.
462.7    Subdivision 1. Grants to local communities Purpose. The purpose of the statewide
462.8health improvement program is to:
462.9(1) address the top three leading preventable causes of illness, preventable health
462.10costs, and death: tobacco use and exposure, poor diet, and lack of regular physical activity;
462.11(2) promote the development, availability, and use of evidence-based, community
462.12level, comprehensive strategies to create healthy communities; and
462.13(3) measure the impact of the evidence-based, community health improvement
462.14practices which over time work to contain health care costs and reduce chronic diseases.
462.15    Subd. 1a. Grants to local communities. (a) Beginning July 1, 2009 2013,
462.16the commissioner of health shall award competitive grants to all community health
462.17boards established pursuant to section 145A.09 and tribal governments to convene,
462.18coordinate, and implement evidence-based strategies targeted at reducing the percentage
462.19of Minnesotans who are obese or overweight and to reduce the use of tobacco.
462.20    (b) Grantee activities shall:
462.21    (1) be based on scientific evidence;
462.22    (2) be based on community input;
462.23    (3) address behavior change at the individual, community, and systems levels;
462.24    (4) occur in community, school, worksite, and health care settings; and
462.25    (5) be focused on policy, systems, and environmental changes that support healthy
462.26behaviors.; and
462.27(6) address the health disparities and inequities that exist in the grantee's community.
462.28    (c) To receive a grant under this section, community health boards and tribal
462.29governments must submit proposals to the commissioner. A local match of ten percent
462.30of the total funding allocation is required. This local match may include funds donated
462.31by community partners.
462.32    (d) In order to receive a grant, community health boards and tribal governments
462.33must submit a health improvement plan to the commissioner of health for approval. The
462.34commissioner may require the plan to identify a community leadership team, community
463.1partners, and a community action plan that includes an assessment of area strengths and
463.2needs, proposed action strategies, technical assistance needs, and a staffing plan.
463.3    (e) The grant recipient must implement the health improvement plan, evaluate the
463.4effectiveness of the interventions strategies, and modify or discontinue interventions
463.5 strategies found to be ineffective.
463.6    (f) By January 15, 2011, the commissioner of health shall recommend whether any
463.7funding should be distributed to community health boards and tribal governments based
463.8on health disparities demonstrated in the populations served.
463.9    (g) (f) Grant recipients shall report their activities and their progress toward the
463.10outcomes established under subdivision 2 to the commissioner in a format and at a time
463.11specified by the commissioner.
463.12    (h) (g) All grant recipients shall be held accountable for making progress toward
463.13the measurable outcomes established in subdivision 2. The commissioner shall require a
463.14corrective action plan and may reduce the funding level of grant recipients that do not
463.15make adequate progress toward the measurable outcomes.
463.16    Subd. 2. Outcomes. (a) The commissioner shall set measurable outcomes to meet
463.17the goals specified in subdivision 1, and annually review the progress of grant recipients
463.18in meeting the outcomes.
463.19    (b) The commissioner shall measure current public health status, using existing
463.20measures and data collection systems when available, to determine baseline data against
463.21which progress shall be monitored.
463.22    Subd. 3. Technical assistance and oversight. (a) The commissioner shall provide
463.23content expertise, technical expertise, and training to grant recipients and advice on
463.24evidence-based strategies, including those based on populations and types of communities
463.25served. The commissioner shall ensure that the statewide health improvement program
463.26meets the outcomes established under subdivision 2 by conducting a comprehensive
463.27statewide evaluation and assisting grant recipients to modify or discontinue interventions
463.28found to be ineffective.
463.29    (b) In carrying out its responsibilities for administration, technical assistance, and
463.30oversight, the commissioner may contract out its responsibilities within the limits of the
463.31administrative budget given for those purposes.
463.32    Subd. 4. Evaluation. (a) Using the outcome measures established in subdivision 3,
463.33the commissioner shall conduct a biennial evaluation of the statewide health improvement
463.34program funded under this section. Grant recipients shall cooperate with the commissioner
463.35in the evaluation and provide the commissioner with the information necessary to conduct
463.36the evaluation.
464.1(b) Grant recipients will collect, monitor, and submit to the Department of Health
464.2baseline and annual data, and provide information to improve the quality and impact of
464.3community health improvement strategies.
464.4    Subd. 5. Report. The commissioner shall submit a biennial report to the legislature
464.5on the statewide health improvement program funded under this section. These reports
464.6 The report must include information on each grant recipients recipient, including the
464.7activities that were conducted by the grantee using grant funds, evaluation data, and
464.8outcome measures, if available. the grantee's progress toward achieving the measurable
464.9outcomes established under subdivision 2, and the data provided to the commissioner by
464.10the grantee to measure these outcomes for grant activities. The commissioner shall provide
464.11information on grants in which a corrective action plan was required under subdivision
464.121a, the types of plan action, and the progress that has been made toward meeting the
464.13measurable outcomes. In addition, the commissioner shall provide recommendations on
464.14future areas of focus for health improvement. These reports are due by January 15 of every
464.15other year, beginning in 2010. In the report due on January 15, 2010, the commissioner
464.16shall include recommendations on a sustainable funding source for the statewide health
464.17improvement program other than the health care access fund In the report due on January
464.1815, 2014, the commissioner shall include a description of the contracts awarded under
464.19subdivision 4, paragraph (c), and the monitoring and evaluation systems that were
464.20designed and implemented under these contracts. The commissioner shall prepare the
464.21report using existing resources.
464.22    Subd. 6. Supplantation of existing funds. Community health boards and tribal
464.23governments must use funds received under this section to develop new programs, expand
464.24current programs that work to reduce the percentage of Minnesotans who are obese or
464.25overweight or who use tobacco, or replace discontinued state or federal funds previously
464.26used to reduce the percentage of Minnesotans who are obese or overweight or who use
464.27tobacco. Funds must not be used to supplant current state or local funding to community
464.28health boards or tribal governments used to reduce the percentage of Minnesotans who are
464.29obese or overweight or to reduce tobacco use.

464.30    Sec. 31. Minnesota Statutes 2012, section 149A.02, subdivision 1a, is amended to read:
464.31    Subd. 1a. Alkaline hydrolysis. "Alkaline hydrolysis" means the reduction of a dead
464.32human body to essential elements through exposure to a combination of heat and alkaline
464.33hydrolysis and the repositioning or movement of the body during the process to facilitate
464.34reduction, a water-based dissolution process using alkaline chemicals, heat, agitation, and
464.35pressure to accelerate natural decomposition; the processing of the hydrolyzed remains
465.1after removal from the alkaline hydrolysis chamber, vessel; placement of the processed
465.2remains in a hydrolyzed remains container,; and release of the hydrolyzed remains to an
465.3appropriate party. Alkaline hydrolysis is a form of final disposition.

465.4    Sec. 32. Minnesota Statutes 2012, section 149A.02, is amended by adding a
465.5subdivision to read:
465.6    Subd. 1b. Alkaline hydrolysis container. "Alkaline hydrolysis container" means a
465.7hydrolyzable or biodegradable closed container or pouch resistant to leakage of bodily
465.8fluids that encases the body and into which a dead human body is placed prior to insertion
465.9into an alkaline hydrolysis vessel. Alkaline hydrolysis containers may be hydrolyzable or
465.10biodegradable alternative containers or caskets.

465.11    Sec. 33. Minnesota Statutes 2012, section 149A.02, is amended by adding a
465.12subdivision to read:
465.13    Subd. 1c. Alkaline hydrolysis facility. "Alkaline hydrolysis facility" means a
465.14building or structure containing one or more alkaline hydrolysis vessels for the alkaline
465.15hydrolysis of dead human bodies.

465.16    Sec. 34. Minnesota Statutes 2012, section 149A.02, is amended by adding a
465.17subdivision to read:
465.18    Subd. 1d. Alkaline hydrolysis vessel. "Alkaline hydrolysis vessel" means the
465.19container in which the alkaline hydrolysis of a dead human body is performed.

465.20    Sec. 35. Minnesota Statutes 2012, section 149A.02, subdivision 2, is amended to read:
465.21    Subd. 2. Alternative container. "Alternative container" means a nonmetal
465.22receptacle or enclosure, without ornamentation or a fixed interior lining, which is designed
465.23for the encasement of dead human bodies and is made of hydrolyzable or biodegradable
465.24materials, corrugated cardboard, fiberboard, pressed-wood, or other like materials.

465.25    Sec. 36. Minnesota Statutes 2012, section 149A.02, subdivision 3, is amended to read:
465.26    Subd. 3. Arrangements for disposition. "Arrangements for disposition" means
465.27any action normally taken by a funeral provider in anticipation of or preparation for the
465.28entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.

465.29    Sec. 37. Minnesota Statutes 2012, section 149A.02, subdivision 4, is amended to read:
466.1    Subd. 4. Cash advance item. "Cash advance item" means any item of service
466.2or merchandise described to a purchaser as a "cash advance," "accommodation," "cash
466.3disbursement," or similar term. A cash advance item is also any item obtained from a
466.4third party and paid for by the funeral provider on the purchaser's behalf. Cash advance
466.5items include, but are not limited to, cemetery, alkaline hydrolysis, or crematory services,
466.6pallbearers, public transportation, clergy honoraria, flowers, musicians or singers, obituary
466.7notices, gratuities, and death records.

466.8    Sec. 38. Minnesota Statutes 2012, section 149A.02, subdivision 5, is amended to read:
466.9    Subd. 5. Casket. "Casket" means a rigid container which is designed for the
466.10encasement of a dead human body and is usually constructed of hydrolyzable or
466.11biodegradable materials, wood, metal, fiberglass, plastic, or like material, and ornamented
466.12and lined with fabric.

466.13    Sec. 39. Minnesota Statutes 2012, section 149A.02, is amended by adding a
466.14subdivision to read:
466.15    Subd. 12a. Crypt. "Crypt" means a space in a mausoleum of sufficient size, used or
466.16intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.

466.17    Sec. 40. Minnesota Statutes 2012, section 149A.02, is amended by adding a
466.18subdivision to read:
466.19    Subd. 12b. Direct alkaline hydrolysis. "Direct alkaline hydrolysis" means a
466.20final disposition of a dead human body by alkaline hydrolysis, without formal viewing,
466.21visitation, or ceremony with the body present.

466.22    Sec. 41. Minnesota Statutes 2012, section 149A.02, subdivision 16, is amended to read:
466.23    Subd. 16. Final disposition. "Final disposition" means the acts leading to and the
466.24entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.

466.25    Sec. 42. Minnesota Statutes 2012, section 149A.02, subdivision 23, is amended to read:
466.26    Subd. 23. Funeral services. "Funeral services" means any services which may
466.27be used to: (1) care for and prepare dead human bodies for burial, alkaline hydrolysis,
466.28cremation, or other final disposition; and (2) arrange, supervise, or conduct the funeral
466.29ceremony or the final disposition of dead human bodies.

467.1    Sec. 43. Minnesota Statutes 2012, section 149A.02, is amended by adding a
467.2subdivision to read:
467.3    Subd. 24b. Hydrolyzed remains. "Hydrolyzed remains" means the remains of a
467.4dead human body following the alkaline hydrolysis process. Hydrolyzed remains does not
467.5include pacemakers, prostheses, or similar foreign materials.

467.6    Sec. 44. Minnesota Statutes 2012, section 149A.02, is amended by adding a
467.7subdivision to read:
467.8    Subd. 24c. Hydrolyzed remains container. "Hydrolyzed remains container" means
467.9a receptacle in which hydrolyzed remains are placed. For purposes of this chapter, a
467.10hydrolyzed remains container is interchangeable with "urn" or similar keepsake storage
467.11jewelry.

467.12    Sec. 45. Minnesota Statutes 2012, section 149A.02, is amended by adding a
467.13subdivision to read:
467.14    Subd. 26a. Inurnment. "Inurnment" means placing hydrolyzed or cremated remains
467.15in a hydrolyzed or cremated remains container suitable for placement, burial, or shipment.

467.16    Sec. 46. Minnesota Statutes 2012, section 149A.02, subdivision 27, is amended to read:
467.17    Subd. 27. Licensee. "Licensee" means any person or entity that has been issued
467.18a license to practice mortuary science, to operate a funeral establishment, to operate an
467.19alkaline hydrolysis facility, or to operate a crematory by the Minnesota commissioner
467.20of health.

467.21    Sec. 47. Minnesota Statutes 2012, section 149A.02, is amended by adding a
467.22subdivision to read:
467.23    Subd. 30a. Niche. "Niche" means a space in a columbarium used, or intended to be
467.24used, for the placement of hydrolyzed or cremated remains.

467.25    Sec. 48. Minnesota Statutes 2012, section 149A.02, is amended by adding a
467.26subdivision to read:
467.27    Subd. 32a. Placement. "Placement" means the placing of a container holding
467.28hydrolyzed or cremated remains in a crypt, vault, or niche.

467.29    Sec. 49. Minnesota Statutes 2012, section 149A.02, subdivision 34, is amended to read:
468.1    Subd. 34. Preparation of the body. "Preparation of the body" means placement of
468.2the body into an appropriate cremation or alkaline hydrolysis container, embalming of
468.3the body or such items of care as washing, disinfecting, shaving, positioning of features,
468.4restorative procedures, application of cosmetics, dressing, and casketing.

468.5    Sec. 50. Minnesota Statutes 2012, section 149A.02, subdivision 35, is amended to read:
468.6    Subd. 35. Processing. "Processing" means the removal of foreign objects, drying or
468.7cooling, and the reduction of the hydrolyzed or cremated remains by mechanical means
468.8including, but not limited to, grinding, crushing, or pulverizing, to a granulated appearance
468.9appropriate for final disposition.

468.10    Sec. 51. Minnesota Statutes 2012, section 149A.02, subdivision 37, is amended to read:
468.11    Subd. 37. Public transportation. "Public transportation" means all manner of
468.12transportation via common carrier available to the general public including airlines, buses,
468.13railroads, and ships. For purposes of this chapter, a livery service providing transportation
468.14to private funeral establishments, alkaline hydrolysis facilities, or crematories is not public
468.15transportation.

468.16    Sec. 52. Minnesota Statutes 2012, section 149A.02, is amended by adding a
468.17subdivision to read:
468.18    Subd. 37c. Scattering. "Scattering" means the authorized dispersal of hydrolyzed
468.19or cremated remains in a defined area of a dedicated cemetery or in areas where no local
468.20prohibition exists provided that the hydrolyzed or cremated remains are not distinguishable
468.21to the public, are not in a container, and that the person who has control over disposition
468.22of the hydrolyzed or cremated remains has obtained written permission of the property
468.23owner or governing agency to scatter on the property.

468.24    Sec. 53. Minnesota Statutes 2012, section 149A.02, is amended by adding a
468.25subdivision to read:
468.26    Subd. 41. Vault. "Vault" means a space in a mausoleum of sufficient size, used or
468.27intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.
468.28Vault may also mean a sealed and lined casket enclosure.

468.29    Sec. 54. Minnesota Statutes 2012, section 149A.03, is amended to read:
468.30149A.03 DUTIES OF COMMISSIONER.
468.31    The commissioner shall:
469.1    (1) enforce all laws and adopt and enforce rules relating to the:
469.2    (i) removal, preparation, transportation, arrangements for disposition, and final
469.3disposition of dead human bodies;
469.4    (ii) licensure and professional conduct of funeral directors, morticians, interns,
469.5practicum students, and clinical students;
469.6    (iii) licensing and operation of a funeral establishment; and
469.7(iv) licensing and operation of an alkaline hydrolysis facility; and
469.8    (iv) (v) licensing and operation of a crematory;
469.9    (2) provide copies of the requirements for licensure and permits to all applicants;
469.10    (3) administer examinations and issue licenses and permits to qualified persons
469.11and other legal entities;
469.12    (4) maintain a record of the name and location of all current licensees and interns;
469.13    (5) perform periodic compliance reviews and premise inspections of licensees;
469.14    (6) accept and investigate complaints relating to conduct governed by this chapter;
469.15    (7) maintain a record of all current preneed arrangement trust accounts;
469.16    (8) maintain a schedule of application, examination, permit, and licensure fees,
469.17initial and renewal, sufficient to cover all necessary operating expenses;
469.18    (9) educate the public about the existence and content of the laws and rules for
469.19mortuary science licensing and the removal, preparation, transportation, arrangements
469.20for disposition, and final disposition of dead human bodies to enable consumers to file
469.21complaints against licensees and others who may have violated those laws or rules;
469.22    (10) evaluate the laws, rules, and procedures regulating the practice of mortuary
469.23science in order to refine the standards for licensing and to improve the regulatory and
469.24enforcement methods used; and
469.25    (11) initiate proceedings to address and remedy deficiencies and inconsistencies in
469.26the laws, rules, or procedures governing the practice of mortuary science and the removal,
469.27preparation, transportation, arrangements for disposition, and final disposition of dead
469.28human bodies.

