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, children and family services, program integrity, health-related
1.5licensing boards, chemical and mental health services, managed care
1.6organizations, waiver provider standards, home care, and the Department of
1.7Health; redesigning home and community-based services; establishing payment
1.8methodologies for home and community-based services; adjusting provider
1.9rates; setting and modifying fees; modifying autism coverage; modifying
1.10assistance programs; establishing Northstar care for children; making technical
1.11changes; requiring studies; requiring reports; appropriating money;amending
1.12Minnesota Statutes 2012, sections 13.381, subdivisions 2, 10; 13.461, by adding
1.13subdivisions; 16A.724, subdivisions 2, 3; 16C.10, subdivision 5; 16C.155,
1.14subdivision 1; 43A.23, by adding a subdivision; 62J.692, subdivisions 1, 3, 4,
1.155, 9, by adding a subdivision; 62Q.19, subdivision 1; 103I.005, by adding a
1.16subdivision; 103I.521; 119B.011, by adding a subdivision; 119B.02, by adding
1.17a subdivision; 119B.025, subdivision 1; 119B.03, subdivision 4; 119B.05,
1.18subdivision 1; 119B.13, subdivisions 1, 1a, 3a, 6, 7, by adding subdivisions;
1.19144.051, by adding subdivisions; 144.0724, subdivisions 4, 6; 144.123,
1.20subdivision 1; 144.125, subdivision 1; 144.212; 144.213; 144.215, subdivisions
1.213, 4; 144.216, subdivision 1; 144.217, subdivision 2; 144.218, subdivision 5;
1.22144.225, subdivisions 1, 4, 7, 8; 144.226; 144.966, subdivisions 2, 3a; 144.98,
1.23subdivisions 3, 5, by adding subdivisions; 144.99, subdivision 4; 144A.071,
1.24subdivision 4b; 144A.351; 144A.43; 144A.44; 144A.45; 144D.01, subdivision 4;
1.25145.906; 145.986; 145A.17, subdivision 1; 145C.01, subdivision 7; 148B.17,
1.26subdivision 2; 148E.065, subdivision 4a; 149A.02, subdivisions 1a, 2, 3, 4, 5,
1.2716, 23, 27, 34, 35, 37, by adding subdivisions; 149A.03; 149A.65, by adding
1.28subdivisions; 149A.70, subdivisions 1, 2, 3, 5; 149A.71, subdivisions 2, 4;
1.29149A.72, subdivisions 3, 9, by adding a subdivision; 149A.73, subdivisions 1,
1.302, 4; 149A.74; 149A.91, subdivision 9; 149A.93, subdivisions 3, 6; 149A.94;
1.31149A.96, subdivision 9; 151.19, subdivisions 1, 3; 151.37, subdivision 4; 151.47,
1.32subdivision 1, by adding a subdivision; 151.49; 174.30, subdivision 1; 214.12, by
1.33adding a subdivision; 214.40, subdivision 1; 243.166, subdivisions 4b, 7; 245.03,
1.34subdivision 1; 245.462, subdivision 20; 245.4661, subdivisions 5, 6; 245.4682,
1.35subdivision 2; 245.4871, subdivision 26; 245.4875, subdivision 8; 245.4881,
1.36subdivision 1; 245.91, by adding a subdivision; 245.94, subdivisions 2, 2a;
1.37245A.02, subdivisions 1, 9, 10, 14; 245A.03, subdivisions 7, 8, 9; 245A.04,
1.38subdivision 13; 245A.042, subdivision 3; 245A.07, subdivisions 2a, 3; 245A.08,
1.39subdivision 2a; 245A.10; 245A.11, subdivisions 2a, 7, 7a, 7b, 8; 245A.1435;
2.1245A.144; 245A.1444; 245A.16, subdivision 1; 245A.40, subdivision 5;
2.2245A.50; 245C.04, by adding a subdivision; 245C.08, subdivision 1; 245D.02;
2.3245D.03; 245D.04; 245D.05; 245D.06; 245D.07; 245D.09; 245D.10; 246.18,
2.4subdivision 8, by adding a subdivision; 246.54; 252.27, subdivision 2a;
2.5252.291, by adding a subdivision; 252.41, subdivision 3; 252.42; 252.43;
2.6252.44; 252.45; 252.46, subdivision 1a; 253B.10, subdivision 1; 254B.04,
2.7subdivision 1; 254B.13; 256.01, subdivisions 2, 24, 34, by adding subdivisions;
2.8256.0112, by adding a subdivision; 256.015, subdivision 1; 256.82, subdivisions
2.92, 3; 256.9657, subdivisions 3, 3a, 4; 256.969, subdivision 29; 256.975,
2.10subdivision 7, by adding subdivisions; 256.9754, subdivision 5, by adding
2.11subdivisions; 256.98, subdivision 8; 256B.02, subdivision 17, as added, by
2.12adding subdivisions; 256B.021, by adding subdivisions; 256B.04, subdivisions
2.1318, 21, by adding a subdivision; 256B.055, subdivisions 3a, 6, 10, 14, 15, by
2.14adding a subdivision; 256B.056, subdivisions 1, 1c, 3, 4, as amended, 5c, 10, by
2.15adding a subdivision; 256B.057, subdivisions 1, 8, 10, by adding a subdivision;
2.16256B.06, subdivision 4; 256B.0623, subdivision 2; 256B.0625, subdivisions 9,
2.1713, 13e, 19c, 31, 39, 48, 56, 58, by adding subdivisions; 256B.0631, subdivision
2.181; 256B.064, subdivisions 1a, 1b, 2; 256B.0659, subdivision 21; 256B.0755,
2.19subdivision 3; 256B.0756; 256B.0911, subdivisions 1, 1a, 3a, 4d, 6, 7, by
2.20adding a subdivision; 256B.0913, subdivision 4; 256B.0915, subdivisions 3a,
2.215, by adding a subdivision; 256B.0916, by adding a subdivision; 256B.0917,
2.22subdivisions 6, 13, by adding subdivisions; 256B.092, subdivisions 1a, 7,
2.2311, 12, by adding subdivisions; 256B.0943, subdivisions 1, 2, 7, by adding a
2.24subdivision; 256B.0946; 256B.095; 256B.0951, subdivisions 1, 4; 256B.0952,
2.25subdivisions 1, 5; 256B.0955; 256B.097, subdivisions 1, 3; 256B.196,
2.26subdivision 2; 256B.431, subdivision 44; 256B.434, subdivision 4, by adding
2.27subdivisions; 256B.437, subdivision 6; 256B.439, subdivisions 1, 2, 3, 4, by
2.28adding subdivisions; 256B.441, subdivisions 13, 44, 53, by adding subdivisions;
2.29256B.49, subdivisions 11a, 12, 13, 14, 15, by adding subdivisions; 256B.4912,
2.30subdivisions 1, 2, 3, 7, by adding subdivisions; 256B.4913, subdivisions 5, 6, by
2.31adding a subdivision; 256B.492; 256B.493, subdivision 2; 256B.501, by adding
2.32a subdivision; 256B.5011, subdivision 2; 256B.5012, by adding subdivisions;
2.33256B.69, subdivisions 5c, 5i, 8, 9c, 31, by adding subdivisions; 256B.694;
2.34256B.76, subdivisions 1, 2, 4, by adding a subdivision; 256B.761; 256B.764;
2.35256B.766; 256B.767; 256D.44, subdivision 5; 256I.05, by adding a subdivision;
2.36256J.08, subdivision 24; 256J.21, subdivisions 2, 3; 256J.24, subdivisions 5, 7;
2.37256J.35; 256J.621; 256J.626, subdivision 7; 256K.45; 256L.01, subdivisions
2.383a, 5, by adding subdivisions; 256L.02, subdivision 2, by adding subdivisions;
2.39256L.03, subdivisions 1, 1a, 3, 5, 6, by adding a subdivision; 256L.04,
2.40subdivisions 1, 7, 8, 10, 12, by adding subdivisions; 256L.05, subdivisions
2.411, 2, 3, 3c; 256L.06, subdivision 3; 256L.07, subdivisions 1, 2, 3; 256L.09,
2.42subdivision 2; 256L.11, subdivisions 1, 3; 256L.12, subdivision 1; 256L.15,
2.43subdivisions 1, 2; 256M.40, subdivision 1; 257.0755, subdivision 1; 257.75,
2.44subdivision 7; 257.85, subdivisions 2, 5, 6; 259A.20, subdivision 4; 260B.007,
2.45subdivisions 6, 16; 260C.007, subdivisions 6, 31; 260C.446; 260C.635,
2.46subdivision 1; 299C.093; 402A.10; 402A.18; 471.59, subdivision 1; 517.001;
2.47518A.60; 626.556, subdivisions 2, 3, 10d; 626.557, subdivisions 4, 9, 9a, 9e;
2.48626.5572, subdivision 13; Laws 1998, chapter 407, article 6, section 116; Laws
2.492011, First Special Session chapter 9, article 1, section 3; article 2, section 27;
2.50article 10, section 3, subdivision 3, as amended; Laws 2012, chapter 247, article
2.516, section 4; Laws 2013, chapter 1, section 6; proposing coding for new law in
2.52Minnesota Statutes, chapters 62A; 144; 144A; 145; 149A; 151; 214; 245; 245A;
2.53245D; 254B; 256; 256B; 256J; 256L; 259A; 260C; 402A; proposing coding
2.54for new law as Minnesota Statutes, chapters 245E; 256N; repealing Minnesota
2.55Statutes 2012, sections 62J.693; 103I.005, subdivision 20; 144.123, subdivision
2.562; 144A.46; 144A.461; 149A.025; 149A.20, subdivision 8; 149A.30, subdivision
2.572; 149A.40, subdivision 8; 149A.45, subdivision 6; 149A.50, subdivision 6;
2.58149A.51, subdivision 7; 149A.52, subdivision 5a; 149A.53, subdivision 9;
3.1151.19, subdivision 2; 151.25; 151.45; 151.47, subdivision 2; 151.48; 245A.655;
3.2245B.01; 245B.02; 245B.03; 245B.031; 245B.04; 245B.05, subdivisions 1, 2,
3.33, 5, 6, 7; 245B.055; 245B.06; 245B.07; 245B.08; 245D.08; 252.40; 252.46,
3.4subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 16, 17, 18, 19, 20, 21; 256.82,
3.5subdivision 4; 256B.055, subdivisions 3, 5, 10b; 256B.056, subdivision 5b;
3.6256B.057, subdivisions 1c, 2; 256B.0911, subdivisions 4a, 4b, 4c; 256B.0917,
3.7subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14; 256B.096, subdivisions 1, 2, 3,
3.84; 256B.14, subdivision 3a; 256B.49, subdivision 16a; 256B.4913, subdivisions
3.91, 2, 3, 4; 256B.501, subdivision 8; 256B.5012, subdivision 13; 256J.24;
3.10256L.01, subdivision 4a; 256L.031; 256L.04, subdivisions 1b, 9, 10a; 256L.05,
3.11subdivision 3b; 256L.07, subdivisions 1, 5, 8, 9; 256L.11, subdivisions 5, 6;
3.12256L.17, subdivisions 1, 2, 3, 4, 5; 260C.441; 485.14; 609.093; Laws 2011, First
3.13Special Session chapter 9, article 7, section 54, as amended; Minnesota Rules,
3.14parts 4668.0002; 4668.0003; 4668.0005; 4668.0008; 4668.0012; 4668.0016;
3.154668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040; 4668.0050;
3.164668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100;
3.174668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160;
3.184668.0170; 4668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220;
3.194668.0230; 4668.0240; 4668.0800; 4668.0805; 4668.0810; 4668.0815;
3.204668.0820; 4668.0825; 4668.0830; 4668.0835; 4668.0840; 4668.0845;
3.214668.0855; 4668.0860; 4668.0865; 4668.0870; 4669.0001; 4669.0010;
3.224669.0020; 4669.0030; 4669.0040; 4669.0050; 9525.1860, subparts 3, items B,
3.23C, 4, item D; 9560.0650, subparts 1, 3, 6; 9560.0651; 9560.0655.
3.24BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:


3.28    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 3, is amended to read:
3.29    Subd. 3. MinnesotaCare federal receipts. Receipts received as a result of federal
3.30participation pertaining to administrative costs of the Minnesota health care reform waiver
3.31shall be deposited as nondedicated revenue in the health care access fund. Receipts
3.32received as a result of federal participation pertaining to grants shall be deposited in the
3.33federal fund and shall offset health care access funds for payments to providers. All federal
3.34funding received by Minnesota for implementation and administration of MinnesotaCare
3.35as a basic health program, as authorized in section 1331 of the Affordable Care Act,
3.36Public Law 111-148, as amended by Public Law 111-152, is dedicated to that program and
3.37shall be deposited into the health care access fund. Federal funding that is received for
3.38implementing and administering MinnesotaCare as a basic health program and deposited in
3.39the fund shall be used only for that program to purchase health care coverage for enrollees
3.40and reduce enrollee premiums and cost-sharing or provide additional enrollee benefits.
3.41EFFECTIVE DATE.This section is effective January 1, 2015.

3.42    Sec. 2. Minnesota Statutes 2012, section 254B.04, subdivision 1, is amended to read:
4.1    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal
4.2Regulations, title 25, part 20, persons eligible for medical assistance benefits under
4.3sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, or who meet
4.4the income standards of section 256B.056, subdivision 4, and persons eligible for general
4.5assistance medical care under section 256D.03, subdivision 3, are entitled to chemical
4.6dependency fund services. State money appropriated for this paragraph must be placed in
4.7a separate account established for this purpose.
4.8Persons with dependent children who are determined to be in need of chemical
4.9dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
4.10a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
4.11local agency to access needed treatment services. Treatment services must be appropriate
4.12for the individual or family, which may include long-term care treatment or treatment in a
4.13facility that allows the dependent children to stay in the treatment facility. The county
4.14shall pay for out-of-home placement costs, if applicable.
4.15(b) A person not entitled to services under paragraph (a), but with family income
4.16that is less than 215 percent of the federal poverty guidelines for the applicable family
4.17size, shall be eligible to receive chemical dependency fund services within the limit
4.18of funds appropriated for this group for the fiscal year. If notified by the state agency
4.19of limited funds, a county must give preferential treatment to persons with dependent
4.20children who are in need of chemical dependency treatment pursuant to an assessment
4.21under section 626.556, subdivision 10, or a case plan under section 260C.201, subdivision
4.226 , or 260C.212. A county may spend money from its own sources to serve persons under
4.23this paragraph. State money appropriated for this paragraph must be placed in a separate
4.24account established for this purpose.
4.25(c) Persons whose income is between 215 percent and 412 percent of the federal
4.26poverty guidelines for the applicable family size shall be eligible for chemical dependency
4.27services on a sliding fee basis, within the limit of funds appropriated for this group for the
4.28fiscal year. Persons eligible under this paragraph must contribute to the cost of services
4.29according to the sliding fee scale established under subdivision 3. A county may spend
4.30money from its own sources to provide services to persons under this paragraph. State
4.31money appropriated for this paragraph must be placed in a separate account established
4.32for this purpose.
4.33EFFECTIVE DATE.This section is effective January 1, 2014.

4.34    Sec. 3. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
4.35to read:
5.1    Subd. 35. Federal approval. (a) The commissioner shall seek federal authority
5.2from the U.S. Department of Health and Human Services necessary to operate a health
5.3coverage program for Minnesotans with incomes up to 275 percent of the federal poverty
5.4guidelines (FPG). The proposal shall seek to secure all federal funding available from at
5.5least the following services:
5.6(1) all premium tax credits and cost sharing subsidies available under United States
5.7Code, title 26, section 36B, and United States Code, title 42, section 18071, for individuals
5.8with incomes above 133 percent and at or below 275 percent of the federal poverty
5.9guidelines who would otherwise be enrolled in the Minnesota Insurance Marketplace as
5.10defined in section 62V.02;
5.11(2) Medicaid funding; and
5.12(3) other funding sources identified by the commissioner that support coverage or
5.13care redesign in Minnesota.
5.14(b) Funding received shall be used to design and implement a health coverage
5.15program that creates a single streamlined program and meets the needs of Minnesotans with
5.16incomes up to 275 percent of the federal poverty guidelines. The program must incorporate:
5.17(1) payment reform characteristics included in the health care delivery system and
5.18accountable care organization payment models;
5.19(2) flexibility in benefit set design such that benefits can be targeted to meet enrollee
5.20needs in different income and health status situations and can provide a more seamless
5.21transition from public to private health care coverage;
5.22(3) flexibility in co-payment or premium structures to incent patients to seek
5.23high-quality, low-cost care settings; and
5.24(4) flexibility in premium structures to ease the transition from public to private
5.25health care coverage.
5.26(c) The commissioner shall develop and submit a proposal consistent with the above
5.27criteria and shall seek all federal authority necessary to implement the health coverage
5.28program. In developing the request, the commissioner shall consult with appropriate
5.29stakeholder groups and consumers.
5.30(d) The commissioner is authorized to seek any available waivers or federal
5.31approvals to accomplish the goals under paragraph (b) prior to 2017.
5.32(e) The commissioner shall report to the chairs and ranking minority members of
5.33the legislative committees with jurisdiction over health and human services policy and
5.34financing by January 15, 2015, on the progress of receiving a federal waiver and shall
5.35make recommendations on any legislative changes necessary to accomplish the project
5.36in this subdivision. Any implementation of the waiver that requires a state financial
6.1contribution to operate a health coverage program for Minnesotans with incomes between
6.2200 and 275 percent of the federal poverty guidelines, shall be contingent on legislative
6.3action approving the contribution.
6.4(f) The commissioner is authorized to accept and expend federal funds that support
6.5the purposes of this subdivision.

6.6    Sec. 4. Minnesota Statutes 2012, section 256.015, subdivision 1, is amended to read:
6.7    Subdivision 1. State agency has lien. When the state agency provides, pays for, or
6.8becomes liable for medical care or furnishes subsistence or other payments to a person,
6.9the agency shall have a lien for the cost of the care and payments on any and all causes of
6.10action or recovery rights under any policy, plan, or contract providing benefits for health
6.11care or injury which accrue to the person to whom the care or payments were furnished,
6.12or to the person's legal representatives, as a result of the occurrence that necessitated the
6.13medical care, subsistence, or other payments. For purposes of this section, "state agency"
6.14includes prepaid health plans under contract with the commissioner according to sections
6.15256B.69 , 256D.03, subdivision 4, paragraph (c), and 256L.12, 256L.01, subdivision 7,
6.16and 256L.03, subdivision 6; children's mental health collaboratives under section 245.493;
6.17demonstration projects for persons with disabilities under section 256B.77; nursing
6.18homes under the alternative payment demonstration project under section 256B.434; and
6.19county-based purchasing entities under section 256B.692.

6.20    Sec. 5. Minnesota Statutes 2012, section 256B.02, subdivision 17, as added by Laws
6.212013, chapter 1, section 1, is amended to read:
6.22    Subd. 17. Affordable Care Act or ACA. "Affordable Care Act" or "ACA" means
6.23Public Law 111-148, as amended by the federal Health Care and Education Reconciliation
6.24Act of 2010 (Public Law 111-152), and any amendments to, or regulations or guidance
6.25issued under, those acts means the federal Patient Protection and Affordable Care Act,
6.26Public Law 111-148, as amended, including the federal Health Care and Education
6.27Reconciliation Act of 2010, Public Law 111-152, and any amendments to, and any federal
6.28guidance or regulations issued under, these acts.
6.29EFFECTIVE DATE.This section is effective July 1, 2013.

6.30    Sec. 6. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
6.31to read:
7.1    Subd. 18. Caretaker relative. "Caretaker relative" means a relative, by blood,
7.2adoption, or marriage, of a child under age 19 with whom the child is living and who
7.3assumes primary responsibility for the child's care.
7.4EFFECTIVE DATE.This section is effective January 1, 2014.

7.5    Sec. 7. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
7.6to read:
7.7    Subd. 19. Insurance affordability program. "Insurance affordability program"
7.8means one of the following programs:
7.9(1) medical assistance under this chapter;
7.10(2) a program that provides advance payments of the premium tax credits established
7.11under section 36B of the Internal Revenue Code or cost-sharing reductions established
7.12under section 1402 of the Affordable Care Act;
7.13(3) MinnesotaCare as defined in chapter 256L; and
7.14(4) a Basic Health Plan as defined in section 1331 of the Affordable Care Act.
7.15EFFECTIVE DATE.This section is effective the day following final enactment.

7.16    Sec. 8. Minnesota Statutes 2012, section 256B.04, subdivision 18, is amended to read:
7.17    Subd. 18. Applications for medical assistance. (a) The state agency may take
7.18 shall accept applications for medical assistance and conduct eligibility determinations for
7.19MinnesotaCare enrollees by telephone, via mail, in-person, online via an Internet Web
7.20site, and through other commonly available electronic means.
7.21    (b) The commissioner of human services shall modify the Minnesota health care
7.22programs application form to add a question asking applicants whether they have ever
7.23served in the United States military.
7.24    (c) For each individual who submits an application or whose eligibility is subject to
7.25renewal or whose eligibility is being redetermined pursuant to a change in circumstances,
7.26if the agency determines the individual is not eligible for medical assistance, the agency
7.27shall determine potential eligibility for other insurance affordability programs.
7.28EFFECTIVE DATE.This section is effective January 1, 2014.

7.29    Sec. 9. Minnesota Statutes 2012, section 256B.055, subdivision 3a, is amended to read:
7.30    Subd. 3a. Families with children. Beginning July 1, 2002, Medical assistance may
7.31be paid for a person who is a child under the age of 18, or age 18 if a full-time student
7.32in a secondary school, or in the equivalent level of vocational or technical training, and
8.1reasonably expected to complete the program before reaching age 19; the parent or
8.2stepparent of a dependent child under the age of 19, including a pregnant woman; or a
8.3caretaker relative of a dependent child under the age of 19.
8.4EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
8.5approval, whichever is later. The commissioner of human services shall notify the revisor
8.6of statutes when federal approval is obtained.

8.7    Sec. 10. Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:
8.8    Subd. 6. Pregnant women; needy unborn child. Medical assistance may be paid
8.9for a pregnant woman who has written verification of a positive pregnancy test from a
8.10physician or licensed registered nurse, who meets the other eligibility criteria of this
8.11section and whose unborn child would be eligible as a needy child under subdivision 10 if
8.12born and living with the woman. In accordance with Code of Federal Regulations, title
8.1342, section 435.956, the commissioner must accept self-attestation of pregnancy unless
8.14the agency has information that is not reasonably compatible with such attestation. For
8.15purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.
8.16EFFECTIVE DATE.This section is effective January 1, 2014.

8.17    Sec. 11. Minnesota Statutes 2012, section 256B.055, subdivision 10, is amended to read:
8.18    Subd. 10. Infants. Medical assistance may be paid for an infant less than one year
8.19of age, whose mother was eligible for and receiving medical assistance at the time of birth
8.20or who is less than two years of age and is in a family with countable income that is equal
8.21to or less than the income standard established under section 256B.057, subdivision 1.
8.22EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
8.23approval, whichever is later. The commissioner of human services shall notify the revisor
8.24of statutes when federal approval is obtained.

8.25    Sec. 12. Minnesota Statutes 2012, section 256B.055, subdivision 15, is amended to read:
8.26    Subd. 15. Adults without children. Medical assistance may be paid for a person
8.27who is:
8.28(1) at least age 21 and under age 65;
8.29(2) not pregnant;
8.30(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII
8.31of the Social Security Act;
9.1(4) not an adult in a family with children as defined in section 256L.01, subdivision
9.23a ; and not otherwise eligible under subdivision 7 as a person who meets the categorical
9.3eligibility requirements of the supplemental security income program;
9.4(5) not enrolled under subdivision 7 as a person who would meet the categorical
9.5eligibility requirements of the supplemental security income program except for excess
9.6income or assets; and
9.7(5) (6) not described in another subdivision of this section.
9.8EFFECTIVE DATE.This section is effective January 1, 2014.

9.9    Sec. 13. Minnesota Statutes 2012, section 256B.055, is amended by adding a
9.10subdivision to read:
9.11    Subd. 17. Adults who were in foster care at the age of 18. Medical assistance may
9.12be paid for a person under 26 years of age who was in foster care under the commissioner's
9.13responsibility on the date of attaining 18 years of age, and who was enrolled in medical
9.14assistance under the state plan or a waiver of the plan while in foster care, in accordance
9.15with section 2004 of the Affordable Care Act.
9.16EFFECTIVE DATE.This section is effective January 1, 2014.

9.17    Sec. 14. Minnesota Statutes 2012, section 256B.056, subdivision 1, is amended to read:
9.18    Subdivision 1. Residency. To be eligible for medical assistance, a person must
9.19reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota,
9.20 in accordance with the rules of the state agency Code of Federal Regulations, title 42,
9.21section 435.403.
9.22EFFECTIVE DATE.This section is effective January 1, 2014.

9.23    Sec. 15. Minnesota Statutes 2012, section 256B.056, subdivision 1c, is amended to read:
9.24    Subd. 1c. Families with children income methodology. (a)(1) [Expired, 1Sp2003
9.25c 14 art 12 s 17]
9.26(2) For applications processed within one calendar month prior to July 1, 2003,
9.27eligibility shall be determined by applying the income standards and methodologies in
9.28effect prior to July 1, 2003, for any months in the six-month budget period before July
9.291, 2003, and the income standards and methodologies in effect on July 1, 2003, for any
9.30months in the six-month budget period on or after that date. The income standards for
9.31each month shall be added together and compared to the applicant's total countable income
9.32for the six-month budget period to determine eligibility.
10.1(3) For children ages one through 18 whose eligibility is determined under section
10.2256B.057, subdivision 2, the following deductions shall be applied to income counted
10.3toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
10.416, 1996: $90 work expense, dependent care, and child support paid under court order.
10.5This clause is effective October 1, 2003.
10.6(b) For families with children whose eligibility is determined using the standard
10.7specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
10.8earned income shall be disregarded for up to four months and the following deductions
10.9shall be applied to each individual's income counted toward eligibility as allowed under
10.10the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
10.11under court order.
10.12(c) If the four-month disregard in paragraph (b) has been applied to the wage
10.13earner's income for four months, the disregard shall not be applied again until the wage
10.14earner's income has not been considered in determining medical assistance eligibility for
10.1512 consecutive months.
10.16(d) (b) The commissioner shall adjust the income standards under this section each
10.17July 1 by the annual update of the federal poverty guidelines following publication by the
10.18United States Department of Health and Human Services except that the income standards
10.19shall not go below those in effect on July 1, 2009.
10.20(e) (c) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
10.21organization to or for the benefit of the child with a life-threatening illness must be
10.22disregarded from income.
10.23EFFECTIVE DATE.This section is effective January 1, 2014.

10.24    Sec. 16. Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:
10.25    Subd. 3. Asset limitations for certain individuals and families. (a) To be
10.26eligible for medical assistance, a person must not individually own more than $3,000 in
10.27assets, or if a member of a household with two family members, husband and wife, or
10.28parent and child, the household must not own more than $6,000 in assets, plus $200 for
10.29each additional legal dependent. In addition to these maximum amounts, an eligible
10.30individual or family may accrue interest on these amounts, but they must be reduced to the
10.31maximum at the time of an eligibility redetermination. The accumulation of the clothing
10.32and personal needs allowance according to section 256B.35 must also be reduced to the
10.33maximum at the time of the eligibility redetermination. The value of assets that are not
10.34considered in determining eligibility for medical assistance is the value of those assets
11.1excluded under the supplemental security income program for aged, blind, and disabled
11.2persons, with the following exceptions:
11.3(1) household goods and personal effects are not considered;
11.4(2) capital and operating assets of a trade or business that the local agency determines
11.5are necessary to the person's ability to earn an income are not considered;
11.6(3) motor vehicles are excluded to the same extent excluded by the supplemental
11.7security income program;
11.8(4) assets designated as burial expenses are excluded to the same extent excluded by
11.9the supplemental security income program. Burial expenses funded by annuity contracts
11.10or life insurance policies must irrevocably designate the individual's estate as contingent
11.11beneficiary to the extent proceeds are not used for payment of selected burial expenses;
11.12(5) for a person who no longer qualifies as an employed person with a disability due
11.13to loss of earnings, assets allowed while eligible for medical assistance under section
11.14256B.057, subdivision 9 , are not considered for 12 months, beginning with the first month
11.15of ineligibility as an employed person with a disability, to the extent that the person's total
11.16assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
11.17    (6) when a person enrolled in medical assistance under section 256B.057, subdivision
11.189 , is age 65 or older and has been enrolled during each of the 24 consecutive months
11.19before the person's 65th birthday, the assets owned by the person and the person's spouse
11.20must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d),
11.21when determining eligibility for medical assistance under section 256B.055, subdivision
11.227 . The income of a spouse of a person enrolled in medical assistance under section
11.23256B.057, subdivision 9 , during each of the 24 consecutive months before the person's
11.2465th birthday must be disregarded when determining eligibility for medical assistance
11.25under section 256B.055, subdivision 7. Persons eligible under this clause are not subject to
11.26the provisions in section 256B.059. A person whose 65th birthday occurs in 2012 or 2013
11.27is required to have qualified for medical assistance under section 256B.057, subdivision 9,
11.28prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and
11.29(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
11.30required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
11.31Law 111-5. For purposes of this clause, an American Indian is any person who meets the
11.32definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
11.33(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
11.3415.
11.35EFFECTIVE DATE.This section is effective January 1, 2014.

12.1    Sec. 17. Minnesota Statutes 2012, section 256B.056, subdivision 4, as amended by
12.2Laws 2013, chapter 1, section 5, is amended to read:
12.3    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under
12.4section 256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of
12.5the federal poverty guidelines. Effective January 1, 2000, and each successive January,
12.6recipients of supplemental security income may have an income up to the supplemental
12.7security income standard in effect on that date.
12.8(b) To be eligible for medical assistance, families and children may have an income
12.9up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996,
12.10AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16,
12.111996, shall be increased by three percent.
12.12(c) (b) Effective January 1, 2014, to be eligible for medical assistance, under section
12.13256B.055, subdivision 3a , a parent or caretaker relative may have an income up to 133
12.14percent of the federal poverty guidelines for the household size.
12.15(d) (c) To be eligible for medical assistance under section 256B.055, subdivision
12.1615 , a person may have an income up to 133 percent of federal poverty guidelines for
12.17the household size.
12.18(e) (d) To be eligible for medical assistance under section 256B.055, subdivision
12.1916 , a child age 19 to 20 may have an income up to 133 percent of the federal poverty
12.20guidelines for the household size.
12.21(f) (e) To be eligible for medical assistance under section 256B.055, subdivision 3a,
12.22a child under age 19 may have income up to 275 percent of the federal poverty guidelines
12.23for the household size or an equivalent standard when converted using modified adjusted
12.24gross income methodology as required under the Affordable Care Act. Children who are
12.25enrolled in medical assistance as of December 31, 2013, and are determined ineligible
12.26for medical assistance because of the elimination of income disregards under modified
12.27adjusted gross income methodology as defined in subdivision 1a remain eligible for
12.28medical assistance under the Children's Health Insurance Program Reauthorization Act
12.29of 2009, Public Law 111-3, until the date of their next regularly scheduled eligibility
12.30redetermination as required in section 256B.056, subdivision 7a.
12.31(f) In computing income to determine eligibility of persons under paragraphs (a) to
12.32(e) who are not residents of long-term care facilities, the commissioner shall disregard
12.33increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
12.34For persons eligible under paragraph (a), veteran aid and attendance benefits and Veterans
12.35Administration unusual medical expense payments are considered income to the recipient.
12.36EFFECTIVE DATE.This section is effective January 1, 2014.

13.1    Sec. 18. Minnesota Statutes 2012, section 256B.056, subdivision 5c, is amended to read:
13.2    Subd. 5c. Excess income standard. (a) The excess income standard for families
13.3with children parents and caretaker relatives, pregnant women, infants, and children ages
13.4two through 20 is the standard specified in subdivision 4, paragraph (b).
13.5(b) The excess income standard for a person whose eligibility is based on blindness,
13.6disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
13.7family size. Effective July 1, 2002, the excess income standard for this paragraph shall
13.8equal 75 percent of the federal poverty guidelines.
13.9EFFECTIVE DATE.This section is effective January 1, 2014.