469.29    Sec. 55. [149A.54] LICENSE TO OPERATE AN ALKALINE HYDROLYSIS
469.30FACILITY.
469.31    Subdivision 1. License requirement. Except as provided in section 149A.01,
469.32subdivision 3, a place or premise shall not be maintained, managed, or operated which
469.33is devoted to or used in the holding and alkaline hydrolysis of a dead human body
469.34without possessing a valid license to operate an alkaline hydrolysis facility issued by the
469.35commissioner of health.
470.1    Subd. 2. Requirements for an alkaline hydrolysis facility. (a) An alkaline
470.2hydrolysis facility licensed under this section must consist of:
470.3(1) a building or structure that complies with applicable local and state building
470.4codes, zoning laws and ordinances, wastewater management and environmental standards,
470.5containing one or more alkaline hydrolysis vessels for the alkaline hydrolysis of dead
470.6human bodies;
470.7(2) a method approved by the commissioner of health to dry the hydrolyzed remains
470.8and which is located within the licensed facility;
470.9(3) a means approved by the commissioner of health for refrigeration of dead human
470.10bodies awaiting alkaline hydrolysis;
470.11(4) an appropriate means of processing hydrolyzed remains to a granulated
470.12appearance appropriate for final disposition; and
470.13(5) an appropriate holding facility for dead human bodies awaiting alkaline
470.14hydrolysis.
470.15(b) An alkaline hydrolysis facility licensed under this section may also contain a
470.16display room for funeral goods.
470.17    Subd. 3. Application procedure; documentation; initial inspection. An
470.18application to license and operate an alkaline hydrolysis facility shall be submitted to the
470.19commissioner of health. A completed application includes:
470.20(1) a completed application form, as provided by the commissioner;
470.21(2) proof of business form and ownership;
470.22(3) proof of liability insurance coverage or other financial documentation, as
470.23determined by the commissioner, that demonstrates the applicant's ability to respond in
470.24damages for liability arising from the ownership, maintenance management, or operation
470.25of an alkaline hydrolysis facility; and
470.26(4) copies of wastewater and other environmental regulatory permits and
470.27environmental regulatory licenses necessary to conduct operations.
470.28Upon receipt of the application and appropriate fee, the commissioner shall review and
470.29verify all information. Upon completion of the verification process and resolution of any
470.30deficiencies in the application information, the commissioner shall conduct an initial
470.31inspection of the premises to be licensed. After the inspection and resolution of any
470.32deficiencies found and any reinspections as may be necessary, the commissioner shall
470.33make a determination, based on all the information available, to grant or deny licensure. If
470.34the commissioner's determination is to grant the license, the applicant shall be notified and
470.35the license shall issue and remain valid for a period prescribed on the license, but not to
470.36exceed one calendar year from the date of issuance of the license. If the commissioner's
471.1determination is to deny the license, the commissioner must notify the applicant in writing
471.2of the denial and provide the specific reason for denial.
471.3    Subd. 4. Nontransferability of license. A license to operate an alkaline hydrolysis
471.4facility is not assignable or transferable and shall not be valid for any entity other than the
471.5one named. Each license issued to operate an alkaline hydrolysis facility is valid only for the
471.6location identified on the license. A 50 percent or more change in ownership or location of
471.7the alkaline hydrolysis facility automatically terminates the license. Separate licenses shall
471.8be required of two or more persons or other legal entities operating from the same location.
471.9    Subd. 5. Display of license. Each license to operate an alkaline hydrolysis
471.10facility must be conspicuously displayed in the alkaline hydrolysis facility at all times.
471.11Conspicuous display means in a location where a member of the general public within the
471.12alkaline hydrolysis facility will be able to observe and read the license.
471.13    Subd. 6. Period of licensure. All licenses to operate an alkaline hydrolysis facility
471.14issued by the commissioner are valid for a period of one calendar year beginning on July 1
471.15and ending on June 30, regardless of the date of issuance.
471.16    Subd. 7. Reporting changes in license information. Any change of license
471.17information must be reported to the commissioner, on forms provided by the
471.18commissioner, no later than 30 calendar days after the change occurs. Failure to report
471.19changes is grounds for disciplinary action.
471.20    Subd. 8. Notification to the commissioner. If the licensee is operating under a
471.21wastewater or an environmental permit or license that is subsequently revoked, denied,
471.22or terminated, the licensee shall notify the commissioner.
471.23    Subd. 9. Application information. All information submitted to the commissioner
471.24for a license to operate an alkaline hydrolysis facility is classified as licensing data under
471.25section 13.41, subdivision 5.

471.26    Sec. 56. [149A.55] RENEWAL OF LICENSE TO OPERATE AN ALKALINE
471.27HYDROLYSIS FACILITY.
471.28    Subdivision 1. Renewal required. All licenses to operate an alkaline hydrolysis
471.29facility issued by the commissioner expire on June 30 following the date of issuance of the
471.30license and must be renewed to remain valid.
471.31    Subd. 2. Renewal procedure and documentation. Licensees who wish to renew
471.32their licenses must submit to the commissioner a completed renewal application no later
471.33than June 30 following the date the license was issued. A completed renewal application
471.34includes:
471.35(1) a completed renewal application form, as provided by the commissioner; and
472.1(2) proof of liability insurance coverage or other financial documentation, as
472.2determined by the commissioner, that demonstrates the applicant's ability to respond in
472.3damages for liability arising from the ownership, maintenance, management, or operation
472.4of an alkaline hydrolysis facility.
472.5Upon receipt of the completed renewal application, the commissioner shall review and
472.6verify the information. Upon completion of the verification process and resolution of
472.7any deficiencies in the renewal application information, the commissioner shall make a
472.8determination, based on all the information available, to reissue or refuse to reissue the
472.9license. If the commissioner's determination is to reissue the license, the applicant shall
472.10be notified and the license shall issue and remain valid for a period prescribed on the
472.11license, but not to exceed one calendar year from the date of issuance of the license. If
472.12the commissioner's determination is to refuse to reissue the license, section 149A.09,
472.13subdivision 2, applies.
472.14    Subd. 3. Penalty for late filing. Renewal applications received after the expiration
472.15date of a license will result in the assessment of a late filing penalty. The late filing penalty
472.16must be paid before the reissuance of the license and received by the commissioner no
472.17later than 31 calendar days after the expiration date of the license.
472.18    Subd. 4. Lapse of license. Licenses to operate alkaline hydrolysis facilities
472.19shall automatically lapse when a completed renewal application is not received by the
472.20commissioner within 31 calendar days after the expiration date of a license, or a late
472.21filing penalty assessed under subdivision 3 is not received by the commissioner within 31
472.22calendar days after the expiration of a license.
472.23    Subd. 5. Effect of lapse of license. Upon the lapse of a license, the person to whom
472.24the license was issued is no longer licensed to operate an alkaline hydrolysis facility in
472.25Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed
472.26license holder from operating an alkaline hydrolysis facility in Minnesota and may pursue
472.27any additional lawful remedies as justified by the case.
472.28    Subd. 6. Restoration of lapsed license. The commissioner may restore a lapsed
472.29license upon receipt and review of a completed renewal application, receipt of the late
472.30filing penalty, and reinspection of the premises, provided that the receipt is made within
472.31one calendar year from the expiration date of the lapsed license and the cease and desist
472.32order issued by the commissioner has not been violated. If a lapsed license is not restored
472.33within one calendar year from the expiration date of the lapsed license, the holder of the
472.34lapsed license cannot be relicensed until the requirements in section 149A.54 are met.
472.35    Subd. 7. Reporting changes in license information. Any change of license
472.36information must be reported to the commissioner, on forms provided by the
473.1commissioner, no later than 30 calendar days after the change occurs. Failure to report
473.2changes is grounds for disciplinary action.
473.3    Subd. 8. Application information. All information submitted to the commissioner
473.4by an applicant for renewal of licensure to operate an alkaline hydrolysis facility is
473.5classified as licensing data under section 13.41, subdivision 5.

473.6    Sec. 57. Minnesota Statutes 2012, section 149A.65, is amended by adding a
473.7subdivision to read:
473.8    Subd. 6. Alkaline hydrolysis facilities. The initial and renewal fee for an alkaline
473.9hydrolysis facility is $300. The late fee charge for a license renewal is $25.

473.10    Sec. 58. Minnesota Statutes 2012, section 149A.65, is amended by adding a
473.11subdivision to read:
473.12    Subd. 7. State government special revenue fund. Fees collected by the
473.13commissioner under this section must be deposited in the state treasury and credited to
473.14the state government special revenue fund.

473.15    Sec. 59. Minnesota Statutes 2012, section 149A.70, subdivision 1, is amended to read:
473.16    Subdivision 1. Use of titles. Only a person holding a valid license to practice
473.17mortuary science issued by the commissioner may use the title of mortician, funeral
473.18director, or any other title implying that the licensee is engaged in the business or practice
473.19of mortuary science. Only the holder of a valid license to operate an alkaline hydrolysis
473.20facility issued by the commissioner may use the title of alkaline hydrolysis facility, water
473.21cremation, water-reduction, biocremation, green-cremation, resomation, dissolution, or
473.22any other title, word, or term implying that the licensee operates an alkaline hydrolysis
473.23facility. Only the holder of a valid license to operate a funeral establishment issued by the
473.24commissioner may use the title of funeral home, funeral chapel, funeral service, or any
473.25other title, word, or term implying that the licensee is engaged in the business or practice
473.26of mortuary science. Only the holder of a valid license to operate a crematory issued by
473.27the commissioner may use the title of crematory, crematorium, green-cremation, or any
473.28other title, word, or term implying that the licensee operates a crematory or crematorium.

473.29    Sec. 60. Minnesota Statutes 2012, section 149A.70, subdivision 2, is amended to read:
473.30    Subd. 2. Business location. A funeral establishment, alkaline hydrolysis facility, or
473.31crematory shall not do business in a location that is not licensed as a funeral establishment,
474.1alkaline hydrolysis facility, or crematory and shall not advertise a service that is available
474.2from an unlicensed location.

474.3    Sec. 61. Minnesota Statutes 2012, section 149A.70, subdivision 3, is amended to read:
474.4    Subd. 3. Advertising. No licensee, clinical student, practicum student, or intern
474.5shall publish or disseminate false, misleading, or deceptive advertising. False, misleading,
474.6or deceptive advertising includes, but is not limited to:
474.7    (1) identifying, by using the names or pictures of, persons who are not licensed to
474.8practice mortuary science in a way that leads the public to believe that those persons will
474.9provide mortuary science services;
474.10    (2) using any name other than the names under which the funeral establishment,
474.11alkaline hydrolysis facility, or crematory is known to or licensed by the commissioner;
474.12    (3) using a surname not directly, actively, or presently associated with a licensed
474.13funeral establishment, alkaline hydrolysis facility, or crematory, unless the surname had
474.14been previously and continuously used by the licensed funeral establishment, alkaline
474.15hydrolysis facility, or crematory; and
474.16    (4) using a founding or establishing date or total years of service not directly or
474.17continuously related to a name under which the funeral establishment, alkaline hydrolysis
474.18facility, or crematory is currently or was previously licensed.
474.19    Any advertising or other printed material that contains the names or pictures of
474.20persons affiliated with a funeral establishment, alkaline hydrolysis facility, or crematory
474.21shall state the position held by the persons and shall identify each person who is licensed
474.22or unlicensed under this chapter.

474.23    Sec. 62. Minnesota Statutes 2012, section 149A.70, subdivision 5, is amended to read:
474.24    Subd. 5. Reimbursement prohibited. No licensee, clinical student, practicum
474.25student, or intern shall offer, solicit, or accept a commission, fee, bonus, rebate, or other
474.26reimbursement in consideration for recommending or causing a dead human body to
474.27be disposed of by a specific body donation program, funeral establishment, alkaline
474.28hydrolysis facility, crematory, mausoleum, or cemetery.

474.29    Sec. 63. Minnesota Statutes 2012, section 149A.71, subdivision 2, is amended to read:
474.30    Subd. 2. Preventive requirements. (a) To prevent unfair or deceptive acts or
474.31practices, the requirements of this subdivision must be met.
474.32    (b) Funeral providers must tell persons who ask by telephone about the funeral
474.33provider's offerings or prices any accurate information from the price lists described in
475.1paragraphs (c) to (e) and any other readily available information that reasonably answers
475.2the questions asked.
475.3    (c) Funeral providers must make available for viewing to people who inquire in
475.4person about the offerings or prices of funeral goods or burial site goods, separate printed
475.5or typewritten price lists using a ten-point font or larger. Each funeral provider must have a
475.6separate price list for each of the following types of goods that are sold or offered for sale:
475.7    (1) caskets;
475.8    (2) alternative containers;
475.9    (3) outer burial containers;
475.10(4) alkaline hydrolysis containers;
475.11    (4) (5) cremation containers;
475.12(6) hydrolyzed remains containers;
475.13    (5) (7) cremated remains containers;
475.14    (6) (8) markers; and
475.15    (7) (9) headstones.
475.16    (d) Each separate price list must contain the name of the funeral provider's place
475.17of business, address, and telephone number and a caption describing the list as a price
475.18list for one of the types of funeral goods or burial site goods described in paragraph (c),
475.19clauses (1) to (7) (9). The funeral provider must offer the list upon beginning discussion
475.20of, but in any event before showing, the specific funeral goods or burial site goods and
475.21must provide a photocopy of the price list, for retention, if so asked by the consumer. The
475.22list must contain, at least, the retail prices of all the specific funeral goods and burial site
475.23goods offered which do not require special ordering, enough information to identify each,
475.24and the effective date for the price list. However, funeral providers are not required to
475.25make a specific price list available if the funeral providers place the information required
475.26by this paragraph on the general price list described in paragraph (e).
475.27    (e) Funeral providers must give a printed price list, for retention, to persons who
475.28inquire in person about the funeral goods, funeral services, burial site goods, or burial site
475.29services or prices offered by the funeral provider. The funeral provider must give the list
475.30upon beginning discussion of either the prices of or the overall type of funeral service or
475.31disposition or specific funeral goods, funeral services, burial site goods, or burial site
475.32services offered by the provider. This requirement applies whether the discussion takes
475.33place in the funeral establishment or elsewhere. However, when the deceased is removed
475.34for transportation to the funeral establishment, an in-person request for authorization to
475.35embalm does not, by itself, trigger the requirement to offer the general price list. If the
475.36provider, in making an in-person request for authorization to embalm, discloses that
476.1embalming is not required by law except in certain special cases, the provider is not
476.2required to offer the general price list. Any other discussion during that time about prices
476.3or the selection of funeral goods, funeral services, burial site goods, or burial site services
476.4triggers the requirement to give the consumer a general price list. The general price list
476.5must contain the following information:
476.6    (1) the name, address, and telephone number of the funeral provider's place of
476.7business;
476.8    (2) a caption describing the list as a "general price list";
476.9    (3) the effective date for the price list;
476.10    (4) the retail prices, in any order, expressed either as a flat fee or as the prices per
476.11hour, mile, or other unit of computation, and other information described as follows:
476.12    (i) forwarding of remains to another funeral establishment, together with a list of
476.13the services provided for any quoted price;
476.14    (ii) receiving remains from another funeral establishment, together with a list of
476.15the services provided for any quoted price;
476.16    (iii) separate prices for each alkaline hydrolysis or cremation offered by the funeral
476.17provider, with the price including an alternative container or alkaline hydrolysis or
476.18cremation container, any alkaline hydrolysis or crematory charges, and a description of the
476.19services and container included in the price, where applicable, and the price of alkaline
476.20hydrolysis or cremation where the purchaser provides the container;
476.21    (iv) separate prices for each immediate burial offered by the funeral provider,
476.22including a casket or alternative container, and a description of the services and container
476.23included in that price, and the price of immediate burial where the purchaser provides the
476.24casket or alternative container;
476.25    (v) transfer of remains to the funeral establishment or other location;
476.26    (vi) embalming;
476.27    (vii) other preparation of the body;
476.28    (viii) use of facilities, equipment, or staff for viewing;
476.29    (ix) use of facilities, equipment, or staff for funeral ceremony;
476.30    (x) use of facilities, equipment, or staff for memorial service;
476.31    (xi) use of equipment or staff for graveside service;
476.32    (xii) hearse or funeral coach;
476.33    (xiii) limousine; and
476.34    (xiv) separate prices for all cemetery-specific goods and services, including all goods
476.35and services associated with interment and burial site goods and services and excluding
476.36markers and headstones;
477.1    (5) the price range for the caskets offered by the funeral provider, together with the
477.2statement "A complete price list will be provided at the funeral establishment or casket
477.3sale location." or the prices of individual caskets, as disclosed in the manner described
477.4in paragraphs (c) and (d);
477.5    (6) the price range for the alternative containers offered by the funeral provider,
477.6together with the statement "A complete price list will be provided at the funeral
477.7establishment or alternative container sale location." or the prices of individual alternative
477.8containers, as disclosed in the manner described in paragraphs (c) and (d);
477.9    (7) the price range for the outer burial containers offered by the funeral provider,
477.10together with the statement "A complete price list will be provided at the funeral
477.11establishment or outer burial container sale location." or the prices of individual outer
477.12burial containers, as disclosed in the manner described in paragraphs (c) and (d);
477.13(8) the price range for the alkaline hydrolysis container offered by the funeral
477.14provider, together with the statement: "A complete price list will be provided at the funeral
477.15establishment or alkaline hydrolysis container sale location.", or the prices of individual
477.16alkaline hydrolysis containers, as disclosed in the manner described in paragraphs (c)
477.17and (d);
477.18(9) the price range for the hydrolyzed remains container offered by the funeral
477.19provider, together with the statement: "A complete price list will be provided at the
477.20funeral establishment or hydrolyzed remains container sale location.", or the prices
477.21of individual hydrolyzed remains container, as disclosed in the manner described in
477.22paragraphs (c) and (d);
477.23    (8) (10) the price range for the cremation containers offered by the funeral provider,
477.24together with the statement "A complete price list will be provided at the funeral
477.25establishment or cremation container sale location." or the prices of individual cremation
477.26containers and cremated remains containers, as disclosed in the manner described in
477.27paragraphs (c) and (d);
477.28    (9) (11) the price range for the cremated remains containers offered by the funeral
477.29provider, together with the statement, "A complete price list will be provided at the funeral
477.30establishment or cremation cremated remains container sale location," or the prices of
477.31individual cremation containers as disclosed in the manner described in paragraphs (c)
477.32and (d);
477.33    (10) (12) the price for the basic services of funeral provider and staff, together with a
477.34list of the principal basic services provided for any quoted price and, if the charge cannot
477.35be declined by the purchaser, the statement "This fee for our basic services will be added
477.36to the total cost of the funeral arrangements you select. (This fee is already included in
478.1our charges for alkaline hydrolysis, direct cremations, immediate burials, and forwarding
478.2or receiving remains.)" If the charge cannot be declined by the purchaser, the quoted
478.3price shall include all charges for the recovery of unallocated funeral provider overhead,
478.4and funeral providers may include in the required disclosure the phrase "and overhead"
478.5after the word "services." This services fee is the only funeral provider fee for services,
478.6facilities, or unallocated overhead permitted by this subdivision to be nondeclinable,
478.7unless otherwise required by law;
478.8    (11) (13) the price range for the markers and headstones offered by the funeral
478.9provider, together with the statement "A complete price list will be provided at the funeral
478.10establishment or marker or headstone sale location." or the prices of individual markers
478.11and headstones, as disclosed in the manner described in paragraphs (c) and (d); and
478.12    (12) (14) any package priced funerals offered must be listed in addition to and
478.13following the information required in paragraph (e) and must clearly state the funeral
478.14goods and services being offered, the price being charged for those goods and services,
478.15and the discounted savings.
478.16    (f) Funeral providers must give an itemized written statement, for retention, to each
478.17consumer who arranges an at-need funeral or other disposition of human remains at the
478.18conclusion of the discussion of the arrangements. The itemized written statement must be
478.19signed by the consumer selecting the goods and services as required in section 149A.80.
478.20If the statement is provided by a funeral establishment, the statement must be signed by
478.21the licensed funeral director or mortician planning the arrangements. If the statement is
478.22provided by any other funeral provider, the statement must be signed by an authorized
478.23agent of the funeral provider. The statement must list the funeral goods, funeral services,
478.24burial site goods, or burial site services selected by that consumer and the prices to be paid
478.25for each item, specifically itemized cash advance items (these prices must be given to the
478.26extent then known or reasonably ascertainable if the prices are not known or reasonably
478.27ascertainable, a good faith estimate shall be given and a written statement of the actual
478.28charges shall be provided before the final bill is paid), and the total cost of goods and
478.29services selected. At the conclusion of an at-need arrangement, the funeral provider is
478.30required to give the consumer a copy of the signed itemized written contract that must
478.31contain the information required in this paragraph.
478.32    (g) Upon receiving actual notice of the death of an individual with whom a funeral
478.33provider has entered a preneed funeral agreement, the funeral provider must provide
478.34a copy of all preneed funeral agreement documents to the person who controls final
478.35disposition of the human remains or to the designee of the person controlling disposition.
478.36The person controlling final disposition shall be provided with these documents at the time
479.1of the person's first in-person contact with the funeral provider, if the first contact occurs
479.2in person at a funeral establishment, alkaline hydrolysis facility, crematory, or other place
479.3of business of the funeral provider. If the contact occurs by other means or at another
479.4location, the documents must be provided within 24 hours of the first contact.

479.5    Sec. 64. Minnesota Statutes 2012, section 149A.71, subdivision 4, is amended to read:
479.6    Subd. 4. Casket, alternate container, alkaline hydrolysis containers, and
479.7cremation container sales; records; required disclosures. Any funeral provider who
479.8sells or offers to sell a casket, alternate container, alkaline hydrolysis container, hydrolyzed
479.9remains container, or cremation container, or cremated remains container to the public
479.10must maintain a record of each sale that includes the name of the purchaser, the purchaser's
479.11mailing address, the name of the decedent, the date of the decedent's death, and the place
479.12of death. These records shall be open to inspection by the regulatory agency. Any funeral
479.13provider selling a casket, alternate container, or cremation container to the public, and not
479.14having charge of the final disposition of the dead human body, shall provide a copy of the
479.15statutes and rules controlling the removal, preparation, transportation, arrangements for
479.16disposition, and final disposition of a dead human body. This subdivision does not apply to
479.17morticians, funeral directors, funeral establishments, crematories, or wholesale distributors
479.18of caskets, alternate containers, alkaline hydrolysis containers, or cremation containers.

479.19    Sec. 65. Minnesota Statutes 2012, section 149A.72, subdivision 3, is amended to read:
479.20    Subd. 3. Casket for alkaline hydrolysis or cremation provisions; deceptive acts
479.21or practices. In selling or offering to sell funeral goods or funeral services to the public, it
479.22is a deceptive act or practice for a funeral provider to represent that a casket is required for
479.23alkaline hydrolysis or cremations by state or local law or otherwise.

479.24    Sec. 66. Minnesota Statutes 2012, section 149A.72, is amended by adding a
479.25subdivision to read:
479.26    Subd. 3a. Casket for alkaline hydrolysis provision; preventive measures. To
479.27prevent deceptive acts or practices, funeral providers must place the following disclosure
479.28in immediate conjunction with the prices shown for alkaline hydrolysis: "Minnesota
479.29law does not require you to purchase a casket for alkaline hydrolysis. If you want to
479.30arrange for alkaline hydrolysis, you can use an alkaline hydrolysis container. An alkaline
479.31hydrolysis container is a hydrolyzable or biodegradable closed container or pouch resistant
479.32to leakage of bodily fluids that encases the body and into which a dead human body is
479.33placed prior to insertion into an alkaline hydrolysis vessel. The containers we provide
480.1are (specify containers provided)." This disclosure is required only if the funeral provider
480.2arranges alkaline hydrolysis.

480.3    Sec. 67. Minnesota Statutes 2012, section 149A.72, subdivision 9, is amended to read:
480.4    Subd. 9. Deceptive acts or practices. In selling or offering to sell funeral goods,
480.5funeral services, burial site goods, or burial site services to the public, it is a deceptive act
480.6or practice for a funeral provider to represent that federal, state, or local laws, or particular
480.7cemeteries, alkaline hydrolysis facilities, or crematories, require the purchase of any funeral
480.8goods, funeral services, burial site goods, or burial site services when that is not the case.

480.9    Sec. 68. Minnesota Statutes 2012, section 149A.73, subdivision 1, is amended to read:
480.10    Subdivision 1. Casket for alkaline hydrolysis or cremation provisions; deceptive
480.11acts or practices. In selling or offering to sell funeral goods, funeral services, burial site
480.12goods, or burial site services to the public, it is a deceptive act or practice for a funeral
480.13provider to require that a casket be purchased for alkaline hydrolysis or cremation.

480.14    Sec. 69. Minnesota Statutes 2012, section 149A.73, subdivision 2, is amended to read:
480.15    Subd. 2. Casket for alkaline hydrolysis or cremation; preventive requirements.
480.16To prevent unfair or deceptive acts or practices, if funeral providers arrange for alkaline
480.17hydrolysis or cremations, they must make a an alkaline hydrolysis container or cremation
480.18container available for alkaline hydrolysis or cremations.

480.19    Sec. 70. Minnesota Statutes 2012, section 149A.73, subdivision 4, is amended to read:
480.20    Subd. 4. Required purchases of funeral goods or services; preventive
480.21requirements. To prevent unfair or deceptive acts or practices, funeral providers must
480.22place the following disclosure in the general price list, immediately above the prices
480.23required by section 149A.71, subdivision 2, paragraph (e), clauses (4) to (10): "The goods
480.24and services shown below are those we can provide to our customers. You may choose
480.25only the items you desire. If legal or other requirements mean that you must buy any items
480.26you did not specifically ask for, we will explain the reason in writing on the statement we
480.27provide describing the funeral goods, funeral services, burial site goods, and burial site
480.28services you selected." However, if the charge for "services of funeral director and staff"
480.29cannot be declined by the purchaser, the statement shall include the sentence "However,
480.30any funeral arrangements you select will include a charge for our basic services." between
480.31the second and third sentences of the sentences specified in this subdivision. The statement
480.32may include the phrase "and overhead" after the word "services" if the fee includes a
481.1charge for the recovery of unallocated funeral overhead. If the funeral provider does
481.2not include this disclosure statement, then the following disclosure statement must be
481.3placed in the statement of funeral goods, funeral services, burial site goods, and burial site
481.4services selected, as described in section 149A.71, subdivision 2, paragraph (f): "Charges
481.5are only for those items that you selected or that are required. If we are required by law or
481.6by a cemetery, alkaline hydrolysis facility, or crematory to use any items, we will explain
481.7the reasons in writing below." A funeral provider is not in violation of this subdivision by
481.8failing to comply with a request for a combination of goods or services which would be
481.9impossible, impractical, or excessively burdensome to provide.

481.10    Sec. 71. Minnesota Statutes 2012, section 149A.74, is amended to read:
481.11149A.74 FUNERAL SERVICES PROVIDED WITHOUT PRIOR APPROVAL.
481.12    Subdivision 1. Services provided without prior approval; deceptive acts or
481.13practices. In selling or offering to sell funeral goods or funeral services to the public, it
481.14is a deceptive act or practice for any funeral provider to embalm a dead human body
481.15unless state or local law or regulation requires embalming in the particular circumstances
481.16regardless of any funeral choice which might be made, or prior approval for embalming
481.17has been obtained from an individual legally authorized to make such a decision. In
481.18seeking approval to embalm, the funeral provider must disclose that embalming is not
481.19required by law except in certain circumstances; that a fee will be charged if a funeral
481.20is selected which requires embalming, such as a funeral with viewing; and that no
481.21embalming fee will be charged if the family selects a service which does not require
481.22embalming, such as direct alkaline hydrolysis, direct cremation, or immediate burial.
481.23    Subd. 2. Services provided without prior approval; preventive requirement.
481.24To prevent unfair or deceptive acts or practices, funeral providers must include on
481.25the itemized statement of funeral goods or services, as described in section 149A.71,
481.26subdivision 2 , paragraph (f), the statement "If you selected a funeral that may require
481.27embalming, such as a funeral with viewing, you may have to pay for embalming. You do
481.28not have to pay for embalming you did not approve if you selected arrangements such
481.29as direct alkaline hydrolysis, direct cremation, or immediate burial. If we charged for
481.30embalming, we will explain why below."

481.31    Sec. 72. Minnesota Statutes 2012, section 149A.91, subdivision 9, is amended to read:
481.32    Subd. 9. Embalmed Bodies awaiting final disposition. All embalmed bodies
481.33awaiting final disposition shall be kept in an appropriate holding facility or preparation
481.34and embalming room. The holding facility must be secure from access by anyone except
482.1the authorized personnel of the funeral establishment, preserve the dignity and integrity of
482.2the body, and protect the health and safety of the personnel of the funeral establishment.

482.3    Sec. 73. Minnesota Statutes 2012, section 149A.93, subdivision 3, is amended to read:
482.4    Subd. 3. Disposition permit. A disposition permit is required before a body can
482.5be buried, entombed, alkaline hydrolyzed, or cremated. No disposition permit shall be
482.6issued until a fact of death record has been completed and filed with the local or state
482.7registrar of vital statistics.

482.8    Sec. 74. Minnesota Statutes 2012, section 149A.93, subdivision 6, is amended to read:
482.9    Subd. 6. Conveyances permitted for transportation. A dead human body may be
482.10transported by means of private vehicle or private aircraft, provided that the body must be
482.11encased in an appropriate container, that meets the following standards:
482.12    (1) promotes respect for and preserves the dignity of the dead human body;
482.13    (2) shields the body from being viewed from outside of the conveyance;
482.14    (3) has ample enclosed area to accommodate a cot, stretcher, rigid tray, casket,
482.15alternative container, alkaline hydrolysis container, or cremation container in a horizontal
482.16position;
482.17    (4) is designed to permit loading and unloading of the body without excessive tilting
482.18of the cot, stretcher, rigid tray, casket, alternative container, alkaline hydrolysis container,
482.19 or cremation container; and
482.20    (5) if used for the transportation of more than one dead human body at one time,
482.21the vehicle must be designed so that a body or container does not rest directly on top of
482.22another body or container and that each body or container is secured to prevent the body
482.23or container from excessive movement within the conveyance.
482.24    A vehicle that is a dignified conveyance and was specified for use by the deceased
482.25or by the family of the deceased may be used to transport the body to the place of final
482.26disposition.

482.27    Sec. 75. Minnesota Statutes 2012, section 149A.94, is amended to read:
482.28149A.94 FINAL DISPOSITION.
482.29    Subdivision 1. Generally. Every dead human body lying within the state, except
482.30unclaimed bodies delivered for dissection by the medical examiner, those delivered for
482.31anatomical study pursuant to section 149A.81, subdivision 2, or lawfully carried through
482.32the state for the purpose of disposition elsewhere; and the remains of any dead human
482.33body after dissection or anatomical study, shall be decently buried, or entombed in a
483.1public or private cemetery, alkaline hydrolyzed or cremated, within a reasonable time
483.2after death. Where final disposition of a body will not be accomplished within 72 hours
483.3following death or release of the body by a competent authority with jurisdiction over the
483.4body, the body must be properly embalmed, refrigerated, or packed with dry ice. A body
483.5may not be kept in refrigeration for a period exceeding six calendar days, or packed in dry
483.6ice for a period that exceeds four calendar days, from the time of death or release of the
483.7body from the coroner or medical examiner.
483.8    Subd. 3. Permit required. No dead human body shall be buried, entombed, or
483.9cremated without a disposition permit. The disposition permit must be filed with the person
483.10in charge of the place of final disposition. Where a dead human body will be transported out
483.11of this state for final disposition, the body must be accompanied by a certificate of removal.
483.12    Subd. 4. Alkaline hydrolysis or cremation. Inurnment of alkaline hydrolyzed or
483.13cremated remains and release to an appropriate party is considered final disposition and no
483.14further permits or authorizations are required for transportation, interment, entombment, or
483.15placement of the cremated remains, except as provided in section 149A.95, subdivision 16.