13.10    Sec. 19. Minnesota Statutes 2012, section 256B.056, is amended by adding a
13.11subdivision to read:
13.12    Subd. 7a. Periodic renewal of eligibility. (a) The commissioner shall make an
13.13annual redetermination of eligibility based on information contained in the enrollee's case
13.14file and other information available to the agency, including but not limited to information
13.15accessed through an electronic database, without requiring the enrollee to submit any
13.16information when sufficient data is available for the agency to renew eligibility.
13.17(b) If the commissioner cannot renew eligibility in accordance with paragraph (a),
13.18the commissioner must provide the enrollee with a prepopulated renewal form containing
13.19eligibility information available to the agency and permit the enrollee to submit the form
13.20with any corrections or additional information to the agency and sign the renewal form via
13.21any of the modes of submission specified in section 256B.04, subdivision 18.
13.22(c) An enrollee who is terminated for failure to complete the renewal process may
13.23subsequently submit the renewal form and required information within four months after
13.24the date of termination and have coverage reinstated without a lapse, if otherwise eligible
13.25under this chapter.
13.26(d) Notwithstanding paragraph (a), individuals eligible under subdivision 5 shall be
13.27required to renew eligibility every six months.
13.28EFFECTIVE DATE.This section is effective January 1, 2014.

13.29    Sec. 20. Minnesota Statutes 2012, section 256B.056, subdivision 10, is amended to read:
13.30    Subd. 10. Eligibility verification. (a) The commissioner shall require women who
13.31are applying for the continuation of medical assistance coverage following the end of the
13.3260-day postpartum period to update their income and asset information and to submit
13.33any required income or asset verification.
14.1    (b) The commissioner shall determine the eligibility of private-sector health care
14.2coverage for infants less than one year of age eligible under section 256B.055, subdivision
14.310 , or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
14.4if this is determined to be cost-effective.
14.5    (c) The commissioner shall verify assets and income for all applicants, and for all
14.6recipients upon renewal.
14.7    (d) The commissioner shall utilize information obtained through the electronic
14.8service established by the secretary of the United States Department of Health and Human
14.9Services and other available electronic data sources in Code of Federal Regulations, title
14.1042, sections 435.940 to 435.956, to verify eligibility requirements. The commissioner
14.11shall establish standards to define when information obtained electronically is reasonably
14.12compatible with information provided by applicants and enrollees, including use of
14.13self-attestation, to accomplish real-time eligibility determinations and maintain program
14.14integrity.
14.15EFFECTIVE DATE.This section is effective January 1, 2014.

14.16    Sec. 21. Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:
14.17    Subdivision 1. Infants and pregnant women. (a)(1) An infant less than one year
14.18 two years of age or a pregnant woman who has written verification of a positive pregnancy
14.19test from a physician or licensed registered nurse is eligible for medical assistance if the
14.20individual's countable family household income is equal to or less than 275 percent of the
14.21federal poverty guideline for the same family household size or an equivalent standard
14.22when converted using modified adjusted gross income methodology as required under
14.23the Affordable Care Act. For purposes of this subdivision, "countable family income"
14.24means the amount of income considered available using the methodology of the AFDC
14.25program under the state's AFDC plan as of July 16, 1996, as required by the Personal
14.26Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public
14.27Law 104-193, except for the earned income disregard and employment deductions.
14.28    (2) For applications processed within one calendar month prior to the effective date,
14.29eligibility shall be determined by applying the income standards and methodologies in
14.30effect prior to the effective date for any months in the six-month budget period before
14.31that date and the income standards and methodologies in effect on the effective date for
14.32any months in the six-month budget period on or after that date. The income standards
14.33for each month shall be added together and compared to the applicant's total countable
14.34income for the six-month budget period to determine eligibility.
14.35    (b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]
15.1    (2) For applications processed within one calendar month prior to July 1, 2003,
15.2eligibility shall be determined by applying the income standards and methodologies in
15.3effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
15.42003, and the income standards and methodologies in effect on the expiration date for any
15.5months in the six-month budget period on or after July 1, 2003. The income standards
15.6for each month shall be added together and compared to the applicant's total countable
15.7income for the six-month budget period to determine eligibility.
15.8    (3) An amount equal to the amount of earned income exceeding 275 percent of
15.9the federal poverty guideline, up to a maximum of the amount by which the combined
15.10total of 185 percent of the federal poverty guideline plus the earned income disregards
15.11and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
15.12by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
15.13Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
15.14pregnant women and infants less than one year of age.
15.15    (c) Dependent care and child support paid under court order shall be deducted from
15.16the countable income of pregnant women.
15.17    (d) (b) An infant born to a woman who was eligible for and receiving medical
15.18assistance on the date of the child's birth shall continue to be eligible for medical assistance
15.19without redetermination until the child's first birthday.
15.20EFFECTIVE DATE.This section is effective January 1, 2014.

15.21    Sec. 22. Minnesota Statutes 2012, section 256B.057, subdivision 8, is amended to read:
15.22    Subd. 8. Children under age two. Medical assistance may be paid for a child under
15.23two years of age whose countable family income is above 275 percent of the federal poverty
15.24guidelines for the same size family but less than or equal to 280 percent of the federal
15.25poverty guidelines for the same size family or an equivalent standard when converted using
15.26modified adjusted gross income methodology as required under the Affordable Care Act.
15.27EFFECTIVE DATE.This section is effective January 1, 2014.

15.28    Sec. 23. Minnesota Statutes 2012, section 256B.057, subdivision 10, is amended to read:
15.29    Subd. 10. Certain persons needing treatment for breast or cervical cancer. (a)
15.30Medical assistance may be paid for a person who:
15.31(1) has been screened for breast or cervical cancer by the Minnesota breast and
15.32cervical cancer control program, and program funds have been used to pay for the person's
15.33screening;
16.1(2) according to the person's treating health professional, needs treatment, including
16.2diagnostic services necessary to determine the extent and proper course of treatment, for
16.3breast or cervical cancer, including precancerous conditions and early stage cancer;
16.4(3) meets the income eligibility guidelines for the Minnesota breast and cervical
16.5cancer control program;
16.6(4) is under age 65;
16.7(5) is not otherwise eligible for medical assistance under United States Code, title
16.842, section 1396a(a)(10)(A)(i); and
16.9(6) is not otherwise covered under creditable coverage, as defined under United
16.10States Code, title 42, section 1396a(aa).
16.11(b) Medical assistance provided for an eligible person under this subdivision shall
16.12be limited to services provided during the period that the person receives treatment for
16.13breast or cervical cancer.
16.14(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance
16.15without meeting the eligibility criteria relating to income and assets in section 256B.056,
16.16subdivisions 1a to 5b 5a.
16.17EFFECTIVE DATE.This section is effective January 1, 2014.

16.18    Sec. 24. Minnesota Statutes 2012, section 256B.057, is amended by adding a
16.19subdivision to read:
16.20    Subd. 12. Presumptive eligibility determinations made by qualified hospitals.
16.21The commissioner shall establish a process to qualify hospitals that are participating
16.22providers under the medical assistance program to determine presumptive eligibility for
16.23medical assistance for applicants who may have a basis of eligibility using the modified
16.24adjusted gross income methodology as defined in section 256B.056, subdivision 1a,
16.25paragraph (b), clause (1).
16.26EFFECTIVE DATE.This section is effective January 1, 2014.

16.27    Sec. 25. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
16.28    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
16.29to citizens of the United States, qualified noncitizens as defined in this subdivision, and
16.30other persons residing lawfully in the United States. Citizens or nationals of the United
16.31States must cooperate in obtaining satisfactory documentary evidence of citizenship or
16.32nationality according to the requirements of the federal Deficit Reduction Act of 2005,
16.33Public Law 109-171.
17.1(b) "Qualified noncitizen" means a person who meets one of the following
17.2immigration criteria:
17.3(1) admitted for lawful permanent residence according to United States Code, title 8;
17.4(2) admitted to the United States as a refugee according to United States Code,
17.5title 8, section 1157;
17.6(3) granted asylum according to United States Code, title 8, section 1158;
17.7(4) granted withholding of deportation according to United States Code, title 8,
17.8section 1253(h);
17.9(5) paroled for a period of at least one year according to United States Code, title 8,
17.10section 1182(d)(5);
17.11(6) granted conditional entrant status according to United States Code, title 8,
17.12section 1153(a)(7);
17.13(7) determined to be a battered noncitizen by the United States Attorney General
17.14according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
17.15title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
17.16(8) is a child of a noncitizen determined to be a battered noncitizen by the United
17.17States Attorney General according to the Illegal Immigration Reform and Immigrant
17.18Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
17.19Public Law 104-200; or
17.20(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
17.21Law 96-422, the Refugee Education Assistance Act of 1980.
17.22(c) All qualified noncitizens who were residing in the United States before August
17.2322, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
17.24medical assistance with federal financial participation.
17.25(d) Beginning December 1, 1996, qualified noncitizens who entered the United
17.26States on or after August 22, 1996, and who otherwise meet the eligibility requirements
17.27of this chapter are eligible for medical assistance with federal participation for five years
17.28if they meet one of the following criteria:
17.29(1) refugees admitted to the United States according to United States Code, title 8,
17.30section 1157;
17.31(2) persons granted asylum according to United States Code, title 8, section 1158;
17.32(3) persons granted withholding of deportation according to United States Code,
17.33title 8, section 1253(h);
17.34(4) veterans of the United States armed forces with an honorable discharge for
17.35a reason other than noncitizen status, their spouses and unmarried minor dependent
17.36children; or
18.1(5) persons on active duty in the United States armed forces, other than for training,
18.2their spouses and unmarried minor dependent children.
18.3 Beginning July 1, 2010, children and pregnant women who are noncitizens
18.4described in paragraph (b) or who are lawfully present in the United States as defined
18.5in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
18.6eligibility requirements of this chapter, are eligible for medical assistance with federal
18.7financial participation as provided by the federal Children's Health Insurance Program
18.8Reauthorization Act of 2009, Public Law 111-3.
18.9(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
18.10are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
18.11subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
18.12Code, title 8, section 1101(a)(15).
18.13(f) Payment shall also be made for care and services that are furnished to noncitizens,
18.14regardless of immigration status, who otherwise meet the eligibility requirements of
18.15this chapter, if such care and services are necessary for the treatment of an emergency
18.16medical condition.
18.17(g) For purposes of this subdivision, the term "emergency medical condition" means
18.18a medical condition that meets the requirements of United States Code, title 42, section
18.191396b(v).
18.20(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
18.21of an emergency medical condition are limited to the following:
18.22(i) services delivered in an emergency room or by an ambulance service licensed
18.23under chapter 144E that are directly related to the treatment of an emergency medical
18.24condition;
18.25(ii) services delivered in an inpatient hospital setting following admission from an
18.26emergency room or clinic for an acute emergency condition; and
18.27(iii) follow-up services that are directly related to the original service provided
18.28to treat the emergency medical condition and are covered by the global payment made
18.29to the provider.
18.30    (2) Services for the treatment of emergency medical conditions do not include:
18.31(i) services delivered in an emergency room or inpatient setting to treat a
18.32nonemergency condition;
18.33(ii) organ transplants, stem cell transplants, and related care;
18.34(iii) services for routine prenatal care;
18.35(iv) continuing care, including long-term care, nursing facility services, home health
18.36care, adult day care, day training, or supportive living services;
19.1(v) elective surgery;
19.2(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
19.3part of an emergency room visit;
19.4(vii) preventative health care and family planning services;
19.5(viii) dialysis;
19.6(ix) chemotherapy or therapeutic radiation services;
19.7(x) rehabilitation services;
19.8(xi) physical, occupational, or speech therapy;
19.9(xii) transportation services;
19.10(xiii) case management;
19.11(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;
19.12(xv) dental services;
19.13(xvi) hospice care;
19.14(xvii) audiology services and hearing aids;
19.15(xviii) podiatry services;
19.16(xix) chiropractic services;
19.17(xx) immunizations;
19.18(xxi) vision services and eyeglasses;
19.19(xxii) waiver services;
19.20(xxiii) individualized education programs; or
19.21(xxiv) chemical dependency treatment.
19.22(i) Beginning July 1, 2009, Pregnant noncitizens who are undocumented,
19.23nonimmigrants, or lawfully present in the United States as defined in Code of Federal
19.24Regulations, title 8, section 103.12, ineligible for federally funded medical assistance
19.25because of immigration status, are not covered by a group health plan or health insurance
19.26coverage according to Code of Federal Regulations, title 42, section 457.310, and who
19.27 otherwise meet the eligibility requirements of this chapter, are eligible for medical
19.28assistance through the period of pregnancy, including labor and delivery, and 60 days
19.29postpartum, to the extent federal funds are available under title XXI of the Social Security
19.30Act, and the state children's health insurance program.
19.31(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
19.32services from a nonprofit center established to serve victims of torture and are otherwise
19.33ineligible for medical assistance under this chapter are eligible for medical assistance
19.34without federal financial participation. These individuals are eligible only for the period
19.35during which they are receiving services from the center. Individuals eligible under this
19.36paragraph shall not be required to participate in prepaid medical assistance.
20.1EFFECTIVE DATE.This section is effective January 1, 2014.

20.2    Sec. 26. Minnesota Statutes 2012, section 256B.0755, subdivision 3, is amended to read:
20.3    Subd. 3. Accountability. (a) Health care delivery systems must accept responsibility
20.4for the quality of care based on standards established under subdivision 1, paragraph (b),
20.5clause (10), and the cost of care or utilization of services provided to its enrollees under
20.6subdivision 1, paragraph (b), clause (1).
20.7(b) A health care delivery system may contract and coordinate with providers and
20.8clinics for the delivery of services and shall contract with community health clinics,
20.9federally qualified health centers, community mental health centers or programs, county
20.10agencies, and rural clinics to the extent practicable.
20.11(c) A health care delivery system must indicate how it will coordinate with other
20.12services affecting its patients' health, quality of care, and cost of care that are provided by
20.13other providers, county agencies, and other organizations in the local service area. The
20.14health care delivery system must indicate how it will engage other providers, counties, and
20.15organizations, including county-based purchasing plans, that provide services to patients
20.16of the health care delivery system on issues related to local population health, including
20.17applicable local needs, priorities, and public health goals. The health care delivery system
20.18must describe how local providers, counties, organizations, including county-based
20.19purchasing plans, and other relevant purchasers were consulted in developing the
20.20application to participate in the demonstration project.
20.21EFFECTIVE DATE.This section is effective July 1, 2013, and applies to health
20.22care delivery system contracts entered into on or after that date.

20.23    Sec. 27. Minnesota Statutes 2012, section 256B.694, is amended to read:
20.24256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
20.25CONTRACT.
20.26    (a) MS 2010 [Expired, 2008 c 364 s 10]
20.27    (b) The commissioner shall consider, and may approve, contracting on a
20.28single-health plan basis with other county-based purchasing plans, or with other qualified
20.29health plans that have coordination arrangements with counties, to serve persons with a
20.30disability who voluntarily enroll enrolled in state public health care programs, in order
20.31to promote better coordination or integration of health care services, social services and
20.32other community-based services, provided that all requirements applicable to health plan
20.33purchasing, including those in section 256B.69, subdivision 23 sections 256B.69 and
21.1256B.692, are satisfied. Nothing in this paragraph supersedes or modifies the requirements
21.2in paragraph (a).

21.3    Sec. 28. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
21.4to read:
21.5    Subd. 1b. Affordable Care Act. "Affordable Care Act" means the federal Patient
21.6Protection and Affordable Care Act, Public Law 111-148, as amended, including the
21.7federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and
21.8any amendments to, and any federal guidance or regulations issued under, these acts.

21.9    Sec. 29. Minnesota Statutes 2012, section 256L.01, subdivision 3a, is amended to read:
21.10    Subd. 3a. Family with children. (a) "Family with children" means:
21.11(1) parents and their children residing in the same household; or
21.12(2) grandparents, foster parents, relative caretakers as defined in the medical
21.13assistance program, or legal guardians; and their wards who are children residing in the
21.14same household. "Family" has the meaning given for family and family size as defined
21.15in Code of Federal Regulations, title 26, section 1.36B-1.
21.16(b) The term includes children who are temporarily absent from the household in
21.17settings such as schools, camps, or parenting time with noncustodial parents.
21.18EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
21.19approval, whichever is later. The commissioner of human services shall notify the revisor
21.20of statutes when federal approval is obtained.

21.21    Sec. 30. Minnesota Statutes 2012, section 256L.01, subdivision 5, is amended to read:
21.22    Subd. 5. Income. (a) "Income" has the meaning given for earned and unearned
21.23income for families and children in the medical assistance program, according to the
21.24state's aid to families with dependent children plan in effect as of July 16, 1996. The
21.25definition does not include medical assistance income methodologies and deeming
21.26requirements. The earned income of full-time and part-time students under age 19 is
21.27not counted as income. Public assistance payments and supplemental security income
21.28are not excluded income modified adjusted gross income, as defined in Code of Federal
21.29Regulations, title 26, section 1.36B-1.
21.30(b) For purposes of this subdivision, and unless otherwise specified in this section,
21.31the commissioner shall use reasonable methods to calculate gross earned and unearned
21.32income including, but not limited to, projecting income based on income received within
21.33the past 30 days, the last 90 days, or the last 12 months.
22.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
22.2approval, whichever is later. The commissioner of human services shall notify the revisor
22.3of statutes when federal approval is obtained.

22.4    Sec. 31. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
22.5to read:
22.6    Subd. 6. Minnesota Insurance Marketplace. "Minnesota Insurance Marketplace"
22.7means the Minnesota Insurance Marketplace as defined in section 62V.02.

22.8    Sec. 32. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
22.9to read:
22.10    Subd. 7. Participating entity. "Participating entity" means a health carrier as
22.11defined in section 62A.01, subdivision 2; a county-based purchasing plan established
22.12under section 256B.692; an accountable care organization or other entity operating a
22.13health care delivery systems demonstration project authorized under section 256B.0755;
22.14an entity operating a county integrated health care delivery network pilot project
22.15authorized under section 256B.0756; or a network of health care providers established to
22.16offer services under MinnesotaCare.
22.17EFFECTIVE DATE.This section is effective January 1, 2015.

22.18    Sec. 33. Minnesota Statutes 2012, section 256L.02, subdivision 2, is amended to read:
22.19    Subd. 2. Commissioner's duties. (a) The commissioner shall establish an office
22.20for the state administration of this plan. The plan shall be used to provide covered health
22.21services for eligible persons. Payment for these services shall be made to all eligible
22.22providers participating entities under contract with the commissioner. The commissioner
22.23shall adopt rules to administer the MinnesotaCare program. The commissioner shall
22.24establish marketing efforts to encourage potentially eligible persons to receive information
22.25about the program and about other medical care programs administered or supervised by
22.26the Department of Human Services.
22.27(b) A toll-free telephone number and Web site must be used to provide information
22.28about medical programs and to promote access to the covered services.
22.29EFFECTIVE DATE.Paragraph (a) is effective January 1, 2015. Paragraph (b) is
22.30effective January 1, 2014, or upon federal approval, whichever is later. The commissioner
22.31of human services shall notify the revisor of statutes when federal approval is obtained.

23.1    Sec. 34. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
23.2to read:
23.3    Subd. 6. Federal approval. (a) The commissioner of human services shall seek
23.4federal approval to implement the MinnesotaCare program under this chapter as a basic
23.5health program. In any agreement with the Centers for Medicare and Medicaid Services
23.6to operate MinnesotaCare as a basic health program, the commissioner shall seek to
23.7include procedures to ensure that federal funding is predictable, stable, and sufficient
23.8to sustain ongoing operation of MinnesotaCare. These procedures must address issues
23.9related to the timing of federal payments, payment reconciliation, enrollee risk adjustment,
23.10and minimization of state financial risk. The commissioner shall consult with the
23.11commissioner of management and budget, when developing the proposal for establishing
23.12MinnesotaCare as a basic health program to be submitted to the Centers for Medicare
23.13and Medicaid Services.
23.14(b) The commissioner of human services, in consultation with the commissioner of
23.15management and budget, shall work with the Centers for Medicare and Medicaid Services
23.16to establish a process for reconciliation and adjustment of federal payments that balances
23.17state and federal liability over time. The commissioner of human services shall request that
23.18the secretary of health and human services hold the state, and enrollees, harmless in the
23.19reconciliation process for the first three years, to allow the state to develop a statistically
23.20valid methodology for predicting enrollment trends and their net effect on federal payments.
23.21EFFECTIVE DATE.This section is effective the day following final enactment.

23.22    Sec. 35. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
23.23to read:
23.24    Subd. 7. Coordination with Minnesota Insurance Marketplace. MinnesotaCare
23.25shall be considered a public health care program for purposes of chapter 62V.
23.26EFFECTIVE DATE.This section is effective January 1, 2014.

23.27    Sec. 36. Minnesota Statutes 2012, section 256L.03, subdivision 1, is amended to read:
23.28    Subdivision 1. Covered health services. (a) "Covered health services" means the
23.29health services reimbursed under chapter 256B, with the exception of inpatient hospital
23.30services, special education services, private duty nursing services, adult dental care
23.31services other than services covered under section 256B.0625, subdivision 9, orthodontic
23.32services, nonemergency medical transportation services, personal care assistance and case
24.1management services, and nursing home or intermediate care facilities services, inpatient
24.2mental health services, and chemical dependency services.
24.3    (b) No public funds shall be used for coverage of abortion under MinnesotaCare
24.4except where the life of the female would be endangered or substantial and irreversible
24.5impairment of a major bodily function would result if the fetus were carried to term; or
24.6where the pregnancy is the result of rape or incest.
24.7    (c) Covered health services shall be expanded as provided in this section.
24.8EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
24.9approval, whichever is later. The commissioner of human services shall notify the revisor
24.10of statutes when federal approval is obtained.

24.11    Sec. 37. Minnesota Statutes 2012, section 256L.03, subdivision 1a, is amended to read:
24.12    Subd. 1a. Pregnant women and Children; MinnesotaCare health care reform
24.13waiver. Beginning January 1, 1999, Children and pregnant women are eligible for coverage
24.14of all services that are eligible for reimbursement under the medical assistance program
24.15according to chapter 256B, except that abortion services under MinnesotaCare shall be
24.16limited as provided under subdivision 1. Pregnant women and Children are exempt from
24.17the provisions of subdivision 5, regarding co-payments. Pregnant women and Children
24.18who are lawfully residing in the United States but who are not "qualified noncitizens" under
24.19title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
24.20Public Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage
24.21of all services provided under the medical assistance program according to chapter 256B.
24.22EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
24.23approval, whichever is later. The commissioner of human services shall notify the revisor
24.24of statutes when federal approval is obtained.

24.25    Sec. 38. Minnesota Statutes 2012, section 256L.03, subdivision 3, is amended to read:
24.26    Subd. 3. Inpatient hospital services. (a) Covered health services shall include
24.27inpatient hospital services, including inpatient hospital mental health services and inpatient
24.28hospital and residential chemical dependency treatment, subject to those limitations
24.29necessary to coordinate the provision of these services with eligibility under the medical
24.30assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
24.31section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
24.322 , with family gross income that exceeds 200 percent of the federal poverty guidelines or
25.1215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
25.2pregnant, is subject to an annual limit of $10,000.
25.3    (b) Admissions for inpatient hospital services paid for under section 256L.11,
25.4subdivision 3 , must be certified as medically necessary in accordance with Minnesota
25.5Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
25.6    (1) all admissions must be certified, except those authorized under rules established
25.7under section 254A.03, subdivision 3, or approved under Medicare; and
25.8    (2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
25.9for admissions for which certification is requested more than 30 days after the day of
25.10admission. The hospital may not seek payment from the enrollee for the amount of the
25.11payment reduction under this clause.
25.12EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
25.13approval, whichever is later. The commissioner of human services shall notify the revisor
25.14of statutes when federal approval is obtained.

25.15    Sec. 39. Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision
25.16to read:
25.17    Subd. 4a. Loss ratio. Health coverage provided through the MinnesotaCare
25.18program must have a medical loss ratio of at least 85 percent, as defined using the loss
25.19ratio methodology described in section 1001 of the Affordable Care Act.
25.20EFFECTIVE DATE.This section is effective January 1, 2015.

25.21    Sec. 40. Minnesota Statutes 2012, section 256L.03, subdivision 5, is amended to read:
25.22    Subd. 5. Cost-sharing. (a) Except as otherwise provided in paragraphs (b) and (c)
25.23 this subdivision, the MinnesotaCare benefit plan shall include the following cost-sharing
25.24requirements for all enrollees:
25.25    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
25.26subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;
25.27    (2) (1) $3 per prescription for adult enrollees;
25.28    (3) (2) $25 for eyeglasses for adult enrollees;
25.29    (4) (3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means
25.30an episode of service which is required because of a recipient's symptoms, diagnosis, or
25.31established illness, and which is delivered in an ambulatory setting by a physician or
25.32physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
25.33audiologist, optician, or optometrist;
26.1    (5) (4) $6 for nonemergency visits to a hospital-based emergency room for services
26.2provided through December 31, 2010, and $3.50 effective January 1, 2011; and
26.3(6) (5) a family deductible equal to the maximum amount allowed under Code of
26.4Federal Regulations, title 42, part 447.54.
26.5    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
26.6children under the age of 21.
26.7    (c) (b) Paragraph (a) does not apply to pregnant women and children under the
26.8age of 21.
26.9    (d) (c) Paragraph (a), clause (4) (3), does not apply to mental health services.
26.10    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
26.11poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
26.12and who are not pregnant shall be financially responsible for the coinsurance amount, if
26.13applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.
26.14    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
26.15or changes from one prepaid health plan to another during a calendar year, any charges
26.16submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
26.17expenses incurred by the enrollee for inpatient services, that were submitted or incurred
26.18prior to enrollment, or prior to the change in health plans, shall be disregarded.
26.19(g) (d) MinnesotaCare reimbursements to fee-for-service providers and payments to
26.20managed care plans or county-based purchasing plans shall not be increased as a result of
26.21the reduction of the co-payments in paragraph (a), clause (5) (4), effective January 1, 2011.
26.22(h) (e) The commissioner, through the contracting process under section 256L.12,
26.23may allow managed care plans and county-based purchasing plans to waive the family
26.24deductible under paragraph (a), clause (6) (5). The value of the family deductible shall not
26.25be included in the capitation payment to managed care plans and county-based purchasing
26.26plans. Managed care plans and county-based purchasing plans shall certify annually to the
26.27commissioner the dollar value of the family deductible.
26.28EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
26.29approval, whichever is later. The commissioner of human services shall notify the revisor
26.30of statutes when federal approval is obtained.

26.31    Sec. 41. Minnesota Statutes 2012, section 256L.03, subdivision 6, is amended to read:
26.32    Subd. 6. Lien. When the state agency provides, pays for, or becomes liable for
26.33covered health services, the agency shall have a lien for the cost of the covered health
26.34services upon any and all causes of action accruing to the enrollee, or to the enrollee's
26.35legal representatives, as a result of the occurrence that necessitated the payment for the
27.1covered health services. All liens under this section shall be subject to the provisions
27.2of section 256.015. For purposes of this subdivision, "state agency" includes prepaid
27.3health plans participating entities, under contract with the commissioner according to
27.4sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based
27.5purchasing entities under section 256B.692 section 256L.121.
27.6EFFECTIVE DATE.This section is effective January 1, 2015.

27.7    Sec. 42. Minnesota Statutes 2012, section 256L.04, subdivision 1, is amended to read:
27.8    Subdivision 1. Families with children. (a) Families with children with family
27.9income above 133 percent of the federal poverty guidelines and equal to or less than 275
27.10 200 percent of the federal poverty guidelines for the applicable family size shall be eligible
27.11for MinnesotaCare according to this section. All other provisions of sections 256L.01 to
27.12256L.18 , including the insurance-related barriers to enrollment under section 256L.07,
27.13 shall apply unless otherwise specified. Children under age 19 with family income at or
27.14below 200 percent of the federal poverty guidelines and who are ineligible for medical
27.15assistance by sole reason of the application of federal household composition rules for
27.16medical assistance are eligible for MinnesotaCare.
27.17    (b) Parents who enroll in the MinnesotaCare program must also enroll their children,
27.18if the children are eligible. Children may be enrolled separately without enrollment by
27.19parents. However, if one parent in the household enrolls, both parents must enroll, unless
27.20other insurance is available. If one child from a family is enrolled, all children must
27.21be enrolled, unless other insurance is available. If one spouse in a household enrolls,
27.22the other spouse in the household must also enroll, unless other insurance is available.
27.23Families cannot choose to enroll only certain uninsured members.
27.24    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies
27.25to the MinnesotaCare program. These persons are no longer counted in the parental
27.26household and may apply as a separate household.
27.27    (d) Parents are not eligible for MinnesotaCare if their gross income exceeds $57,500.
27.28(e) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
27.298 , are exempt from the eligibility requirements of this subdivision.
27.30EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
27.31approval, whichever is later. The commissioner of human services shall notify the revisor
27.32of statutes when federal approval is obtained.

28.1    Sec. 43. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
28.2to read:
28.3    Subd. 1c. General requirements. To be eligible for coverage under MinnesotaCare,
28.4a person must meet the eligibility requirements of this section. A person eligible for
28.5MinnesotaCare shall not be considered a qualified individual under section 1312 of the
28.6Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered
28.7through the Minnesota Insurance Marketplace under chapter 62V.
28.8EFFECTIVE DATE.This section is effective January 1, 2014.

28.9    Sec. 44. Minnesota Statutes 2012, section 256L.04, subdivision 7, is amended to read:
28.10    Subd. 7. Single adults and households with no children. (a) The definition of
28.11eligible persons includes all individuals and households families with no children who
28.12have gross family incomes that are above 133 percent and equal to or less than 200 percent
28.13of the federal poverty guidelines for the applicable family size.
28.14    (b) Effective July 1, 2009, the definition of eligible persons includes all individuals
28.15and households with no children who have gross family incomes that are equal to or less
28.16than 250 percent of the federal poverty guidelines.
28.17EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
28.18approval, whichever is later. The commissioner of human services shall notify the revisor
28.19of statutes when federal approval is obtained.

28.20    Sec. 45. Minnesota Statutes 2012, section 256L.04, subdivision 8, is amended to read:
28.21    Subd. 8. Applicants potentially eligible for medical assistance. (a) Individuals
28.22who receive supplemental security income or retirement, survivors, or disability benefits
28.23due to a disability, or other disability-based pension, who qualify under subdivision 7, but
28.24who are potentially eligible for medical assistance without a spenddown shall be allowed
28.25to enroll in MinnesotaCare for a period of 60 days, so long as the applicant meets all other
28.26conditions of eligibility. The commissioner shall identify and refer the applications of
28.27such individuals to their county social service agency. The county and the commissioner
28.28shall cooperate to ensure that the individuals obtain medical assistance coverage for any
28.29months for which they are eligible.
28.30(b) The enrollee must cooperate with the county social service agency in determining
28.31medical assistance eligibility within the 60-day enrollment period. Enrollees who do not
28.32cooperate with medical assistance within the 60-day enrollment period shall be disenrolled
28.33from the plan within one calendar month. Persons disenrolled for nonapplication for
29.1medical assistance may not reenroll until they have obtained a medical assistance
29.2eligibility determination. Persons disenrolled for noncooperation with medical assistance
29.3may not reenroll until they have cooperated with the county agency and have obtained a
29.4medical assistance eligibility determination.
29.5(c) Beginning January 1, 2000, Counties that choose to become MinnesotaCare
29.6enrollment sites shall consider MinnesotaCare applications to also be applications for
29.7medical assistance. Applicants who are potentially eligible for medical assistance, except
29.8for those described in paragraph (a), may choose to enroll in either MinnesotaCare or
29.9medical assistance.
29.10(d) The commissioner shall redetermine provider payments made under
29.11MinnesotaCare to the appropriate medical assistance payments for those enrollees who
29.12subsequently become eligible for medical assistance.
29.13EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
29.14approval, whichever is later. The commissioner of human services shall notify the revisor
29.15of statutes when federal approval is obtained.

29.16    Sec. 46. Minnesota Statutes 2012, section 256L.04, subdivision 10, is amended to read:
29.17    Subd. 10. Citizenship requirements. (a) Eligibility for MinnesotaCare is limited to
29.18citizens or nationals of the United States, qualified noncitizens, and other persons residing
29.19 and lawfully in the United States present noncitizens as defined in Code of Federal
29.20Regulations, title 8, section 103.12. Undocumented noncitizens and nonimmigrants
29.21 are ineligible for MinnesotaCare. For purposes of this subdivision, a nonimmigrant
29.22is an individual in one or more of the classes listed in United States Code, title 8,
29.23section 1101(a)(15), and an undocumented noncitizen is an individual who resides in the
29.24United States without the approval or acquiescence of the United States Citizenship and
29.25Immigration Services. Families with children who are citizens or nationals of the United
29.26States must cooperate in obtaining satisfactory documentary evidence of citizenship or
29.27nationality according to the requirements of the federal Deficit Reduction Act of 2005,
29.28Public Law 109-171.
29.29(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
29.30individuals who are lawfully present and ineligible for medical assistance by reason of
29.31immigration status and who have incomes equal to or less than 200 percent of federal
29.32poverty guidelines.
30.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
30.2approval, whichever is later. The commissioner of human services shall notify the revisor
30.3of statutes when federal approval is obtained.