483.16    Sec. 76. [149A.941] ALKALINE HYDROLYSIS FACILITIES AND ALKALINE
483.17HYDROLYSIS.
483.18    Subdivision 1. License required. A dead human body may only be hydrolyzed in
483.19this state at an alkaline hydrolysis facility licensed by the commissioner of health.
483.20    Subd. 2. General requirements. Any building to be used as an alkaline hydrolysis
483.21facility must comply with all applicable local and state building codes, zoning laws and
483.22ordinances, wastewater management regulations, and environmental statutes, rules, and
483.23standards. An alkaline hydrolysis facility must have, on site, a purpose built human
483.24alkaline hydrolysis system approved by the commissioner of health, a system approved by
483.25the commissioner of health for drying the hydrolyzed remains, a motorized mechanical
483.26device approved by the commissioner of health for processing hydrolyzed remains and
483.27must have in the building a holding facility approved by the commissioner of health for
483.28the retention of dead human bodies awaiting alkaline hydrolysis. The holding facility
483.29must be secure from access by anyone except the authorized personnel of the alkaline
483.30hydrolysis facility, preserve the dignity of the remains, and protect the health and safety of
483.31the alkaline hydrolysis facility personnel.
483.32    Subd. 3. Lighting and ventilation. The room where the alkaline hydrolysis vessel
483.33is located and the room where the chemical storage takes place shall be properly lit and
483.34ventilated with an exhaust fan that provides at least 12 air changes per hour.
484.1    Subd. 4. Plumbing connections. All plumbing fixtures, water supply lines,
484.2plumbing vents, and waste drains shall be properly vented and connected pursuant to the
484.3Minnesota Plumbing Code. The alkaline hydrolysis facility shall be equipped with a
484.4functional sink with hot and cold running water.
484.5    Subd. 5. Flooring, walls, ceiling, doors, and windows. The room where the
484.6alkaline hydrolysis vessel is located and the room where the chemical storage takes place
484.7shall have nonporous flooring, so that a sanitary condition is provided. The walls and
484.8ceiling of the room where the alkaline hydrolysis vessel is located and the room where
484.9the chemical storage takes place shall run from floor to ceiling and be covered with tile,
484.10or by plaster or sheetrock painted with washable paint or other appropriate material so
484.11that a sanitary condition is provided. The doors, walls, ceiling, and windows shall be
484.12constructed to prevent odors from entering any other part of the building. All windows
484.13or other openings to the outside must be screened and all windows must be treated in a
484.14manner that prevents viewing into the room where the alkaline hydrolysis vessel is located
484.15and the room where the chemical storage takes place. A viewing window for authorized
484.16family members or their designees is not a violation of this subdivision.
484.17    Subd. 6. Equipment and supplies. The alkaline hydrolysis facility must have a
484.18functional emergency eye wash and quick drench shower.
484.19    Subd. 7. Access and privacy. (a) The room where the alkaline hydrolysis vessel is
484.20located and the room where the chemical storage takes place must be private and have no
484.21general passageway through it. The room shall, at all times, be secure from the entrance of
484.22unauthorized persons. Authorized persons are:
484.23(1) licensed morticians;
484.24(2) registered interns or students as described in section 149A.91, subdivision 6;
484.25(3) public officials or representatives in the discharge of their official duties;
484.26(4) trained alkaline hydrolysis facility operators; and
484.27(5) the person(s) with the right to control the dead human body as defined in section
484.28149A.80, subdivision 2, and their designees.
484.29    (b) Each door allowing ingress or egress shall carry a sign that indicates that the
484.30room is private and access is limited. All authorized persons who are present in or enter
484.31the room where the alkaline hydrolysis vessel is located while a body is being prepared for
484.32final disposition must be attired according to all applicable state and federal regulations
484.33regarding the control of infectious disease and occupational and workplace health and
484.34safety.
484.35    Subd. 8. Sanitary conditions and permitted use. The room where the alkaline
484.36hydrolysis vessel is located and the room where the chemical storage takes place and all
485.1fixtures, equipment, instruments, receptacles, clothing, and other appliances or supplies
485.2stored or used in the room must be maintained in a clean and sanitary condition at all times.
485.3    Subd. 9. Boiler use. When a boiler is required by the manufacturer of the alkaline
485.4hydrolysis vessel for its operation, all state and local regulations for that boiler must be
485.5followed.
485.6    Subd. 10. Occupational and workplace safety. All applicable provisions of state
485.7and federal regulations regarding exposure to workplace hazards and accidents shall be
485.8followed in order to protect the health and safety of all authorized persons at the alkaline
485.9hydrolysis facility.
485.10    Subd. 11. Licensed personnel. A licensed alkaline hydrolysis facility must employ
485.11a licensed mortician to carry out the process of alkaline hydrolysis of a dead human body.
485.12It is the duty of the licensed alkaline hydrolysis facility to provide proper procedures for
485.13all personnel, and the licensed alkaline hydrolysis facility shall be strictly accountable for
485.14compliance with this chapter and other applicable state and federal regulations regarding
485.15occupational and workplace health and safety.
485.16    Subd. 12. Authorization to hydrolyze required. No alkaline hydrolysis facility
485.17shall hydrolyze or cause to be hydrolyzed any dead human body or identifiable body part
485.18without receiving written authorization to do so from the person or persons who have the
485.19legal right to control disposition as described in section 149A.80 or the person's legal
485.20designee. The written authorization must include:
485.21(1) the name of the deceased and the date of death of the deceased;
485.22(2) a statement authorizing the alkaline hydrolysis facility to hydrolyze the body;
485.23(3) the name, address, telephone number, relationship to the deceased, and signature
485.24of the person or persons with legal right to control final disposition or a legal designee;
485.25(4) directions for the disposition of any nonhydrolyzed materials or items recovered
485.26from the alkaline hydrolysis vessel;
485.27(5) acknowledgment that the hydrolyzed remains will be dried and mechanically
485.28reduced to a granulated appearance and placed in an appropriate container and
485.29authorization to place any hydrolyzed remains that a selected urn or container will not
485.30accommodate into a temporary container;
485.31(6) acknowledgment that, even with the exercise of reasonable care, it is not possible
485.32to recover all particles of the hydrolyzed remains and that some particles may inadvertently
485.33become commingled with particles of other hydrolyzed remains that remain in the alkaline
485.34hydrolysis vessel or other mechanical devices used to process the hydrolyzed remains;
485.35(7) directions for the ultimate disposition of the hydrolyzed remains; and
486.1(8) a statement that includes, but is not limited to, the following information:
486.2"During the alkaline hydrolysis process, chemical dissolution using heat, water, and an
486.3alkaline solution is used to chemically break down the human tissue and the hydrolyzable
486.4alkaline hydrolysis container. After the process is complete, the liquid effluent solution
486.5contains the chemical by-products of the alkaline hydrolysis process except for the
486.6deceased's bone fragments. The solution is cooled and released according to local
486.7environmental regulations. A water rinse is applied to the hydrolyzed remains which are
486.8then dried and processed to facilitate inurnment or scattering."
486.9    Subd. 13. Limitation of liability. A licensed alkaline hydrolysis facility acting in
486.10good faith, with reasonable reliance upon an authorization to hydrolyze, pursuant to an
486.11authorization to hydrolyze and in an otherwise lawful manner, shall be held harmless from
486.12civil liability and criminal prosecution for any actions taken by the alkaline hydrolysis
486.13facility.
486.14    Subd. 14. Acceptance of delivery of body. (a) No dead human body shall be
486.15accepted for final disposition by alkaline hydrolysis unless:
486.16(1) encased in an appropriate alkaline hydrolysis container;
486.17(2) accompanied by a disposition permit issued pursuant to section 149A.93,
486.18subdivision 3, including a photocopy of the completed death record or a signed release
486.19authorizing alkaline hydrolysis of the body received from the coroner or medical
486.20examiner; and
486.21(3) accompanied by an alkaline hydrolysis authorization that complies with
486.22subdivision 12.
486.23    (b) An alkaline hydrolysis facility shall refuse to accept delivery of an alkaline
486.24hydrolysis container where there is:
486.25(1) evidence of leakage of fluids from the alkaline hydrolysis container;
486.26(2) a known dispute concerning hydrolysis of the body delivered;
486.27(3) a reasonable basis for questioning any of the representations made on the written
486.28authorization to hydrolyze; or
486.29(4) any other lawful reason.
486.30    Subd. 15. Bodies awaiting hydrolysis. A dead human body must be hydrolyzed
486.31within 24 hours of the alkaline hydrolysis facility accepting legal and physical custody of
486.32the body.
486.33    Subd. 16. Handling of alkaline hydrolysis containers for dead human bodies.
486.34All alkaline hydrolysis facility employees handling alkaline hydrolysis containers for
486.35dead human bodies shall use universal precautions and otherwise exercise all reasonable
487.1precautions to minimize the risk of transmitting any communicable disease from the body.
487.2No dead human body shall be removed from the container in which it is delivered.
487.3    Subd. 17. Identification of body. All licensed alkaline hydrolysis facilities shall
487.4develop, implement, and maintain an identification procedure whereby dead human
487.5bodies can be identified from the time the alkaline hydrolysis facility accepts delivery
487.6of the remains until the hydrolyzed remains are released to an authorized party. After
487.7hydrolyzation, an identifying disk, tab, or other permanent label shall be placed within the
487.8hydrolyzed remains container before the hydrolyzed remains are released from the alkaline
487.9hydrolysis facility. Each identification disk, tab, or label shall have a number that shall
487.10be recorded on all paperwork regarding the decedent. This procedure shall be designed
487.11to reasonably ensure that the proper body is hydrolyzed and that the hydrolyzed remains
487.12are returned to the appropriate party. Loss of all or part of the hydrolyzed remains or the
487.13inability to individually identify the hydrolyzed remains is a violation of this subdivision.
487.14    Subd. 18. Alkaline hydrolysis vessel for human remains. A licensed alkaline
487.15hydrolysis facility shall knowingly hydrolyze only dead human bodies or human remains
487.16in an alkaline hydrolysis vessel, along with the alkaline hydrolysis container used for
487.17infectious disease control.
487.18    Subd. 19. Alkaline hydrolysis procedures; privacy. The final disposition of
487.19dead human bodies by alkaline hydrolysis shall be done in privacy. Unless there is
487.20written authorization from the person with the legal right to control the disposition,
487.21only authorized alkaline hydrolysis facility personnel shall be permitted in the alkaline
487.22hydrolysis area while any dead human body is in the alkaline hydrolysis area awaiting
487.23alkaline hydrolysis, in the alkaline hydrolysis vessel, being removed from the alkaline
487.24hydrolysis vessel, or being processed and placed in a hydrolyzed remains container.
487.25    Subd. 20. Alkaline hydrolysis procedures; commingling of hydrolyzed remains
487.26prohibited. Except with the express written permission of the person with the legal right
487.27to control the disposition, no alkaline hydrolysis facility shall hydrolyze more than one
487.28dead human body at the same time and in the same alkaline hydrolysis vessel, or introduce
487.29a second dead human body into an alkaline hydrolysis vessel until reasonable efforts have
487.30been employed to remove all fragments of the preceding hydrolyzed remains, or hydrolyze
487.31a dead human body and other human remains at the same time and in the same alkaline
487.32hydrolysis vessel. This section does not apply where commingling of human remains
487.33during alkaline hydrolysis is otherwise provided by law. The fact that there is incidental
487.34and unavoidable residue in the alkaline hydrolysis vessel used in a prior hydrolyzation is
487.35not a violation of this subdivision.
488.1    Subd. 21. Alkaline hydrolysis procedures; removal from alkaline hydrolysis
488.2vessel. Upon completion of the alkaline hydrolysis process, reasonable efforts shall be
488.3made to remove from the alkaline hydrolysis vessel all of the recoverable hydrolyzed
488.4remains and nonhydrolyzed materials or items. Further, all reasonable efforts shall be
488.5made to separate and recover the nonhydrolyzed materials or items from the hydrolyzed
488.6human remains and dispose of these materials in a lawful manner, by the alkaline
488.7hydrolysis facility. The hydrolyzed human remains shall be placed in an appropriate
488.8container to be transported to the processing area.
488.9    Subd. 22. Drying device or mechanical processor procedures; commingling of
488.10hydrolyzed remains prohibited. Except with the express written permission of the
488.11person with the legal right to control the final disposition or otherwise provided by
488.12law, no alkaline hydrolysis facility shall dry or mechanically process the hydrolyzed
488.13human remains of more than one body at a time in the same drying device or mechanical
488.14processor, or introduce the hydrolyzed human remains of a second body into a drying
488.15device or mechanical processor until processing of any preceding hydrolyzed human
488.16remains has been terminated and reasonable efforts have been employed to remove all
488.17fragments of the preceding hydrolyzed remains. The fact that there is incidental and
488.18unavoidable residue in the drying device, the mechanical processor, or any container used
488.19in a prior alkaline hydrolysis process, is not a violation of this provision.
488.20    Subd. 23. Alkaline hydrolysis procedures; processing hydrolyzed remains. The
488.21hydrolyzed human remains shall be dried and then reduced by a motorized mechanical
488.22device to a granulated appearance appropriate for final disposition and placed in an
488.23alkaline hydrolysis remains container along with the appropriate identifying disk, tab,
488.24or permanent label. Processing must take place within the licensed alkaline hydrolysis
488.25facility. Dental gold, silver or amalgam, jewelry, or mementos, to the extent that they
488.26can be identified, may be removed prior to processing the hydrolyzed remains, only by
488.27staff licensed or registered by the commissioner of health; however, any dental gold and
488.28silver, jewelry, or mementos that are removed shall be returned to the hydrolyzed remains
488.29container unless otherwise directed by the person or persons having the right to control the
488.30final disposition. Every person who removes or possesses dental gold or silver, jewelry,
488.31or mementos from any hydrolyzed remains without specific written permission of the
488.32person or persons having the right to control those remains is guilty of a misdemeanor.
488.33The fact that residue and any unavoidable dental gold or dental silver, or other precious
488.34metals remain in the alkaline hydrolysis vessel or other equipment or any container used
488.35in a prior hydrolysis is not a violation of this section.
489.1    Subd. 24. Alkaline hydrolysis procedures; container of insufficient capacity.
489.2If a hydrolyzed remains container is of insufficient capacity to accommodate all
489.3hydrolyzed remains of a given dead human body, subject to directives provided in the
489.4written authorization to hydrolyze, the alkaline hydrolysis facility shall place the excess
489.5hydrolyzed remains in a secondary alkaline hydrolysis remains container and attach the
489.6second container, in a manner so as not to be easily detached through incidental contact, to
489.7the primary alkaline hydrolysis remains container. The secondary container shall contain a
489.8duplicate of the identification disk, tab, or permanent label that was placed in the primary
489.9container and all paperwork regarding the given body shall include a notation that the
489.10hydrolyzed remains were placed in two containers. Keepsake jewelry or similar miniature
489.11hydrolyzed remains containers are not subject to the requirements of this subdivision.
489.12    Subd. 25. Disposition procedures; commingling of hydrolyzed remains
489.13prohibited. No hydrolyzed remains shall be disposed of or scattered in a manner or in
489.14a location where the hydrolyzed remains are commingled with those of another person
489.15without the express written permission of the person with the legal right to control
489.16disposition or as otherwise provided by law. This subdivision does not apply to the
489.17scattering or burial of hydrolyzed remains at sea or in a body of water from individual
489.18containers, to the scattering or burial of hydrolyzed remains in a dedicated cemetery, to
489.19the disposal in a dedicated cemetery of accumulated residue removed from an alkaline
489.20hydrolysis vessel or other alkaline hydrolysis equipment, to the inurnment of members
489.21of the same family in a common container designed for the hydrolyzed remains of more
489.22than one body, or to the inurnment in a container or interment in a space that has been
489.23previously designated, at the time of sale or purchase, as being intended for the inurnment
489.24or interment of the hydrolyzed remains of more than one person.
489.25    Subd. 26. Alkaline hydrolysis procedures; disposition of accumulated residue.
489.26Every alkaline hydrolysis facility shall provide for the removal and disposition in a
489.27dedicated cemetery of any accumulated residue from any alkaline hydrolysis vessel,
489.28drying device, mechanical processor, container, or other equipment used in alkaline
489.29hydrolysis. Disposition of accumulated residue shall be according to the regulations of the
489.30dedicated cemetery and any applicable local ordinances.
489.31    Subd. 27. Alkaline hydrolysis procedures; release of hydrolyzed remains.
489.32Following completion of the hydrolyzation, the inurned hydrolyzed remains shall be
489.33released according to the instructions given on the written authorization to hydrolyze. If
489.34the hydrolyzed remains are to be shipped, they must be securely packaged and transported
489.35by a method which has an internal tracing system available and which provides for a
489.36receipt signed by the person accepting delivery. Where there is a dispute over release
490.1or disposition of the hydrolyzed remains, an alkaline hydrolysis facility may deposit
490.2the hydrolyzed remains with a court of competent jurisdiction pending resolution of the
490.3dispute or retain the hydrolyzed remains until the person with the legal right to control
490.4disposition presents satisfactory indication that the dispute is resolved.
490.5    Subd. 28. Unclaimed hydrolyzed remains. If, after 30 calendar days following
490.6the inurnment, the hydrolyzed remains are not claimed or disposed of according to the
490.7written authorization to hydrolyze, the alkaline hydrolysis facility or funeral establishment
490.8may give written notice, by certified mail, to the person with the legal right to control
490.9the final disposition or a legal designee, that the hydrolyzed remains are unclaimed and
490.10requesting further release directions. Should the hydrolyzed remains be unclaimed 120
490.11calendar days following the mailing of the written notification, the alkaline hydrolysis
490.12facility or funeral establishment may dispose of the hydrolyzed remains in any lawful
490.13manner deemed appropriate.
490.14    Subd. 29. Required records. Every alkaline hydrolysis facility shall create and
490.15maintain on its premises or other business location in Minnesota an accurate record of
490.16every hydrolyzation provided. The record shall include all of the following information
490.17for each hydrolyzation:
490.18(1) the name of the person or funeral establishment delivering the body for alkaline
490.19hydrolysis;
490.20(2) the name of the deceased and the identification number assigned to the body;
490.21(3) the date of acceptance of delivery;
490.22(4) the names of the alkaline hydrolysis vessel, drying device, and mechanical
490.23processor operator;
490.24(5) the time and date that the body was placed in and removed from the alkaline
490.25hydrolysis vessel;
490.26(6) the time and date that processing and inurnment of the hydrolyzed remains
490.27was completed;
490.28(7) the time, date, and manner of release of the hydrolyzed remains;
490.29(8) the name and address of the person who signed the authorization to hydrolyze;
490.30(9) all supporting documentation, including any transit or disposition permits, a
490.31photocopy of the death record, and the authorization to hydrolyze; and
490.32(10) the type of alkaline hydrolysis container.
490.33    Subd. 30. Retention of records. Records required under subdivision 29 shall be
490.34maintained for a period of three calendar years after the release of the hydrolyzed remains.
490.35Following this period and subject to any other laws requiring retention of records, the
490.36alkaline hydrolysis facility may then place the records in storage or reduce them to
491.1microfilm, microfiche, laser disc, or any other method that can produce an accurate
491.2reproduction of the original record, for retention for a period of ten calendar years from
491.3the date of release of the hydrolyzed remains. At the end of this period and subject to any
491.4other laws requiring retention of records, the alkaline hydrolysis facility may destroy
491.5the records by shredding, incineration, or any other manner that protects the privacy of
491.6the individuals identified.

491.7    Sec. 77. Minnesota Statutes 2012, section 149A.96, subdivision 9, is amended to read:
491.8    Subd. 9. Hydrolyzed and cremated remains. Subject to section 149A.95,
491.9subdivision 16 , inurnment of the hydrolyzed or cremated remains and release to an
491.10appropriate party is considered final disposition and no further permits or authorizations
491.11are required for disinterment, transportation, or placement of the hydrolyzed or cremated
491.12remains.

491.13    Sec. 78. Laws 2011, First Special Session chapter 9, article 2, section 27, is amended to
491.14read:
491.15    Sec. 27. MINNESOTA TASK FORCE ON PREMATURITY.
491.16    Subdivision 1. Establishment. The Minnesota Task Force on Prematurity is
491.17established to evaluate and make recommendations on methods for reducing prematurity
491.18and improving premature infant health care in the state.
491.19    Subd. 2. Membership; meetings; staff. (a) The task force shall be composed of at
491.20least the following members, who serve at the pleasure of their appointing authority:
491.21(1) 15 representatives of the Minnesota Prematurity Coalition including, but not
491.22limited to, health care providers who treat pregnant women or neonates, organizations
491.23focused on preterm births, early childhood education and development professionals, and
491.24families affected by prematurity;
491.25(2) one representative appointed by the commissioner of human services;
491.26(3) two representatives appointed by the commissioner of health;
491.27(4) one representative appointed by the commissioner of education;
491.28(5) two members of the house of representatives, one appointed by the speaker of
491.29the house and one appointed by the minority leader; and
491.30(6) two members of the senate, appointed according to the rules of the senate.
491.31(b) Members of the task force serve without compensation or payment of expenses.
491.32(c) The commissioner of health must convene the first meeting of the Minnesota
491.33Task Force on Prematurity by July 31, 2011. The task force must continue to meet at
492.1least quarterly. Staffing and technical assistance shall be provided by the Minnesota
492.2Perinatal Coalition.
492.3    Subd. 3. Duties. The task force must report the current state of prematurity in
492.4Minnesota and develop recommendations on strategies for reducing prematurity and
492.5improving premature infant health care in the state by considering the following:
492.6(1) promoting adherence to standards of care for premature infants born less than 37
492.7weeks gestational age, including recommendations to improve utilization of appropriate
492.8 hospital discharge and follow-up care procedures;
492.9(2) coordination of information among appropriate professional and advocacy
492.10organizations on measures to improve health care for infants born prematurely;
492.11(3) identification and centralization of available resources to improve access and
492.12awareness for caregivers of premature infants; and
492.13(4) development and dissemination of evidence-based practices through networking
492.14and educational opportunities;
492.15(5) a review of relevant evidence-based research regarding the causes and effects of
492.16premature births in Minnesota;
492.17(6) a review of relevant evidence-based research regarding premature infant health
492.18care, including methods for improving quality of and access to care for premature infants;
492.19(7) (4) a review of the potential improvements in health status related to the use of
492.20health care homes to provide and coordinate pregnancy-related services; and.
492.21(8) identification of gaps in public reporting measures and possible effects of these
492.22measures on prematurity rates.
492.23    Subd. 4. Report; expiration. (a) By November 30, 2011 January 15, 2015, the
492.24task force must submit a final report to the chairs and ranking minority members of
492.25the legislative policy committees on health and human services on the current state of
492.26prematurity in Minnesota to the chairs of the legislative policy committees on health and
492.27human services, including any recommendations to reduce premature births and improve
492.28premature infant health in the state.
492.29(b) By January 15, 2013, the task force must report its final recommendations,
492.30including any draft legislation necessary for implementation, to the chairs of the legislative
492.31policy committees on health and human services.
492.32(c) (b) This task force expires on January 31, 2013 2015, or upon submission of the
492.33final report required in paragraph (b) (a), whichever is earlier.

492.34    Sec. 79. FUNERAL ESTABLISHMENTS; BRANCH LOCATIONS.
493.1The commissioner of health shall review the statutory requirements for preparation
493.2and embalming rooms and develop legislation with input from stakeholders that provides
493.3appropriate health and safety protection for funeral home locations where deceased bodies
493.4are present but are branch locations associated through a majority ownership of a licensed
493.5funeral establishment that meets the requirements of Minnesota Statutes, sections 149A.50
493.6and 149A.92, subdivisions 2 to 10. The review shall include consideration of distance
493.7between the main location and branch and other health and safety issues.

493.8    Sec. 80. STAFFING PLAN DISCLOSURE ACT.
493.9    Subdivision 1. Definitions. (a) For the purposes of this section, the following terms
493.10have the meanings given.
493.11(b) "Core staffing plan" means the projected number of full-time equivalent
493.12nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit.
493.13(c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses,
493.14and other health care workers, which may include but is not limited to nursing assistants,
493.15nursing aides, patient care technicians, and patient care assistants, who perform
493.16nonmanagerial direct patient care functions for more than 50 percent of their scheduled
493.17hours on a given patient care unit.
493.18(d) "Inpatient care unit" means a designated inpatient area for assigning patients and
493.19staff for which a distinct staffing plan exists and that operates 24 hours per day, seven days
493.20per week in a hospital setting. Inpatient care unit does not include any hospital-based
493.21clinic, long-term care facility, or outpatient hospital department.
493.22(e) "Staffing hours per patient day" means the number of full-time equivalent
493.23nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
493.24divided by the expected average number of patients upon which such assignments are based.
493.25(f) "Patient acuity tool" means a system for measuring an individual patient's need
493.26for nursing care. This includes utilizing a professional registered nursing assessment of
493.27patient condition to assess staffing need.
493.28    Subd. 2. Hospital staffing report. (a) The chief nursing executive or nursing
493.29designee of every reporting hospital in Minnesota under section 144.50 will develop a
493.30core staffing plan for each patient care unit.
493.31(b) Core staffing plans shall specify the full-time equivalent for each patient care
493.32unit for each 24-hour period.
493.33(c) Prior to submitting the core staffing plan, as required in subdivision 3,
493.34hospitals shall consult with representatives of the hospital medical staff, managerial and
494.1nonmanagerial care staff, and other relevant hospital personnel about the core staffing plan
494.2and the expected average number of patients upon which the staffing plan is based.
494.3    Subd. 3. Standard electronic reporting developed. (a) Hospitals must submit
494.4the core staffing plans to the Minnesota Hospital Association by January 1, 2014. The
494.5Minnesota Hospital Association shall include each reporting hospital's core staffing plan on
494.6the Minnesota Hospital Association's Minnesota Hospital Quality Report Web site by April
494.71, 2014. Any substantial changes to the core staffing plan shall be updated within 30 days.
494.8(b) The Minnesota Hospital Association shall include on its Web site for each
494.9reporting hospital on a quarterly basis the actual direct patient care hours per patient and
494.10per unit. Hospitals must submit the direct patient care report to the Minnesota Hospital
494.11Association by July 1, 2014, and quarterly thereafter.

494.12    Sec. 81. STUDY; NURSE STAFFING LEVELS AND PATIENT OUTCOMES.
494.13The Department of Health shall convene a work group to study the correlation
494.14between nurse staffing levels and patient outcomes. This report shall be presented to the
494.15chairs and ranking minority members of the health and human services committees in the
494.16house of representatives and the senate by January 15, 2015.

494.17    Sec. 82. LEVEL-1 TRAUMA CENTERS.
494.18The commissioner of health, through the Office of Rural Health and Primary Care,
494.19and in consultation with the commissioner of human services, shall study the cost of
494.20maintaining a level of 24-hour readiness in a hospital designated as a level-1 trauma center
494.21under Minnesota Statutes, section 144.605, and shall present recommendations to the
494.22legislature by December 15, 2013, on a state public programs level of readiness payment
494.23modifier for hospitals designated as level-1 trauma centers.

494.24    Sec. 83. HEALTH EQUITY REPORT.
494.25By February 1, 2014, the commissioner of health, in consultation with local public
494.26health, health care, and community partners, must submit a report to the chairs and ranking
494.27minority members of the committees with jurisdiction over health policy and finance, on a
494.28plan for advancing health equity in Minnesota. The report must include the following:
494.29(1) assessment of health disparities that exist in the state and how these disparities
494.30relate to health equity;
494.31(2) identification of policies, processes, and systems that contribute to health
494.32inequity in the state;
495.1(3) recommendations for changes to policies, processes and systems within the
495.2Department of Health that would increase the department's leadership in addressing health
495.3inequities;
495.4(4) identification of best practices for local public health, health care, and community
495.5partners to provide culturally responsive services and advance health equity; and
495.6(5) recommendations for strategies for the use of data to document and monitor
495.7existing health inequities and to evaluate effectiveness of policies, processes, systems,
495.8and environmental changes that will advance health equity.

495.9    Sec. 84. ELIMINATING HEALTH DISPARITIES GRANTS; ORGANIZATIONS
495.10WITH LIMITED FISCAL CAPACITY.
495.11For grants awarded from the general fund under Minnesota Statutes, section 145.928,
495.12during the fiscal years ending June 30, 2013, and June 30, 2014, the commissioner
495.13of health may provide working capital advanced to grantees determined during the
495.14application process to have limited financial capacity, in accordance with Office of Grant
495.15Management Policies.

495.16    Sec. 85. ASSESSMENT OF QUALITY METRICS FOR MEASURING THE
495.17SCREENING, DIAGNOSIS, AND TREATMENT OF YOUNG CHILDREN WITH
495.18AUTISM SPECTRUM DISORDER.
495.19    As part of the annual review and ongoing development of quality measures under
495.20Minnesota Statutes, section 62U.02, the commissioner of health shall assess the medical
495.21evidence and feasibility of adding a set of quality metrics for measuring the screening,
495.22diagnosis, and treatment of young children with autism spectrum disorder.

495.23    Sec. 86. REVISOR'S INSTRUCTION.
495.24The revisor shall substitute the term "vertical heat exchangers" or "vertical
495.25heat exchanger" with "bored geothermal heat exchangers" or "bored geothermal heat
495.26exchanger" wherever it appears in Minnesota Statutes, sections 103I.005, subdivisions
495.272 and 12; 103I.101, subdivisions 2 and 5; 103I.105; 103I.205, subdivision 4; 103I.208,
495.28subdivision 2; 103I.501; 103I.531, subdivision 5; and 103I.641, subdivisions 1, 2, and 3.

495.29    Sec. 87. REPEALER.
495.30(a) Minnesota Statutes 2012, sections 103I.005, subdivision 20; 149A.025; 149A.20,
495.31subdivision 8; 149A.30, subdivision 2; 149A.40, subdivision 8; 149A.45, subdivision 6;
496.1149A.50, subdivision 6; 149A.51, subdivision 7; 149A.52, subdivision 5a; 149A.53,
496.2subdivision 9; and 485.14, are repealed.
496.3(b) Minnesota Statutes 2012, section 144.123, subdivision 2, is repealed effective
496.4July 1, 2014.

496.7 496.8

Section 1. COMMISSIONER OF HUMAN SERVICES

496.9

Subdivision 1.Total Appropriation

$

(161,031,000)

496.10	Appropriations by Fund
496.11		2013
496.12	General Fund	(158,668,000)
496.13	Health Care Access	(7,179,000)
496.14	TANF	4,816,000

496.15	Subd. 2.Forecasted Programs
496.16	(a) MFIP/DWP Grants

496.17	Appropriations by Fund
496.18	General Fund	(8,211,000)
496.19	TANF	4,399,000

496.20

(b) MFIP Child Care Assistance Grants

10,113,000

496.21

(c) General Assistance Grants

3,230,000

496.22

(d) Minnesota Supplemental Aid Grants

(1,008,000)

496.23

(e) Group Residential Housing Grants

(5,423,000)

496.24

(f) MinnesotaCare Grants

(7,179,000)

496.25This appropriation is from the health care
496.26access fund.

496.27

(g) Medical Assistance Grants

(159,733,000)

496.28

(h) Alternative Care Grants

-0-

496.29

(i) CD Entitlement Grants

2,364,000

496.30

Subd. 3.Technical Activities

417,000

496.31This appropriation is from the TANF fund.