30.4    Sec. 47. Minnesota Statutes 2012, section 256L.04, subdivision 12, is amended to read:
30.5    Subd. 12. Persons in detention. Beginning January 1, 1999, An applicant or
30.6enrollee residing in a correctional or detention facility is not eligible for MinnesotaCare,
30.7unless the applicant or enrollee is awaiting disposition of charges. An enrollee residing in
30.8a correctional or detention facility is not eligible at renewal of eligibility under section
30.9256L.05, subdivision 3a.
30.10EFFECTIVE DATE.This section is effective January 1, 2014.

30.11    Sec. 48. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
30.12to read:
30.13    Subd. 14. Coordination with medical assistance. (a) Individuals eligible for
30.14medical assistance under chapter 256B are not eligible for MinnesotaCare under this
30.15section.
30.16(b) The commissioner shall coordinate eligibility and coverage to ensure that
30.17individuals transitioning between medical assistance and MinnesotaCare have seamless
30.18eligibility and access to health care services.
30.19EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
30.20approval, whichever is later. The commissioner of human services shall notify the revisor
30.21of statutes when federal approval is obtained.

30.22    Sec. 49. Minnesota Statutes 2012, section 256L.05, subdivision 1, is amended to read:
30.23    Subdivision 1. Application assistance and information availability. (a) Applicants
30.24may submit applications online, in person, by mail, or by phone in accordance with the
30.25Affordable Care Act, and by any other means by which medical assistance applications
30.26may be submitted. Applicants may submit applications through the Minnesota Insurance
30.27Marketplace or through the MinnesotaCare program. Applications and application
30.28assistance must be made available at provider offices, local human services agencies,
30.29school districts, public and private elementary schools in which 25 percent or more of
30.30the students receive free or reduced price lunches, community health offices, Women,
30.31Infants and Children (WIC) program sites, Head Start program sites, public housing
30.32councils, crisis nurseries, child care centers, early childhood education and preschool
31.1program sites, legal aid offices, and libraries, and at any other locations at which medical
31.2assistance applications must be made available. These sites may accept applications and
31.3forward the forms to the commissioner or local county human services agencies that
31.4choose to participate as an enrollment site. Otherwise, applicants may apply directly to the
31.5commissioner or to participating local county human services agencies.
31.6(b) Application assistance must be available for applicants choosing to file an online
31.7application through the Minnesota Insurance Marketplace.
31.8EFFECTIVE DATE.This section is effective January 1, 2014.

31.9    Sec. 50. Minnesota Statutes 2012, section 256L.05, subdivision 2, is amended to read:
31.10    Subd. 2. Commissioner's duties. The commissioner or county agency shall use
31.11electronic verification through the Minnesota Insurance Marketplace as the primary
31.12method of income verification. If there is a discrepancy between reported income
31.13and electronically verified income, an individual may be required to submit additional
31.14verification to the extent permitted under the Affordable Care Act. In addition, the
31.15commissioner shall perform random audits to verify reported income and eligibility. The
31.16commissioner may execute data sharing arrangements with the Department of Revenue
31.17and any other governmental agency in order to perform income verification related to
31.18eligibility and premium payment under the MinnesotaCare program.
31.19EFFECTIVE DATE.This section is effective January 1, 2014.

31.20    Sec. 51. Minnesota Statutes 2012, section 256L.05, subdivision 3, is amended to read:
31.21    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
31.22first day of the month following the month in which eligibility is approved and the first
31.23premium payment has been received. As provided in section 256B.057, coverage for
31.24newborns is automatic from the date of birth and must be coordinated with other health
31.25coverage. The effective date of coverage for eligible newly adoptive children added to a
31.26family receiving covered health services is the month of placement. The effective date
31.27of coverage for other new members added to the family is the first day of the month
31.28following the month in which the change is reported. All eligibility criteria must be met
31.29by the family at the time the new family member is added. The income of the new family
31.30member is included with the family's modified adjusted gross income and the adjusted
31.31premium begins in the month the new family member is added.
31.32(b) The initial premium must be received by the last working day of the month for
31.33coverage to begin the first day of the following month.
32.1(c) Benefits are not available until the day following discharge if an enrollee is
32.2hospitalized on the first day of coverage.
32.3(d) (c) Notwithstanding any other law to the contrary, benefits under sections
32.4256L.01 to 256L.18 are secondary to a plan of insurance or benefit program under which
32.5an eligible person may have coverage and the commissioner shall use cost avoidance
32.6techniques to ensure coordination of any other health coverage for eligible persons. The
32.7commissioner shall identify eligible persons who may have coverage or benefits under
32.8other plans of insurance or who become eligible for medical assistance.
32.9(e) (d) The effective date of coverage for individuals or families who are exempt
32.10from paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first
32.11day of the month following the month in which verification of American Indian status
32.12is received or eligibility is approved, whichever is later.
32.13(f) The effective date of coverage for children eligible under section 256L.07,
32.14subdivision 8, is the first day of the month following the date of termination from foster
32.15care or release from a juvenile residential correctional facility.
32.16EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
32.17approval, whichever is later. The commissioner of human services shall notify the revisor
32.18of statutes when federal approval is obtained.

32.19    Sec. 52. Minnesota Statutes 2012, section 256L.05, subdivision 3c, is amended to read:
32.20    Subd. 3c. Retroactive coverage. Notwithstanding subdivision 3, the effective
32.21date of coverage shall be the first day of the month following termination from medical
32.22assistance for families and individuals who are eligible for MinnesotaCare and who
32.23submitted a written request for retroactive MinnesotaCare coverage with a completed
32.24application within 30 days of the mailing of notification of termination from medical
32.25assistance. The applicant must provide all required verifications within 30 days of the
32.26written request for verification. For retroactive coverage, premiums must be paid in full
32.27for any retroactive month, current month, and next month within 30 days of the premium
32.28billing. General assistance medical care recipients may qualify for retroactive coverage
32.29under this subdivision at six-month renewal. This subdivision does not apply, and shall not
32.30be implemented by the commissioner, once eligibility determination for MinnesotaCare is
32.31conducted by the Minnesota Insurance Marketplace eligibility determination system.
32.32EFFECTIVE DATE.This section is effective January 1, 2014.

32.33    Sec. 53. Minnesota Statutes 2012, section 256L.06, subdivision 3, is amended to read:
33.1    Subd. 3. Commissioner's duties and payment. (a) Premiums are dedicated to the
33.2commissioner for MinnesotaCare.
33.3    (b) The commissioner shall develop and implement procedures to: (1) require
33.4enrollees to report changes in income; (2) adjust sliding scale premium payments, based
33.5upon both increases and decreases in enrollee income, at the time the change in income
33.6is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
33.7premiums. Failure to pay includes payment with a dishonored check, a returned automatic
33.8bank withdrawal, or a refused credit card or debit card payment. The commissioner may
33.9demand a guaranteed form of payment, including a cashier's check or a money order, as
33.10the only means to replace a dishonored, returned, or refused payment.
33.11    (c) Premiums are calculated on a calendar month basis and may be paid on a
33.12monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
33.13commissioner of the premium amount required. The commissioner shall inform applicants
33.14and enrollees of these premium payment options. Premium payment is required before
33.15enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
33.16received before noon are credited the same day. Premium payments received after noon
33.17are credited on the next working day.
33.18    (d) Nonpayment of the premium will result in disenrollment from the plan effective
33.19for the calendar month for which the premium was due. Persons disenrolled for
33.20nonpayment or who voluntarily terminate coverage from the program may not reenroll
33.21until four calendar months have elapsed. Persons disenrolled for nonpayment who pay
33.22all past due premiums as well as current premiums due, including premiums due for the
33.23period of disenrollment, within 20 days of disenrollment, shall be reenrolled retroactively
33.24to the first day of disenrollment. Persons disenrolled for nonpayment or who voluntarily
33.25terminate coverage from the program may not reenroll for four calendar months unless
33.26the person demonstrates good cause for nonpayment. Good cause does not exist if a
33.27person chooses to pay other family expenses instead of the premium. The commissioner
33.28shall define good cause in rule.
33.29EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
33.30approval, whichever is later. The commissioner of human services shall notify the revisor
33.31of statutes when federal approval is obtained.

33.32    Sec. 54. Minnesota Statutes 2012, section 256L.07, subdivision 1, is amended to read:
33.33    Subdivision 1. General requirements. (a) Children enrolled in the original
33.34children's health plan as of September 30, 1992, children who enrolled in the
33.35MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
34.1article 4, section 17, and children who have family gross incomes that are equal to or
34.2less than 200 percent of the federal poverty guidelines are eligible without meeting the
34.3requirements of subdivision 2 and the four-month requirement in subdivision 3, as long as
34.4they maintain continuous coverage in the MinnesotaCare program or medical assistance.
34.5    Parents Individuals enrolled in MinnesotaCare under section 256L.04, subdivision 1,
34.6and individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7, whose
34.7income increases above 275 200 percent of the federal poverty guidelines, are no longer
34.8eligible for the program and shall be disenrolled by the commissioner. Beginning January
34.91, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
34.107 , whose income increases above 200 percent of the federal poverty guidelines or 250
34.11percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
34.12the program and shall be disenrolled by the commissioner. For persons disenrolled under
34.13this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
34.14following the month in which the commissioner determines that the income of a family or
34.15individual exceeds program income limits.
34.16    (b) Children may remain enrolled in MinnesotaCare if their gross family income as
34.17defined in section 256L.01, subdivision 4, is greater than 275 percent of federal poverty
34.18guidelines. The premium for children remaining eligible under this paragraph shall be the
34.19maximum premium determined under section 256L.15, subdivision 2, paragraph (b).
34.20    (c) Notwithstanding paragraph (a), parents are not eligible for MinnesotaCare if
34.21gross household income exceeds $57,500 for the 12-month period of eligibility.
34.22EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
34.23approval, whichever is later. The commissioner of human services shall notify the revisor
34.24of statutes when federal approval is obtained.

34.25    Sec. 55. Minnesota Statutes 2012, section 256L.07, subdivision 2, is amended to read:
34.26    Subd. 2. Must not have access to employer-subsidized minimum essential
34.27 coverage. (a) To be eligible, a family or individual must not have access to subsidized
34.28health coverage through an employer and must not have had access to employer-subsidized
34.29coverage through a current employer for 18 months prior to application or reapplication.
34.30A family or individual whose employer-subsidized coverage is lost due to an employer
34.31terminating health care coverage as an employee benefit during the previous 18 months is
34.32not eligible that is affordable and provides minimum value as defined in Code of Federal
34.33Regulations, title 26, section 1.36B-2.
34.34(b) This subdivision does not apply to a family or individual who was enrolled
34.35in MinnesotaCare within six months or less of reapplication and who no longer has
35.1employer-subsidized coverage due to the employer terminating health care coverage as an
35.2employee benefit. This subdivision does not apply to children with family gross incomes
35.3that are equal to or less than 200 percent of federal poverty guidelines.
35.4(c) For purposes of this requirement, subsidized health coverage means health
35.5coverage for which the employer pays at least 50 percent of the cost of coverage for
35.6the employee or dependent, or a higher percentage as specified by the commissioner.
35.7Children are eligible for employer-subsidized coverage through either parent, including
35.8the noncustodial parent. The commissioner must treat employer contributions to Internal
35.9Revenue Code Section 125 plans and any other employer benefits intended to pay
35.10health care costs as qualified employer subsidies toward the cost of health coverage for
35.11employees for purposes of this subdivision.
35.12EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
35.13approval, whichever is later. The commissioner of human services shall notify the revisor
35.14of statutes when federal approval is obtained.

35.15    Sec. 56. Minnesota Statutes 2012, section 256L.07, subdivision 3, is amended to read:
35.16    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the
35.17MinnesotaCare program must have no To be eligible, a family or individual must not have
35.18minimum essential health coverage while enrolled, as defined by section 5000A of the
35.19Internal Revenue Code. Children with family gross incomes equal to or greater than 200
35.20percent of federal poverty guidelines, and adults, must have had no health coverage for
35.21at least four months prior to application and renewal. Children enrolled in the original
35.22children's health plan and children in families with income equal to or less than 200
35.23percent of the federal poverty guidelines, who have other health insurance, are eligible if
35.24the coverage:
35.25(1) lacks two or more of the following:
35.26(i) basic hospital insurance;
35.27(ii) medical-surgical insurance;
35.28(iii) prescription drug coverage;
35.29(iv) dental coverage; or
35.30(v) vision coverage;
35.31(2) requires a deductible of $100 or more per person per year; or
35.32(3) lacks coverage because the child has exceeded the maximum coverage for a
35.33particular diagnosis or the policy excludes a particular diagnosis.
36.1The commissioner may change this eligibility criterion for sliding scale premiums
36.2in order to remain within the limits of available appropriations. The requirement of no
36.3health coverage does not apply to newborns.
36.4(b) Coverage purchased as provided under section 256L.031, subdivision 2, medical
36.5assistance, and the Civilian Health and Medical Program of the Uniformed Service,
36.6CHAMPUS, or other coverage provided under United States Code, title 10, subtitle A,
36.7part II, chapter 55, are not considered insurance or health coverage for purposes of the
36.8four-month requirement described in this subdivision.
36.9(c) (b) For purposes of this subdivision, an applicant or enrollee who is entitled to
36.10Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
36.11Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered
36.12to have minimum essential health coverage. An applicant or enrollee who is entitled to
36.13premium-free Medicare Part A may not refuse to apply for or enroll in Medicare coverage
36.14to establish eligibility for MinnesotaCare.
36.15(d) Applicants who were recipients of medical assistance within one month of
36.16application must meet the provisions of this subdivision and subdivision 2.
36.17(e) Cost-effective health insurance that was paid for by medical assistance is not
36.18considered health coverage for purposes of the four-month requirement under this
36.19section, except if the insurance continued after medical assistance no longer considered it
36.20cost-effective or after medical assistance closed.
36.21EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
36.22approval, whichever is later. The commissioner of human services shall notify the revisor
36.23of statutes when federal approval is obtained.

36.24    Sec. 57. Minnesota Statutes 2012, section 256L.09, subdivision 2, is amended to read:
36.25    Subd. 2. Residency requirement. To be eligible for health coverage under the
36.26MinnesotaCare program, pregnant women, individuals, and families with children must
36.27meet the residency requirements as provided by Code of Federal Regulations, title 42,
36.28section 435.403, except that the provisions of section 256B.056, subdivision 1, shall apply
36.29upon receipt of federal approval.
36.30EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
36.31approval, whichever is later. The commissioner of human services shall notify the revisor
36.32of statutes when federal approval is obtained.

36.33    Sec. 58. Minnesota Statutes 2012, section 256L.11, subdivision 1, is amended to read:
37.1    Subdivision 1. Medical assistance rate to be used. (a) Payment to providers
37.2under sections 256L.01 to 256L.11 this chapter shall be at the same rates and conditions
37.3established for medical assistance, except as provided in subdivisions 2 to 6 this section.
37.4(b) Effective for services provided on or after July 1, 2009, total payments for basic
37.5care services shall be reduced by three percent, in accordance with section 256B.766.
37.6Payments made to managed care and county-based purchasing plans shall be reduced for
37.7services provided on or after October 1, 2009, to reflect this reduction.
37.8(c) Effective for services provided on or after July 1, 2009, payment rates for
37.9physician and professional services shall be reduced as described under section 256B.76,
37.10subdivision 1, paragraph (c). Payments made to managed care and county-based
37.11purchasing plans shall be reduced for services provided on or after October 1, 2009,
37.12to reflect this reduction.
37.13EFFECTIVE DATE.This section is effective January 1, 2014.

37.14    Sec. 59. Minnesota Statutes 2012, section 256L.11, subdivision 3, is amended to read:
37.15    Subd. 3. Inpatient hospital services. Inpatient hospital services provided under
37.16section 256L.03, subdivision 3, shall be paid for as provided in subdivisions 4 to 6 at the
37.17medical assistance rate.
37.18EFFECTIVE DATE.This section is effective January 1, 2014.

37.19    Sec. 60. Minnesota Statutes 2012, section 256L.12, subdivision 1, is amended to read:
37.20    Subdivision 1. Selection of vendors. In order to contain costs, the commissioner of
37.21human services shall select vendors of medical care who can provide the most economical
37.22care consistent with high medical standards and shall, where possible, contract with
37.23organizations on a prepaid capitation basis to provide these services. The commissioner
37.24shall consider proposals by counties and vendors for managed care plans and managed
37.25care-like entities as defined by the final regulation implementing section 1331 of the
37.26Affordable Care Act regarding basic health plans, which may include: prepaid capitation
37.27programs, competitive bidding programs, or other vendor payment mechanisms designed
37.28to provide services in an economical manner or to control utilization, with safeguards to
37.29ensure that necessary services are provided.

37.30    Sec. 61. [256L.121] SERVICE DELIVERY.
37.31    Subdivision 1. Competitive process. The commissioner of human services shall
37.32establish a competitive process for entering into contracts with participating entities for
38.1the offering of standard health plans through MinnesotaCare. Coverage through standard
38.2health plans must be available to enrollees beginning January 1, 2015. Each standard
38.3health plan must cover the health services listed in and meet the requirements of section
38.4256L.03. The competitive process must meet the requirements of section 1331 of the
38.5Affordable Care Act and be designed to ensure enrollee access to high-quality health care
38.6coverage options. The commissioner, to the extent feasible, shall seek to ensure that
38.7enrollees have a choice of coverage from more than one participating entity within a
38.8geographic area. In counties that were part of a county-based purchasing plan on January
38.91, 2013, the commissioner shall use the medical assistance competitive procurement
38.10process under section 256B.69, subdivisions 1 to 32, under which selection of entities is
38.11based on criteria related to provider network access, coordination of health care with other
38.12local services, alignment with local public health goals, and other factors.
38.13    Subd. 2. Other requirements for participating entities. The commissioner shall
38.14require participating entities, as a condition of contract, to document to the commissioner:
38.15(1) the provision of culturally and linguistically appropriate services, including
38.16marketing materials, to MinnesotaCare enrollees; and
38.17(2) the inclusion in provider networks of providers designated as essential
38.18community providers under section 62Q.19.
38.19    Subd. 3. Coordination with state-administered health programs. The
38.20commissioner shall coordinate the administration of the MinnesotaCare program with
38.21medical assistance to maximize efficiency and improve the continuity of care. This
38.22includes, but is not limited to:
38.23(1) establishing geographic areas for MinnesotaCare that are consistent with the
38.24geographic areas of the medical assistance program, within which participating entities
38.25may offer health plans;
38.26(2) requiring, as a condition of participation in MinnesotaCare, participating entities
38.27to also participate in the medical assistance program;
38.28(3) complying with sections 256B.69, subdivision 3a; 256B.692, subdivision 1; and
38.29256B.694, when contracting with MinnesotaCare participating entities;
38.30(4) providing MinnesotaCare enrollees, to the extent possible, with the option to
38.31remain in the same health plan and provider network, if they later become eligible for
38.32medical assistance or coverage through the Minnesota health benefit exchange and if, in
38.33the case of becoming eligible for medical assistance, the enrollee's MinnesotaCare health
38.34plan is also a medical assistance health plan in the enrollee's county of residence; and
38.35(5) establishing requirements and criteria for selection that ensure that covered
38.36health care services will be coordinated with local public health services, social services,
39.1long-term care services, mental health services, and other local services affecting
39.2enrollees' health, access, and quality of care.
39.3EFFECTIVE DATE.This section is effective the day following final enactment.

39.4    Sec. 62. Minnesota Statutes 2012, section 256L.15, subdivision 1, is amended to read:
39.5    Subdivision 1. Premium determination. (a) Families with children and individuals
39.6shall pay a premium determined according to subdivision 2.
39.7    (b) Pregnant women and children under age two are exempt from the provisions
39.8of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
39.9for failure to pay premiums. For pregnant women, this exemption continues until the
39.10first day of the month following the 60th day postpartum. Women who remain enrolled
39.11during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
39.12disenrolled on the first of the month following the 60th day postpartum for the penalty
39.13period that otherwise applies under section 256L.06, unless they begin paying premiums.
39.14    (c) (b) Members of the military and their families who meet the eligibility criteria
39.15for MinnesotaCare upon eligibility approval made within 24 months following the end
39.16of the member's tour of active duty shall have their premiums paid by the commissioner.
39.17The effective date of coverage for an individual or family who meets the criteria of this
39.18paragraph shall be the first day of the month following the month in which eligibility is
39.19approved. This exemption applies for 12 months.
39.20(d) (c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and
39.21their families shall have their premiums waived by the commissioner in accordance with
39.22section 5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5.
39.23An individual must document status as an American Indian, as defined under Code of
39.24Federal Regulations, title 42, section 447.50, to qualify for the waiver of premiums.
39.25EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
39.26approval, whichever is later. The commissioner of human services shall notify the revisor
39.27of statutes when federal approval is obtained.

39.28    Sec. 63. Minnesota Statutes 2012, section 256L.15, subdivision 2, is amended to read:
39.29    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The
39.30commissioner shall establish a sliding fee scale to determine the percentage of monthly
39.31gross individual or family income that households at different income levels must pay to
39.32obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
39.33on the enrollee's monthly gross individual or family income. The sliding fee scale must
40.1contain separate tables based on enrollment of one, two, or three or more persons. Until
40.2June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
40.3individual or family income for individuals or families with incomes below the limits for
40.4the medical assistance program for families and children in effect on January 1, 1999, and
40.5proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
40.68.8 percent. These percentages are matched to evenly spaced income steps ranging from
40.7the medical assistance income limit for families and children in effect on January 1, 1999,
40.8to 275 percent of the federal poverty guidelines for the applicable family size, up to a
40.9family size of five. The sliding fee scale for a family of five must be used for families of
40.10more than five. The sliding fee scale and percentages are not subject to the provisions of
40.11chapter 14. If a family or individual reports increased income after enrollment, premiums
40.12shall be adjusted at the time the change in income is reported.
40.13    (b) Children in families whose gross income is above 275 percent of the federal
40.14poverty guidelines shall pay the maximum premium. The maximum premium is defined
40.15as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
40.16cases paid the maximum premium, the total revenue would equal the total cost of
40.17MinnesotaCare medical coverage and administration. In this calculation, administrative
40.18costs shall be assumed to equal ten percent of the total. The costs of medical coverage
40.19for pregnant women and children under age two and the enrollees in these groups shall
40.20be excluded from the total. The maximum premium for two enrollees shall be twice the
40.21maximum premium for one, and the maximum premium for three or more enrollees shall
40.22be three times the maximum premium for one.
40.23    (c) Beginning July 1, 2009 January 1, 2014, MinnesotaCare enrollees shall pay
40.24premiums according to the premium scale specified in paragraph (d) (c) with the exception
40.25that children 20 years of age and younger in families with income at or below 200 percent
40.26of the federal poverty guidelines shall pay no premiums. For purposes of paragraph (d),
40.27"minimum" means a monthly premium of $4.
40.28    (d) (c) The following premium scale is established for individuals and families
40.29with gross family incomes of 275 percent of the federal poverty guidelines or less each
40.30individual in the household who is 21 years of age or older and enrolled in MinnesotaCare:

40.31	Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
40.32	0-45%	minimum
40.33 40.34	46-54%	$4 or 1.1% of family income, whichever is greater
40.35	55-81%	1.6%
40.36	82-109%	2.2%
40.37	110-136%	2.9%
41.1	137-164%	3.6%
41.2	165-191%	4.6%
41.3	192-219%	5.6%
41.4	220-248%	6.5%
41.5	249-275%	7.2%

41.6 41.7	Federal Poverty Guideline Greater than or Equal to	Less than	Individual Premium Amount
41.8	0%	55%	$4
41.9	55%	80%	$6
41.10	80%	90%	$8
41.11	90%	100%	$10
41.12	100%	110%	$12
41.13	110%	120%	$15
41.14	120%	130%	$18
41.15	130%	140%	$21
41.16	140%	150%	$25
41.17	150%	160%	$29
41.18	160%	170%	$33
41.19	170%	180%	$38
41.20	180%	190%	$43
41.21	190%		$50

41.22EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
41.23approval, whichever is later. The commissioner of human services shall notify the revisor
41.24of statutes when federal approval is obtained.

41.25    Sec. 64. DETERMINATION OF FUNDING ADEQUACY FOR
41.26MINNESOTACARE.
41.27The commissioners of revenue and management and budget, in consultation with
41.28the commissioner of human services, shall conduct an assessment of health care taxes,
41.29including the gross premiums tax, the provider tax, and Medicaid surcharges, and their
41.30relationship to the long-term solvency of the health care access fund, as part of the state
41.31revenue and expenditure forecast in November 2013. The commissioners shall determine
41.32the amount of state funding that will be required after December 31, 2019, in addition
41.33to the federal payments made available under section 1331 of the Affordable Care Act,
41.34for the MinnesotaCare program. The commissioners shall evaluate the stability and
41.35likelihood of long-term federal funding for the MinnesotaCare program under section
41.361331. The commissioners shall report the results of this assessment to the chairs and
41.37ranking minority members of the legislative committees with jurisdiction over human
41.38services, finances, and taxes by January 15, 2014, along with recommendations for
42.1changes to state revenue for the health care access fund, if state funding continues to
42.2be required beyond December 31, 2019.

42.3    Sec. 65. STATE-BASED RISK ADJUSTMENT SYSTEM ASSESSMENT.
42.4(a) Notwithstanding Minnesota Rules, chapter 4653, the commissioner of health,
42.5as part of the commissioner's responsibilities under Minnesota Statutes, section 62U.04,
42.6subdivision 4, paragraph (b), shall collect from health carriers in the individual and
42.7small group health insurance market, beginning on January 1, 2014, for service dates
42.8beginning October 1, 2013, through December 31, 2014, all data required for conducting
42.9risk adjustment with standard risk adjusters such as the Adjusted Clinical Groups or the
42.10Hierarchical Condition Category System, including, but not limited to:
42.11(1) an indicator identifying the health plan product under which an enrollee is covered;
42.12(2) an indicator identifying whether an enrollee's policy is an individual or small
42.13group market policy;
42.14(3) an indicator identifying, if applicable, the metal level of an enrollee's health plan
42.15product, and whether the policy is a catastrophic policy; and
42.16(4) additional identified demographic data necessary to link individuals' data across
42.17health carriers and insurance affordability programs with 95 percent accuracy. The
42.18commissioner shall not collect more than the last four digits of an individual's Social
42.19Security number.
42.20(b) The commissioner of health shall assess the extent to which data collected under
42.21paragraph (a) and under Minnesota Statutes, section 62U.04, subdivision 4, paragraph (a),
42.22are sufficient for developing and operating a state alternative risk adjustment methodology
42.23consistent with applicable federal rules by evaluating:
42.24(1) if the data submitted are adequately complete, accurate, and timely;
42.25(2) if the data should be further enriched by nontraditional risk adjusters that help
42.26in better explaining variation in health care costs of a given population and account for
42.27risk selection across metal levels;
42.28(3) whether additional data or identifiers have the potential to strengthen a
42.29Minnesota-based risk adjustment approach; and
42.30(4) what, if any, changes to the technical infrastructure will be necessary to
42.31effectively perform state-based risk adjustment.
42.32(c) For purposes of paragraph (b), the commissioner of health shall have the
42.33authority to use identified data to validate and audit a statistically valid sample of data for
42.34each health carrier in the individual and small group health insurance market.
43.1(d) If the assessment conducted in paragraph (b) finds that the data collected
43.2under Minnesota Statutes, section 62U.04, subdivision 4, are sufficient for developing
43.3and operating a state alternative risk adjustment methodology consistent with applicable
43.4federal rules, the commissioners of health and human services, in consultation with the
43.5commissioner of commerce and the Board of MNsure, shall study whether Minnesota-based
43.6risk adjustment of the individual and small group health insurance market, using either the
43.7federal risk adjustment model or a state-based alternative, can be more cost-effective and
43.8perform better than risk adjustment conducted by federal agencies. The study shall assess
43.9the policies, infrastructure, and resources necessary to satisfy the requirements of Code of
43.10Federal Regulations, title 45, section 153, subpart D. The study shall also evaluate the
43.11extent to which Minnesota-based risk adjustment could meet requirements established in
43.12Code of Federal Regulations, title 45, section 153.330, including:
43.13(1) explaining the variation in health care costs of a given population;
43.14(2) linking risk factors to daily clinical practices and that which is clinically
43.15meaningful to providers;
43.16(3) encouraging favorable behavior among health care market participants and
43.17discouraging unfavorable behavior;
43.18(4) whether risk adjustment factors are relatively easy for stakeholders to understand
43.19and participate in;
43.20(5) providing stable risk scores over time and across health plan products;
43.21(6) minimizing administrative costs;
43.22(7) accounting for risk selection across metal levels;
43.23(8) aligning each of the elements of the methodology; and
43.24(9) can be conducted at per-member cost equal to or lower than the projected cost of
43.25the federal risk adjustment model.
43.26(e) In conducting the study described in paragraph (d), the commissioner of health
43.27shall contract with entities that do not have an economic interest in the outcome of
43.28Minnesota-based risk adjustment, but have demonstrated expertise in actuarial science
43.29or health economics and demonstrated experience with designing and implementing risk
43.30adjustment models. The commissioner of human services shall evaluate opportunities
43.31to maximize federal funding under section 1331 of the Affordable Care Act. The
43.32commissioner of human services shall make recommendations on risk adjustment
43.33strategies to maximize federal funding to the state of Minnesota.
43.34(f) The commissioner of health shall submit an interim report to the legislature by
43.35March 15, 2014, with preliminary findings from the assessment conducted in paragraph
43.36(b). The interim report shall include legislative recommendations for any necessary
44.1changes to Minnesota Statutes, section 62Q.03. The commissioners of health and human
44.2services shall submit a final report to the legislature by October 1, 2015. The final report
44.3must include findings from the overall assessment conducted under paragraph (e), and a
44.4recommendation on whether to conduct state-based risk adjustment.
44.5(g) The Board of MNsure shall apply for federal funding under section 1311 or
44.61321 of the Affordable Care Act, to fund the work under paragraphs (a), (b), (d), and (e).
44.7Federal funding awarded to MNsure for this purpose is approved and appropriated for
44.8this purpose. The commissioners of health and human services may only proceed with
44.9activities under paragraphs (a) to (e) if funding has been made available for this purpose.
44.10(h) For purposes of this section, the Board of MNsure means the board established
44.11under Minnesota Statutes, section 62V.03, and the Affordable Care Act has the meaning
44.12given in Minnesota Statutes, section 256B.02, subdivision 17.

44.13    Sec. 66. REQUEST FOR FEDERAL AUTHORITY.
44.14The commissioner of human services shall seek authority from the federal Centers
44.15for Medicare and Medicaid Services to allow persons under age 65, participating in
44.16a home and community-based services waiver under section 1915(c) of the Social
44.17Security Act, to continue to disregard spousal income and assets, in place of the spousal
44.18impoverishment provisions under the federal Patient Protection and Affordable Care Act,
44.19Public Law 111-148, section 2404, as amended by the federal Health Care and Education
44.20Reconciliation Act of 2010, Public Law 111-152, and any amendments to, or regulations
44.21and guidance issued under, those acts.

44.22    Sec. 67. REVISOR'S INSTRUCTION.
44.23The revisor of statutes shall: (1) remove cross-references to the sections repealed
44.24in this article wherever they appear in Minnesota Statutes and Minnesota Rules; (2)
44.25change the term "Minnesota Insurance Marketplace" to "MNsure" wherever it appears
44.26in this article and in Minnesota Statutes; and (3) make changes necessary to correct the
44.27punctuation, grammar, or structure of the remaining text and preserve its meaning.

44.28    Sec. 68. REPEALER.
44.29Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.031; 256L.04,
44.30subdivisions 1b, 9, and 10a; 256L.05, subdivision 3b; 256L.07, subdivisions 1, 5, 8, and 9;
44.31256L.11, subdivisions 5 and 6; and 256L.17, subdivisions 1, 2, 3, 4, and 5, are repealed
44.32effective January 1, 2014.
45.1(b) Minnesota Statutes 2012, sections 256B.055, subdivisions 3, 5, and 10b;
45.2256B.056, subdivision 5b; and 256B.057, subdivisions 1c and 2, are repealed effective
45.3January 1, 2014.