497.1    Sec. 2. EFFECTIVE DATE.
497.2Section 1 is effective the day following final enactment.

497.5

Section 1. SUMMARY OF APPROPRIATIONS.

497.6The amounts shown in this section summarize direct appropriations, by fund, made
497.7in this article.

497.8			2014		2015		Total
497.9	General	$	5,643,757,000	$	5,877,152,000	$	11,520,909,000
497.10 497.11	State Government Special Revenue		69,619,000		74,135,000		143,754,000
497.12	Health Care Access		664,087,000		432,345,000		1,096,433,000
497.13	Federal TANF		269,628,000		266,526,000		536,154,000
497.14	Lottery Prize Fund		1,667,000		1,668,000		3,335,000
497.15	Total	$	6,648,757,000	$	6,651,827,000	$	13,300,584,000

497.16

Sec. 2. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

497.17The sums shown in the columns marked "Appropriations" are appropriated to the
497.18agencies and for the purposes specified in this article. The appropriations are from the
497.19general fund, or another named fund, and are available for the fiscal years indicated
497.20for each purpose. The figures "2014" and "2015" used in this article mean that the
497.21appropriations listed under them are available for the fiscal year ending June 30, 2014, or
497.22June 30, 2015, respectively. "The first year" is fiscal year 2014. "The second year" is fiscal
497.23year 2015. "The biennium" is fiscal years 2014 and 2015.

497.24				APPROPRIATIONS
497.25				Available for the Year
497.26				Ending June 30
497.27					2014		2015

497.28 497.29

Sec. 3. COMMISSIONER OF HUMAN SERVICES

497.30

Subdivision 1.Total Appropriation

$

6,454,078,000

$

6,455,116,000

497.31	Appropriations by Fund
497.32		2014	2015
497.33	General	5,558,235,000	5,796,754,000
497.34 497.35	State Government Special Revenue	4,099,000	6,332,000
497.36	Health Care Access	631,807,000	395,628,000
498.1	Federal TANF	257,915,000	254,813,000
498.2	Lottery Prize Fund	1,667,000	1,668,000

498.3Receipts for Systems Projects.
498.4Appropriations and federal receipts for
498.5information systems projects for MAXIS,
498.6PRISM, MMIS, and SSIS must be deposited
498.7in the state system account authorized
498.8in Minnesota Statutes, section 256.014.
498.9Money appropriated for computer projects
498.10approved by the commissioner of Minnesota
498.11information technology services, funded
498.12by the legislature, and approved by the
498.13commissioner of management and budget,
498.14may be transferred from one project to
498.15another and from development to operations
498.16as the commissioner of human services
498.17considers necessary. Any unexpended
498.18balance in the appropriation for these
498.19projects does not cancel but is available for
498.20ongoing development and operations.
498.21Nonfederal Share Transfers. The
498.22nonfederal share of activities for which
498.23federal administrative reimbursement is
498.24appropriated to the commissioner may be
498.25transferred to the special revenue fund.
498.26ARRA Supplemental Nutrition Assistance
498.27Benefit Increases. The funds provided for
498.28food support benefit increases under the
498.29Supplemental Nutrition Assistance Program
498.30provisions of the American Recovery and
498.31Reinvestment Act (ARRA) of 2009 must be
498.32used for benefit increases beginning July 1,
498.332009.
498.34Supplemental Nutrition Assistance
498.35Program Employment and Training.
499.1(1) Notwithstanding Minnesota Statutes,
499.2sections 256D.051, subdivisions 1a, 6b,
499.3and 6c, and 256J.626, federal Supplemental
499.4Nutrition Assistance employment and
499.5training funds received as reimbursement of
499.6MFIP consolidated fund grant expenditures
499.7for diversionary work program participants
499.8and child care assistance program
499.9expenditures must be deposited in the general
499.10fund. The amount of funds must be limited to
499.11$4,900,000 per year in fiscal years 2014 and
499.122015, and to $4,400,000 per year in fiscal
499.13years 2016 and 2017, contingent on approval
499.14by the federal Food and Nutrition Service.
499.15(2) Consistent with the receipt of the federal
499.16funds, the commissioner may adjust the
499.17level of working family credit expenditures
499.18claimed as TANF maintenance of effort.
499.19Notwithstanding any contrary provision in
499.20this article, this rider expires June 30, 2017.
499.21TANF Maintenance of Effort. (a) In order
499.22to meet the basic maintenance of effort
499.23(MOE) requirements of the TANF block grant
499.24specified under Code of Federal Regulations,
499.25title 45, section 263.1, the commissioner may
499.26only report nonfederal money expended for
499.27allowable activities listed in the following
499.28clauses as TANF/MOE expenditures:
499.29(1) MFIP cash, diversionary work program,
499.30and food assistance benefits under Minnesota
499.31Statutes, chapter 256J;
499.32(2) the child care assistance programs
499.33under Minnesota Statutes, sections 119B.03
499.34and 119B.05, and county child care
500.1administrative costs under Minnesota
500.2Statutes, section 119B.15;
500.3(3) state and county MFIP administrative
500.4costs under Minnesota Statutes, chapters
500.5256J and 256K;
500.6(4) state, county, and tribal MFIP
500.7employment services under Minnesota
500.8Statutes, chapters 256J and 256K;
500.9(5) expenditures made on behalf of legal
500.10noncitizen MFIP recipients who qualify for
500.11the MinnesotaCare program under Minnesota
500.12Statutes, chapter 256L;
500.13(6) qualifying working family credit
500.14expenditures under Minnesota Statutes,
500.15section 290.0671;
500.16(7) qualifying Minnesota education credit
500.17expenditures under Minnesota Statutes,
500.18section 290.0674; and
500.19(8) qualifying Head Start expenditures under
500.20Minnesota Statutes, section 119A.50.
500.21(b) The commissioner shall ensure that
500.22sufficient qualified nonfederal expenditures
500.23are made each year to meet the state's
500.24TANF/MOE requirements. For the activities
500.25listed in paragraph (a), clauses (2) to
500.26(8), the commissioner may only report
500.27expenditures that are excluded from the
500.28definition of assistance under Code of
500.29Federal Regulations, title 45, section 260.31.
500.30(c) For fiscal years beginning with state fiscal
500.31year 2003, the commissioner shall ensure
500.32that the maintenance of effort used by the
500.33commissioner of management and budget
500.34for the February and November forecasts
501.1required under Minnesota Statutes, section
501.216A.103, contains expenditures under
501.3paragraph (a), clause (1), equal to at least 16
501.4percent of the total required under Code of
501.5Federal Regulations, title 45, section 263.1.
501.6(d) The requirement in Minnesota Statutes,
501.7section 256.011, subdivision 3, that federal
501.8grants or aids secured or obtained under that
501.9subdivision be used to reduce any direct
501.10appropriations provided by law, do not apply
501.11if the grants or aids are federal TANF funds.
501.12(e) For the federal fiscal years beginning on
501.13or after October 1, 2007, the commissioner
501.14may not claim an amount of TANF/MOE in
501.15excess of the 75 percent standard in Code
501.16of Federal Regulations, title 45, section
501.17263.1(a)(2), except:
501.18(1) to the extent necessary to meet the 80
501.19percent standard under Code of Federal
501.20Regulations, title 45, section 263.1(a)(1),
501.21if it is determined by the commissioner
501.22that the state will not meet the TANF work
501.23participation target rate for the current year;
501.24(2) to provide any additional amounts
501.25under Code of Federal Regulations, title 45,
501.26section 264.5, that relate to replacement of
501.27TANF funds due to the operation of TANF
501.28penalties; and
501.29(3) to provide any additional amounts that
501.30may contribute to avoiding or reducing
501.31TANF work participation penalties through
501.32the operation of the excess MOE provisions
501.33of Code of Federal Regulations, title 45,
501.34section 261.43(a)(2).
502.1For the purposes of clauses (1) to (3),
502.2the commissioner may supplement the
502.3MOE claim with working family credit
502.4expenditures or other qualified expenditures
502.5to the extent such expenditures are otherwise
502.6available after considering the expenditures
502.7allowed in this subdivision and subdivisions
502.82 and 3.
502.9(f) Notwithstanding any contrary provision
502.10in this article, paragraphs (a) to (e) expire
502.11June 30, 2017.
502.12Working Family Credit Expenditures
502.13as TANF/MOE. The commissioner may
502.14claim as TANF maintenance of effort up to
502.15$6,707,000 per year of working family credit
502.16expenditures in each fiscal year.

502.17 502.18

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

502.19The commissioner may count the following
502.20amounts of working family credit
502.21expenditures as TANF/MOE:
502.22(1) fiscal year 2014, $43,576,000; and
502.23(2) fiscal year 2015, $43,548,000.

502.24 502.25

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

502.26(a) The following TANF fund amounts
502.27are appropriated to the commissioner for
502.28purposes of MFIP/transition year child care
502.29assistance under Minnesota Statutes, section
502.30119B.05:
502.31(1) fiscal year 2014; $14,020,000; and
502.32(2) fiscal year 2015, $14,020,000.
502.33(b) The commissioner shall authorize the
502.34transfer of sufficient TANF funds to the
503.1federal child care and development fund to
503.2meet this appropriation and shall ensure that
503.3all transferred funds are expended according
503.4to federal child care and development fund
503.5regulations.

503.6

Subd. 4.Central Office

503.7The amounts that may be spent from this
503.8appropriation for each purpose are as follows:

503.9

(a) Operations

503.10	Appropriations by Fund
503.11	General	88,410,000	89,985,000
503.12 503.13	State Government Special Revenue	3,974,000	6,207,000
503.14	Health Care Access	13,252,000	13,154,000
503.15	Federal TANF	117,000	100,000

503.16Return on Taxpayer Investment
503.17Implementation Study. $100,000 is
503.18appropriated in fiscal year 2014 from the
503.19general fund to the commissioner of human
503.20services for transfer to the commissioner
503.21of management and budget to develop
503.22recommendations for implementing a return
503.23on taxpayer investment (ROTI) methodology
503.24and practice related to human services and
503.25corrections programs administered and
503.26funded by state and county government.
503.27The scope of the study shall include
503.28assessments of ROTI initiatives in other
503.29states, design implications for Minnesota,
503.30and identification of one or more Minnesota
503.31institutions of higher education capable of
503.32providing rigorous and consistent nonpartisan
503.33institutional support for ROTI. The scope of
503.34the study shall also include recommendations
503.35on methods to evaluate the value of prepaid
503.36medical assistance services (PMAP)
504.1versus other ways of delivering public
504.2health care programs. The commissioner
504.3shall consult with representatives of other
504.4state agencies, counties, legislative staff,
504.5Minnesota institutions of higher education,
504.6and other stakeholders in developing
504.7recommendations. The commissioner shall
504.8report findings and recommendations to the
504.9governor and legislature by November 30,
504.102013.
504.11DHS Receipt Center Accounting. The
504.12commissioner is authorized to transfer
504.13appropriations to, and account for DHS
504.14receipt center operations in, the special
504.15revenue fund.
504.16Administrative Recovery; Set-Aside. The
504.17commissioner may invoice local entities
504.18through the SWIFT accounting system as an
504.19alternative means to recover the actual cost
504.20of administering the following provisions:
504.21(1) Minnesota Statutes, section 125A.744,
504.22subdivision 3;
504.23(2) Minnesota Statutes, section 245.495,
504.24paragraph (b);
504.25(3) Minnesota Statutes, section 256B.0625,
504.26subdivision 20, paragraph (k);
504.27(4) Minnesota Statutes, section 256B.0924,
504.28subdivision 6, paragraph (g);
504.29(5) Minnesota Statutes, section 256B.0945,
504.30subdivision 4, paragraph (d); and
504.31(6) Minnesota Statutes, section 256F.10,
504.32subdivision 6, paragraph (b).
504.33Systems Modernization. The following
504.34amounts are appropriated for transfer to
505.1the state systems account authorized in
505.2Minnesota Statutes, section 256.014:
505.3(1) $1,825,000 in fiscal year 2014 and
505.4$2,502,000 in fiscal year 2015 is for the
505.5state share of Medicaid-allocated costs of
505.6the health insurance exchange information
505.7technology and operational structure. The
505.8funding base is $3,222,000 in fiscal year 2016
505.9and $3,037,000 in fiscal year 2017 but shall
505.10not be included in the base thereafter; and
505.11(2) Any unexpended balance from
505.12the contingent system modernization
505.13appropriation in article 15 must be
505.14transferred from the Department of Human
505.15Services state systems account to the Office
505.16of Enterprise Technology when the Office
505.17of Enterprise Technology has negotiated a
505.18federally approved internal service fund rates
505.19and billing process with sufficient internal
505.20accounting controls to properly maximize
505.21federal reimbursement to Minnesota for
505.22human services system modernization
505.23projects, but not later than June 30, 2015.
505.24Base Adjustment. The general fund base
505.25is increased by $6,099,000 in fiscal year
505.262016 and $1,185,000 in fiscal year 2017.
505.27The health access fund base is decreased by
505.28$551,000 in fiscal years 2016 and 2017.

505.29

(b) Children and Families

505.30	Appropriations by Fund
505.31	General	7,626,000	7,634,000
505.32	Federal TANF	2,282,000	2,282,000

505.33Financial Institution Data Match and
505.34Payment of Fees. The commissioner is
505.35authorized to allocate up to $310,000 each
506.1year in fiscal years 2014 and 2015 from the
506.2PRISM special revenue account to make
506.3payments to financial institutions in exchange
506.4for performing data matches between account
506.5information held by financial institutions
506.6and the public authority's database of child
506.7support obligors as authorized by Minnesota
506.8Statutes, section 13B.06, subdivision 7.
506.9Base Adjustment. The general fund base is
506.10decreased by $300,000 in fiscal years 2016
506.11and 2017, and the federal TANF fund base is
506.12increased by $300,000 in fiscal years 2016
506.13and 2017.

506.14

(c) Health Care

506.15	Appropriations by Fund
506.16	General	13,924,000	13,795,000
506.17	Health Care Access	26,599,000	30,306,000

506.18Base Adjustment. The health care access
506.19fund base is increased by $8,177,000 in fiscal
506.20year 2016 and by $6,712,000 in fiscal year
506.212017.
506.22Medical assistance costs for inmates. The
506.23commissioner of corrections shall transfer
506.24to the commissioner of human services
506.25$646,000 in fiscal year 2014, $2,022,000 in
506.26fiscal year 2015, $2,123,000 in fiscal year
506.272016, and $2,455,000 in fiscal year 2017 to
506.28cover the state share of medical assistance
506.29costs related to implementation of Minnesota
506.30Statutes, section 256B.055, subdivision 14,
506.31paragraph (c).

506.32

(d) Continuing Care

507.1	Appropriations by Fund
507.2	General	18,734,000	19,272,000
507.3 507.4	State Government Special Revenue	125,000	125,000

507.5Base Adjustment. The general fund base is
507.6increased by $3,324,000 in fiscal year 2016
507.7and by $3,324,000 in fiscal year 2017.

507.8

(e) Chemical and Mental Health

507.9	Appropriations by Fund
507.10	General	4,480,000	4,300,000
507.11	Lottery Prize Fund	159,000	160,000

507.12

Subd. 5.Forecasted Programs

507.13The amounts that may be spent from this
507.14appropriation for each purpose are as follows:

507.15

(a) MFIP/DWP

507.16	Appropriations by Fund
507.17	General	72,583,000	74,634,000
507.18	Federal TANF	83,104,000	80,510,000

507.19

(b) MFIP Child Care Assistance

59,662,000

59,393,000

507.20Notwithstanding Minnesota Statutes, section
507.21256J.021, TANF funds may be used to pay for
507.22any additional costs related to repeal of the
507.23MFIP family cap for individuals identified
507.24under Minnesota Statutes, section 256J.021.

507.25

(c) General Assistance

54,787,000

56,068,000

507.26General Assistance Standard. The
507.27commissioner shall set the monthly standard
507.28of assistance for general assistance units
507.29consisting of an adult recipient who is
507.30childless and unmarried or living apart
507.31from parents or a legal guardian at $203.
507.32The commissioner may reduce this amount
507.33according to Laws 1997, chapter 85, article
507.343, section 54.
508.1Emergency General Assistance. The
508.2amount appropriated for emergency general
508.3assistance funds is limited to no more
508.4than $6,729,812 in fiscal year 2014 and
508.5$6,729,812 in fiscal year 2015. Funds
508.6to counties shall be allocated by the
508.7commissioner using the allocation method in
508.8Minnesota Statutes, section 256D.06.

508.9

(d) MN Supplemental Assistance

38,646,000

39,821,000

508.10

(e) Group Residential Housing

140,447,000

149,984,000

508.11

(f) MinnesotaCare

508.12

Health Care Access

296,282,000

226,619,000

508.13

(g) Medical Assistance

508.14	Appropriations by Fund
508.15	General	4,371,808,000	4,595,789,000
508.16	Health Care Access	292,697,000	123,386,000

508.17The Departments of Human Services and
508.18Management and Budget shall identify
508.19general fund medical assistance populations
508.20costing $240,426,000 for fiscal year 2016
508.21and $218,557,000 for fiscal year 2017 and
508.22transfer those costs to the HCAF. The base for
508.23these costs shall be counted in the health care
508.24access fund for fiscal years 2016 and 2017.
508.25Newborn Screening. $121,000 in fiscal
508.26year 2014 and $141,000 in fiscal year 2015
508.27are appropriated from the general fund, and
508.28$10,000 in fiscal year 2014 and $13,000 in
508.29fiscal year 2015 are appropriated from the
508.30health care access fund to the commissioner
508.31of human services for the hospital
508.32reimbursement increase in Minnesota
508.33Statutes, section 256.969, subdivision 29.
509.1The base for this appropriation in fiscal year
509.22016 is $14,000.
509.3Transfer. $704,000 in fiscal year 2014 and
509.4$2,090,000 in fiscal year 2015 is transferred
509.5from the health care access fund to the
509.6general fund to provide increases in dental
509.7payment rates under Minnesota Statutes,
509.8section 256B.76, subdivision 2, paragraph (j).

509.9

(h) Alternative Care

47,197,000

45,084,000

509.10Alternative Care Transfer. Any money
509.11allocated to the alternative care program that
509.12is not spent for the purposes indicated does
509.13not cancel but shall be transferred to the
509.14medical assistance account.

509.15

(i) CD Treatment Fund

81,440,000

74,875,000

509.16Balance Transfer. The commissioner must
509.17transfer $18,188,000 from the consolidated
509.18chemical dependency treatment fund to the
509.19general fund by September 30, 2013.

509.20

Subd. 6.Grant Programs

509.21The amounts that may be spent from this
509.22appropriation for each purpose are as follows:

509.23

(a) Support Services Grants

509.24	Appropriations by Fund
509.25	General	8,715,000	8,715,000
509.26	Federal TANF	91,832,000	90,952,000

509.27MFIP Housing Assistance Grants. MFIP
509.28housing assistance grants under Minnesota
509.29Statutes, section 256J.35, paragraph (d),
509.30must be paid out of support services grants
509.31under this paragraph.
509.32Base Adjustment. The general fund base is
509.33decreased by $4,618,000 in fiscal years 2016
510.1and 2017. The TANF fund base is increased
510.2by $1,700,000 in fiscal years 2016 and 2017.

510.3 510.4

(b) Basic Sliding Fee Child Care Assistance Grants

38,356,000

38,681,000

510.5Base Adjustment. The general fund base is
510.6increased by $1,278,000 in fiscal year 2016
510.7and by $1,349,000 in fiscal year 2017.

510.8

(c) Child Care Development Grants

1,487,000

1,487,000

510.9

(d) Child Support Enforcement Grants

50,000

50,000

510.10Federal Child Support Demonstration
510.11Grants. Federal administrative
510.12reimbursement resulting from the federal
510.13child support grant expenditures authorized
510.14under United States Code, title 42, section
510.151315, is appropriated to the commissioner
510.16for this activity.

510.17

(e) Children's Services Grants

510.18	Appropriations by Fund
510.19	General	47,438,000	47,801,000
510.20	Federal TANF	140,000	140,000

510.21Adoption Assistance and Relative Custody
510.22Assistance. The commissioner may transfer
510.23unencumbered appropriation balances for
510.24adoption assistance and relative custody
510.25assistance between fiscal years and between
510.26programs.
510.27Privatized Adoption Grants. Federal
510.28reimbursement for privatized adoption grant
510.29and foster care recruitment grant expenditures
510.30is appropriated to the commissioner for
510.31adoption grants and foster care and adoption
510.32administrative purposes.
510.33Adoption Assistance Incentive Grants.
510.34Federal funds available during fiscal years
511.12014 and 2015 for adoption incentive grants
511.2are appropriated to the commissioner for
511.3these purposes.
511.4Base Adjustment. The general fund base is
511.5increased by $5,139,000 in fiscal year 2016
511.6and by $9,155,000 in fiscal year 2017.

511.7

(f) Child and Community Service Grants

53,301,000

53,301,000

511.8

(g) Child and Economic Support Grants

16,597,000

16,598,000

511.9Minnesota Food Assistance Program.
511.10Unexpended funds for the Minnesota food
511.11assistance program for fiscal year 2014 do
511.12not cancel but are available for this purpose
511.13in fiscal year 2015.
511.14Family Assets for Independence. $250,000
511.15each year is for the Family Assets for
511.16Independence Minnesota program. This
511.17appropriation is available in either year of the
511.18biennium and may be transferred between
511.19fiscal years. This appropriation is added to
511.20the base.
511.21Food Shelf Programs. $25,000 each year
511.22from the general fund is for food shelf
511.23programs under Minnesota Statutes, section
511.24256E.34. This appropriation is onetime.
511.25Notwithstanding Minnesota Statutes, section
511.26256E.34, subdivision 4, no portion of this
511.27appropriation may be used by Hunger
511.28Solutions for its administrative expenses,
511.29including but not limited to rent and salaries.

511.30

(h) Health Care Grants

511.31	Appropriations by Fund
511.32	General	90,000	90,000
511.33	Health Care Access	2,228,000	1,413,000

512.1Base Adjustment. The health care access
512.2fund is decreased by $1,223,000 in fiscal
512.3years 2016 and 2017.

512.4

(i) Aging and Adult Services Grants

18,556,000

19,422,000

512.5Community Service Development Grants
512.6and Community Services Grants. Of
512.7this appropriation, $1,025,000 each year is
512.8for community service development grants
512.9and $1,165,000 each year is for community
512.10services grants.

512.11

(j) Deaf and Hard-of-Hearing Grants

1,767,000

1,767,000

512.12

(k) Disabilities Grants

17,984,000

17,861,000

512.13$180,000 each year from the general fund is
512.14for a grant to the Minnesota Organization
512.15on Fetal Alcohol Syndrome (MOFAS) to
512.16support nonprofit Fetal Alcohol Spectrum
512.17Disorders (FASD) outreach prevention
512.18programs in Olmsted County. This is a
512.19onetime appropriation.
512.20Base Adjustment. The general fund base
512.21is increased by $502,000 in fiscal year 2016
512.22and by $676,000 in fiscal year 2017.

512.23

(l) Adult Mental Health Grants

512.24	Appropriations by Fund
512.25	General	71,257,000	69,588,000
512.26	Health Care Access	750,000	750,000
512.27	Lottery Prize	1,508,000	1,508,000

512.28Funding Usage. Up to 75 percent of a fiscal
512.29year's appropriations for adult mental health
512.30grants may be used to fund allocations in that
512.31portion of the fiscal year ending December
512.3231.
513.1Base Adjustment. The general fund base is
513.2decreased by $4,461,000 in fiscal years 2016
513.3and 2017.
513.4Mental Health Pilot Project. $230,000
513.5each year is for a grant to the Zumbro
513.6Valley Mental Health Center. The grant
513.7shall be used to implement a pilot project
513.8to test an integrated behavioral health care
513.9coordination model. The grant recipient must
513.10report measurable outcomes and savings
513.11to the commissioner of human services
513.12by January 15, 2016. This is a onetime
513.13appropriation.
513.14High-risk adults. $100,000 in fiscal year
513.152014 and $100,000 in fiscal year 2015 are
513.16appropriated from the general fund to the
513.17commissioner of human services for a grant
513.18to the nonprofit organization selected to
513.19administer the demonstration project for
513.20high-risk adults under Laws 2007, chapter
513.2154, article 1, section 19, in order to complete
513.22the project. This is a onetime appropriation.

513.23

(m) Child Mental Health Grants

17,599,000

19,988,000

513.24Funding Usage. Up to 75 percent of a fiscal
513.25year's appropriation for child mental health
513.26grants may be used to fund allocations in that
513.27portion of the fiscal year ending December
513.2831.

513.29

(n) CD Treatment Support Grants

1,516,000

1,516,000

513.30Base Adjustment. The general fund base is
513.31decreased by $300,000 in fiscal years 2016
513.32and 2017.

513.33

Subd. 7.State-Operated Services

186,744,000

188,183,000

514.1Transfer Authority Related to
514.2State-Operated Services. Money
514.3appropriated for state-operated services
514.4may be transferred between fiscal years
514.5of the biennium with the approval of the
514.6commissioner of management and budget.
514.7The amounts that may be spent from the
514.8appropriation for each purpose are as follows:

514.9

(a) SOS Mental Health

116,598,000

117,467,000

514.10Dedicated Receipts Available. Of the
514.11revenue received under Minnesota Statutes,
514.12section 246.18, subdivision 8, paragraph
514.13(a), $1,000,000 each year is available for
514.14the purposes of paragraph (b), clause (1),
514.15of that subdivision, $1,000,000 each year
514.16is available to transfer to the adult mental
514.17health budget activity for the purposes of
514.18paragraph (b), clause (2), of that subdivision,
514.19and up to $2,713,000 each year is available
514.20for the purposes of paragraph (b), clause (3),
514.21of that subdivision.

514.22

(b) SOS MN Security Hospital

70,146,000

70,715,000

514.23

Subd. 8.Sex Offender Program

77,341,000

80,895,000

514.24Transfer Authority Related to Minnesota
514.25Sex Offender Program. Money
514.26appropriated for the Minnesota sex offender
514.27program may be transferred between fiscal
514.28years of the biennium with the approval of the
514.29commissioner of management and budget.

514.30

Subd. 9.Technical Activities

80,440,000

80,829,000

514.31This appropriation is from the federal TANF
514.32fund.
515.1Base Adjustment. The federal TANF fund
515.2base is decreased by $22,000 in fiscal year
515.32016 and by $49,000 in fiscal year 2017.

515.4

Subd. 10.Transfer.

515.5The commissioner of management and
515.6budget must transfer $65,000,000 in fiscal
515.7year 2014 from the general fund to the health
515.8care access fund. This is a onetime transfer.

515.9

Sec. 4. COMMISSIONER OF HEALTH

515.10

Subdivision 1.Total Appropriation

$

172,440,000

$

173,946,000

515.11	Appropriations by Fund
515.12		2014	2015
515.13	General	80,151,000	75,001,000
515.14 515.15	State Government Special Revenue	48,296,000	50,515,000
515.16	Health Care Access	32,280,000	36,717,000
515.17	Federal TANF	11,713,000	11,713,000

515.18The amounts that may be spent for each
515.19purpose are specified in the following
515.20subdivisions.

515.21

Subd. 2.Health Improvement

515.22	Appropriations by Fund
515.23	General	53,475,000	48,260,000
515.24 515.25	State Government Special Revenue	1,040,000	1,047,000
515.26	Health Care Access	21,725,000	26,731,000
515.27	Federal TANF	11,713,000	11,713,000

515.28Notwithstanding the cancellation requirement
515.29in Minnesota Statutes, section 256J.02,
515.30subdivision 6, TANF funds awarded under
515.31Minnesota Statutes, section 145.928, during
515.32fiscal year 2013 to grantees determined
515.33during the application process to have limited
515.34financial capacity, are available until June
515.3530, 2014.
516.1Statewide Health Improvement Program.
516.2(a) $20,000,000 in fiscal year 2014 and
516.3$25,000,000 in fiscal year 2015 is from the
516.4Health Care Access fund for the Statewide
516.5Health Improvement Program (SHIP) for
516.6grants to all local community health boards
516.7and tribal governments. Funds appropriated
516.8under this paragraph are available until
516.9expended. Public health agencies in their
516.10third cycle of SHIP funding shall incorporate
516.11activities targeted to addressing populations
516.12with health disparities or persons with
516.13disabilities.
516.14(b) Of the appropriated amount, $500,000
516.15in fiscal year 2015 shall be distributed as
516.16two-year pilot grants focused on improving
516.17health and reducing health care costs in
516.18populations over age 60. Grants shall be
516.19awarded by February 1, 2014, to five county
516.20public health agencies, multicounty public
516.21health agency partnerships, or county/city
516.22public health agency partnerships to initiate
516.23evidence-based strategies for improving
516.24the physical activity levels of citizens over
516.25age 60 with a goal of improving health and
516.26reducing health care costs. Partnerships with
516.27community education, health providers, or
516.28other local institutions shall be encouraged
516.29to establish ongoing outreach and sustainable
516.30programming.
516.31(c) Pilot project funds shall be distributed
516.32based on a $30,000 base with a per senior
516.33add-on based on the population to be served
516.34and shall include urban, suburban, regional
516.35center, and rural counties. Each grant shall
517.1serve an area with a minimum population
517.2base of persons over age 60 and shall target
517.3those seniors most at risk of high health costs
517.4due to a sedentary lifestyle, chronic disease,
517.5or other risk factors. Up to 8 percent of the
517.6above appropriation is available for creating
517.7a library of evidence-based programs that
517.8improve health and reduce health care costs,
517.9outcome-based reporting, and administration.
517.10The planning for the pilots shall engage
517.11local public health officials, other health
517.12promotion organizations and Board of Aging
517.13staff, and explore the potential future use of
517.14Title III Older American Act funds and other
517.15nonstate funding.
517.16(d) No more than 16 percent of the SHIP
517.17budget may be used for administration,
517.18technical assistance, and state-level
517.19evaluation costs.
517.20Statewide Cancer Surveillance System.
517.21 Of the general fund appropriation, $350,000
517.22in fiscal year 2014 and $350,000 in fiscal
517.23year 2015 are appropriated to develop and
517.24implement a new cancer reporting system
517.25under Minnesota Statutes, sections 144.671
517.26to 144.69. Any information technology
517.27development or support costs necessary
517.28for the cancer surveillance system must
517.29be incorporated into the agency's service
517.30level agreement and paid to the Office of
517.31Enterprise Technology.
517.32Eliminating Reproductive Health
517.33Disparities. To the extent funds are
517.34available for fiscal years 2014 and 2015
517.35for grants provided pursuant to Minnesota
518.1Statutes, section 145.928, the commissioner
518.2may provide a grant to a Somali-based
518.3organization located in Minnesota to
518.4develop a reproductive health strategic
518.5plan to eliminate reproductive health
518.6disparities for Somali women. The plan shall
518.7develop initiatives to provide educational
518.8and information resources to health care
518.9providers, community organizations, and
518.10Somali women to ensure effective interaction
518.11with Somali culture and western medicine
518.12and the delivery of appropriate health care
518.13services, and the achievement of better health
518.14outcomes for Somali women. The plan must
518.15engage health care providers, the Somali
518.16community, and Somali health-centered
518.17organizations. The commissioner shall
518.18submit a report to the chairs and ranking
518.19minority members of the senate and house
518.20committees with jurisdiction over health
518.21policy on the strategic plan developed under
518.22this grant for eliminating reproductive health
518.23disparities for Somali women. The report
518.24must be submitted by February 15, 2014.
518.25TANF Appropriations. (1) $1,156,000 of
518.26the TANF funds is appropriated each year of
518.27the biennium to the commissioner for family
518.28planning grants under Minnesota Statutes,
518.29section 145.925.
518.30(2) $3,579,000 of the TANF funds is
518.31appropriated each year of the biennium to
518.32the commissioner for home visiting and
518.33nutritional services listed under Minnesota
518.34Statutes, section 145.882, subdivision 7,
518.35clauses (6) and (7). Funds must be distributed
518.36to community health boards according to
519.1Minnesota Statutes, section 145A.131,
519.2subdivision 1.
519.3(3) $2,000,000 of the TANF funds is
519.4appropriated each year of the biennium to
519.5the commissioner for decreasing racial and
519.6ethnic disparities in infant mortality rates
519.7under Minnesota Statutes, section 145.928,
519.8subdivision 7.
519.9(4) $4,978,000 of the TANF funds is
519.10appropriated each year of the biennium to the
519.11commissioner for the family home visiting
519.12grant program according to Minnesota
519.13Statutes, section 145A.17. $4,000,000 of the
519.14funding must be distributed to community
519.15health boards according to Minnesota
519.16Statutes, section 145A.131, subdivision 1.
519.17$978,000 of the funding must be distributed
519.18to tribal governments based on Minnesota
519.19Statutes, section 145A.14, subdivision 2a.
519.20(5) The commissioner may use up to 6.23
519.21percent of the funds appropriated each fiscal
519.22year to conduct the ongoing evaluations
519.23required under Minnesota Statutes, section
519.24145A.17, subdivision 7, and training and
519.25technical assistance as required under
519.26Minnesota Statutes, section 145A.17,
519.27subdivisions 4 and 5.
519.28TANF Carryforward. Any unexpended
519.29balance of the TANF appropriation in the
519.30first year of the biennium does not cancel but
519.31is available for the second year.