45.7    Section 1. Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:
45.8    Subd. 4. Resident assessment schedule. (a) A facility must conduct and
45.9electronically submit to the commissioner of health case mix assessments that conform
45.10with the assessment schedule defined by Code of Federal Regulations, title 42, section
45.11483.20, and published by the United States Department of Health and Human Services,
45.12Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
45.13Instrument User's Manual, version 3.0, and subsequent updates when issued by the
45.14Centers for Medicare and Medicaid Services. The commissioner of health may substitute
45.15successor manuals or question and answer documents published by the United States
45.16Department of Health and Human Services, Centers for Medicare and Medicaid Services,
45.17to replace or supplement the current version of the manual or document.
45.18(b) The assessments used to determine a case mix classification for reimbursement
45.19include the following:
45.20(1) a new admission assessment must be completed by day 14 following admission;
45.21(2) an annual assessment which must have an assessment reference date (ARD)
45.22within 366 days of the ARD of the last comprehensive assessment;
45.23(3) a significant change assessment must be completed within 14 days of the
45.24identification of a significant change; and
45.25(4) all quarterly assessments must have an assessment reference date (ARD) within
45.2692 days of the ARD of the previous assessment.
45.27(c) In addition to the assessments listed in paragraph (b), the assessments used to
45.28determine nursing facility level of care include the following:
45.29(1) preadmission screening completed under section 256B.0911, subdivision 4a, by a
45.30county, tribe, or managed care organization under contract with the Department of Human
45.31Services 256.975, subdivision 7a, by the Senior LinkAge Line or other organization under
45.32contract with the Minnesota Board on Aging; and
45.33(2) a nursing facility level of care determination as provided for under section
45.34256B.0911, subdivision 4e, as part of a face-to-face long-term care consultation assessment
46.1completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
46.2managed care organization under contract with the Department of Human Services.

46.3    Sec. 2. Minnesota Statutes 2012, section 144A.351, is amended to read:
46.4144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS:
46.5REPORT AND STUDY REQUIRED.
46.6    Subdivision 1. Report requirements. The commissioners of health and human
46.7services, with the cooperation of counties and in consultation with stakeholders, including
46.8persons who need or are using long-term care services and supports, lead agencies,
46.9regional entities, senior, disability, and mental health organization representatives, service
46.10providers, and community members shall prepare a report to the legislature by August 15,
46.112013, and biennially thereafter, regarding the status of the full range of long-term care
46.12services and supports for the elderly and children and adults with disabilities and mental
46.13illnesses in Minnesota. The report shall address:
46.14    (1) demographics and need for long-term care services and supports in Minnesota;
46.15    (2) summary of county and regional reports on long-term care gaps, surpluses,
46.16imbalances, and corrective action plans;
46.17    (3) status of long-term care services and related mental health services, housing
46.18options, and supports by county and region including:
46.19    (i) changes in availability of the range of long-term care services and housing options;
46.20    (ii) access problems, including access to the least restrictive and most integrated
46.21services and settings, regarding long-term care services; and
46.22    (iii) comparative measures of long-term care services availability, including serving
46.23people in their home areas near family, and changes over time; and
46.24    (4) recommendations regarding goals for the future of long-term care services and
46.25supports, policy and fiscal changes, and resource development and transition needs.
46.26    Subd. 2. Critical access study. The commissioner of human services shall conduct
46.27a onetime study to assess local capacity and availability of home and community-based
46.28services for older adults, people with disabilities, and people with mental illnesses. The
46.29study must assess critical access at the community level and identify potential strategies
46.30to build home and community-based service capacity in critical access areas. The report
46.31shall be submitted to the legislature no later than August 15, 2015.

46.32    Sec. 3. Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:
46.33    Subd. 4a. City, county, and state social workers. (a) Beginning July 1, 2016, the
46.34licensure of city, county, and state agency social workers is voluntary, except an individual
47.1who is newly employed by a city or state agency after July 1, 2016, must be licensed
47.2if the individual who provides social work services, as those services are defined in
47.3section 148E.010, subdivision 11, paragraph (b), is presented to the public by any title
47.4incorporating the words "social work" or "social worker."
47.5(b) City, county, and state agencies employing social workers and staff who are
47.6designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
47.7256.01, subdivision 24, are not required to employ licensed social workers.

47.8    Sec. 4. Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:
47.9    Subd. 2. Specific powers. Subject to the provisions of section 241.021, subdivision
47.102 , the commissioner of human services shall carry out the specific duties in paragraphs (a)
47.11through (cc) (dd):
47.12    (a) Administer and supervise all forms of public assistance provided for by state law
47.13and other welfare activities or services as are vested in the commissioner. Administration
47.14and supervision of human services activities or services includes, but is not limited to,
47.15assuring timely and accurate distribution of benefits, completeness of service, and quality
47.16program management. In addition to administering and supervising human services
47.17activities vested by law in the department, the commissioner shall have the authority to:
47.18    (1) require county agency participation in training and technical assistance programs
47.19to promote compliance with statutes, rules, federal laws, regulations, and policies
47.20governing human services;
47.21    (2) monitor, on an ongoing basis, the performance of county agencies in the
47.22operation and administration of human services, enforce compliance with statutes, rules,
47.23federal laws, regulations, and policies governing welfare services and promote excellence
47.24of administration and program operation;
47.25    (3) develop a quality control program or other monitoring program to review county
47.26performance and accuracy of benefit determinations;
47.27    (4) require county agencies to make an adjustment to the public assistance benefits
47.28issued to any individual consistent with federal law and regulation and state law and rule
47.29and to issue or recover benefits as appropriate;
47.30    (5) delay or deny payment of all or part of the state and federal share of benefits and
47.31administrative reimbursement according to the procedures set forth in section 256.017;
47.32    (6) make contracts with and grants to public and private agencies and organizations,
47.33both profit and nonprofit, and individuals, using appropriated funds; and
47.34    (7) enter into contractual agreements with federally recognized Indian tribes with
47.35a reservation in Minnesota to the extent necessary for the tribe to operate a federally
48.1approved family assistance program or any other program under the supervision of the
48.2commissioner. The commissioner shall consult with the affected county or counties in
48.3the contractual agreement negotiations, if the county or counties wish to be included,
48.4in order to avoid the duplication of county and tribal assistance program services. The
48.5commissioner may establish necessary accounts for the purposes of receiving and
48.6disbursing funds as necessary for the operation of the programs.
48.7    (b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
48.8regulation, and policy necessary to county agency administration of the programs.
48.9    (c) Administer and supervise all child welfare activities; promote the enforcement of
48.10laws protecting disabled, dependent, neglected and delinquent children, and children born
48.11to mothers who were not married to the children's fathers at the times of the conception
48.12nor at the births of the children; license and supervise child-caring and child-placing
48.13agencies and institutions; supervise the care of children in boarding and foster homes or
48.14in private institutions; and generally perform all functions relating to the field of child
48.15welfare now vested in the State Board of Control.
48.16    (d) Administer and supervise all noninstitutional service to disabled persons,
48.17including those who are visually impaired, hearing impaired, or physically impaired
48.18or otherwise disabled. The commissioner may provide and contract for the care and
48.19treatment of qualified indigent children in facilities other than those located and available
48.20at state hospitals when it is not feasible to provide the service in state hospitals.
48.21    (e) Assist and actively cooperate with other departments, agencies and institutions,
48.22local, state, and federal, by performing services in conformity with the purposes of Laws
48.231939, chapter 431.
48.24    (f) Act as the agent of and cooperate with the federal government in matters of
48.25mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
48.26431, including the administration of any federal funds granted to the state to aid in the
48.27performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
48.28and including the promulgation of rules making uniformly available medical care benefits
48.29to all recipients of public assistance, at such times as the federal government increases its
48.30participation in assistance expenditures for medical care to recipients of public assistance,
48.31the cost thereof to be borne in the same proportion as are grants of aid to said recipients.
48.32    (g) Establish and maintain any administrative units reasonably necessary for the
48.33performance of administrative functions common to all divisions of the department.
48.34    (h) Act as designated guardian of both the estate and the person of all the wards of
48.35the state of Minnesota, whether by operation of law or by an order of court, without any
48.36further act or proceeding whatever, except as to persons committed as developmentally
49.1disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
49.2recognized by the Secretary of the Interior whose interests would be best served by
49.3adoptive placement, the commissioner may contract with a licensed child-placing agency
49.4or a Minnesota tribal social services agency to provide adoption services. A contract
49.5with a licensed child-placing agency must be designed to supplement existing county
49.6efforts and may not replace existing county programs or tribal social services, unless the
49.7replacement is agreed to by the county board and the appropriate exclusive bargaining
49.8representative, tribal governing body, or the commissioner has evidence that child
49.9placements of the county continue to be substantially below that of other counties. Funds
49.10encumbered and obligated under an agreement for a specific child shall remain available
49.11until the terms of the agreement are fulfilled or the agreement is terminated.
49.12    (i) Act as coordinating referral and informational center on requests for service for
49.13newly arrived immigrants coming to Minnesota.
49.14    (j) The specific enumeration of powers and duties as hereinabove set forth shall in no
49.15way be construed to be a limitation upon the general transfer of powers herein contained.
49.16    (k) Establish county, regional, or statewide schedules of maximum fees and charges
49.17which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
49.18nursing home care and medicine and medical supplies under all programs of medical
49.19care provided by the state and for congregate living care under the income maintenance
49.20programs.
49.21    (l) Have the authority to conduct and administer experimental projects to test methods
49.22and procedures of administering assistance and services to recipients or potential recipients
49.23of public welfare. To carry out such experimental projects, it is further provided that the
49.24commissioner of human services is authorized to waive the enforcement of existing specific
49.25statutory program requirements, rules, and standards in one or more counties. The order
49.26establishing the waiver shall provide alternative methods and procedures of administration,
49.27shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and
49.28in no event shall the duration of a project exceed four years. It is further provided that no
49.29order establishing an experimental project as authorized by the provisions of this section
49.30shall become effective until the following conditions have been met:
49.31    (1) the secretary of health and human services of the United States has agreed, for
49.32the same project, to waive state plan requirements relative to statewide uniformity; and
49.33    (2) a comprehensive plan, including estimated project costs, shall be approved by
49.34the Legislative Advisory Commission and filed with the commissioner of administration.
50.1    (m) According to federal requirements, establish procedures to be followed by
50.2local welfare boards in creating citizen advisory committees, including procedures for
50.3selection of committee members.
50.4    (n) Allocate federal fiscal disallowances or sanctions which are based on quality
50.5control error rates for the aid to families with dependent children program formerly
50.6codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
50.7following manner:
50.8    (1) one-half of the total amount of the disallowance shall be borne by the county
50.9boards responsible for administering the programs. For the medical assistance and the
50.10AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
50.11shared by each county board in the same proportion as that county's expenditures for the
50.12sanctioned program are to the total of all counties' expenditures for the AFDC program
50.13formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
50.14food stamp program, sanctions shall be shared by each county board, with 50 percent of
50.15the sanction being distributed to each county in the same proportion as that county's
50.16administrative costs for food stamps are to the total of all food stamp administrative costs
50.17for all counties, and 50 percent of the sanctions being distributed to each county in the
50.18same proportion as that county's value of food stamp benefits issued are to the total of
50.19all benefits issued for all counties. Each county shall pay its share of the disallowance
50.20to the state of Minnesota. When a county fails to pay the amount due hereunder, the
50.21commissioner may deduct the amount from reimbursement otherwise due the county, or
50.22the attorney general, upon the request of the commissioner, may institute civil action
50.23to recover the amount due; and
50.24    (2) notwithstanding the provisions of clause (1), if the disallowance results from
50.25knowing noncompliance by one or more counties with a specific program instruction, and
50.26that knowing noncompliance is a matter of official county board record, the commissioner
50.27may require payment or recover from the county or counties, in the manner prescribed in
50.28clause (1), an amount equal to the portion of the total disallowance which resulted from the
50.29noncompliance, and may distribute the balance of the disallowance according to clause (1).
50.30    (o) Develop and implement special projects that maximize reimbursements and
50.31result in the recovery of money to the state. For the purpose of recovering state money,
50.32the commissioner may enter into contracts with third parties. Any recoveries that result
50.33from projects or contracts entered into under this paragraph shall be deposited in the
50.34state treasury and credited to a special account until the balance in the account reaches
50.35$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
51.1transferred and credited to the general fund. All money in the account is appropriated to
51.2the commissioner for the purposes of this paragraph.
51.3    (p) Have the authority to make direct payments to facilities providing shelter
51.4to women and their children according to section 256D.05, subdivision 3. Upon
51.5the written request of a shelter facility that has been denied payments under section
51.6256D.05, subdivision 3 , the commissioner shall review all relevant evidence and make
51.7a determination within 30 days of the request for review regarding issuance of direct
51.8payments to the shelter facility. Failure to act within 30 days shall be considered a
51.9determination not to issue direct payments.
51.10    (q) Have the authority to establish and enforce the following county reporting
51.11requirements:
51.12    (1) the commissioner shall establish fiscal and statistical reporting requirements
51.13necessary to account for the expenditure of funds allocated to counties for human
51.14services programs. When establishing financial and statistical reporting requirements, the
51.15commissioner shall evaluate all reports, in consultation with the counties, to determine if
51.16the reports can be simplified or the number of reports can be reduced;
51.17    (2) the county board shall submit monthly or quarterly reports to the department
51.18as required by the commissioner. Monthly reports are due no later than 15 working days
51.19after the end of the month. Quarterly reports are due no later than 30 calendar days after
51.20the end of the quarter, unless the commissioner determines that the deadline must be
51.21shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
51.22or risking a loss of federal funding. Only reports that are complete, legible, and in the
51.23required format shall be accepted by the commissioner;
51.24    (3) if the required reports are not received by the deadlines established in clause (2),
51.25the commissioner may delay payments and withhold funds from the county board until
51.26the next reporting period. When the report is needed to account for the use of federal
51.27funds and the late report results in a reduction in federal funding, the commissioner shall
51.28withhold from the county boards with late reports an amount equal to the reduction in
51.29federal funding until full federal funding is received;
51.30    (4) a county board that submits reports that are late, illegible, incomplete, or not
51.31in the required format for two out of three consecutive reporting periods is considered
51.32noncompliant. When a county board is found to be noncompliant, the commissioner
51.33shall notify the county board of the reason the county board is considered noncompliant
51.34and request that the county board develop a corrective action plan stating how the
51.35county board plans to correct the problem. The corrective action plan must be submitted
52.1to the commissioner within 45 days after the date the county board received notice
52.2of noncompliance;
52.3    (5) the final deadline for fiscal reports or amendments to fiscal reports is one year
52.4after the date the report was originally due. If the commissioner does not receive a report
52.5by the final deadline, the county board forfeits the funding associated with the report for
52.6that reporting period and the county board must repay any funds associated with the
52.7report received for that reporting period;
52.8    (6) the commissioner may not delay payments, withhold funds, or require repayment
52.9under clause (3) or (5) if the county demonstrates that the commissioner failed to
52.10provide appropriate forms, guidelines, and technical assistance to enable the county to
52.11comply with the requirements. If the county board disagrees with an action taken by the
52.12commissioner under clause (3) or (5), the county board may appeal the action according
52.13to sections 14.57 to 14.69; and
52.14    (7) counties subject to withholding of funds under clause (3) or forfeiture or
52.15repayment of funds under clause (5) shall not reduce or withhold benefits or services to
52.16clients to cover costs incurred due to actions taken by the commissioner under clause
52.17(3) or (5).
52.18    (r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
52.19federal fiscal disallowances or sanctions are based on a statewide random sample in direct
52.20proportion to each county's claim for that period.
52.21    (s) Be responsible for ensuring the detection, prevention, investigation, and
52.22resolution of fraudulent activities or behavior by applicants, recipients, and other
52.23participants in the human services programs administered by the department.
52.24    (t) Require county agencies to identify overpayments, establish claims, and utilize
52.25all available and cost-beneficial methodologies to collect and recover these overpayments
52.26in the human services programs administered by the department.
52.27    (u) Have the authority to administer a drug rebate program for drugs purchased
52.28pursuant to the prescription drug program established under section 256.955 after the
52.29beneficiary's satisfaction of any deductible established in the program. The commissioner
52.30shall require a rebate agreement from all manufacturers of covered drugs as defined in
52.31section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
52.32or after July 1, 2002, must include rebates for individuals covered under the prescription
52.33drug program who are under 65 years of age. For each drug, the amount of the rebate shall
52.34be equal to the rebate as defined for purposes of the federal rebate program in United
52.35States Code, title 42, section 1396r-8. The manufacturers must provide full payment
52.36within 30 days of receipt of the state invoice for the rebate within the terms and conditions
53.1used for the federal rebate program established pursuant to section 1927 of title XIX of
53.2the Social Security Act. The manufacturers must provide the commissioner with any
53.3information necessary to verify the rebate determined per drug. The rebate program shall
53.4utilize the terms and conditions used for the federal rebate program established pursuant to
53.5section 1927 of title XIX of the Social Security Act.
53.6    (v) Have the authority to administer the federal drug rebate program for drugs
53.7purchased under the medical assistance program as allowed by section 1927 of title XIX
53.8of the Social Security Act and according to the terms and conditions of section 1927.
53.9Rebates shall be collected for all drugs that have been dispensed or administered in an
53.10outpatient setting and that are from manufacturers who have signed a rebate agreement
53.11with the United States Department of Health and Human Services.
53.12    (w) Have the authority to administer a supplemental drug rebate program for drugs
53.13purchased under the medical assistance program. The commissioner may enter into
53.14supplemental rebate contracts with pharmaceutical manufacturers and may require prior
53.15authorization for drugs that are from manufacturers that have not signed a supplemental
53.16rebate contract. Prior authorization of drugs shall be subject to the provisions of section
53.17256B.0625, subdivision 13 .
53.18    (x) Operate the department's communication systems account established in Laws
53.191993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
53.20communication costs necessary for the operation of the programs the commissioner
53.21supervises. A communications account may also be established for each regional
53.22treatment center which operates communications systems. Each account must be used
53.23to manage shared communication costs necessary for the operations of the programs the
53.24commissioner supervises. The commissioner may distribute the costs of operating and
53.25maintaining communication systems to participants in a manner that reflects actual usage.
53.26Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
53.27other costs as determined by the commissioner. Nonprofit organizations and state, county,
53.28and local government agencies involved in the operation of programs the commissioner
53.29supervises may participate in the use of the department's communications technology and
53.30share in the cost of operation. The commissioner may accept on behalf of the state any
53.31gift, bequest, devise or personal property of any kind, or money tendered to the state for
53.32any lawful purpose pertaining to the communication activities of the department. Any
53.33money received for this purpose must be deposited in the department's communication
53.34systems accounts. Money collected by the commissioner for the use of communication
53.35systems must be deposited in the state communication systems account and is appropriated
53.36to the commissioner for purposes of this section.
54.1    (y) Receive any federal matching money that is made available through the medical
54.2assistance program for the consumer satisfaction survey. Any federal money received for
54.3the survey is appropriated to the commissioner for this purpose. The commissioner may
54.4expend the federal money received for the consumer satisfaction survey in either year of
54.5the biennium.
54.6    (z) Designate community information and referral call centers and incorporate
54.7cost reimbursement claims from the designated community information and referral
54.8call centers into the federal cost reimbursement claiming processes of the department
54.9according to federal law, rule, and regulations. Existing information and referral centers
54.10provided by Greater Twin Cities United Way or existing call centers for which Greater
54.11Twin Cities United Way has legal authority to represent, shall be included in these
54.12designations upon review by the commissioner and assurance that these services are
54.13accredited and in compliance with national standards. Any reimbursement is appropriated
54.14to the commissioner and all designated information and referral centers shall receive
54.15payments according to normal department schedules established by the commissioner
54.16upon final approval of allocation methodologies from the United States Department of
54.17Health and Human Services Division of Cost Allocation or other appropriate authorities.
54.18    (aa) Develop recommended standards for foster care homes that address the
54.19components of specialized therapeutic services to be provided by foster care homes with
54.20those services.
54.21    (bb) Authorize the method of payment to or from the department as part of the
54.22human services programs administered by the department. This authorization includes the
54.23receipt or disbursement of funds held by the department in a fiduciary capacity as part of
54.24the human services programs administered by the department.
54.25    (cc) Have the authority to administer a drug rebate program for drugs purchased for
54.26persons eligible for general assistance medical care under section 256D.03, subdivision 3.
54.27For manufacturers that agree to participate in the general assistance medical care rebate
54.28program, the commissioner shall enter into a rebate agreement for covered drugs as
54.29defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
54.30rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
54.31United States Code, title 42, section 1396r-8. The manufacturers must provide payment
54.32within the terms and conditions used for the federal rebate program established under
54.33section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
54.34the terms and conditions used for the federal rebate program established under section
54.351927 of title XIX of the Social Security Act.
55.1    Effective January 1, 2006, drug coverage under general assistance medical care shall
55.2be limited to those prescription drugs that:
55.3    (1) are covered under the medical assistance program as described in section
55.4256B.0625, subdivisions 13 and 13d ; and
55.5    (2) are provided by manufacturers that have fully executed general assistance
55.6medical care rebate agreements with the commissioner and comply with such agreements.
55.7Prescription drug coverage under general assistance medical care shall conform to
55.8coverage under the medical assistance program according to section 256B.0625,
55.9subdivisions 13 to 13g .
55.10    The rebate revenues collected under the drug rebate program are deposited in the
55.11general fund.
55.12(dd) Designate the agencies that operate the Senior LinkAge Line under section
55.13256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state
55.14of Minnesota Aging and the Disability Resource Centers under United States Code, title
55.1542, section 3001, the Older Americans Act Amendments of 2006, and incorporate cost
55.16reimbursement claims from the designated centers into the federal cost reimbursement
55.17claiming processes of the department according to federal law, rule, and regulations. Any
55.18reimbursement must be appropriated to the commissioner and treated consistent with
55.19section 256.011. All Aging and Disability Resource Center designated agencies shall
55.20receive payments of grant funding that supports the activity and generates the federal
55.21financial participation according to Board on Aging administrative granting mechanisms.

55.22    Sec. 5. Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:
55.23    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability
55.24Linkage Line, to which shall serve people with disabilities as the designated Aging and
55.25Disability Resource Center under United States Code, title 42, section 3001, the Older
55.26Americans Act Amendments of 2006, in partnership with the Senior LinkAge Line and
55.27shall serve as Minnesota's neutral access point for statewide disability information and
55.28assistance and must be available during business hours through a statewide toll-free
55.29number and the Internet. The Disability Linkage Line shall:
55.30(1) deliver information and assistance based on national and state standards;
55.31    (2) provide information about state and federal eligibility requirements, benefits,
55.32and service options;
55.33(3) provide benefits and options counseling;
55.34    (4) make referrals to appropriate support entities;
56.1    (5) educate people on their options so they can make well-informed choices and link
56.2them to quality profiles;
56.3    (6) help support the timely resolution of service access and benefit issues;
56.4(7) inform people of their long-term community services and supports;
56.5(8) provide necessary resources and supports that can lead to employment and
56.6increased economic stability of people with disabilities; and
56.7(9) serve as the technical assistance and help center for the Web-based tool,
56.8Minnesota's Disability Benefits 101.org.

56.9    Sec. 6. Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:
56.10    Subd. 7. Consumer information and assistance and long-term care options
56.11counseling; Senior LinkAge Line. (a) The Minnesota Board on Aging shall operate a
56.12statewide service to aid older Minnesotans and their families in making informed choices
56.13about long-term care options and health care benefits. Language services to persons
56.14with limited English language skills may be made available. The service, known as
56.15Senior LinkAge Line, shall serve older adults as the designated Aging and Disability
56.16Resource Center under United States Code, title 42, section 3001, the Older Americans
56.17Act Amendments of 2006 in partnership with the Disability LinkAge Line under section
56.18256.01, subdivision 24, and must be available during business hours through a statewide
56.19toll-free number and must also be available through the Internet. The Minnesota Board
56.20on Aging shall consult with, and when appropriate work through, the area agencies on
56.21aging counties, and other entities that serve aging and disabled populations of all ages,
56.22to provide and maintain the telephone infrastructure and related support for the Aging
56.23and Disability Resource Center partners which agree by memorandum to access the
56.24infrastructure, including the designated providers of the Senior LinkAge Line and the
56.25Disability Linkage Line.
56.26    (b) The service must provide long-term care options counseling by assisting older
56.27adults, caregivers, and providers in accessing information and options counseling about
56.28choices in long-term care services that are purchased through private providers or available
56.29through public options. The service must:
56.30    (1) develop and provide for regular updating of a comprehensive database that
56.31includes detailed listings in both consumer- and provider-oriented formats that can provide
56.32search results down to the neighborhood level;
56.33    (2) make the database accessible on the Internet and through other telecommunication
56.34and media-related tools;
57.1    (3) link callers to interactive long-term care screening tools and make these tools
57.2available through the Internet by integrating the tools with the database;
57.3    (4) develop community education materials with a focus on planning for long-term
57.4care and evaluating independent living, housing, and service options;
57.5    (5) conduct an outreach campaign to assist older adults and their caregivers in
57.6finding information on the Internet and through other means of communication;
57.7    (6) implement a messaging system for overflow callers and respond to these callers
57.8by the next business day;
57.9    (7) link callers with county human services and other providers to receive more
57.10in-depth assistance and consultation related to long-term care options;
57.11    (8) link callers with quality profiles for nursing facilities and other home and
57.12community-based services providers developed by the commissioner commissioners of
57.13health and human services;
57.14(9) develop an outreach plan to seniors and their caregivers with a particular focus
57.15on establishing a clear presence in places that seniors recognize and:
57.16(i) place a significant emphasis on improved outreach and service to seniors and
57.17their caregivers by establishing annual plans by neighborhood, city, and county, as
57.18necessary, to address the unique needs of geographic areas in the state where there are
57.19dense populations of seniors;
57.20(ii) establish an efficient workforce management approach and assign community
57.21living specialist staff and volunteers to geographic areas as well as aging and disability
57.22resource center sites so that seniors and their caregivers and professionals recognize the
57.23Senior LinkAge Line as the place to call for aging services and information;
57.24(iii) recognize the size and complexity of the metropolitan area service system by
57.25working with metropolitan counties to establish a clear partnership with them, including
57.26seeking county advice on the establishment of local aging and disabilities resource center
57.27sites; and
57.28(iv) maintain dashboards with metrics that demonstrate how the service is expanding
57.29and extending or enhancing its outreach efforts in dispersed or hard to reach locations in
57.30varied population centers;
57.31    (9) (10) incorporate information about the availability of housing options, as well
57.32as registered housing with services and consumer rights within the MinnesotaHelp.info
57.33network long-term care database to facilitate consumer comparison of services and costs
57.34among housing with services establishments and with other in-home services and to
57.35support financial self-sufficiency as long as possible. Housing with services establishments
57.36and their arranged home care providers shall provide information that will facilitate price
58.1comparisons, including delineation of charges for rent and for services available. The
58.2commissioners of health and human services shall align the data elements required by
58.3section 144G.06, the Uniform Consumer Information Guide, and this section to provide
58.4consumers standardized information and ease of comparison of long-term care options.
58.5The commissioner of human services shall provide the data to the Minnesota Board on
58.6Aging for inclusion in the MinnesotaHelp.info network long-term care database;
58.7(10) (11) provide long-term care options counseling. Long-term care options
58.8counselors shall:
58.9(i) for individuals not eligible for case management under a public program or public
58.10funding source, provide interactive decision support under which consumers, family
58.11members, or other helpers are supported in their deliberations to determine appropriate
58.12long-term care choices in the context of the consumer's needs, preferences, values, and
58.13individual circumstances, including implementing a community support plan;
58.14(ii) provide Web-based educational information and collateral written materials to
58.15familiarize consumers, family members, or other helpers with the long-term care basics,
58.16issues to be considered, and the range of options available in the community;
58.17(iii) provide long-term care futures planning, which means providing assistance to
58.18individuals who anticipate having long-term care needs to develop a plan for the more
58.19distant future; and
58.20(iv) provide expertise in benefits and financing options for long-term care, including
58.21Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
58.22private pay options, and ways to access low or no-cost services or benefits through
58.23volunteer-based or charitable programs;
58.24(11) (12) using risk management and support planning protocols, provide long-term
58.25care options counseling to current residents of nursing homes deemed appropriate for
58.26discharge by the commissioner and older adults who request service after consultation
58.27with the Senior LinkAge Line under clause (12). In order to meet this requirement, The
58.28Senior LinkAge Line shall also receive referrals from the residents or staff of nursing
58.29homes. The Senior LinkAge Line shall identify and contact residents deemed appropriate
58.30for discharge by developing targeting criteria in consultation with the commissioner who
58.31shall provide designated Senior LinkAge Line contact centers with a list of nursing
58.32home residents that meet the criteria as being appropriate for discharge planning via a
58.33secure Web portal. Senior LinkAge Line shall provide these residents, if they indicate a
58.34preference to receive long-term care options counseling, with initial assessment, review of
58.35risk factors, independent living support consultation, or and, if appropriate, a referral to:
58.36(i) long-term care consultation services under section 256B.0911;
59.1(ii) designated care coordinators of contracted entities under section 256B.035 for
59.2persons who are enrolled in a managed care plan; or
59.3(iii) the long-term care consultation team for those who are appropriate eligible
59.4 for relocation service coordination due to high-risk factors or psychological or physical
59.5disability; and
59.6(12) (13) develop referral protocols and processes that will assist certified health
59.7care homes and hospitals to identify at-risk older adults and determine when to refer these
59.8individuals to the Senior LinkAge Line for long-term care options counseling under this
59.9section. The commissioner is directed to work with the commissioner of health to develop
59.10protocols that would comply with the health care home designation criteria and protocols
59.11available at the time of hospital discharge. The commissioner shall keep a record of the
59.12number of people who choose long-term care options counseling as a result of this section.

59.13    Sec. 7. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
59.14to read:
59.15    Subd. 7a. Preadmission screening activities related to nursing facility
59.16admissions. (a) All individuals seeking admission to Medicaid certified nursing facilities,
59.17including certified boarding care facilities, must be screened prior to admission regardless
59.18of income, assets, or funding sources for nursing facility care, except as described in
59.19subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the
59.20need for nursing facility level of care as described in section 256B.0911, subdivision
59.214e, and to complete activities required under federal law related to mental illness and
59.22developmental disability as outlined in paragraph (b).
59.23(b) A person who has a diagnosis or possible diagnosis of mental illness or
59.24developmental disability must receive a preadmission screening before admission
59.25regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify
59.26the need for further evaluation and specialized services, unless the admission prior to
59.27screening is authorized by the local mental health authority or the local developmental
59.28disabilities case manager, or unless authorized by the county agency according to Public
59.29Law 101-508.
59.30(c) The following criteria apply to the preadmission screening:
59.31(1) requests for preadmission screenings must be submitted via an online form
59.32developed by the commissioner;
59.33(2) the Senior LinkAge Line must use forms and criteria developed by the
59.34commissioner to identify persons who require referral for further evaluation and
59.35determination of the need for specialized services; and
60.1(3) the evaluation and determination of the need for specialized services must be
60.2done by:
60.3(i) a qualified independent mental health professional, for persons with a primary or
60.4secondary diagnosis of a serious mental illness; or
60.5(ii) a qualified developmental disability professional, for persons with a primary or
60.6secondary diagnosis of developmental disability. For purposes of this requirement, a
60.7qualified developmental disability professional must meet the standards for a qualified
60.8developmental disability professional under Code of Federal Regulations, title 42, section
60.9483.430.
60.10(d) The local county mental health authority or the state developmental disability
60.11authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
60.12nursing facility if the individual does not meet the nursing facility level of care criteria or
60.13needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
60.14purposes of this section, "specialized services" for a person with developmental disability
60.15means active treatment as that term is defined under Code of Federal Regulations, title
60.1642, section 483.440(a)(1).
60.17(e) In assessing a person's needs, the screener shall:
60.18(1) use an automated system designated by the commissioner;
60.19(2) consult with care transitions coordinators or physician; and
60.20(3) consider the assessment of the individual's physician.
60.21Other personnel may be included in the level of care determination as deemed
60.22necessary by the screener.
60.23EFFECTIVE DATE.This section is effective October 1, 2013.

60.24    Sec. 8. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
60.25to read:
60.26    Subd. 7b. Exemptions and emergency admissions. (a) Exemptions from the federal
60.27screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:
60.28(1) a person who, having entered an acute care facility from a certified nursing
60.29facility, is returning to a certified nursing facility; or
60.30(2) a person transferring from one certified nursing facility in Minnesota to another
60.31certified nursing facility in Minnesota.
60.32(b) Persons who are exempt from preadmission screening for purposes of level of
60.33care determination include:
60.34(1) persons described in paragraph (a);
61.1(2) an individual who has a contractual right to have nursing facility care paid for
61.2indefinitely by the Veterans' Administration;
61.3(3) an individual enrolled in a demonstration project under section 256B.69,
61.4subdivision 8, at the time of application to a nursing facility; and
61.5(4) an individual currently being served under the alternative care program or under
61.6a home and community-based services waiver authorized under section 1915(c) of the
61.7federal Social Security Act.
61.8(c) Persons admitted to a Medicaid-certified nursing facility from the community
61.9on an emergency basis as described in paragraph (d) or from an acute care facility on a
61.10nonworking day must be screened the first working day after admission.
61.11(d) Emergency admission to a nursing facility prior to screening is permitted when
61.12all of the following conditions are met:
61.13(1) a person is admitted from the community to a certified nursing or certified
61.14boarding care facility during Senior LinkAge Line nonworking hours;
61.15(2) a physician has determined that delaying admission until preadmission screening
61.16is completed would adversely affect the person's health and safety;
61.17(3) there is a recent precipitating event that precludes the client from living safely in
61.18the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
61.19inability to continue to provide care;
61.20(4) the attending physician has authorized the emergency placement and has
61.21documented the reason that the emergency placement is recommended; and
61.22(5) the Senior LinkAge Line is contacted on the first working day following the
61.23emergency admission.
61.24Transfer of a patient from an acute care hospital to a nursing facility is not considered
61.25an emergency except for a person who has received hospital services in the following
61.26situations: hospital admission for observation, care in an emergency room without hospital
61.27admission, or following hospital 24-hour bed care and from whom admission is being
61.28sought on a nonworking day.
61.29(e) A nursing facility must provide written information to all persons admitted
61.30regarding the person's right to request and receive long-term care consultation services as
61.31defined in section 256B.0911, subdivision 1a. The information must be provided prior to
61.32the person's discharge from the facility and in a format specified by the commissioner.
61.33EFFECTIVE DATE.This section is effective October 1, 2013.

61.34    Sec. 9. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
61.35to read:
62.1    Subd. 7c. Screening requirements. (a) A person may be screened for nursing
62.2facility admission by telephone or in a face-to-face screening interview. The Senior
62.3LinkAge Line shall identify each individual's needs using the following categories:
62.4(1) the person needs no face-to-face long-term care consultation assessment
62.5completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
62.6managed care organization under contract with the Department of Human Services to
62.7determine the need for nursing facility level of care based on information obtained from
62.8other health care professionals;
62.9(2) the person needs an immediate face-to-face long-term care consultation
62.10assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county,
62.11tribe, or managed care organization under contract with the Department of Human
62.12Services to determine the need for nursing facility level of care and complete activities
62.13required under subdivision 7a; or
62.14(3) the person may be exempt from screening requirements as outlined in subdivision
62.157b, but will need transitional assistance after admission or in-person follow-along after
62.16a return home.
62.17(b) Individuals under 65 years of age who are admitted to nursing facilities with
62.18only a telephone screening must receive a face-to-face assessment from the long-term
62.19care consultation team member of the county in which the facility is located or from the
62.20recipient's county case manager within 40 calendar days of admission as described in
62.21section 256B.0911, subdivision 4d, paragraph (c).
62.22(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
62.23facility must be screened prior to admission.
62.24(d) Screenings provided by the Senior LinkAge Line must include processes
62.25to identify persons who may require transition assistance described in subdivision 7,
62.26paragraph (b), clause (12), and section 256B.0911, subdivision 3b.
62.27EFFECTIVE DATE.This section is effective October 1, 2013.

62.28    Sec. 10. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
62.29to read:
62.30    Subd. 7d. Payment for preadmission screening. Funding for preadmission
62.31screening shall be provided to the Minnesota Board on Aging by the Department of
62.32Human Services to cover screener salaries and expenses to provide the services described
62.33in subdivisions 7a to 7c. The Minnesota Board on Aging shall employ, or contract with
62.34other agencies to employ, within the limits of available funding, sufficient personnel to
62.35provide preadmission screening and level of care determination services and shall seek to
63.1maximize federal funding for the service as provided under section 256.01, subdivision
63.22, paragraph (dd).
63.3EFFECTIVE DATE.This section is effective October 1, 2013.

63.4    Sec. 11. Minnesota Statutes 2012, section 256.9754, is amended by adding a
63.5subdivision to read:
63.6    Subd. 3a. Priority for other grants. The commissioner of health shall give priority
63.7to a grantee selected under subdivision 3 when awarding technology-related grants, if the
63.8grantee is using technology as part of the proposal unless that priority conflicts with
63.9existing state or federal guidance related to grant awards by the Department of Health.
63.10The commissioner of transportation shall give priority to a grantee under subdivision 3
63.11when distributing transportation-related funds to create transportation options for older
63.12adults unless that preference conflicts with existing state or federal guidance related to
63.13grant awards by the Department of Transportation.

63.14    Sec. 12. Minnesota Statutes 2012, section 256.9754, is amended by adding a
63.15subdivision to read:
63.16    Subd. 3b. State waivers. The commissioner of health may waive applicable state
63.17laws and rules on a time-limited basis if the commissioner of health determines that a
63.18participating grantee requires a waiver in order to achieve demonstration project goals.

63.19    Sec. 13. Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:
63.20    Subd. 5. Grant preference. The commissioner of human services shall give
63.21preference when awarding grants under this section to areas where nursing facility
63.22closures have occurred or are occurring or areas with service needs identified by section
63.23144A.351. The commissioner may award grants to the extent grant funds are available
63.24and to the extent applications are approved by the commissioner. Denial of approval of an
63.25application in one year does not preclude submission of an application in a subsequent
63.26year. The maximum grant amount is limited to $750,000.

63.27    Sec. 14. Minnesota Statutes 2012, section 256B.021, is amended by adding a
63.28subdivision to read:
63.29    Subd. 4a. Evaluation. The commissioner shall evaluate the projects contained in
63.30subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:
63.31(1) an impact assessment focusing on program outcomes, especially those
63.32experienced directly by the person receiving services;
64.1(2) study samples drawn from the population of interest for each project; and
64.2(3) a time series analysis to examine aggregate trends in average monthly
64.3utilization, expenditures, and other outcomes in the targeted populations before and after
64.4implementation of the initiatives.

64.5    Sec. 15. Minnesota Statutes 2012, section 256B.021, is amended by adding a
64.6subdivision to read:
64.7    Subd. 6. Work, empower, and encourage independence. As provided under
64.8subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a
64.9demonstration project to provide navigation, employment supports, and benefits planning
64.10services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014.
64.11This demonstration shall promote economic stability, increase independence, and reduce
64.12applications for disability benefits while providing a positive impact on the health and
64.13future of participants.

64.14    Sec. 16. Minnesota Statutes 2012, section 256B.021, is amended by adding a
64.15subdivision to read:
64.16    Subd. 7. Housing stabilization. As provided under subdivision 4, paragraph (e),
64.17upon federal approval, the commissioner shall establish a demonstration project to provide
64.18service coordination, outreach, in-reach, tenancy support, and community living assistance
64.19to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This
64.20demonstration shall promote housing stability, reduce costly medical interventions, and
64.21increase opportunities for independent community living.

64.22    Sec. 17. Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:
64.23    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation
64.24services is to assist persons with long-term or chronic care needs in making care
64.25decisions and selecting support and service options that meet their needs and reflect
64.26their preferences. The availability of, and access to, information and other types of
64.27assistance, including assessment and support planning, is also intended to prevent or delay
64.28institutional placements and to provide access to transition assistance after admission.
64.29Further, the goal of these services is to contain costs associated with unnecessary
64.30institutional admissions. Long-term consultation services must be available to any person
64.31regardless of public program eligibility. The commissioner of human services shall seek
64.32to maximize use of available federal and state funds and establish the broadest program
64.33possible within the funding available.
65.1(b) These services must be coordinated with long-term care options counseling
65.2provided under subdivision 4d, section 256.975, subdivision subdivisions 7 to 7c, and
65.3section 256.01, subdivision 24. The lead agency providing long-term care consultation
65.4services shall encourage the use of volunteers from families, religious organizations, social
65.5clubs, and similar civic and service organizations to provide community-based services.

65.6    Sec. 18. Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to
65.7read:
65.8    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
65.9    (a) Until additional requirements apply under paragraph (b), "long-term care
65.10consultation services" means:
65.11    (1) intake for and access to assistance in identifying services needed to maintain an
65.12individual in the most inclusive environment;
65.13    (2) providing recommendations for and referrals to cost-effective community
65.14services that are available to the individual;
65.15    (3) development of an individual's person-centered community support plan;
65.16    (4) providing information regarding eligibility for Minnesota health care programs;
65.17    (5) face-to-face long-term care consultation assessments, which may be completed
65.18in a hospital, nursing facility, intermediate care facility for persons with developmental
65.19disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
65.20residence;
65.21    (6) federally mandated preadmission screening activities described under
65.22subdivisions 4a and 4b;
65.23    (7) (6) determination of home and community-based waiver and other service
65.24eligibility as required under sections 256B.0913, 256B.0915, and 256B.49, including level
65.25of care determination for individuals who need an institutional level of care as determined
65.26under section 256B.0911, subdivision 4a, paragraph (d) 4e, based on assessment and
65.27community support plan development, appropriate referrals to obtain necessary diagnostic
65.28information, and including an eligibility determination for consumer-directed community
65.29supports;
65.30    (8) (7) providing recommendations for institutional placement when there are no
65.31cost-effective community services available;
65.32    (9) (8) providing access to assistance to transition people back to community settings
65.33after institutional admission; and
65.34(10) (9) providing information about competitive employment, with or without
65.35supports, for school-age youth and working-age adults and referrals to the Disability
66.1Linkage Line and Disability Benefits 101 to ensure that an informed choice about
66.2competitive employment can be made. For the purposes of this subdivision, "competitive
66.3employment" means work in the competitive labor market that is performed on a full-time
66.4or part-time basis in an integrated setting, and for which an individual is compensated at or
66.5above the minimum wage, but not less than the customary wage and level of benefits paid
66.6by the employer for the same or similar work performed by individuals without disabilities.
66.7(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
66.82c, and 3a, "long-term care consultation services" also means:
66.9(1) service eligibility determination for state plan home care services identified in:
66.10(i) section 256B.0625, subdivisions 7, 19a, and 19c;
66.11(ii) section 256B.0657; or
66.12(iii) consumer support grants under section 256.476;
66.13(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
66.14determination of eligibility for case management services available under sections
66.15256B.0621, subdivision 2 , paragraph (4), and 256B.0924 and Minnesota Rules, part
66.169525.0016;
66.17(3) determination of institutional level of care, home and community-based service
66.18waiver, and other service eligibility as required under section 256B.092, determination
66.19of eligibility for family support grants under section 252.32, semi-independent living
66.20services under section 252.275, and day training and habilitation services under section
66.21256B.092 ; and
66.22(4) obtaining necessary diagnostic information to determine eligibility under clauses
66.23(2) and (3).
66.24    (c) "Long-term care options counseling" means the services provided by the linkage
66.25lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and
66.26also includes telephone assistance and follow up once a long-term care consultation
66.27assessment has been completed.
66.28    (d) "Minnesota health care programs" means the medical assistance program under
66.29chapter 256B and the alternative care program under section 256B.0913.
66.30    (e) "Lead agencies" means counties administering or tribes and health plans under
66.31contract with the commissioner to administer long-term care consultation assessment and
66.32support planning services.

66.33    Sec. 19. Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
66.34read:
67.1    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
67.2services planning, or other assistance intended to support community-based living,
67.3including persons who need assessment in order to determine waiver or alternative care
67.4program eligibility, must be visited by a long-term care consultation team within 20
67.5calendar days after the date on which an assessment was requested or recommended.
67.6Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
67.7applies to an assessment of a person requesting personal care assistance services and
67.8private duty nursing. The commissioner shall provide at least a 90-day notice to lead
67.9agencies prior to the effective date of this requirement. Face-to-face assessments must be
67.10conducted according to paragraphs (b) to (i).
67.11    (b) The lead agency may utilize a team of either the social worker or public health
67.12nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
67.13use certified assessors to conduct the assessment. The consultation team members must
67.14confer regarding the most appropriate care for each individual screened or assessed. For
67.15a person with complex health care needs, a public health or registered nurse from the
67.16team must be consulted.
67.17    (c) The assessment must be comprehensive and include a person-centered assessment
67.18of the health, psychological, functional, environmental, and social needs of referred
67.19individuals and provide information necessary to develop a community support plan that
67.20meets the consumers needs, using an assessment form provided by the commissioner.
67.21    (d) The assessment must be conducted in a face-to-face interview with the person
67.22being assessed and the person's legal representative, and other individuals as requested by
67.23the person, who can provide information on the needs, strengths, and preferences of the
67.24person necessary to develop a community support plan that ensures the person's health and
67.25safety, but who is not a provider of service or has any financial interest in the provision
67.26of services. For persons who are to be assessed for elderly waiver customized living
67.27services under section 256B.0915, with the permission of the person being assessed or
67.28the person's designated or legal representative, the client's current or proposed provider
67.29of services may submit a copy of the provider's nursing assessment or written report
67.30outlining its recommendations regarding the client's care needs. The person conducting
67.31the assessment will notify the provider of the date by which this information is to be
67.32submitted. This information shall be provided to the person conducting the assessment
67.33prior to the assessment.
67.34    (e) If the person chooses to use community-based services, the person or the person's
67.35legal representative must be provided with a written community support plan within 40
68.1calendar days of the assessment visit, regardless of whether the individual is eligible for
68.2Minnesota health care programs. The written community support plan must include:
68.3(1) a summary of assessed needs as defined in paragraphs (c) and (d);
68.4(2) the individual's options and choices to meet identified needs, including all
68.5available options for case management services and providers;
68.6(3) identification of health and safety risks and how those risks will be addressed,
68.7including personal risk management strategies;
68.8(4) referral information; and
68.9(5) informal caregiver supports, if applicable.
68.10For a person determined eligible for state plan home care under subdivision 1a,
68.11paragraph (b), clause (1), the person or person's representative must also receive a copy of
68.12the home care service plan developed by the certified assessor.
68.13(f) A person may request assistance in identifying community supports without
68.14participating in a complete assessment. Upon a request for assistance identifying
68.15community support, the person must be transferred or referred to long-term care options
68.16counseling services available under sections 256.975, subdivision 7, and 256.01,
68.17subdivision 24, for telephone assistance and follow up.
68.18    (g) The person has the right to make the final decision between institutional
68.19placement and community placement after the recommendations have been provided,
68.20except as provided in section 256.975, subdivision 4a, paragraph (c) 7a, paragraph (d).
68.21    (h) The lead agency must give the person receiving assessment or support planning,
68.22or the person's legal representative, materials, and forms supplied by the commissioner
68.23containing the following information:
68.24    (1) written recommendations for community-based services and consumer-directed
68.25options;
68.26(2) documentation that the most cost-effective alternatives available were offered to
68.27the individual. For purposes of this clause, "cost-effective" means community services and
68.28living arrangements that cost the same as or less than institutional care. For an individual
68.29found to meet eligibility criteria for home and community-based service programs under
68.30section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
68.31approved waiver plan for each program;
68.32(3) the need for and purpose of preadmission screening conducted by long-term care
68.33options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
68.34nursing facility placement. If the individual selects nursing facility placement, the lead
68.35agency shall forward information needed to complete the level of care determinations and
69.1screening for developmental disability and mental illness collected during the assessment
69.2to the long-term care options counselor using forms provided by the commissioner;
69.3    (4) the role of long-term care consultation assessment and support planning in
69.4eligibility determination for waiver and alternative care programs, and state plan home
69.5care, case management, and other services as defined in subdivision 1a, paragraphs (a),
69.6clause (7), and (b);
69.7    (5) information about Minnesota health care programs;
69.8    (6) the person's freedom to accept or reject the recommendations of the team;
69.9    (7) the person's right to confidentiality under the Minnesota Government Data
69.10Practices Act, chapter 13;
69.11    (8) the certified assessor's decision regarding the person's need for institutional level
69.12of care as determined under criteria established in section 256B.0911, subdivision 4a,
69.13paragraph (d) 4e, and the certified assessor's decision regarding eligibility for all services
69.14and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
69.15    (9) the person's right to appeal the certified assessor's decision regarding eligibility
69.16for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
69.17(b), and incorporating the decision regarding the need for institutional level of care or the
69.18lead agency's final decisions regarding public programs eligibility according to section
69.19256.045, subdivision 3 .
69.20    (i) Face-to-face assessment completed as part of eligibility determination for
69.21the alternative care, elderly waiver, community alternatives for disabled individuals,
69.22community alternative care, and brain injury waiver programs under sections 256B.0913,
69.23256B.0915 , and 256B.49 is valid to establish service eligibility for no more than 60
69.24calendar days after the date of assessment.
69.25(j) The effective eligibility start date for programs in paragraph (i) can never be
69.26prior to the date of assessment. If an assessment was completed more than 60 days
69.27before the effective waiver or alternative care program eligibility start date, assessment
69.28and support plan information must be updated in a face-to-face visit and documented in
69.29the department's Medicaid Management Information System (MMIS). Notwithstanding
69.30retroactive medical assistance coverage of state plan services, the effective date of
69.31eligibility for programs included in paragraph (i) cannot be prior to the date the most
69.32recent updated assessment is completed.

69.33    Sec. 20. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
69.34read:
70.1    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a)
70.2It is the policy of the state of Minnesota to ensure that individuals with disabilities or
70.3chronic illness are served in the most integrated setting appropriate to their needs and have
70.4the necessary information to make informed choices about home and community-based
70.5service options.
70.6    (b) Individuals under 65 years of age who are admitted to a Medicaid-certified
70.7 nursing facility from a hospital must be screened prior to admission as outlined in
70.8subdivisions 4a through 4c according to the requirements outlined in section 256.975,
70.9subdivisions 7a to 7c. This shall be provided by the Senior LinkAge Line as required
70.10under section 256.975, subdivision 7.
70.11    (c) Individuals under 65 years of age who are admitted to nursing facilities with
70.12only a telephone screening must receive a face-to-face assessment from the long-term
70.13care consultation team member of the county in which the facility is located or from the
70.14recipient's county case manager within 40 calendar days of admission.
70.15    (d) Individuals under 65 years of age who are admitted to a nursing facility
70.16without preadmission screening according to the exemption described in subdivision 4b,
70.17paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
70.18a face-to-face assessment within 40 days of admission.
70.19    (e) (d) At the face-to-face assessment, the long-term care consultation team member
70.20or county case manager must perform the activities required under subdivision 3b.
70.21    (f) (e) For individuals under 21 years of age, a screening interview which
70.22recommends nursing facility admission must be face-to-face and approved by the
70.23commissioner before the individual is admitted to the nursing facility.
70.24    (g) (f) In the event that an individual under 65 years of age is admitted to a nursing
70.25facility on an emergency basis, the county Senior LinkAge Line must be notified of
70.26the admission on the next working day, and a face-to-face assessment as described in
70.27paragraph (c) must be conducted within 40 calendar days of admission.
70.28    (h) (g) At the face-to-face assessment, the long-term care consultation team member
70.29or the case manager must present information about home and community-based options,
70.30including consumer-directed options, so the individual can make informed choices. If the
70.31individual chooses home and community-based services, the long-term care consultation
70.32team member or case manager must complete a written relocation plan within 20 working
70.33days of the visit. The plan shall describe the services needed to move out of the facility
70.34and a time line for the move which is designed to ensure a smooth transition to the
70.35individual's home and community.
71.1    (i) (h) An individual under 65 years of age residing in a nursing facility shall receive
71.2a face-to-face assessment at least every 12 months to review the person's service choices
71.3and available alternatives unless the individual indicates, in writing, that annual visits are
71.4not desired. In this case, the individual must receive a face-to-face assessment at least
71.5once every 36 months for the same purposes.
71.6    (j) (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay
71.7county agencies directly for face-to-face assessments for individuals under 65 years of age
71.8who are being considered for placement or residing in a nursing facility.
71.9(j) Funding for preadmission screening follow-up shall be provided to the Disability
71.10Linkage Line for the under 60 population by the Department of Human Services to
71.11cover options counseling salaries and expenses to provide the services described in
71.12subdivisions 7a to 7c. The Disability Linkage Line shall employ, or contract with other
71.13agencies to employ, within the limits of available funding, sufficient personnel to provide
71.14preadmission screening follow-up services and shall seek to maximize federal funding for
71.15the service as provided under section 256.01, subdivision 2, paragraph (dd).
71.16EFFECTIVE DATE.This section is effective October 1, 2013.

71.17    Sec. 21. Minnesota Statutes 2012, section 256B.0911, is amended by adding a
71.18subdivision to read:
71.19    Subd. 4e. Determination of institutional level of care. The determination of the
71.20need for nursing facility, hospital, and intermediate care facility levels of care must be
71.21made according to criteria developed by the commissioner, and in section 256B.092,
71.22using forms developed by the commissioner. Effective January 1, 2014, for individuals
71.23age 21 and older, the determination of need for nursing facility level of care shall be
71.24based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the
71.25determination of the need for nursing facility level of care must be made according to
71.26criteria developed by the commissioner until criteria in section 144.0724, subdivision 11,
71.27becomes effective on or after October 1, 2019.

71.28    Sec. 22. Minnesota Statutes 2012, section 256B.0911, subdivision 6, is amended to read:
71.29    Subd. 6. Payment for long-term care consultation services. (a) Until September
71.3030, 2013, payment for long-term care consultation face-to-face assessment shall be made
71.31as described in this subdivision.
71.32    (b) The total payment for each county must be paid monthly by certified nursing
71.33facilities in the county. The monthly amount to be paid by each nursing facility for each
71.34fiscal year must be determined by dividing the county's annual allocation for long-term
72.1care consultation services by 12 to determine the monthly payment and allocating the
72.2monthly payment to each nursing facility based on the number of licensed beds in the
72.3nursing facility. Payments to counties in which there is no certified nursing facility must be
72.4made by increasing the payment rate of the two facilities located nearest to the county seat.
72.5    (b) (c) The commissioner shall include the total annual payment determined under
72.6paragraph (a) for each nursing facility reimbursed under section 256B.431, 256B.434,
72.7or 256B.441.
72.8    (c) (d) In the event of the layaway, delicensure and decertification, or removal
72.9from layaway of 25 percent or more of the beds in a facility, the commissioner may
72.10adjust the per diem payment amount in paragraph (b) (c) and may adjust the monthly
72.11payment amount in paragraph (a) (b). The effective date of an adjustment made under this
72.12paragraph shall be on or after the first day of the month following the effective date of the
72.13layaway, delicensure and decertification, or removal from layaway.
72.14    (d) (e) Payments for long-term care consultation services are available to the county
72.15or counties to cover staff salaries and expenses to provide the services described in
72.16subdivision 1a. The county shall employ, or contract with other agencies to employ,
72.17within the limits of available funding, sufficient personnel to provide long-term care
72.18consultation services while meeting the state's long-term care outcomes and objectives as
72.19defined in subdivision 1. The county shall be accountable for meeting local objectives
72.20as approved by the commissioner in the biennial home and community-based services
72.21quality assurance plan on a form provided by the commissioner.
72.22    (e) (f) Notwithstanding section 256B.0641, overpayments attributable to payment
72.23of the screening costs under the medical assistance program may not be recovered from
72.24a facility.
72.25    (f) (g) The commissioner of human services shall amend the Minnesota medical
72.26assistance plan to include reimbursement for the local consultation teams.
72.27    (g) (h) Until the alternative payment methodology in paragraph (h) (i) is implemented,
72.28the county may bill, as case management services, assessments, support planning, and
72.29follow-along provided to persons determined to be eligible for case management under
72.30Minnesota health care programs. No individual or family member shall be charged for an
72.31initial assessment or initial support plan development provided under subdivision 3a or 3b.
72.32(h) (i) The commissioner shall develop an alternative payment methodology,
72.33effective on October 1, 2013, for long-term care consultation services that includes
72.34the funding available under this subdivision, and for assessments authorized under
72.35sections 256B.092 and 256B.0659. In developing the new payment methodology, the
72.36commissioner shall consider the maximization of other funding sources, including federal
73.1administrative reimbursement through federal financial participation funding, for all
73.2long-term care consultation and preadmission screening activity. The alternative payment
73.3methodology shall include the use of the appropriate time studies and the state financing
73.4of nonfederal share as part of the state's medical assistance program.

73.5    Sec. 23. Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:
73.6    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance
73.7reimbursement for nursing facilities shall be authorized for a medical assistance recipient
73.8only if a preadmission screening has been conducted prior to admission or the county has
73.9authorized an exemption. Medical assistance reimbursement for nursing facilities shall
73.10not be provided for any recipient who the local screener has determined does not meet the
73.11level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
73.12if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
73.13Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
73.14mental illness is approved by the local mental health authority or an admission for a
73.15recipient with developmental disability is approved by the state developmental disability
73.16authority.
73.17    (b) The nursing facility must not bill a person who is not a medical assistance
73.18recipient for resident days that preceded the date of completion of screening activities
73.19as required under section 256.975, subdivisions 4a, 4b, and 4c 7a to 7c. The nursing
73.20facility must include unreimbursed resident days in the nursing facility resident day totals
73.21reported to the commissioner.

73.22    Sec. 24. Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:
73.23    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
73.24    (a) Funding for services under the alternative care program is available to persons who
73.25meet the following criteria:
73.26    (1) the person has been determined by a community assessment under section
73.27256B.0911 to be a person who would require the level of care provided in a nursing
73.28facility, as determined under section 256B.0911, subdivision 4a, paragraph (d) 4e, but for
73.29the provision of services under the alternative care program;
73.30    (2) the person is age 65 or older;
73.31    (3) the person would be eligible for medical assistance within 135 days of admission
73.32to a nursing facility;
74.1    (4) the person is not ineligible for the payment of long-term care services by the
74.2medical assistance program due to an asset transfer penalty under section 256B.0595 or
74.3equity interest in the home exceeding $500,000 as stated in section 256B.056;
74.4    (5) the person needs long-term care services that are not funded through other
74.5state or federal funding, or other health insurance or other third-party insurance such as
74.6long-term care insurance;
74.7    (6) except for individuals described in clause (7), the monthly cost of the alternative
74.8care services funded by the program for this person does not exceed 75 percent of the
74.9monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
74.10does not prohibit the alternative care client from payment for additional services, but in no
74.11case may the cost of additional services purchased under this section exceed the difference
74.12between the client's monthly service limit defined under section 256B.0915, subdivision
74.133 , and the alternative care program monthly service limit defined in this paragraph. If
74.14care-related supplies and equipment or environmental modifications and adaptations are or
74.15will be purchased for an alternative care services recipient, the costs may be prorated on a
74.16monthly basis for up to 12 consecutive months beginning with the month of purchase.
74.17If the monthly cost of a recipient's other alternative care services exceeds the monthly
74.18limit established in this paragraph, the annual cost of the alternative care services shall be
74.19determined. In this event, the annual cost of alternative care services shall not exceed 12
74.20times the monthly limit described in this paragraph;
74.21    (7) for individuals assigned a case mix classification A as described under section
74.22256B.0915, subdivision 3a , paragraph (a), with (i) no dependencies in activities of daily
74.23living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating
74.24when the dependency score in eating is three or greater as determined by an assessment
74.25performed under section 256B.0911, the monthly cost of alternative care services funded
74.26by the program cannot exceed $593 per month for all new participants enrolled in
74.27the program on or after July 1, 2011. This monthly limit shall be applied to all other
74.28participants who meet this criteria at reassessment. This monthly limit shall be increased
74.29annually as described in section 256B.0915, subdivision 3a, paragraph (a). This monthly
74.30limit does not prohibit the alternative care client from payment for additional services, but
74.31in no case may the cost of additional services purchased exceed the difference between the
74.32client's monthly service limit defined in this clause and the limit described in clause (6)
74.33for case mix classification A; and
74.34(8) the person is making timely payments of the assessed monthly fee.
74.35A person is ineligible if payment of the fee is over 60 days past due, unless the person
74.36agrees to:
75.1    (i) the appointment of a representative payee;
75.2    (ii) automatic payment from a financial account;
75.3    (iii) the establishment of greater family involvement in the financial management of
75.4payments; or
75.5    (iv) another method acceptable to the lead agency to ensure prompt fee payments.
75.6    The lead agency may extend the client's eligibility as necessary while making
75.7arrangements to facilitate payment of past-due amounts and future premium payments.
75.8Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
75.9reinstated for a period of 30 days.
75.10    (b) Alternative care funding under this subdivision is not available for a person who
75.11is a medical assistance recipient or who would be eligible for medical assistance without a
75.12spenddown or waiver obligation. A person whose initial application for medical assistance
75.13and the elderly waiver program is being processed may be served under the alternative care
75.14program for a period up to 60 days. If the individual is found to be eligible for medical
75.15assistance, medical assistance must be billed for services payable under the federally
75.16approved elderly waiver plan and delivered from the date the individual was found eligible
75.17for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
75.18care funds may not be used to pay for any service the cost of which: (i) is payable by
75.19medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to
75.20pay a medical assistance income spenddown for a person who is eligible to participate in the
75.21federally approved elderly waiver program under the special income standard provision.
75.22    (c) Alternative care funding is not available for a person who resides in a licensed
75.23nursing home, certified boarding care home, hospital, or intermediate care facility, except
75.24for case management services which are provided in support of the discharge planning
75.25process for a nursing home resident or certified boarding care home resident to assist with
75.26a relocation process to a community-based setting.
75.27    (d) Alternative care funding is not available for a person whose income is greater
75.28than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
75.29to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
75.30year for which alternative care eligibility is determined, who would be eligible for the
75.31elderly waiver with a waiver obligation.

75.32    Sec. 25. Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:
75.33    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
75.34shall receive an initial assessment of strengths, informal supports, and need for services
75.35in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
76.1client served under the elderly waiver must be conducted at least every 12 months and at
76.2other times when the case manager determines that there has been significant change in
76.3the client's functioning. This may include instances where the client is discharged from
76.4the hospital. There must be a determination that the client requires nursing facility level
76.5of care as defined in section 256B.0911, subdivision 4a, paragraph (d) 4e, at initial and
76.6subsequent assessments to initiate and maintain participation in the waiver program.
76.7(b) Regardless of other assessments identified in section 144.0724, subdivision
76.84, as appropriate to determine nursing facility level of care for purposes of medical
76.9assistance payment for nursing facility services, only face-to-face assessments conducted
76.10according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
76.11level of care determination will be accepted for purposes of initial and ongoing access to
76.12waiver service payment.

76.13    Sec. 26. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
76.14subdivision to read:
76.15    Subd. 1a. Home and community-based services for older adults. (a) The purpose
76.16of projects selected by the commissioner of human services under this section is to
76.17make strategic changes in the long-term services and supports system for older adults
76.18including statewide capacity for local service development and technical assistance, and
76.19statewide availability of home and community-based services for older adult services,
76.20caregiver support and respite care services, and other supports in the state of Minnesota.
76.21These projects are intended to create incentives for new and expanded home and
76.22community-based services in Minnesota in order to:
76.23(1) reach older adults early in the progression of their need for long-term services
76.24and supports, providing them with low-cost, high-impact services that will prevent or
76.25delay the use of more costly services;
76.26(2) support older adults to live in the most integrated, least restrictive community
76.27setting;
76.28(3) support the informal caregivers of older adults;
76.29(4) develop and implement strategies to integrate long-term services and supports
76.30with health care services, in order to improve the quality of care and enhance the quality
76.31of life of older adults and their informal caregivers;
76.32(5) ensure cost-effective use of financial and human resources;
76.33(6) build community-based approaches and community commitment to delivering
76.34long-term services and supports for older adults in their own homes;
77.1(7) achieve a broad awareness and use of lower-cost in-home services as an
77.2alternative to nursing homes and other residential services;
77.3(8) strengthen and develop additional home and community-based services and
77.4alternatives to nursing homes and other residential services; and
77.5(9) strengthen programs that use volunteers.
77.6(b) The services provided by these projects are available to older adults who are
77.7eligible for medical assistance and the elderly waiver under section 256B.0915, the
77.8alternative care program under section 256B.0913, or essential community supports grant
77.9under subdivision 14, paragraph (b), and to persons who have their own funds to pay for
77.10services.

77.11    Sec. 27. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
77.12subdivision to read:
77.13    Subd. 1b. Definitions. (a) For purposes of this section, the following terms have
77.14the meanings given.
77.15(b) "Community" means a town; township; city; or targeted neighborhood within a
77.16city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.
77.17(c) "Core home and community-based services provider" means a Faith in Action,
77.18Living at Home Block Nurse, Congregational Nurse, or similar community-based
77.19program governed by a board, the majority of whose members reside within the program's
77.20service area, that organizes and uses volunteers and paid staff to deliver nonmedical
77.21services intended to assist older adults to identify and manage risks and to maintain their
77.22community living and integration in the community.
77.23(d) "Eldercare development partnership" means a team of representatives of county
77.24social service and public health agencies, the area agency on aging, local nursing home
77.25providers, local home care providers, and other appropriate home and community-based
77.26providers in the area agency's planning and service area.
77.27(e) "Long-term services and supports" means any service available under the
77.28elderly waiver program or alternative care grant programs, nursing facility services,
77.29transportation services, caregiver support and respite care services, and other home and
77.30community-based services identified as necessary either to maintain lifestyle choices for
77.31older adults or to support them to remain in their own home.
77.32(f) "Older adult" refers to an individual who is 65 years of age or older.