519.32

Subd. 3.Policy Quality and Compliance

519.33	Appropriations by Fund
519.34	General	9,400,000	9,409,000
520.1 520.2	State Government Special Revenue	14,481,000	16,548,000
520.3	Health Care Access	10,555,000	9,986,000

520.4Base Level Adjustment. The state
520.5government special revenue fund base shall
520.6be reduced by $2,000 in fiscal year 2017. The
520.7health care access base shall be increased by
520.8$600,000 in fiscal year 2015.

520.9

Subd. 4.Health Protection

520.10	Appropriations by Fund
520.11	General	9,503,000	9,558,000
520.12 520.13	State Government Special Revenue	32,794,000	32,939,000

520.14$19,000 in fiscal year 2014 and $19,000 in
520.15fiscal year 2015 are appropriated from the
520.16state government special revenue fund to the
520.17commissioner for licensing activities under
520.18Minnesota Statutes, section 145.417.
520.19Infectious Disease Laboratory. Of the
520.20general fund appropriation, $200,000 in
520.21fiscal year 2014 and $200,000 in fiscal year
520.222015 are appropriated to the commissioner
520.23to monitor infectious disease trends and
520.24investigate infectious disease outbreaks.
520.25Surveillance for Elevated Blood Lead
520.26Levels. Of the general fund appropriation,
520.27$100,000 in fiscal year 2014 and $100,000
520.28in fiscal year 2015 are appropriated to the
520.29commissioner for the blood lead surveillance
520.30system under Minnesota Statutes, section
520.31144.9502.
520.32Newborn Screening. (a) $365,000 in fiscal
520.33year 2014 and $349,000 in fiscal year 2015
520.34are appropriated for the purpose of providing
520.35support services to families as required
521.1under Minnesota Statutes, section 144.966,
521.2subdivision 3a.
521.3(b) $164,000 in fiscal year 2014 and
521.4$156,000 in fiscal year 2015 are appropriated
521.5for home-based education in American Sign
521.6Language for families with children who
521.7are deaf or have hearing loss, as required
521.8under Minnesota Statutes, section 144.966,
521.9subdivision 3a.
521.10Sexual Violence Prevention. Within
521.11available appropriations, by January 15,
521.122015, the commissioner must report to the
521.13legislature on its activities to prevent sexual
521.14violence, including activities to promote
521.15coordination of existing state programs and
521.16services to achieve maximum impact on
521.17addressing the root causes of sexual violence.
521.18Safe Harbor for Sexually Exploited
521.19Youth. (a) $1,000,000 in fiscal year 2014
521.20and $1,000,000 in fiscal year 2015 are
521.21for supportive service grants for the safe
521.22harbor for sexually exploited youth program,
521.23under Minnesota Statutes, section 145.4716,
521.24including advocacy services, civil legal
521.25services, health care services, mental and
521.26chemical health services, education and
521.27employment services, aftercare and relapse
521.28prevention, and family reunification services.
521.29This appropriation shall be added to the base.
521.30(b) $381,000 in fiscal year 2014 and
521.31$381,000 in fiscal year 2015 are for
521.32grants to six regional navigators under
521.33Minnesota Statutes, section 145.4717. This
521.34appropriation shall be added to the base.
522.1(c) $82,500 in fiscal year 2014 and $82,500
522.2in fiscal year 2015 are for the director of
522.3child sex trafficking prevention position.
522.4This appropriation shall be added to the base.
522.5(d) $72,900 in fiscal year 2015 is for
522.6program evaluation required under
522.7Minnesota Statutes, section 145.4718. This
522.8appropriation shall be added to the base.
522.9Base Level Adjustment. The state
522.10government special revenue base is increased
522.11by $6,000 in fiscal year 2016 and by $27,000
522.12in fiscal year 2017.

522.13

Subd. 5.Administrative Support Services

7,773,000

7,774,000

522.14Regional Support for Local Public Health
522.15Departments. $350,000 in fiscal year
522.162014 and $350,000 in fiscal year 2015
522.17are appropriated to the commissioner for
522.18regional staff who provide specialized
522.19expertise to local public health departments.

522.20

Sec. 5. HEALTH-RELATED BOARDS

522.21

Subdivision 1.Total Appropriation

$

17,224,000

$

17,288,000

522.22This appropriation is from the state
522.23government special revenue fund. The
522.24amounts that may be spent for each purpose
522.25are specified in the following subdivisions.

522.26

Subd. 2.Board of Chiropractic Examiners

473,000

477,000

522.27

Subd. 3.Board of Dentistry

1,835,000

1,850,000

522.28Health Professional Services Program. Of
522.29this appropriation, $704,000 in fiscal year
522.302014 and $704,000 in fiscal year 2015 from
522.31the state government special revenue fund are
522.32for the health professional services program.

523.1 523.2

Subd. 4.Board of Dietetic and Nutrition Practice

112,000

112,000

523.3 523.4

Subd. 5.Board of Marriage and Family Therapy

169,000

170,000

523.5

Subd. 6.Board of Medical Practice

3,883,000

3,900,000

523.6

Subd. 7.Board of Nursing

3,664,000

3,692,000

523.7 523.8

Subd. 8.Board of Nursing Home Administrators

1,630,000

1,586,000

523.9Administrative Services Unit - Operating
523.10Costs. Of this appropriation, $676,000
523.11in fiscal year 2014 and $626,000 in
523.12fiscal year 2015 are for operating costs
523.13of the administrative services unit. The
523.14administrative services unit may receive
523.15and expend reimbursements for services
523.16performed by other agencies.
523.17Administrative Services Unit - Volunteer
523.18Health Care Provider Program. Of this
523.19appropriation, $150,000 in fiscal year 2014
523.20and $150,000 in fiscal year 2015 are to pay
523.21for medical professional liability coverage
523.22required under Minnesota Statutes, section
523.23214.40.
523.24Administrative Services Unit - Contested
523.25Cases and Other Legal Proceedings. Of
523.26this appropriation, $200,000 in fiscal year
523.272014 and $200,000 in fiscal year 2015 are
523.28for costs of contested case hearings and other
523.29unanticipated costs of legal proceedings
523.30involving health-related boards funded
523.31under this section. Upon certification of a
523.32health-related board to the administrative
523.33services unit that the costs will be incurred
523.34and that there is insufficient money available
523.35to pay for the costs out of money currently
524.1available to that board, the administrative
524.2services unit is authorized to transfer money
524.3from this appropriation to the board for
524.4payment of those costs with the approval
524.5of the commissioner of management and
524.6budget. This appropriation does not cancel.
524.7Any unencumbered and unspent balances
524.8remain available for these expenditures in
524.9subsequent fiscal years.
524.10Criminal Background Checks. $390,000
524.11each year from the state government special
524.12revenue fund is for the Administrative
524.13Support Services Unit for the implementation
524.14of a criminal background check program.

524.15

Subd. 9.Board of Optometry

108,000

108,000

524.16

Subd. 10.Board of Pharmacy

2,362,000

2,380,000

524.17Prescription Electronic Reporting. Of
524.18this appropriation, $356,000 in fiscal year
524.192014 and $356,000 in fiscal year 2015 from
524.20the state government special revenue fund
524.21are to the board to operate the prescription
524.22electronic reporting system in Minnesota
524.23Statutes, section 152.126.

524.24

Subd. 11.Board of Physical Therapy

348,000

351,000

524.25

Subd. 12.Board of Podiatry

76,000

77,000

524.26

Subd. 13.Board of Psychology

853,000

861,000

524.27

Subd. 14.Board of Social Work

1,061,000

1,069,000

524.28

Subd. 15.Board of Veterinary Medicine

232,000

234,000

524.29 524.30

Subd. 16.Board of Behavioral Health and Therapy

418,000

421,000

524.31 524.32

Sec. 6. EMERGENCY MEDICAL SERVICES REGULATORY BOARD

$

2,749,000

$

2,756,000

525.1Regional Grants. $585,000 in fiscal year
525.22014 and $585,000 in fiscal year 2015 are
525.3for regional emergency medical services
525.4programs, to be distributed equally to the
525.5eight emergency medical service regions.
525.6Cooper/Sams Volunteer Ambulance
525.7Program. $700,000 in fiscal year 2014 and
525.8$700,000 in fiscal year 2015 are for the
525.9Cooper/Sams volunteer ambulance program
525.10under Minnesota Statutes, section 144E.40.
525.11(a) Of this amount, $611,000 in fiscal year
525.122014 and $611,000 in fiscal year 2015
525.13are for the ambulance service personnel
525.14longevity award and incentive program under
525.15Minnesota Statutes, section 144E.40.
525.16(b) Of this amount, $89,000 in fiscal year
525.172014 and $89,000 in fiscal year 2015 are
525.18for the operations of the ambulance service
525.19personnel longevity award and incentive
525.20program under Minnesota Statutes, section
525.21144E.40.
525.22Ambulance Training Grant. $361,000 in
525.23fiscal year 2014 and $361,000 in fiscal year
525.242015 are for training grants.
525.25EMSRB Board Operations. $1,095,000 in
525.26fiscal year 2014 and $1,095,000 in fiscal year
525.272015 are for operations.

525.28

Sec. 7. COUNCIL ON DISABILITY

$

618,000

$

622,000

525.29 525.30 525.31

Sec. 8. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES

$

1,668,000

$

1,680,000

525.32

Sec. 9. OMBUDSPERSON FOR FAMILIES

$

336,000

$

339,000

526.1    Sec. 10. Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:
526.2    Subd. 34. Federal administrative reimbursement dedicated. Federal
526.3administrative reimbursement resulting from the following activities is appropriated to the
526.4commissioner for the designated purposes:
526.5(1) reimbursement for the Minnesota senior health options project; and
526.6(2) reimbursement related to prior authorization and inpatient admission certification
526.7by a professional review organization. A portion of these funds must be used for activities
526.8to decrease unnecessary pharmaceutical costs in medical assistance.; and
526.9(3) reimbursement resulting from the federal child support grant expenditures
526.10authorized under United States Code, title 42, section 1315.

526.11    Sec. 11. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
526.12to read:
526.13    Subd. 35. Federal reimbursement for privatized adoption grants. Federal
526.14reimbursement for privatized adoption grant and foster care recruitment grant expenditures
526.15is appropriated to the commissioner for adoption grants and foster care and adoption
526.16administrative purposes.

526.17    Sec. 12. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
526.18to read:
526.19    Subd. 36. DHS receipt center accounting. The commissioner may transfer
526.20appropriations to, and account for DHS receipt center operations in, the special revenue
526.21fund.

526.22    Sec. 13. TRANSFERS.
526.23    Subdivision 1. Grants. The commissioner of human services, with the approval of
526.24the commissioner of management and budget, may transfer unencumbered appropriation
526.25balances for the biennium ending June 30, 2015, within fiscal years among the MFIP,
526.26general assistance, general assistance medical care under Minnesota Statutes 2009
526.27Supplement, section 256D.03, subdivision 3, medical assistance, MinnesotaCare, MFIP
526.28child care assistance under Minnesota Statutes, section 119B.05, Minnesota supplemental
526.29aid, group residential housing programs, the entitlement portion of the chemical
526.30dependency consolidated treatment fund, and between fiscal years of the biennium. The
526.31commissioner shall inform the chairs and ranking minority members of the senate Health
526.32and Human Services Finance Division and the house of representatives Health and Human
526.33Services Finance Committee quarterly about transfers made under this provision.
527.1    Subd. 2. Administration. Positions, salary money, and nonsalary administrative
527.2money may be transferred within the Departments of Human Services and Health as the
527.3commissioners consider necessary, with the advance approval of the commissioner of
527.4management and budget. The commissioner shall inform the chairs and ranking minority
527.5members of the senate Health and Human Services Finance Division and the house of
527.6representatives Health and Human Services Finance Committee quarterly about transfers
527.7made under this provision.

527.8    Sec. 14. INDIRECT COSTS NOT TO FUND PROGRAMS.
527.9The commissioners of health and human services shall not use indirect cost
527.10allocations to pay for the operational costs of any program for which they are responsible.

527.11    Sec. 15. EXPIRATION OF UNCODIFIED LANGUAGE.
527.12All uncodified language contained in this article expires on June 30, 2015, unless a
527.13different expiration date is explicit.

527.14    Sec. 16. EFFECTIVE DATE.
527.15This article is effective July 1, 2013, unless a different effective date is specified.

527.18

Section 1. HUMAN SERVICES APPROPRIATIONS.

527.19The sums shown in the columns marked "Appropriations" are added to or, if shown
527.20in parentheses, subtracted from the appropriations in article 14 to the agencies and for the
527.21purposes specified in this article. The appropriations are from the general fund or other
527.22named fund and are available for the fiscal years indicated for each purpose. The figures
527.23"2014" and "2015" used in this article mean that the addition to or subtraction from the
527.24appropriation listed under them is available for the fiscal year ending June 30, 2014, or
527.25June 30, 2015, respectively. Supplemental appropriations and reductions to appropriations
527.26for the fiscal year ending June 30, 2014, are effective the day following final enactment
527.27unless a different effective date is explicit.

527.28				APPROPRIATIONS
527.29				Available for the Year
527.30				Ending June 30
527.31					2014		2015

528.1 528.2

Sec. 2. COMMISSIONER OF HUMAN SERVICES

528.3

Subdivision 1.Total Appropriation

$

1,906,000

$

2,047,000

528.4	Appropriations by Fund
528.5		2014	2015
528.6	General	1,906,000	2,047,000

528.7Reform 2020 Contingency. The
528.8appropriation from the general fund may
528.9be adjusted as provided in article 2, section
528.1049, in order to implement Reform 2020 and
528.11systems modernization.

528.12

Subd. 2.Central Office Operations

528.13

(a) Operations

3,384,000

14,506,000

528.14Systems Modernization Transfer. If
528.15contingent funding is fully or partially
528.16disbursed as provided in article 2, section 49,
528.17and transferred to the state systems account,
528.18the unexpended balance of that appropriation
528.19must be transferred to the Office of Enterprise
528.20Technology in accordance with clause (2)
528.21of the systems modernization provision in
528.22article 14. Contingent funding under this
528.23provision must not exceed $16,992,000 for
528.24the biennium.

528.25

(b) Children and Families

109,000

206,000

528.26

(c) Health Care

100,000

100,000

528.27

(d) Continuing Care

5,236,000

5,541,000

528.28

Subd. 3.Forecasted Programs

528.29

(a) Group Residential Housing

(1,166,000)

(8,602,000)

528.30

(b) Medical Assistance

(3,770,000)

(10,086,000)

528.31

(c) Alternative Care

(6,981,000)

(4,394,000)

528.32

Subd. 4.Grant Programs

529.1

(a) Child and Community Services Grants

3,000,000

3,000,000

529.2

(b) Aging and Adult Services Grants

1,430,000

1,237,000

529.3

(c) Disability Grants

564,000

539,000