77.33    Sec. 28. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
77.34subdivision to read:
78.1    Subd. 1c. Eldercare development partnerships. The commissioner of human
78.2services shall select and contract with eldercare development partnerships sufficient to
78.3provide statewide availability of service development and technical assistance using a
78.4request for proposals process. Eldercare development partnerships shall:
78.5(1) develop a local long-term services and supports strategy consistent with state
78.6goals and objectives;
78.7(2) identify and use existing local skills, knowledge, and relationships, and build
78.8on these assets;
78.9(3) coordinate planning for funds to provide services to older adults, including funds
78.10received under Title III of the Older Americans Act, Title XX of the Social Security Act,
78.11and the Local Public Health Act;
78.12(4) target service development and technical assistance where nursing facility
78.13closures have occurred or are occurring or in areas where service needs have been
78.14identified through activities under section 144A.351;
78.15(5) provide sufficient staff for development and technical support in its designated
78.16area; and
78.17(6) designate a single public or nonprofit member of the eldercare development
78.18partnerships to apply grant funding and manage the project.

78.19    Sec. 29. Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:
78.20    Subd. 6. Caregiver support and respite care projects. (a) The commissioner
78.21shall establish up to 36 projects to expand the respite care network in the state and to
78.22support caregivers in their responsibilities for care. The purpose of each project shall
78.23be to availability of caregiver support and respite care services for family and other
78.24caregivers. The commissioner shall use a request for proposals to select nonprofit entities
78.25to administer the projects. Projects shall:
78.26(1) establish a local coordinated network of volunteer and paid respite workers;
78.27(2) coordinate assignment of respite workers care services to clients and care
78.28receivers and assure the health and safety of the client; and caregivers of older adults;
78.29(3) provide training for caregivers and ensure that support groups are available
78.30in the community.
78.31(b) The caregiver support and respite care funds shall be available to the four to six
78.32local long-term care strategy projects designated in subdivisions 1 to 5.
78.33(c) The commissioner shall publish a notice in the State Register to solicit proposals
78.34from public or private nonprofit agencies for the projects not included in the four to six
78.35local long-term care strategy projects defined in subdivision 2. A county agency may,
79.1alone or in combination with other county agencies, apply for caregiver support and
79.2respite care project funds. A public or nonprofit agency within a designated SAIL project
79.3area may apply for project funds if the agency has a letter of agreement with the county
79.4or counties in which services will be developed, stating the intention of the county or
79.5counties to coordinate their activities with the agency requesting a grant.
79.6(d) The commissioner shall select grantees based on the following criteria:
79.7(1) the ability of the proposal to demonstrate need in the area served, as evidenced
79.8by a community needs assessment or other demographic data;
79.9(2) the ability of the proposal to clearly describe how the project
79.10(3) assure the health and safety of the older adults;
79.11(4) identify at-risk caregivers;
79.12(5) provide information, education, and training for caregivers in the designated
79.13community; and
79.14(6) demonstrate the need in the proposed service area particularly where nursing
79.15facility closures have occurred or are occurring or areas with service needs identified
79.16by section 144A.351. Preference must be given for projects that reach underserved
79.17populations.
79.18(b) Projects must clearly describe:
79.19(1) how they will achieve the their purpose defined in paragraph (b);
79.20(3) the ability of the proposal to reach underserved populations;
79.21(4) the ability of the proposal to demonstrate community commitment to the project,
79.22as evidenced by letters of support and cooperation as well as formation of a community
79.23task force;
79.24(5) the ability of the proposal to clearly describe (2) the process for recruiting,
79.25training, and retraining volunteers; and
79.26(6) the inclusion in the proposal of the (3) a plan to promote the project in the
79.27designated community, including outreach to persons needing the services.
79.28(e) (c) Funds for all projects under this subdivision may be used to:
79.29(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
79.30care services and assign workers to clients;
79.31(2) recruit and train volunteer providers;
79.32(3) train provide information, training, and education to caregivers;
79.33(4) ensure the development of support groups for caregivers;
79.34(5) (4) advertise the availability of the caregiver support and respite care project; and
79.35(6) (5) purchase equipment to maintain a system of assigning workers to clients.
79.36(f) (d) Project funds may not be used to supplant existing funding sources.

80.1    Sec. 30. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
80.2subdivision to read:
80.3    Subd. 7a. Core home and community-based services. The commissioner shall
80.4select and contract with core home and community-based services providers for projects
80.5to provide services and supports to older adults both with and without family and other
80.6informal caregivers using a request for proposals process. Projects must:
80.7(1) have a credible, public, or private nonprofit sponsor providing ongoing financial
80.8support;
80.9(2) have a specific, clearly defined geographic service area;
80.10(3) use a practice framework designed to identify high-risk older adults and help them
80.11take action to better manage their chronic conditions and maintain their community living;
80.12(4) have a team approach to coordination and care, ensuring that the older adult
80.13participants, their families, and the formal and informal providers are all part of planning
80.14and providing services;
80.15(5) provide information, support services, homemaking services, counseling, and
80.16training for the older adults and family caregivers;
80.17(6) encourage service area or neighborhood residents and local organizations to
80.18collaborate in meeting the needs of older adults in their geographic service areas;
80.19(7) recruit, train, and direct the use of volunteers to provide informal services and
80.20other appropriate support to older adults and their caregivers; and
80.21(8) provide coordination and management of formal and informal services to older
80.22adults and their families using less expensive alternatives.

80.23    Sec. 31. Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to
80.24read:
80.25    Subd. 13. Community service grants. The commissioner shall award contracts
80.26for grants to public and private nonprofit agencies to establish services that strengthen
80.27a community's ability to provide a system of home and community-based services
80.28for elderly persons. The commissioner shall use a request for proposal process. The
80.29commissioner shall give preference when awarding grants under this section to areas
80.30where nursing facility closures have occurred or are occurring or to areas with service
80.31needs identified under section 144A.351. The commissioner shall consider grants for:
80.32(1) caregiver support and respite care projects under subdivision 6;
80.33(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and
80.34(3) services identified as needed for community transition.

81.1    Sec. 32. Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:
81.2    Subd. 3. Consumer surveys of nursing facilities residents. Following
81.3identification of the quality measurement tool, the commissioners shall conduct surveys
81.4of long-term care service consumers of nursing facilities to develop quality profiles
81.5of providers. To the extent possible, surveys must be conducted face-to-face by state
81.6employees or contractors. At the discretion of the commissioners, surveys may be
81.7conducted by telephone or by provider staff. Surveys must be conducted periodically to
81.8update quality profiles of individual service nursing facilities providers.

81.9    Sec. 33. Minnesota Statutes 2012, section 256B.439, is amended by adding a
81.10subdivision to read:
81.11    Subd. 3a. Home and community-based services report card in cooperation with
81.12the commissioner of health. The commissioner shall work with existing Department
81.13of Human Services advisory groups to develop recommendations for a home and
81.14community-based services report card. Health and human services staff that regulate
81.15home and community-based services as provided in chapter 245D and licensed home care
81.16as provided in chapter 144A shall be consulted. The advisory groups shall consider the
81.17requirements from the Minnesota consumer information guide under section 144G.06 as a
81.18base for development of the home and community-based services report card to compare
81.19the housing options available to consumers. Other items to be considered by the advisory
81.20groups in developing recommendations include:
81.21(1) defining the goals of the report card, including measuring outcomes, providing
81.22consumer information, and defining vehicle-for-pay performance;
81.23(2) developing separate measures for programs for the elderly population and for
81.24persons with disabilities;
81.25(3) the sources of information needed that are standardized and contain sufficient data;
81.26(4) the financial support needed for creating and publicizing the housing information
81.27guide, and ongoing funding for data collection and staffing to monitor, report, and analyze;
81.28(5) a recognition that home and community-based services settings exist with
81.29significant variations in size, settings, and services available;
81.30(6) ensuring that consumer choice and consumer information is retained and valued;
81.31(7) the applicability of these measures to providers based on payor source, size,
81.32and population served; and
81.33(8) dissemination of quality profiles.
81.34The advisory groups shall discuss whether there are additional funding, resources,
81.35and research needed. The commissioner shall report recommendations to the chairs and
82.1ranking minority members of the legislative committees and divisions with jurisdiction
82.2over health and human services issues by August 1, 2014. The report card shall be
82.3available on July 1, 2015.

82.4    Sec. 34. Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:
82.5    Subd. 4. Dissemination of quality profiles. By July 1, 2003 2014, the
82.6commissioners shall implement a system public awareness effort to disseminate the quality
82.7profiles developed from consumer surveys using the quality measurement tool. Profiles
82.8may be disseminated to through the Senior LinkAge Line and Disability Linkage Line and
82.9to consumers, providers, and purchasers of long-term care services through all feasible
82.10printed and electronic outlets. The commissioners may conduct a public awareness
82.11campaign to inform potential users regarding profile contents and potential uses.

82.12    Sec. 35. Minnesota Statutes 2012, section 256B.441, subdivision 13, is amended to read:
82.13    Subd. 13. External fixed costs. "External fixed costs" means costs related to the
82.14nursing home surcharge under section 256.9657, subdivision 1; licensure fees under
82.15section 144.122; until September 30, 2013, long-term care consultation fees under
82.16section 256B.0911, subdivision 6; family advisory council fee under section 144A.33;
82.17scholarships under section 256B.431, subdivision 36; planned closure rate adjustments
82.18under section 256B.437; or single bed room incentives under section 256B.431,
82.19subdivision 42 ; property taxes and property insurance; and PERA.

82.20    Sec. 36. Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:
82.21    Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
82.22shall calculate a payment rate for external fixed costs.
82.23    (a) For a facility licensed as a nursing home, the portion related to section 256.9657
82.24shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
82.25home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
82.26result of its number of nursing home beds divided by its total number of licensed beds.
82.27    (b) The portion related to the licensure fee under section 144.122, paragraph (d),
82.28shall be the amount of the fee divided by actual resident days.
82.29    (c) The portion related to scholarships shall be determined under section 256B.431,
82.30subdivision 36.
82.31    (d) Until September 30, 2013, the portion related to long-term care consultation shall
82.32be determined according to section 256B.0911, subdivision 6.
83.1    (e) The portion related to development and education of resident and family advisory
83.2councils under section 144A.33 shall be $5 divided by 365.
83.3    (f) The portion related to planned closure rate adjustments shall be as determined
83.4under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.
83.5Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
83.6be included in the payment rate for external fixed costs beginning October 1, 2016.
83.7Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
83.8longer be included in the payment rate for external fixed costs beginning on October 1 of
83.9the first year not less than two years after their effective date.
83.10    (g) The portions related to property insurance, real estate taxes, special assessments,
83.11and payments made in lieu of real estate taxes directly identified or allocated to the nursing
83.12facility shall be the actual amounts divided by actual resident days.
83.13    (h) The portion related to the Public Employees Retirement Association shall be
83.14actual costs divided by resident days.
83.15    (i) The single bed room incentives shall be as determined under section 256B.431,
83.16subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
83.17no longer be included in the payment rate for external fixed costs beginning October 1,
83.182016. Single bed room incentives that take effect on or after October 1, 2014, shall no
83.19longer be included in the payment rate for external fixed costs beginning on October 1 of
83.20the first year not less than two years after their effective date.
83.21    (j) The payment rate for external fixed costs shall be the sum of the amounts in
83.22paragraphs (a) to (i).

83.23    Sec. 37. Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:
83.24    Subd. 12. Informed choice. Persons who are determined likely to require the level
83.25of care provided in a nursing facility as determined under section 256B.0911, subdivision
83.264e, or a hospital shall be informed of the home and community-based support alternatives
83.27to the provision of inpatient hospital services or nursing facility services. Each person
83.28must be given the choice of either institutional or home and community-based services
83.29using the provisions described in section 256B.77, subdivision 2, paragraph (p).

83.30    Sec. 38. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
83.31    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
83.32shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
83.33With the permission of the recipient or the recipient's designated legal representative,
83.34the recipient's current provider of services may submit a written report outlining their
84.1recommendations regarding the recipient's care needs prepared by a direct service
84.2employee with at least 20 hours of service to that client. The person conducting the
84.3assessment or reassessment must notify the provider of the date by which this information
84.4is to be submitted. This information shall be provided to the person conducting the
84.5assessment and the person or the person's legal representative and must be considered
84.6prior to the finalization of the assessment or reassessment.
84.7(b) There must be a determination that the client requires a hospital level of care or a
84.8nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
84.9(d) 4e, at initial and subsequent assessments to initiate and maintain participation in the
84.10waiver program.
84.11(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
84.12appropriate to determine nursing facility level of care for purposes of medical assistance
84.13payment for nursing facility services, only face-to-face assessments conducted according
84.14to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
84.15determination or a nursing facility level of care determination must be accepted for
84.16purposes of initial and ongoing access to waiver services payment.
84.17(d) Recipients who are found eligible for home and community-based services under
84.18this section before their 65th birthday may remain eligible for these services after their
84.1965th birthday if they continue to meet all other eligibility factors.
84.20(e) The commissioner shall develop criteria to identify recipients whose level of
84.21functioning is reasonably expected to improve and reassess these recipients to establish
84.22a baseline assessment. Recipients who meet these criteria must have a comprehensive
84.23transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
84.24reassessed every six months until there has been no significant change in the recipient's
84.25functioning for at least 12 months. After there has been no significant change in the
84.26recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
84.27informal support systems, and need for services shall be conducted at least every 12
84.28months and at other times when there has been a significant change in the recipient's
84.29functioning. Counties, case managers, and service providers are responsible for
84.30conducting these reassessments and shall complete the reassessments out of existing funds.

84.31    Sec. 39. Minnesota Statutes 2012, section 256B.69, subdivision 8, is amended to read:
84.32    Subd. 8. Preadmission screening waiver. Except as applicable to the project's
84.33operation, the provisions of section sections 256.975 and 256B.0911 are waived for the
84.34purposes of this section for recipients enrolled with demonstration providers or in the
84.35prepaid medical assistance program for seniors.

85.1    Sec. 40. Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
85.2to read:
85.3    Subd. 1o. Supplementary service rate; exemptions. A county agency shall not
85.4negotiate a supplementary service rate under this section for any individual that has been
85.5determined to be eligible for Housing Stability Services as approved by the Centers
85.6for Medicare and Medicaid Services, and who resides in an establishment voluntarily
85.7registered under section 144D.025, as a supportive housing establishment or participates
85.8in the Minnesota supportive housing demonstration program under section 256I.04,
85.9subdivision 3, paragraph (a), clause (4).

85.10    Sec. 41. Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:
85.11    Subd. 4. Reporting. (a) Except as provided in paragraph (b), a mandated reporter
85.12shall immediately make an oral report to the common entry point. The common entry
85.13point may accept electronic reports submitted through a Web-based reporting system
85.14established by the commissioner. Use of a telecommunications device for the deaf or other
85.15similar device shall be considered an oral report. The common entry point may not require
85.16written reports. To the extent possible, the report must be of sufficient content to identify
85.17the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment,
85.18any evidence of previous maltreatment, the name and address of the reporter, the time,
85.19date, and location of the incident, and any other information that the reporter believes
85.20might be helpful in investigating the suspected maltreatment. A mandated reporter may
85.21disclose not public data, as defined in section 13.02, and medical records under sections
85.22144.291 to 144.298, to the extent necessary to comply with this subdivision.
85.23(b) A boarding care home that is licensed under sections 144.50 to 144.58 and
85.24certified under Title 19 of the Social Security Act, a nursing home that is licensed under
85.25section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a
85.26hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under
85.27Code of Federal Regulations, title 42, section 482.66, may submit a report electronically
85.28to the common entry point instead of submitting an oral report. The report may be a
85.29duplicate of the initial report the facility submits electronically to the commissioner of
85.30health to comply with the reporting requirements under Code of Federal Regulations, title
85.3142, section 483.13. The commissioner of health may modify these reporting requirements
85.32to include items required under paragraph (a) that are not currently included in the
85.33electronic reporting form.
85.34EFFECTIVE DATE.This section is effective July 1, 2014.

86.1    Sec. 42. Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:
86.2    Subd. 9. Common entry point designation. (a) Each county board shall designate
86.3a common entry point for reports of suspected maltreatment. Two or more county boards
86.4may jointly designate a single The commissioner of human services shall establish a
86.5 common entry point effective July 1, 2014. The common entry point is the unit responsible
86.6for receiving the report of suspected maltreatment under this section.
86.7(b) The common entry point must be available 24 hours per day to take calls from
86.8reporters of suspected maltreatment. The common entry point shall use a standard intake
86.9form that includes:
86.10(1) the time and date of the report;
86.11(2) the name, address, and telephone number of the person reporting;
86.12(3) the time, date, and location of the incident;
86.13(4) the names of the persons involved, including but not limited to, perpetrators,
86.14alleged victims, and witnesses;
86.15(5) whether there was a risk of imminent danger to the alleged victim;
86.16(6) a description of the suspected maltreatment;
86.17(7) the disability, if any, of the alleged victim;
86.18(8) the relationship of the alleged perpetrator to the alleged victim;
86.19(9) whether a facility was involved and, if so, which agency licenses the facility;
86.20(10) any action taken by the common entry point;
86.21(11) whether law enforcement has been notified;
86.22(12) whether the reporter wishes to receive notification of the initial and final
86.23reports; and
86.24(13) if the report is from a facility with an internal reporting procedure, the name,
86.25mailing address, and telephone number of the person who initiated the report internally.
86.26(c) The common entry point is not required to complete each item on the form prior
86.27to dispatching the report to the appropriate lead investigative agency.
86.28(d) The common entry point shall immediately report to a law enforcement agency
86.29any incident in which there is reason to believe a crime has been committed.
86.30(e) If a report is initially made to a law enforcement agency or a lead investigative
86.31agency, those agencies shall take the report on the appropriate common entry point intake
86.32forms and immediately forward a copy to the common entry point.
86.33(f) The common entry point staff must receive training on how to screen and
86.34dispatch reports efficiently and in accordance with this section.
86.35(g) The commissioner of human services shall maintain a centralized database
86.36for the collection of common entry point data, lead investigative agency data including
87.1maltreatment report disposition, and appeals data. The common entry point shall
87.2have access to the centralized database and must log the reports into the database and
87.3immediately identify and locate prior reports of abuse, neglect, or exploitation.
87.4(h) When appropriate, the common entry point staff must refer calls that do not
87.5allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations
87.6that might resolve the reporter's concerns.
87.7(i) a common entry point must be operated in a manner that enables the
87.8commissioner of human services to:
87.9(1) track critical steps in the reporting, evaluation, referral, response, disposition,
87.10and investigative process to ensure compliance with all requirements for all reports;
87.11(2) maintain data to facilitate the production of aggregate statistical reports for
87.12monitoring patterns of abuse, neglect, or exploitation;
87.13(3) serve as a resource for the evaluation, management, and planning of preventative
87.14and remedial services for vulnerable adults who have been subject to abuse, neglect,
87.15or exploitation;
87.16(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
87.17of the common entry point; and
87.18(5) track and manage consumer complaints related to the common entry point.
87.19(j) The commissioners of human services and health shall collaborate on the
87.20creation of a system for referring reports to the lead investigative agencies. This system
87.21shall enable the commissioner of human services to track critical steps in the reporting,
87.22evaluation, referral, response, disposition, investigation, notification, determination, and
87.23appeal processes.

87.24    Sec. 43. Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:
87.25    Subd. 9e. Education requirements. (a) The commissioners of health, human
87.26services, and public safety shall cooperate in the development of a joint program for
87.27education of lead investigative agency investigators in the appropriate techniques for
87.28investigation of complaints of maltreatment. This program must be developed by July
87.291, 1996. The program must include but need not be limited to the following areas: (1)
87.30information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
87.31conclusions based on evidence; (5) interviewing skills, including specialized training to
87.32interview people with unique needs; (6) report writing; (7) coordination and referral
87.33to other necessary agencies such as law enforcement and judicial agencies; (8) human
87.34relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
87.35systems and the appropriate methods for interviewing relatives in the course of the
88.1assessment or investigation; (10) the protective social services that are available to protect
88.2alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
88.3which lead investigative agency investigators and law enforcement workers cooperate in
88.4conducting assessments and investigations in order to avoid duplication of efforts; and
88.5(12) data practices laws and procedures, including provisions for sharing data.
88.6(b) The commissioner of human services shall conduct an outreach campaign to
88.7promote the common entry point for reporting vulnerable adult maltreatment. This
88.8campaign shall use the Internet and other means of communication.
88.9(b) (c) The commissioners of health, human services, and public safety shall offer at
88.10least annual education to others on the requirements of this section, on how this section is
88.11implemented, and investigation techniques.
88.12(c) (d) The commissioner of human services, in coordination with the commissioner
88.13of public safety shall provide training for the common entry point staff as required in this
88.14subdivision and the program courses described in this subdivision, at least four times
88.15per year. At a minimum, the training shall be held twice annually in the seven-county
88.16metropolitan area and twice annually outside the seven-county metropolitan area. The
88.17commissioners shall give priority in the program areas cited in paragraph (a) to persons
88.18currently performing assessments and investigations pursuant to this section.
88.19(d) (e) The commissioner of public safety shall notify in writing law enforcement
88.20personnel of any new requirements under this section. The commissioner of public
88.21safety shall conduct regional training for law enforcement personnel regarding their
88.22responsibility under this section.
88.23(e) (f) Each lead investigative agency investigator must complete the education
88.24program specified by this subdivision within the first 12 months of work as a lead
88.25investigative agency investigator.
88.26A lead investigative agency investigator employed when these requirements take
88.27effect must complete the program within the first year after training is available or as soon
88.28as training is available.
88.29All lead investigative agency investigators having responsibility for investigation
88.30duties under this section must receive a minimum of eight hours of continuing education
88.31or in-service training each year specific to their duties under this section.

88.32    Sec. 44. FEDERAL APPROVAL.
88.33This article is contingent on federal approval.

88.34    Sec. 45. REPEALER.
89.1(a) Minnesota Statutes 2012, sections 245A.655; and 256B.0917, subdivisions 1, 2,
89.23, 4, 5, 7, 8, 9, 10, 11, and 12, are repealed.
89.3(b) Minnesota Statutes 2012, section 256B.0911, subdivisions 4a, 4b, and 4c, are
89.4repealed effective October 1, 2013.


89.8    Section 1. Minnesota Statutes 2012, section 119B.011, is amended by adding a
89.9subdivision to read:
89.10    Subd. 19b. Student parent. "Student parent" means a person who is:
89.11(1) under 21 years of age and has a child;
89.12(2) pursuing a high school or general equivalency diploma;
89.13(3) residing within a county that has a basic sliding fee waiting list under section
89.14119B.03, subdivision 4; and
89.15(4) not an MFIP participant.
89.16EFFECTIVE DATE.This section is effective November 11, 2013.

89.17    Sec. 2. Minnesota Statutes 2012, section 119B.02, is amended by adding a subdivision
89.18to read:
89.19    Subd. 7. Child care market rate survey. Biennially, the commissioner shall survey
89.20prices charged by child care providers in Minnesota to determine the 75th percentile for
89.21like-care arrangements in county price clusters.
89.22EFFECTIVE DATE.This section is effective February 3, 2014.

89.23    Sec. 3. Minnesota Statutes 2012, section 119B.025, subdivision 1, is amended to read:
89.24    Subdivision 1. Factors which must be verified. (a) The county shall verify the
89.25following at all initial child care applications using the universal application:
89.26(1) identity of adults;
89.27(2) presence of the minor child in the home, if questionable;
89.28(3) relationship of minor child to the parent, stepparent, legal guardian, eligible
89.29relative caretaker, or the spouses of any of the foregoing;
89.30(4) age;
89.31(5) immigration status, if related to eligibility;
89.32(6) Social Security number, if given;
90.1(7) income;
90.2(8) spousal support and child support payments made to persons outside the
90.3household;
90.4(9) residence; and
90.5(10) inconsistent information, if related to eligibility.
90.6(b) If a family did not use the universal application or child care addendum to apply
90.7for child care assistance, the family must complete the universal application or child care
90.8addendum at its next eligibility redetermination and the county must verify the factors
90.9listed in paragraph (a) as part of that redetermination. Once a family has completed a
90.10universal application or child care addendum, the county shall use the redetermination
90.11form described in paragraph (c) for that family's subsequent redeterminations. Eligibility
90.12must be redetermined at least every six months. A family is considered to have met the
90.13eligibility redetermination requirement if a complete redetermination form and all required
90.14verifications are received within 30 days after the date the form was due. Assistance shall
90.15be payable retroactively from the redetermination due date. For a family where at least
90.16one parent is under the age of 21, does not have a high school or general equivalency
90.17diploma, and is a student in a school district or another similar program that provides or
90.18arranges for child care, as well as parenting, social services, career and employment
90.19supports, and academic support to achieve high school graduation, the redetermination of
90.20eligibility shall be deferred beyond six months, but not to exceed 12 months, to the end of
90.21the student's school year. If a family reports a change in an eligibility factor before the
90.22family's next regularly scheduled redetermination, the county must recalculate eligibility
90.23without requiring verification of any eligibility factor that did not change.
90.24(c) The commissioner shall develop a redetermination form to redetermine eligibility
90.25and a change report form to report changes that minimize paperwork for the county and
90.26the participant.
90.27EFFECTIVE DATE.This section is effective August 4, 2014.

90.28    Sec. 4. Minnesota Statutes 2012, section 119B.03, subdivision 4, is amended to read:
90.29    Subd. 4. Funding priority. (a) First priority for child care assistance under the
90.30basic sliding fee program must be given to eligible non-MFIP families who do not have a
90.31high school or general equivalency diploma or who need remedial and basic skill courses
90.32in order to pursue employment or to pursue education leading to employment and who
90.33need child care assistance to participate in the education program. This includes student
90.34parents as defined under section 119B.011, subdivision 19b. Within this priority, the
90.35following subpriorities must be used:
91.1(1) child care needs of minor parents;
91.2(2) child care needs of parents under 21 years of age; and
91.3(3) child care needs of other parents within the priority group described in this
91.4paragraph.
91.5(b) Second priority must be given to parents who have completed their MFIP or
91.6DWP transition year, or parents who are no longer receiving or eligible for diversionary
91.7work program supports.
91.8(c) Third priority must be given to families who are eligible for portable basic sliding
91.9fee assistance through the portability pool under subdivision 9.
91.10(d) Fourth priority must be given to families in which at least one parent is a veteran
91.11as defined under section 197.447.
91.12(e) Families under paragraph (b) must be added to the basic sliding fee waiting list
91.13on the date they begin the transition year under section 119B.011, subdivision 20, and
91.14must be moved into the basic sliding fee program as soon as possible after they complete
91.15their transition year.
91.16EFFECTIVE DATE.This section is effective November 11, 2013.

91.17    Sec. 5. Minnesota Statutes 2012, section 119B.05, subdivision 1, is amended to read:
91.18    Subdivision 1. Eligible participants. Families eligible for child care assistance
91.19under the MFIP child care program are:
91.20    (1) MFIP participants who are employed or in job search and meet the requirements
91.21of section 119B.10;
91.22    (2) persons who are members of transition year families under section 119B.011,
91.23subdivision 20 , and meet the requirements of section 119B.10;
91.24    (3) families who are participating in employment orientation or job search, or
91.25other employment or training activities that are included in an approved employability
91.26development plan under section 256J.95;
91.27    (4) MFIP families who are participating in work job search, job support,
91.28employment, or training activities as required in their employment plan, or in appeals,
91.29hearings, assessments, or orientations according to chapter 256J;
91.30    (5) MFIP families who are participating in social services activities under chapter
91.31256J as required in their employment plan approved according to chapter 256J;
91.32    (6) families who are participating in services or activities that are included in an
91.33approved family stabilization plan under section 256J.575;
91.34    (7) families who are participating in programs as required in tribal contracts under
91.35section 119B.02, subdivision 2, or 256.01, subdivision 2; and
92.1    (8) families who are participating in the transition year extension under section
92.2119B.011, subdivision 20a; and
92.3(9) student parents as defined under section 119B.011, subdivision 19b.
92.4EFFECTIVE DATE.This section is effective November 11, 2013.

92.5    Sec. 6. Minnesota Statutes 2012, section 119B.13, subdivision 1, is amended to read:
92.6    Subdivision 1. Subsidy restrictions. (a) Beginning October 31, 2011 February 3,
92.72014, the maximum rate paid for child care assistance in any county or multicounty region
92.8 county price cluster under the child care fund shall be the rate for like-care arrangements in
92.9the county effective July 1, 2006, decreased by 2.5 percent greater of the 25th percentile of
92.10the 2011 child care provider rate survey or the maximum rate effective November 28, 2011.
92.11The commissioner may: (1) assign a county with no reported provider prices to a similar
92.12price cluster; and (2) consider county level access when determining final price clusters.
92.13    (b) Biennially, beginning in 2012, the commissioner shall survey rates charged
92.14by child care providers in Minnesota to determine the 75th percentile for like-care
92.15arrangements in counties. When the commissioner determines that, using the
92.16commissioner's established protocol, the number of providers responding to the survey is
92.17too small to determine the 75th percentile rate for like-care arrangements in a county or
92.18multicounty region, the commissioner may establish the 75th percentile maximum rate
92.19based on like-care arrangements in a county, region, or category that the commissioner
92.20deems to be similar.
92.21    (c) (b) A rate which includes a special needs rate paid under subdivision 3 or under a
92.22school readiness service agreement paid under section 119B.231, may be in excess of the
92.23maximum rate allowed under this subdivision.
92.24    (d) (c) The department shall monitor the effect of this paragraph on provider rates.
92.25The county shall pay the provider's full charges for every child in care up to the maximum
92.26established. The commissioner shall determine the maximum rate for each type of care
92.27on an hourly, full-day, and weekly basis, including special needs and disability care. The
92.28maximum payment to a provider for one day of care must not exceed the daily rate. The
92.29maximum payment to a provider for one week of care must not exceed the weekly rate.
92.30(e) (d) Child care providers receiving reimbursement under this chapter must not
92.31be paid activity fees or an additional amount above the maximum rates for care provided
92.32during nonstandard hours for families receiving assistance.
92.33    (f) (e) When the provider charge is greater than the maximum provider rate allowed,
92.34the parent is responsible for payment of the difference in the rates in addition to any
92.35family co-payment fee.
93.1    (g) (f) All maximum provider rates changes shall be implemented on the Monday
93.2following the effective date of the maximum provider rate.
93.3    (g) Notwithstanding Minnesota Rules, part 3400.0130, subpart 7, maximum
93.4registration fees in effect on January 1, 2013, shall remain in effect.

93.5    Sec. 7. Minnesota Statutes 2012, section 119B.13, subdivision 1a, is amended to read:
93.6    Subd. 1a. Legal nonlicensed family child care provider rates. (a) Legal
93.7nonlicensed family child care providers receiving reimbursement under this chapter must
93.8be paid on an hourly basis for care provided to families receiving assistance.
93.9(b) The maximum rate paid to legal nonlicensed family child care providers must be
93.1068 percent of the county maximum hourly rate for licensed family child care providers. In
93.11counties or county price clusters where the maximum hourly rate for licensed family child
93.12care providers is higher than the maximum weekly rate for those providers divided by 50,
93.13the maximum hourly rate that may be paid to legal nonlicensed family child care providers
93.14is the rate equal to the maximum weekly rate for licensed family child care providers
93.15divided by 50 and then multiplied by 0.68. The maximum payment to a provider for one
93.16day of care must not exceed the maximum hourly rate times ten. The maximum payment
93.17to a provider for one week of care must not exceed the maximum hourly rate times 50.
93.18(c) A rate which includes a special needs rate paid under subdivision 3 may be in
93.19excess of the maximum rate allowed under this subdivision.
93.20(d) Legal nonlicensed family child care providers receiving reimbursement under
93.21this chapter may not be paid registration fees for families receiving assistance.
93.22EFFECTIVE DATE.This section is effective February 3, 2014.

93.23    Sec. 8. Minnesota Statutes 2012, section 119B.13, subdivision 3a, is amended to read:
93.24    Subd. 3a. Provider rate differential for accreditation. A family child care
93.25provider or child care center shall be paid a 15 percent differential above the maximum
93.26rate established in subdivision 1, up to the actual provider rate, if the provider or center
93.27holds a current early childhood development credential or is accredited. For a family
93.28child care provider, early childhood development credential and accreditation includes
93.29an individual who has earned a child development associate degree, a child development
93.30associate credential, a diploma in child development from a Minnesota state technical
93.31college, or a bachelor's or post baccalaureate degree in early childhood education from
93.32an accredited college or university, or who is accredited by the National Association for
93.33Family Child Care or the Competency Based Training and Assessment Program. For a
93.34child care center, accreditation includes accreditation that meets the following criteria:
94.1the accrediting organization must demonstrate the use of standards that promote the
94.2physical, social, emotional, and cognitive development of children. The accreditation
94.3standards shall include, but are not limited to, positive interactions between adults and
94.4children, age-appropriate learning activities, a system of tracking children's learning,
94.5use of assessment to meet children's needs, specific qualifications for staff, a learning
94.6environment that supports developmentally appropriate experiences for children, health
94.7and safety requirements, and family engagement strategies. The commissioner of human
94.8services, in conjunction with the commissioners of education and health, will develop an
94.9application and approval process based on the criteria in this section and any additional
94.10criteria. The process developed by the commissioner of human services must address
94.11periodic reassessment of approved accreditations. The commissioner of human services
94.12must report the criteria developed, the application, approval, and reassessment processes,
94.13and any additional recommendations by February 15, 2013, to the chairs and ranking
94.14minority members of the legislative committees having jurisdiction over early childhood
94.15issues. Based on an application process developed by the commissioner in conjunction
94.16with the commissioners of education and health, the Department of Human Services must
94.17accept applications from accrediting organizations beginning on July 1, 2013, and on an
94.18annual basis thereafter. The provider rate differential shall be paid to centers holding an
94.19accreditation from an approved accrediting organization beginning on a billing cycle to be
94.20determined by the commissioner, no later than the last Monday in February of a calendar
94.21year. The commissioner shall annually publish a list of approved accrediting organizations.
94.22An approved accreditation must be reassessed by the commissioner every two years. If an
94.23approved accrediting organization is determined to no longer meet the approval criteria, the
94.24organization and centers being paid the differential under that accreditation must be given
94.25a 90-day notice by the commissioner and the differential payment must end after a 15-day
94.26notice to affected families and centers as directed in Minnesota Rules, part 3400.0185,
94.27subparts 3 and 4. The following accreditations shall be recognized for the provider rate
94.28differential until an approval process is implemented: the National Association for the
94.29Education of Young Children, the Council on Accreditation, the National Early Childhood
94.30Program Accreditation, the National School-Age Care Association, or the National Head
94.31Start Association Program of Excellence. For Montessori programs, accreditation includes
94.32the American Montessori Society, Association of Montessori International-USA, or the
94.33National Center for Montessori Education.

94.34    Sec. 9. Minnesota Statutes 2012, section 119B.13, is amended by adding a subdivision
94.35to read:
95.1    Subd. 3b. Provider rate differential for Parent Aware. A family child care
95.2provider or child care center shall be paid a 15 percent differential if they hold a three-star
95.3Parent Aware rating or a 20 percent differential if they hold a four-star Parent Aware
95.4rating. A 15 percent or 20 percent rate differential must be paid above the maximum rate
95.5established in subdivision 1, up to the actual provider rate.
95.6EFFECTIVE DATE.This section is effective March 3, 2014.

95.7    Sec. 10. Minnesota Statutes 2012, section 119B.13, is amended by adding a subdivision
95.8to read:
95.9    Subd. 3c. Weekly rate paid for children attending high-quality care. A licensed
95.10child care provider or license-exempt center may be paid up to the applicable weekly
95.11maximum rate, not to exceed the provider's actual charge, when the following conditions
95.12are met:
95.13(1) the child is age birth to five years, but not yet in kindergarten;
95.14(2) the child attends a child care provider that qualifies for the rate differential
95.15identified in subdivision 3a or 3b; and
95.16(3) the applicant's activities qualify for at least 30 hours of care per week under
95.17sections 119B.03, 119B.05, 119B.10, and Minnesota Rules, chapter 3400.
95.18EFFECTIVE DATE.This section is effective August 4, 2014.

95.19    Sec. 11. Minnesota Statutes 2012, section 119B.13, subdivision 6, is amended to read:
95.20    Subd. 6. Provider payments. (a) The provider shall bill for services provided
95.21within ten days of the end of the service period. If bills are submitted within ten days of
95.22the end of the service period, payments under the child care fund shall be made within 30
95.23days of receiving a bill from the provider. Counties or the state may establish policies that
95.24make payments on a more frequent basis.
95.25(b) If a provider has received an authorization of care and been issued a billing form
95.26for an eligible family, the bill must be submitted within 60 days of the last date of service on
95.27the bill. A bill submitted more than 60 days after the last date of service must be paid if the
95.28county determines that the provider has shown good cause why the bill was not submitted
95.29within 60 days. Good cause must be defined in the county's child care fund plan under
95.30section 119B.08, subdivision 3, and the definition of good cause must include county error.
95.31Any bill submitted more than a year after the last date of service on the bill must not be paid.
95.32(c) If a provider provided care for a time period without receiving an authorization
95.33of care and a billing form for an eligible family, payment of child care assistance may only
96.1be made retroactively for a maximum of six months from the date the provider is issued
96.2an authorization of care and billing form.
96.3(d) A county may refuse to issue a child care authorization to a licensed or legal
96.4nonlicensed provider, revoke an existing child care authorization to a licensed or legal
96.5nonlicensed provider, stop payment issued to a licensed or legal nonlicensed provider, or
96.6refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:
96.7(1) the provider admits to intentionally giving the county materially false information
96.8on the provider's billing forms;
96.9(2) a county finds by a preponderance of the evidence that the provider intentionally
96.10gave the county materially false information on the provider's billing forms;
96.11(3) the provider is in violation of child care assistance program rules, until the
96.12agency determines those violations have been corrected;
96.13    (4) the provider is operating after receipt of an order of suspension or an order
96.14of revocation of the provider's license, or the provider has been issued an order citing
96.15violations of licensing standards that affect the health and safety of children in care due to
96.16the nature, chronicity, or severity of the licensing violations, until the licensing agency
96.17determines those violations have been corrected;
96.18(5) the provider submits false attendance reports or refuses to provide documentation
96.19of the child's attendance upon request; or
96.20(6) the provider gives false child care price information.
96.21The county may withhold the provider's authorization or payment for a period of
96.22time not to exceed three months beyond the time the condition has been corrected.
96.23(e) A county's payment policies must be included in the county's child care plan
96.24under section 119B.08, subdivision 3. If payments are made by the state, in addition to
96.25being in compliance with this subdivision, the payments must be made in compliance
96.26with section 16A.124.
96.27EFFECTIVE DATE.This section is effective February 3, 2014.

96.28    Sec. 12. Minnesota Statutes 2012, section 119B.13, subdivision 7, is amended to read:
96.29    Subd. 7. Absent days. (a) Licensed child care providers and license-exempt centers
96.30must not be reimbursed for more than ten 25 full-day absent days per child, excluding
96.31holidays, in a fiscal year, or for more than ten consecutive full-day absent days. Legal
96.32nonlicensed family child care providers must not be reimbursed for absent days. If a child
96.33attends for part of the time authorized to be in care in a day, but is absent for part of the
96.34time authorized to be in care in that same day, the absent time must be reimbursed but
96.35the time must not count toward the ten absent day days limit. Child care providers must
97.1only be reimbursed for absent days if the provider has a written policy for child absences
97.2and charges all other families in care for similar absences.
97.3(b) Notwithstanding paragraph (a), children with documented medical conditions
97.4that cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
97.5full-day absent days limit. Absences due to a documented medical condition of a parent
97.6or sibling who lives in the same residence as the child receiving child care assistance
97.7do not count against the absent days limit in a fiscal year. Documentation of medical
97.8conditions must be on the forms and submitted according to the timelines established by
97.9the commissioner. A public health nurse or school nurse may verify the illness in lieu of
97.10a medical practitioner. If a provider sends a child home early due to a medical reason,
97.11including, but not limited to, fever or contagious illness, the child care center director or
97.12lead teacher may verify the illness in lieu of a medical practitioner.
97.13(b) (c) Notwithstanding paragraph (a), children in families may exceed the ten absent
97.14days limit if at least one parent: (1) is under the age of 21; (2) does not have a high school
97.15or general equivalency diploma; and (3) is a student in a school district or another similar
97.16program that provides or arranges for child care, parenting support, social services, career
97.17and employment supports, and academic support to achieve high school graduation, upon
97.18request of the program and approval of the county. If a child attends part of an authorized
97.19day, payment to the provider must be for the full amount of care authorized for that day.
97.20    (c) (d) Child care providers must be reimbursed for up to ten federal or state holidays
97.21or designated holidays per year when the provider charges all families for these days and the
97.22holiday or designated holiday falls on a day when the child is authorized to be in attendance.
97.23Parents may substitute other cultural or religious holidays for the ten recognized state and
97.24federal holidays. Holidays do not count toward the ten absent day days limit.
97.25    (d) (e) A family or child care provider must not be assessed an overpayment for an
97.26absent day payment unless (1) there was an error in the amount of care authorized for the
97.27family, (2) all of the allowed full-day absent payments for the child have been paid, or (3)
97.28the family or provider did not timely report a change as required under law.
97.29    (e) (f) The provider and family shall receive notification of the number of absent
97.30days used upon initial provider authorization for a family and ongoing notification of the
97.31number of absent days used as of the date of the notification.
97.32(g) For purposes of this subdivision, "absent days limit" means 25 full-day absent
97.33days per child, excluding holidays, in a fiscal year; and ten consecutive full-day absent days.
97.34EFFECTIVE DATE.This section is effective February 1, 2014.

97.35    Sec. 13. Minnesota Statutes 2012, section 245A.07, subdivision 2a, is amended to read:
98.1    Subd. 2a. Immediate suspension expedited hearing. (a) Within five working days
98.2of receipt of the license holder's timely appeal, the commissioner shall request assignment
98.3of an administrative law judge. The request must include a proposed date, time, and place
98.4of a hearing. A hearing must be conducted by an administrative law judge within 30
98.5calendar days of the request for assignment, unless an extension is requested by either
98.6party and granted by the administrative law judge for good cause. The commissioner shall
98.7issue a notice of hearing by certified mail or personal service at least ten working days
98.8before the hearing. The scope of the hearing shall be limited solely to the issue of whether
98.9the temporary immediate suspension should remain in effect pending the commissioner's
98.10final order under section 245A.08, regarding a licensing sanction issued under subdivision
98.113 following the immediate suspension. The burden of proof in expedited hearings under
98.12this subdivision shall be limited to the commissioner's demonstration that reasonable
98.13cause exists to believe that the license holder's actions or failure to comply with applicable
98.14law or rule poses, or if the actions of other individuals or conditions in the program
98.15poses an imminent risk of harm to the health, safety, or rights of persons served by the
98.16program. "Reasonable cause" means there exist specific articulable facts or circumstances
98.17which provide the commissioner with a reasonable suspicion that there is an imminent
98.18risk of harm to the health, safety, or rights of persons served by the program. When the
98.19commissioner has determined there is reasonable cause to order the temporary immediate
98.20suspension of a license based on a violation of safe sleep requirements, as defined in
98.21section 245A.1435, the commissioner is not required to demonstrate that an infant died or
98.22was injured as a result of the safe sleep violations.
98.23    (b) The administrative law judge shall issue findings of fact, conclusions, and a
98.24recommendation within ten working days from the date of hearing. The parties shall have
98.25ten calendar days to submit exceptions to the administrative law judge's report. The
98.26record shall close at the end of the ten-day period for submission of exceptions. The
98.27commissioner's final order shall be issued within ten working days from the close of the
98.28record. Within 90 calendar days after a final order affirming an immediate suspension, the
98.29commissioner shall make a determination regarding whether a final licensing sanction
98.30shall be issued under subdivision 3. The license holder shall continue to be prohibited
98.31from operation of the program during this 90-day period.
98.32    (c) When the final order under paragraph (b) affirms an immediate suspension, and a
98.33final licensing sanction is issued under subdivision 3 and the license holder appeals that
98.34sanction, the license holder continues to be prohibited from operation of the program
98.35pending a final commissioner's order under section 245A.08, subdivision 5, regarding the
98.36final licensing sanction.

99.1    Sec. 14. Minnesota Statutes 2012, section 245A.1435, is amended to read:
99.2245A.1435 REDUCTION OF RISK OF SUDDEN UNEXPECTED INFANT
99.3DEATH SYNDROME IN LICENSED PROGRAMS.
99.4    (a) When a license holder is placing an infant to sleep, the license holder must
99.5place the infant on the infant's back, unless the license holder has documentation from
99.6the infant's parent physician directing an alternative sleeping position for the infant. The
99.7parent physician directive must be on a form approved by the commissioner and must
99.8include a statement that the parent or legal guardian has read the information provided by
99.9the Minnesota Sudden Infant Death Center, related to the risk of SIDS and the importance
99.10of placing an infant or child on its back to sleep to reduce the risk of SIDS. remain on file
99.11at the licensed location. An infant who independently rolls onto its stomach after being
99.12placed to sleep on its back may be allowed to remain sleeping on its stomach if the infant
99.13is at least six months of age or the license holder has a signed statement from the parent
99.14indicating that the infant regularly rolls over at home.
99.15(b) The license holder must place the infant in a crib directly on a firm mattress with
99.16a fitted crib sheet that fits tightly on the mattress and overlaps the mattress so it cannot be
99.17dislodged by pulling on the corner of the sheet. The license holder must not place pillows,
99.18quilts, comforters, sheepskin, pillow-like stuffed toys, or other soft products in the crib
99.19with the infant The license holder must place the infant in a crib directly on a firm mattress
99.20with a fitted sheet that is appropriate to the mattress size, that fits tightly on the mattress,
99.21and overlaps the underside of the mattress so it cannot be dislodged by pulling on the
99.22corner of the sheet with reasonable effort. The license holder must not place anything in
99.23the crib with the infant except for the infant's pacifier, as defined in Code of Federal
99.24Regulations, title 16, part 1511. The requirements of this section apply to license holders
99.25serving infants up to and including 12 months younger than one year of age. Licensed
99.26child care providers must meet the crib requirements under section 245A.146.
99.27(c) If an infant falls asleep before being placed in a crib, the license holder must
99.28move the infant to a crib as soon as practicable, and must keep the infant within sight of
99.29the license holder until the infant is placed in a crib. When an infant falls asleep while
99.30being held, the license holder must consider the supervision needs of other children in
99.31care when determining how long to hold the infant before placing the infant in a crib to
99.32sleep. The sleeping infant must not be in a position where the airway may be blocked or
99.33with anything covering the infant's face.
99.34(d) Placing a swaddled infant down to sleep in a licensed setting is not recommended
99.35for an infant of any age and is prohibited for any infant who has begun to roll over
99.36independently. However, with the written consent of a parent or guardian according to this
100.1paragraph, a license holder may place the infant who has not yet begun to roll over on its
100.2own down to sleep in a one-piece sleeper equipped with an attached system that fastens
100.3securely only across the upper torso, with no constriction of the hips or legs, to create a
100.4swaddle. Prior to any use of swaddling for sleep by a provider licensed under this chapter,
100.5the license holder must obtain informed written consent for the use of swaddling from the
100.6parent or guardian of the infant on a form provided by the commissioner and prepared in
100.7partnership with the Minnesota Sudden Infant Death Center.

100.8    Sec. 15. Minnesota Statutes 2012, section 245A.144, is amended to read:
100.9245A.144 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
100.10DEATH AND SHAKEN BABY SYNDROME ABUSIVE HEAD TRAUMA FOR
100.11CHILD FOSTER CARE PROVIDERS.
100.12    (a) Licensed child foster care providers that care for infants or children through five
100.13years of age must document that before staff persons and caregivers assist in the care
100.14of infants or children through five years of age, they are instructed on the standards in
100.15section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
100.16death syndrome and shaken baby syndrome for abusive head trauma from shaking infants
100.17and young children. This section does not apply to emergency relative placement under
100.18section 245A.035. The training on reducing the risk of sudden unexpected infant death
100.19syndrome and shaken baby syndrome abusive head trauma may be provided as:
100.20    (1) orientation training to child foster care providers, who care for infants or children
100.21through five years of age, under Minnesota Rules, part 2960.3070, subpart 1; or
100.22    (2) in-service training to child foster care providers, who care for infants or children
100.23through five years of age, under Minnesota Rules, part 2960.3070, subpart 2.
100.24    (b) Training required under this section must be at least one hour in length and must
100.25be completed at least once every five years. At a minimum, the training must address
100.26the risk factors related to sudden unexpected infant death syndrome and shaken baby
100.27syndrome abusive head trauma, means of reducing the risk of sudden unexpected infant
100.28death syndrome and shaken baby syndrome abusive head trauma, and license holder
100.29communication with parents regarding reducing the risk of sudden unexpected infant
100.30death syndrome and shaken baby syndrome abusive head trauma.
100.31    (c) Training for child foster care providers must be approved by the county or
100.32private licensing agency that is responsible for monitoring the child foster care provider
100.33under section 245A.16. The approved training fulfills, in part, training required under
100.34Minnesota Rules, part 2960.3070.

101.1    Sec. 16. Minnesota Statutes 2012, section 245A.1444, is amended to read:
101.2245A.1444 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
101.3DEATH SYNDROME AND SHAKEN BABY SYNDROME ABUSIVE HEAD
101.4TRAUMA BY OTHER PROGRAMS.
101.5    A licensed chemical dependency treatment program that serves clients with infants
101.6or children through five years of age, who sleep at the program and a licensed children's
101.7residential facility that serves infants or children through five years of age, must document
101.8that before program staff persons or volunteers assist in the care of infants or children
101.9through five years of age, they are instructed on the standards in section 245A.1435 and
101.10receive training on reducing the risk of sudden unexpected infant death syndrome and
101.11shaken baby syndrome abusive head trauma from shaking infants and young children. The
101.12training conducted under this section may be used to fulfill training requirements under
101.13Minnesota Rules, parts 2960.0100, subpart 3; and 9530.6490, subpart 4, item B.
101.14    This section does not apply to child care centers or family child care programs
101.15governed by sections 245A.40 and 245A.50.

101.16    Sec. 17. [245A.1446] FAMILY CHILD CARE DIAPERING AREA
101.17DISINFECTION.
101.18Notwithstanding Minnesota Rules, part 9502.0435, a family child care provider may
101.19disinfect the diaper changing surface with chlorine bleach in a manner consistent with label
101.20directions for disinfection or with a surface disinfectant that meets the following criteria:
101.21(1) the manufacturer's label or instructions state that the product is registered with
101.22the United States Environmental Protection Agency;
101.23(2) the manufacturer's label or instructions state that the disinfectant is effective
101.24against Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa;
101.25(3) the manufacturer's label or instructions state that the disinfectant is effective with
101.26a ten minute or less contact time;
101.27(4) the disinfectant is clearly labeled by the manufacturer with directions for mixing
101.28and use;
101.29(5) the disinfectant is used only in accordance with the manufacturer's directions; and
101.30(6) the product does not include triclosan or derivatives of triclosan.

101.31    Sec. 18. [245A.147] FAMILY CHILD CARE INFANT SLEEP SUPERVISION
101.32REQUIREMENTS.
102.1    Subdivision 1. In-person checks on infants. (a) License holders that serve infants
102.2are encouraged to monitor sleeping infants by conducting in-person checks on each infant
102.3in their care every 30 minutes.
102.4(b) Upon enrollment of an infant in a family child care program, the license holder is
102.5encouraged to conduct in-person checks on the sleeping infant every 15 minutes, during
102.6the first four months of care.
102.7(c) When an infant has an upper respiratory infection, the license holder is
102.8encouraged to conduct in-person checks on the sleeping infant every 15 minutes
102.9throughout the hours of sleep.
102.10    Subd. 2. Use of audio or visual monitoring devices. In addition to conducting
102.11the in-person checks encouraged under subdivision 1, license holders serving infants are
102.12encouraged to use and maintain an audio or visual monitoring device to monitor each
102.13sleeping infant in care during all hours of sleep.

102.14    Sec. 19. [245A.152] CHILD CARE LICENSE HOLDER INSURANCE.
102.15(a) A license holder must provide a written notice to all parents or guardians of all
102.16children to be accepted for care prior to admission stating whether the license holder has
102.17liability insurance. This notice may be incorporated into and provided on the admission
102.18form used by the license holder.
102.19(b) If the license holder has liability insurance:
102.20(1) the license holder shall inform parents in writing that a current certificate of
102.21coverage for insurance is available for inspection to all parents or guardians of children
102.22receiving services and to all parents seeking services from the family child care program;
102.23(2) the notice must provide the parent or guardian with the date of expiration or
102.24next renewal of the policy; and
102.25(3) upon the expiration date of the policy, the license holder must provide a new
102.26written notice indicating whether the insurance policy has lapsed or whether the license
102.27holder has renewed the policy.
102.28If the policy was renewed, the license holder must provide the new expiration date of the
102.29policy in writing to the parents or guardians.
102.30(c) If the license holder does not have liability insurance, the license holder must
102.31provide an annual notice, on a form developed and made available by the commissioner,
102.32to the parents or guardians of children in care indicating that the license holder does not
102.33carry liability insurance.
102.34(d) The license holder must notify all parents and guardians in writing immediately
102.35of any change in insurance status.
103.1(e) The license holder must make available upon request the certificate of liability
103.2insurance to the parents of children in care, to the commissioner, and to county licensing
103.3agents.
103.4(f) The license holder must document, with the signature of the parent or guardian,
103.5that the parent or guardian received the notices required by this section.

103.6    Sec. 20. Minnesota Statutes 2012, section 245A.40, subdivision 5, is amended to read:
103.7    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome
103.8 abusive head trauma training. (a) License holders must document that before staff
103.9persons and volunteers care for infants, they are instructed on the standards in section
103.10245A.1435 and receive training on reducing the risk of sudden unexpected infant death
103.11syndrome. In addition, license holders must document that before staff persons care for
103.12infants or children under school age, they receive training on the risk of shaken baby
103.13syndrome abusive head trauma from shaking infants and young children. The training
103.14in this subdivision may be provided as orientation training under subdivision 1 and
103.15in-service training under subdivision 7.
103.16    (b) Sudden unexpected infant death syndrome reduction training required under
103.17this subdivision must be at least one-half hour in length and must be completed at least
103.18once every five years year. At a minimum, the training must address the risk factors
103.19related to sudden unexpected infant death syndrome, means of reducing the risk of sudden
103.20unexpected infant death syndrome in child care, and license holder communication with
103.21parents regarding reducing the risk of sudden unexpected infant death syndrome.
103.22    (c) Shaken baby syndrome Abusive head trauma training under this subdivision
103.23must be at least one-half hour in length and must be completed at least once every five
103.24years year. At a minimum, the training must address the risk factors related to shaken
103.25baby syndrome for shaking infants and young children, means to reduce the risk of shaken
103.26baby syndrome abusive head trauma in child care, and license holder communication with
103.27parents regarding reducing the risk of shaken baby syndrome abusive head trauma.
103.28(d) The commissioner shall make available for viewing a video presentation on the
103.29dangers associated with shaking infants and young children. The video presentation must
103.30be part of the orientation and annual in-service training of licensed child care center
103.31staff persons caring for children under school age. The commissioner shall provide to
103.32child care providers and interested individuals, at cost, copies of a video approved by the
103.33commissioner of health under section 144.574 on the dangers associated with shaking
103.34infants and young children.

104.1    Sec. 21. Minnesota Statutes 2012, section 245A.50, is amended to read:
104.2245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.
104.3    Subdivision 1. Initial training. (a) License holders, caregivers, and substitutes must
104.4comply with the training requirements in this section.
104.5    (b) Helpers who assist with care on a regular basis must complete six hours of
104.6training within one year after the date of initial employment.
104.7    Subd. 2. Child growth and development and behavior guidance training. (a) For
104.8purposes of family and group family child care, the license holder and each adult caregiver
104.9who provides care in the licensed setting for more than 30 days in any 12-month period
104.10shall complete and document at least two four hours of child growth and development
104.11and behavior guidance training within the first year of prior to initial licensure, and before
104.12caring for children. For purposes of this subdivision, "child growth and development
104.13training" means training in understanding how children acquire language and develop
104.14physically, cognitively, emotionally, and socially. "Behavior guidance training" means
104.15training in the understanding of the functions of child behavior and strategies for managing
104.16challenging situations. Child growth and development and behavior guidance training
104.17must be repeated annually. Training curriculum shall be developed or approved by the
104.18commissioner of human services by January 1, 2014.
104.19    (b) Notwithstanding paragraph (a), individuals are exempt from this requirement if
104.20they:
104.21    (1) have taken a three-credit course on early childhood development within the
104.22past five years;
104.23    (2) have received a baccalaureate or master's degree in early childhood education or
104.24school-age child care within the past five years;
104.25    (3) are licensed in Minnesota as a prekindergarten teacher, an early childhood
104.26educator, a kindergarten to grade 6 teacher with a prekindergarten specialty, an early
104.27childhood special education teacher, or an elementary teacher with a kindergarten
104.28endorsement; or
104.29    (4) have received a baccalaureate degree with a Montessori certificate within the
104.30past five years.
104.31    Subd. 3. First aid. (a) When children are present in a family child care home
104.32governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person
104.33must be present in the home who has been trained in first aid. The first aid training must
104.34have been provided by an individual approved to provide first aid instruction. First aid
104.35training may be less than eight hours and persons qualified to provide first aid training
105.1include individuals approved as first aid instructors. First aid training must be repeated
105.2every two years.
105.3    (b) A family child care provider is exempt from the first aid training requirements
105.4under this subdivision related to any substitute caregiver who provides less than 30 hours
105.5of care during any 12-month period.
105.6    (c) Video training reviewed and approved by the county licensing agency satisfies
105.7the training requirement of this subdivision.
105.8    Subd. 4. Cardiopulmonary resuscitation. (a) When children are present in a family
105.9child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least
105.10one staff person must be present in the home who has been trained in cardiopulmonary
105.11resuscitation (CPR) and in the treatment of obstructed airways that includes CPR
105.12techniques for infants and children. The CPR training must have been provided by an
105.13individual approved to provide CPR instruction, must be repeated at least once every three
105.14 two years, and must be documented in the staff person's records.
105.15    (b) A family child care provider is exempt from the CPR training requirement in
105.16this subdivision related to any substitute caregiver who provides less than 30 hours of
105.17care during any 12-month period.
105.18    (c) Video training reviewed and approved by the county licensing agency satisfies
105.19the training requirement of this subdivision. Persons providing CPR training must use
105.20CPR training that has been developed:
105.21    (1) by the American Heart Association or the American Red Cross and incorporates
105.22psychomotor skills to support the instruction; or
105.23    (2) using nationally recognized, evidence-based guidelines for CPR training and
105.24incorporates psychomotor skills to support the instruction.
105.25    Subd. 5. Sudden unexpected infant death syndrome and shaken baby syndrome
105.26 abusive head trauma training. (a) License holders must document that before staff
105.27persons, caregivers, and helpers assist in the care of infants, they are instructed on the
105.28standards in section 245A.1435 and receive training on reducing the risk of sudden
105.29unexpected infant death syndrome. In addition, license holders must document that before
105.30staff persons, caregivers, and helpers assist in the care of infants and children under
105.31school age, they receive training on reducing the risk of shaken baby syndrome abusive
105.32head trauma from shaking infants and young children. The training in this subdivision
105.33may be provided as initial training under subdivision 1 or ongoing annual training under
105.34subdivision 7.
105.35    (b) Sudden unexpected infant death syndrome reduction training required under this
105.36subdivision must be at least one-half hour in length and must be completed in person
106.1 at least once every five years two years. On the years when the license holder is not
106.2receiving the in-person training on sudden unexpected infant death reduction, the license
106.3holder must receive sudden unexpected infant death reduction training through a video
106.4of no more than one hour in length developed or approved by the commissioner. At a
106.5minimum, the training must address the risk factors related to sudden unexpected infant
106.6death syndrome, means of reducing the risk of sudden unexpected infant death syndrome
106.7 in child care, and license holder communication with parents regarding reducing the risk
106.8of sudden unexpected infant death syndrome.
106.9    (c) Shaken baby syndrome Abusive head trauma training required under this
106.10subdivision must be at least one-half hour in length and must be completed at least once
106.11every five years year. At a minimum, the training must address the risk factors related
106.12to shaken baby syndrome shaking infants and young children, means of reducing the
106.13risk of shaken baby syndrome abusive head trauma in child care, and license holder
106.14communication with parents regarding reducing the risk of shaken baby syndrome abusive
106.15head trauma.
106.16(d) Training for family and group family child care providers must be developed
106.17by the commissioner in conjunction with the Minnesota Sudden Infant Death Center
106.18and approved by the county licensing agency by the Minnesota Center for Professional
106.19Development.
106.20    (e) The commissioner shall make available for viewing by all licensed child care
106.21providers a video presentation on the dangers associated with shaking infants and young
106.22children. The video presentation shall be part of the initial and ongoing annual training of
106.23licensed child care providers, caregivers, and helpers caring for children under school age.
106.24The commissioner shall provide to child care providers and interested individuals, at cost,
106.25copies of a video approved by the commissioner of health under section 144.574 on the
106.26dangers associated with shaking infants and young children.
106.27    Subd. 6. Child passenger restraint systems; training requirement. (a) A license
106.28holder must comply with all seat belt and child passenger restraint system requirements
106.29under section 169.685.
106.30    (b) Family and group family child care programs licensed by the Department of
106.31Human Services that serve a child or children under nine years of age must document
106.32training that fulfills the requirements in this subdivision.
106.33    (1) Before a license holder, staff person, caregiver, or helper transports a child or
106.34children under age nine in a motor vehicle, the person placing the child or children in a
106.35passenger restraint must satisfactorily complete training on the proper use and installation
107.1of child restraint systems in motor vehicles. Training completed under this subdivision may
107.2be used to meet initial training under subdivision 1 or ongoing training under subdivision 7.
107.3    (2) Training required under this subdivision must be at least one hour in length,
107.4completed at initial training, and repeated at least once every five years. At a minimum,
107.5the training must address the proper use of child restraint systems based on the child's
107.6size, weight, and age, and the proper installation of a car seat or booster seat in the motor
107.7vehicle used by the license holder to transport the child or children.
107.8    (3) Training under this subdivision must be provided by individuals who are certified
107.9and approved by the Department of Public Safety, Office of Traffic Safety. License holders
107.10may obtain a list of certified and approved trainers through the Department of Public
107.11Safety Web site or by contacting the agency.
107.12    (c) Child care providers that only transport school-age children as defined in section
107.13245A.02, subdivision 19 , paragraph (f), in child care buses as defined in section 169.448,
107.14subdivision 1, paragraph (e), are exempt from this subdivision.
107.15    Subd. 7. Training requirements for family and group family child care. For
107.16purposes of family and group family child care, the license holder and each primary
107.17caregiver must complete eight 16 hours of ongoing training each year. For purposes
107.18of this subdivision, a primary caregiver is an adult caregiver who provides services in
107.19the licensed setting for more than 30 days in any 12-month period. Repeat of topical
107.20training requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
107.21requirement. Additional ongoing training subjects to meet the annual 16-hour training
107.22requirement must be selected from the following areas:
107.23    (1) "child growth and development training" has the meaning given in under
107.24 subdivision 2, paragraph (a);
107.25    (2) "learning environment and curriculum" includes, including training in
107.26establishing an environment and providing activities that provide learning experiences to
107.27meet each child's needs, capabilities, and interests;
107.28    (3) "assessment and planning for individual needs" includes, including training in
107.29observing and assessing what children know and can do in order to provide curriculum
107.30and instruction that addresses their developmental and learning needs, including children
107.31with special needs and bilingual children or children for whom English is not their
107.32primary language;
107.33    (4) "interactions with children" includes, including training in establishing
107.34supportive relationships with children, guiding them as individuals and as part of a group;
108.1    (5) "families and communities" includes, including training in working
108.2collaboratively with families and agencies or organizations to meet children's needs and to
108.3encourage the community's involvement;
108.4    (6) "health, safety, and nutrition" includes, including training in establishing and
108.5maintaining an environment that ensures children's health, safety, and nourishment,
108.6including child abuse, maltreatment, prevention, and reporting; home and fire safety; child
108.7injury prevention; communicable disease prevention and control; first aid; and CPR; and
108.8    (7) "program planning and evaluation" includes, including training in establishing,
108.9implementing, evaluating, and enhancing program operations.; and
108.10(8) behavior guidance, including training in the understanding of the functions of
108.11child behavior and strategies for managing behavior.
108.12    Subd. 8. Other required training requirements. (a) The training required of
108.13family and group family child care providers and staff must include training in the cultural
108.14dynamics of early childhood development and child care. The cultural dynamics and
108.15disabilities training and skills development of child care providers must be designed to
108.16achieve outcomes for providers of child care that include, but are not limited to:
108.17    (1) an understanding and support of the importance of culture and differences in
108.18ability in children's identity development;
108.19    (2) understanding the importance of awareness of cultural differences and
108.20similarities in working with children and their families;
108.21    (3) understanding and support of the needs of families and children with differences
108.22in ability;
108.23    (4) developing skills to help children develop unbiased attitudes about cultural
108.24differences and differences in ability;
108.25    (5) developing skills in culturally appropriate caregiving; and
108.26    (6) developing skills in appropriate caregiving for children of different abilities.
108.27    The commissioner shall approve the curriculum for cultural dynamics and disability
108.28training.
108.29    (b) The provider must meet the training requirement in section 245A.14, subdivision
108.3011 , paragraph (a), clause (4), to be eligible to allow a child cared for at the family child
108.31care or group family child care home to use the swimming pool located at the home.
108.32    Subd. 9. Supervising for safety; training requirement. Effective July 1, 2014,
108.33all family child care license holders and each adult caregiver who provides care in the
108.34licensed family child care home for more than 30 days in any 12-month period shall
108.35complete and document at least six hours of approved training on supervising for safety
108.36prior to initial licensure, and before caring for children. At least two hours of training
109.1on supervising for safety must be repeated annually. For purposes of this subdivision,
109.2"supervising for safety" includes supervision basics, supervision outdoors, equipment and
109.3materials, illness, injuries, and disaster preparedness. The commissioner shall develop
109.4the supervising for safety curriculum by January 1, 2014.
109.5    Subd. 10. Approved training. County licensing staff must accept training approved
109.6by the Minnesota Center for Professional Development, including:
109.7(1) face-to-face or classroom training;
109.8(2) online training; and
109.9(3) relationship-based professional development, such as mentoring, coaching,
109.10and consulting.
109.11    Subd. 11. Provider training. New and increased training requirements under this
109.12section must not be imposed on providers until the commissioner establishes statewide
109.13accessibility to the required provider training.

109.14    Sec. 22. Minnesota Statutes 2012, section 252.27, subdivision 2a, is amended to read:
109.15    Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor
109.16child, including a child determined eligible for medical assistance without consideration of
109.17parental income, must contribute to the cost of services used by making monthly payments
109.18on a sliding scale based on income, unless the child is married or has been married, parental
109.19rights have been terminated, or the child's adoption is subsidized according to section
109.20259.67 or through title IV-E of the Social Security Act. The parental contribution is a partial
109.21or full payment for medical services provided for diagnostic, therapeutic, curing, treating,
109.22mitigating, rehabilitation, maintenance, and personal care services as defined in United
109.23States Code, title 26, section 213, needed by the child with a chronic illness or disability.
109.24    (b) For households with adjusted gross income equal to or greater than 100 275
109.25 percent of federal poverty guidelines, the parental contribution shall be computed by
109.26applying the following schedule of rates to the adjusted gross income of the natural or
109.27adoptive parents:
109.28    (1) if the adjusted gross income is equal to or greater than 100 percent of federal
109.29poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
109.30contribution is $4 per month;
109.31    (2) (1) if the adjusted gross income is equal to or greater than 175 275 percent
109.32of federal poverty guidelines and less than or equal to 545 percent of federal poverty
109.33guidelines, the parental contribution shall be determined using a sliding fee scale
109.34established by the commissioner of human services which begins at one 2.76 percent of
109.35adjusted gross income at 175 275 percent of federal poverty guidelines and increases to
110.17.5 percent of adjusted gross income for those with adjusted gross income up to 545
110.2percent of federal poverty guidelines;
110.3    (3) (2) if the adjusted gross income is greater than 545 percent of federal poverty
110.4guidelines and less than 675 percent of federal poverty guidelines, the parental
110.5contribution shall be 7.5 percent of adjusted gross income;
110.6    (4) (3) if the adjusted gross income is equal to or greater than 675 percent of federal
110.7poverty guidelines and less than 975 percent of federal poverty guidelines, the parental
110.8contribution shall be determined using a sliding fee scale established by the commissioner
110.9of human services which begins at 7.5 percent of adjusted gross income at 675 percent of
110.10federal poverty guidelines and increases to ten percent of adjusted gross income for those
110.11with adjusted gross income up to 975 percent of federal poverty guidelines; and
110.12    (5) (4) if the adjusted gross income is equal to or greater than 975 percent of federal
110.13poverty guidelines, the parental contribution shall be 12.5 percent of adjusted gross income.
110.14    If the child lives with the parent, the annual adjusted gross income is reduced by
110.15$2,400 prior to calculating the parental contribution. If the child resides in an institution
110.16specified in section 256B.35, the parent is responsible for the personal needs allowance
110.17specified under that section in addition to the parental contribution determined under this
110.18section. The parental contribution is reduced by any amount required to be paid directly to
110.19the child pursuant to a court order, but only if actually paid.
110.20    (c) The household size to be used in determining the amount of contribution under
110.21paragraph (b) includes natural and adoptive parents and their dependents, including the
110.22child receiving services. Adjustments in the contribution amount due to annual changes
110.23in the federal poverty guidelines shall be implemented on the first day of July following
110.24publication of the changes.
110.25    (d) For purposes of paragraph (b), "income" means the adjusted gross income of the
110.26natural or adoptive parents determined according to the previous year's federal tax form,
110.27except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
110.28have been used to purchase a home shall not be counted as income.
110.29    (e) The contribution shall be explained in writing to the parents at the time eligibility
110.30for services is being determined. The contribution shall be made on a monthly basis
110.31effective with the first month in which the child receives services. Annually upon
110.32redetermination or at termination of eligibility, if the contribution exceeded the cost of
110.33services provided, the local agency or the state shall reimburse that excess amount to
110.34the parents, either by direct reimbursement if the parent is no longer required to pay a
110.35contribution, or by a reduction in or waiver of parental fees until the excess amount is
110.36exhausted. All reimbursements must include a notice that the amount reimbursed may be
111.1taxable income if the parent paid for the parent's fees through an employer's health care
111.2flexible spending account under the Internal Revenue Code, section 125, and that the
111.3parent is responsible for paying the taxes owed on the amount reimbursed.
111.4    (f) The monthly contribution amount must be reviewed at least every 12 months;
111.5when there is a change in household size; and when there is a loss of or gain in income
111.6from one month to another in excess of ten percent. The local agency shall mail a written
111.7notice 30 days in advance of the effective date of a change in the contribution amount.
111.8A decrease in the contribution amount is effective in the month that the parent verifies a
111.9reduction in income or change in household size.
111.10    (g) Parents of a minor child who do not live with each other shall each pay the
111.11contribution required under paragraph (a). An amount equal to the annual court-ordered
111.12child support payment actually paid on behalf of the child receiving services shall be
111.13deducted from the adjusted gross income of the parent making the payment prior to
111.14calculating the parental contribution under paragraph (b).
111.15    (h) The contribution under paragraph (b) shall be increased by an additional five
111.16percent if the local agency determines that insurance coverage is available but not
111.17obtained for the child. For purposes of this section, "available" means the insurance is a
111.18benefit of employment for a family member at an annual cost of no more than five percent
111.19of the family's annual income. For purposes of this section, "insurance" means health
111.20and accident insurance coverage, enrollment in a nonprofit health service plan, health
111.21maintenance organization, self-insured plan, or preferred provider organization.
111.22    Parents who have more than one child receiving services shall not be required
111.23to pay more than the amount for the child with the highest expenditures. There shall
111.24be no resource contribution from the parents. The parent shall not be required to pay
111.25a contribution in excess of the cost of the services provided to the child, not counting
111.26payments made to school districts for education-related services. Notice of an increase in
111.27fee payment must be given at least 30 days before the increased fee is due.
111.28    (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if,
111.29in the 12 months prior to July 1:
111.30    (1) the parent applied for insurance for the child;
111.31    (2) the insurer denied insurance;
111.32    (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted
111.33a complaint or appeal, in writing, to the commissioner of health or the commissioner of
111.34commerce, or litigated the complaint or appeal; and
111.35    (4) as a result of the dispute, the insurer reversed its decision and granted insurance.
111.36    For purposes of this section, "insurance" has the meaning given in paragraph (h).
112.1    A parent who has requested a reduction in the contribution amount under this
112.2paragraph shall submit proof in the form and manner prescribed by the commissioner or
112.3county agency, including, but not limited to, the insurer's denial of insurance, the written
112.4letter or complaint of the parents, court documents, and the written response of the insurer
112.5approving insurance. The determinations of the commissioner or county agency under this
112.6paragraph are not rules subject to chapter 14.
112.7(j) Notwithstanding paragraph (b), for the period from July 1, 2010, to June 30,
112.82015, the parental contribution shall be computed by applying the following contribution
112.9schedule to the adjusted gross income of the natural or adoptive parents:
112.10(1) if the adjusted gross income is equal to or greater than 100 percent of federal
112.11poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
112.12contribution is $4 per month;
112.13(2) if the adjusted gross income is equal to or greater than 175 percent of federal
112.14poverty guidelines and less than or equal to 525 percent of federal poverty guidelines,
112.15the parental contribution shall be determined using a sliding fee scale established by the
112.16commissioner of human services which begins at one percent of adjusted gross income
112.17at 175 percent of federal poverty guidelines and increases to eight percent of adjusted
112.18gross income for those with adjusted gross income up to 525 percent of federal poverty
112.19guidelines;
112.20(3) if the adjusted gross income is greater than 525 percent of federal poverty
112.21guidelines and less than 675 percent of federal poverty guidelines, the parental
112.22contribution shall be 9.5 percent of adjusted gross income;
112.23(4) if the adjusted gross income is equal to or greater than 675 percent of federal
112.24poverty guidelines and less than 900 percent of federal poverty guidelines, the parental
112.25contribution shall be determined using a sliding fee scale established by the commissioner
112.26of human services which begins at 9.5 percent of adjusted gross income at 675 percent of
112.27federal poverty guidelines and increases to 12 percent of adjusted gross income for those
112.28with adjusted gross income up to 900 percent of federal poverty guidelines; and
112.29(5) if the adjusted gross income is equal to or greater than 900 percent of federal
112.30poverty guidelines, the parental contribution shall be 13.5 percent of adjusted gross
112.31income. If the child lives with the parent, the annual adjusted gross income is reduced by
112.32$2,400 prior to calculating the parental contribution. If the child resides in an institution
112.33specified in section 256B.35, the parent is responsible for the personal needs allowance
112.34specified under that section in addition to the parental contribution determined under this
112.35section. The parental contribution is reduced by any amount required to be paid directly to
112.36the child pursuant to a court order, but only if actually paid.
113.1EFFECTIVE DATE.Paragraph (b) is effective January 1, 2014. Paragraph (j)
113.2is effective July 1, 2013.

113.3    Sec. 23. Minnesota Statutes 2012, section 256.98, subdivision 8, is amended to read:
113.4    Subd. 8. Disqualification from program. (a) Any person found to be guilty of
113.5wrongfully obtaining assistance by a federal or state court or by an administrative hearing
113.6determination, or waiver thereof, through a disqualification consent agreement, or as part
113.7of any approved diversion plan under section 401.065, or any court-ordered stay which
113.8carries with it any probationary or other conditions, in the Minnesota family investment
113.9program and any affiliated program to include the diversionary work program and the
113.10work participation cash benefit program, the food stamp or food support program, the
113.11general assistance program, the group residential housing program, or the Minnesota
113.12supplemental aid program shall be disqualified from that program. In addition, any person
113.13disqualified from the Minnesota family investment program shall also be disqualified from
113.14the food stamp or food support program. The needs of that individual shall not be taken
113.15into consideration in determining the grant level for that assistance unit:
113.16(1) for one year after the first offense;
113.17(2) for two years after the second offense; and
113.18(3) permanently after the third or subsequent offense.
113.19The period of program disqualification shall begin on the date stipulated on the
113.20advance notice of disqualification without possibility of postponement for administrative
113.21stay or administrative hearing and shall continue through completion unless and until the
113.22findings upon which the sanctions were imposed are reversed by a court of competent
113.23jurisdiction. The period for which sanctions are imposed is not subject to review. The
113.24sanctions provided under this subdivision are in addition to, and not in substitution
113.25for, any other sanctions that may be provided for by law for the offense involved. A
113.26disqualification established through hearing or waiver shall result in the disqualification
113.27period beginning immediately unless the person has become otherwise ineligible for
113.28assistance. If the person is ineligible for assistance, the disqualification period begins
113.29when the person again meets the eligibility criteria of the program from which they were
113.30disqualified and makes application for that program.
113.31(b) A family receiving assistance through child care assistance programs under
113.32chapter 119B with a family member who is found to be guilty of wrongfully obtaining child
113.33care assistance by a federal court, state court, or an administrative hearing determination
113.34or waiver, through a disqualification consent agreement, as part of an approved diversion
113.35plan under section 401.065, or a court-ordered stay with probationary or other conditions,
114.1is disqualified from child care assistance programs. The disqualifications must be for
114.2periods of three months, six months, and one year and two years for the first, and
114.3 second, and third offenses, respectively. Subsequent violations must result in permanent
114.4disqualification. During the disqualification period, disqualification from any child care
114.5program must extend to all child care programs and must be immediately applied.
114.6(c) A provider caring for children receiving assistance through child care assistance
114.7programs under chapter 119B is disqualified from receiving payment for child care
114.8services from the child care assistance program under chapter 119B when the provider is
114.9found to have wrongfully obtained child care assistance by a federal court, state court,
114.10or an administrative hearing determination or waiver under section 256.046, through
114.11a disqualification consent agreement, as part of an approved diversion plan under
114.12section 401.065, or a court-ordered stay with probationary or other conditions. The
114.13disqualification must be for a period of one year for the first offense and two years for
114.14the second offense. Any subsequent violation must result in permanent disqualification.
114.15The disqualification period must be imposed immediately after a determination is made
114.16under this paragraph. During the disqualification period, the provider is disqualified from
114.17receiving payment from any child care program under chapter 119B.
114.18(d) Any person found to be guilty of wrongfully obtaining general assistance
114.19medical care, MinnesotaCare for adults without children, and upon federal approval, all
114.20categories of medical assistance and remaining categories of MinnesotaCare, except
114.21for children through age 18, by a federal or state court or by an administrative hearing
114.22determination, or waiver thereof, through a disqualification consent agreement, or as part
114.23of any approved diversion plan under section 401.065, or any court-ordered stay which
114.24carries with it any probationary or other conditions, is disqualified from that program. The
114.25period of disqualification is one year after the first offense, two years after the second
114.26offense, and permanently after the third or subsequent offense. The period of program
114.27disqualification shall begin on the date stipulated on the advance notice of disqualification
114.28without possibility of postponement for administrative stay or administrative hearing
114.29and shall continue through completion unless and until the findings upon which the
114.30sanctions were imposed are reversed by a court of competent jurisdiction. The period for
114.31which sanctions are imposed is not subject to review. The sanctions provided under this
114.32subdivision are in addition to, and not in substitution for, any other sanctions that may be
114.33provided for by law for the offense involved.
114.34EFFECTIVE DATE.This section is effective February 3, 2014.

114.35    Sec. 24. Minnesota Statutes 2012, section 256J.08, subdivision 24, is amended to read:
115.1    Subd. 24. Disregard. "Disregard" means earned income that is not counted when
115.2determining initial eligibility in the initial income test in section 256J.21, subdivision 3,
115.3 or income that is not counted when determining ongoing eligibility and calculating the
115.4amount of the assistance payment for participants. The commissioner shall determine
115.5the amount of the disregard according to section 256J.24, subdivision 10 for ongoing
115.6eligibility shall be 50 percent of gross earned income.
115.7EFFECTIVE DATE.This section is effective October 1, 2014, or upon approval
115.8from the United States Department of Agriculture, whichever is later.

115.9    Sec. 25. Minnesota Statutes 2012, section 256J.21, subdivision 2, is amended to read:
115.10    Subd. 2. Income exclusions. The following must be excluded in determining a
115.11family's available income:
115.12    (1) payments for basic care, difficulty of care, and clothing allowances received for
115.13providing family foster care to children or adults under Minnesota Rules, parts 9555.5050
115.14to 9555.6265, 9560.0521, and 9560.0650 to 9560.0655, and payments received and used
115.15for care and maintenance of a third-party beneficiary who is not a household member;
115.16    (2) reimbursements for employment training received through the Workforce
115.17Investment Act of 1998, United States Code, title 20, chapter 73, section 9201;
115.18    (3) reimbursement for out-of-pocket expenses incurred while performing volunteer
115.19services, jury duty, employment, or informal carpooling arrangements directly related to
115.20employment;
115.21    (4) all educational assistance, except the county agency must count graduate student
115.22teaching assistantships, fellowships, and other similar paid work as earned income and,
115.23after allowing deductions for any unmet and necessary educational expenses, shall
115.24count scholarships or grants awarded to graduate students that do not require teaching
115.25or research as unearned income;
115.26    (5) loans, regardless of purpose, from public or private lending institutions,
115.27governmental lending institutions, or governmental agencies;
115.28    (6) loans from private individuals, regardless of purpose, provided an applicant or
115.29participant documents that the lender expects repayment;
115.30    (7)(i) state income tax refunds; and
115.31    (ii) federal income tax refunds;
115.32    (8)(i) federal earned income credits;
115.33    (ii) Minnesota working family credits;
115.34    (iii) state homeowners and renters credits under chapter 290A; and
115.35    (iv) federal or state tax rebates;
116.1    (9) funds received for reimbursement, replacement, or rebate of personal or real
116.2property when these payments are made by public agencies, awarded by a court, solicited
116.3through public appeal, or made as a grant by a federal agency, state or local government,
116.4or disaster assistance organizations, subsequent to a presidential declaration of disaster;
116.5    (10) the portion of an insurance settlement that is used to pay medical, funeral, and
116.6burial expenses, or to repair or replace insured property;
116.7    (11) reimbursements for medical expenses that cannot be paid by medical assistance;
116.8    (12) payments by a vocational rehabilitation program administered by the state
116.9under chapter 268A, except those payments that are for current living expenses;
116.10    (13) in-kind income, including any payments directly made by a third party to a
116.11provider of goods and services;
116.12    (14) assistance payments to correct underpayments, but only for the month in which
116.13the payment is received;
116.14    (15) payments for short-term emergency needs under section 256J.626, subdivision 2;
116.15    (16) funeral and cemetery payments as provided by section 256.935;
116.16    (17) nonrecurring cash gifts of $30 or less, not exceeding $30 per participant in
116.17a calendar month;
116.18    (18) any form of energy assistance payment made through Public Law 97-35,
116.19Low-Income Home Energy Assistance Act of 1981, payments made directly to energy
116.20providers by other public and private agencies, and any form of credit or rebate payment
116.21issued by energy providers;
116.22    (19) Supplemental Security Income (SSI), including retroactive SSI payments and
116.23other income of an SSI recipient, except as described in section 256J.37, subdivision 3b;
116.24    (20) Minnesota supplemental aid, including retroactive payments;
116.25    (21) proceeds from the sale of real or personal property;
116.26    (22) state adoption assistance payments under section 259.67, and up to an equal
116.27amount of county adoption assistance payments;
116.28    (23) state-funded family subsidy program payments made under section 252.32 to
116.29help families care for children with developmental disabilities, consumer support grant
116.30funds under section 256.476, and resources and services for a disabled household member
116.31under one of the home and community-based waiver services programs under chapter 256B;
116.32    (24) interest payments and dividends from property that is not excluded from and
116.33that does not exceed the asset limit;
116.34    (25) rent rebates;
117.1    (26) income earned by a minor caregiver, minor child through age 6, or a minor
117.2child who is at least a half-time student in an approved elementary or secondary education
117.3program;
117.4    (27) income earned by a caregiver under age 20 who is at least a half-time student in
117.5an approved elementary or secondary education program;
117.6    (28) MFIP child care payments under section 119B.05;
117.7    (29) all other payments made through MFIP to support a caregiver's pursuit of
117.8greater economic stability;
117.9    (30) income a participant receives related to shared living expenses;
117.10    (31) reverse mortgages;
117.11    (32) benefits provided by the Child Nutrition Act of 1966, United States Code, title
117.1242, chapter 13A, sections 1771 to 1790;
117.13    (33) benefits provided by the women, infants, and children (WIC) nutrition program,
117.14United States Code, title 42, chapter 13A, section 1786;
117.15    (34) benefits from the National School Lunch Act, United States Code, title 42,
117.16chapter 13, sections 1751 to 1769e;
117.17    (35) relocation assistance for displaced persons under the Uniform Relocation
117.18Assistance and Real Property Acquisition Policies Act of 1970, United States Code, title
117.1942, chapter 61, subchapter II, section 4636, or the National Housing Act, United States
117.20Code, title 12, chapter 13, sections 1701 to 1750jj;
117.21    (36) benefits from the Trade Act of 1974, United States Code, title 19, chapter
117.2212, part 2, sections 2271 to 2322;
117.23    (37) war reparations payments to Japanese Americans and Aleuts under United
117.24States Code, title 50, sections 1989 to 1989d;
117.25    (38) payments to veterans or their dependents as a result of legal settlements
117.26regarding Agent Orange or other chemical exposure under Public Law 101-239, section
117.2710405, paragraph (a)(2)(E);
117.28    (39) income that is otherwise specifically excluded from MFIP consideration in
117.29federal law, state law, or federal regulation;
117.30    (40) security and utility deposit refunds;
117.31    (41) American Indian tribal land settlements excluded under Public Laws 98-123,
117.3298-124, and 99-377 to the Mississippi Band Chippewa Indians of White Earth, Leech
117.33Lake, and Mille Lacs reservations and payments to members of the White Earth Band,
117.34under United States Code, title 25, chapter 9, section 331, and chapter 16, section 1407;
118.1    (42) all income of the minor parent's parents and stepparents when determining the
118.2grant for the minor parent in households that include a minor parent living with parents or
118.3stepparents on MFIP with other children;
118.4    (43) income of the minor parent's parents and stepparents equal to 200 percent of the
118.5federal poverty guideline for a family size not including the minor parent and the minor
118.6parent's child in households that include a minor parent living with parents or stepparents
118.7not on MFIP when determining the grant for the minor parent. The remainder of income is
118.8deemed as specified in section 256J.37, subdivision 1b;
118.9    (44) payments made to children eligible for relative custody assistance under section
118.10257.85 ;
118.11    (45) vendor payments for goods and services made on behalf of a client unless the
118.12client has the option of receiving the payment in cash;
118.13    (46) the principal portion of a contract for deed payment; and
118.14    (47) cash payments to individuals enrolled for full-time service as a volunteer under
118.15AmeriCorps programs including AmeriCorps VISTA, AmeriCorps State, AmeriCorps
118.16National, and AmeriCorps NCCC; and
118.17    (48) housing assistance grants under section 256J.35, paragraph (a).

118.18    Sec. 26. Minnesota Statutes 2012, section 256J.21, subdivision 3, is amended to read:
118.19    Subd. 3. Initial income test. The county agency shall determine initial eligibility
118.20by considering all earned and unearned income that is not excluded under subdivision 2.
118.21To be eligible for MFIP, the assistance unit's countable income minus the disregards in
118.22paragraphs (a) and (b) must be below the transitional standard of assistance family wage
118.23level according to section 256J.24 for that size assistance unit.
118.24(a) The initial eligibility determination must disregard the following items:
118.25(1) the employment disregard is 18 percent of the gross earned income whether or
118.26not the member is working full time or part time;
118.27(2) dependent care costs must be deducted from gross earned income for the actual
118.28amount paid for dependent care up to a maximum of $200 per month for each child less
118.29than two years of age, and $175 per month for each child two years of age and older under
118.30this chapter and chapter 119B;
118.31(3) all payments made according to a court order for spousal support or the support
118.32of children not living in the assistance unit's household shall be disregarded from the
118.33income of the person with the legal obligation to pay support, provided that, if there has
118.34been a change in the financial circumstances of the person with the legal obligation to pay
119.1support since the support order was entered, the person with the legal obligation to pay
119.2support has petitioned for a modification of the support order; and
119.3(4) an allocation for the unmet need of an ineligible spouse or an ineligible child
119.4under the age of 21 for whom the caregiver is financially responsible and who lives with
119.5the caregiver according to section 256J.36.
119.6(b) Notwithstanding paragraph (a), when determining initial eligibility for applicant
119.7units when at least one member has received MFIP in this state within four months of
119.8the most recent application for MFIP, apply the disregard as defined in section 256J.08,
119.9subdivision 24 , for all unit members.
119.10After initial eligibility is established, the assistance payment calculation is based on
119.11the monthly income test.
119.12EFFECTIVE DATE.This section is effective October 1, 2014, or upon approval
119.13from the United States Department of Agriculture, whichever is later.

119.14    Sec. 27. Minnesota Statutes 2012, section 256J.24, subdivision 5, is amended to read:
119.15    Subd. 5. MFIP transitional standard. The MFIP transitional standard is based
119.16on the number of persons in the assistance unit eligible for both food and cash assistance
119.17unless the restrictions in subdivision 6 on the birth of a child apply. The amount of the
119.18transitional standard is published annually by the Department of Human Services.
119.19EFFECTIVE DATE.This section is effective January 1, 2015.

119.20    Sec. 28. Minnesota Statutes 2012, section 256J.24, subdivision 7, is amended to read:
119.21    Subd. 7. Family wage level. The family wage level is 110 percent of the transitional
119.22standard under subdivision 5 or 6, when applicable, and is the standard used when there is
119.23earned income in the assistance unit. As specified in section 256J.21. If there is earned
119.24income in the assistance unit, earned income is subtracted from the family wage level to
119.25determine the amount of the assistance payment, as specified in section 256J.21. The
119.26assistance payment may not exceed the transitional standard under subdivision 5 or 6,
119.27or the shared household standard under subdivision 9, whichever is applicable, for the
119.28assistance unit.
119.29EFFECTIVE DATE.This section is effective October 1, 2014, or upon approval
119.30from the United States Department of Agriculture, whichever is later.

120.1    Sec. 29. Minnesota Statutes 2012, section 256J.35, is amended to read:
120.2256J.35 AMOUNT OF ASSISTANCE PAYMENT.
120.3Except as provided in paragraphs (a) to (c) (d), the amount of an assistance payment
120.4is equal to the difference between the MFIP standard of need or the Minnesota family
120.5wage level in section 256J.24 and countable income.
120.6(a) Beginning July 1, 2015, MFIP assistance units are eligible for an MFIP housing
120.7assistance grant of $110 per month, unless:
120.8(1) the housing assistance unit is currently receiving public and assisted rental
120.9subsidies provided through the Department of Housing and Urban Development (HUD)
120.10and is subject to section 256J.37, subdivision 3a; or
120.11(2) the assistance unit is a child-only case under section 256J.88.
120.12(a) (b) When MFIP eligibility exists for the month of application, the amount of
120.13the assistance payment for the month of application must be prorated from the date of
120.14application or the date all other eligibility factors are met for that applicant, whichever is
120.15later. This provision applies when an applicant loses at least one day of MFIP eligibility.
120.16(b) (c) MFIP overpayments to an assistance unit must be recouped according to
120.17section 256J.38, subdivision 4.
120.18(c) (d) An initial assistance payment must not be made to an applicant who is not
120.19eligible on the date payment is made.

120.20    Sec. 30. Minnesota Statutes 2012, section 256J.621, is amended to read:
120.21256J.621 WORK PARTICIPATION CASH BENEFITS.
120.22    Subdivision 1. Program characteristics. (a) Effective October 1, 2009, upon
120.23exiting the diversionary work program (DWP) or upon terminating the Minnesota family
120.24investment program with earnings, a participant who is employed may be eligible for work
120.25participation cash benefits of $25 per month to assist in meeting the family's basic needs
120.26as the participant continues to move toward self-sufficiency.
120.27    (b) To be eligible for work participation cash benefits, the participant shall not
120.28receive MFIP or diversionary work program assistance during the month and the
120.29participant or participants must meet the following work requirements:
120.30    (1) if the participant is a single caregiver and has a child under six years of age, the
120.31participant must be employed at least 87 hours per month;
120.32    (2) if the participant is a single caregiver and does not have a child under six years of
120.33age, the participant must be employed at least 130 hours per month; or
120.34    (3) if the household is a two-parent family, at least one of the parents must be
120.35employed 130 hours per month.
121.1    Whenever a participant exits the diversionary work program or is terminated from
121.2MFIP and meets the other criteria in this section, work participation cash benefits are
121.3available for up to 24 consecutive months.
121.4    (c) Expenditures on the program are maintenance of effort state funds under
121.5a separate state program for participants under paragraph (b), clauses (1) and (2).
121.6Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort
121.7funds. Months in which a participant receives work participation cash benefits under this
121.8section do not count toward the participant's MFIP 60-month time limit.
121.9    Subd. 2. Program suspension. (a) Effective December 1, 2014, the work
121.10participation cash benefits program shall be suspended.
121.11(b) The commissioner of human services may reinstate the work participation cash
121.12benefits program if the United States Department of Human Services determines that the
121.13state of Minnesota did not meet the federal TANF work participation rate and sends a
121.14notice of penalty to reduce Minnesota's federal TANF block grant authorized under title I
121.15of Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation
121.16Act of 1996, and under Public Law 109-171, the Deficit Reduction Act of 2005.
121.17(c) The commissioner shall notify the chairs and ranking minority members of the
121.18legislative committees with jurisdiction over human services policy and finance of the
121.19potential penalty and the commissioner's plans to reinstate the work participation cash
121.20benefit program within 30 days of the date the commissioner receives notification that
121.21the state failed to meet the federal work participation rate.

121.22    Sec. 31. Minnesota Statutes 2012, section 256J.626, subdivision 7, is amended to read:
121.23    Subd. 7. Performance base funds. (a) For the purpose of this section, the following
121.24terms have the meanings given.
121.25(1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota
121.26TANF and separate state program caseload has fallen relative to federal fiscal year 2005
121.27based on caseload data from October 1 to September 30.
121.28(2) "TANF participation rate target" means a 50 percent participation rate reduced by
121.29the CRC for the previous year.
121.30(b) (a) For calendar year 2010 2016 and yearly thereafter, each county and tribe will
121.31 must be allocated 95 100 percent of their initial calendar year allocation. Allocations for
121.32counties and tribes will must be allocated additional funds adjusted based on performance
121.33as follows:
121.34    (1) a county or tribe that achieves the TANF participation rate target or a five
121.35percentage point improvement over the previous year's TANF participation rate under
122.1section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive months for
122.2the most recent year for which the measurements are available, will receive an additional
122.3allocation equal to 2.5 percent of its initial allocation;
122.4    (2) (1) a county or tribe that performs within or above its range of expected
122.5performance on the annualized three-year self-support index under section 256J.751,
122.6subdivision 2 , clause (6), will must receive an additional allocation equal to 2.5 percent of
122.7its initial allocation; and
122.8    (3) a county or tribe that does not achieve the TANF participation rate target or
122.9a five percentage point improvement over the previous year's TANF participation rate
122.10under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive
122.11months for the most recent year for which the measurements are available, will not
122.12receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear
122.13improvement plan with the commissioner; or
122.14    (4) (2) a county or tribe that does not perform within or above performs below its
122.15range of expected performance on the annualized three-year self-support index under
122.16section 256J.751, subdivision 2, clause (6), will not receive an additional allocation equal
122.17to 2.5 percent of its initial allocation until after negotiating for two consecutive years must
122.18negotiate a multiyear improvement plan with the commissioner. If no improvement is
122.19shown by the end of the multiyear plan, the county's or tribe's allocation must be decreased
122.20by 2.5 percent. The decrease must remain in effect until the county or tribe performs
122.21within or above its range of expected performance.
122.22    (c) (b) For calendar year 2009 2016 and yearly thereafter, performance-based funds
122.23for a federally approved tribal TANF program in which the state and tribe have in place a
122.24contract under section 256.01, addressing consolidated funding, will must be allocated
122.25as follows:
122.26    (1) a tribe that achieves the participation rate approved in its federal TANF plan
122.27using the average of 12 consecutive months for the most recent year for which the
122.28measurements are available, will receive an additional allocation equal to 2.5 percent of
122.29its initial allocation; and
122.30    (2) (1) a tribe that performs within or above its range of expected performance on the
122.31annualized three-year self-support index under section 256J.751, subdivision 2, clause (6),
122.32will must receive an additional allocation equal to 2.5 percent of its initial allocation; or
122.33    (3) a tribe that does not achieve the participation rate approved in its federal TANF
122.34plan using the average of 12 consecutive months for the most recent year for which the
122.35measurements are available, will not receive an additional allocation equal to 2.5 percent
123.1of its initial allocation until after negotiating a multiyear improvement plan with the
123.2commissioner; or
123.3    (4) (2) a tribe that does not perform within or above performs below its range of
123.4expected performance on the annualized three-year self-support index under section
123.5256J.751, subdivision 2 , clause (6), will not receive an additional allocation equal to
123.62.5 percent until after negotiating for two consecutive years must negotiate a multiyear
123.7improvement plan with the commissioner. If no improvement is shown by the end of the
123.8multiyear plan, the tribe's allocation must be decreased by 2.5 percent. The decrease must
123.9remain in effect until the tribe performs within or above its range of expected performance.
123.10    (d) (c) Funds remaining unallocated after the performance-based allocations
123.11in paragraph (b) (a) are available to the commissioner for innovation projects under
123.12subdivision 5.
123.13     (1) (d) If available funds are insufficient to meet county and tribal allocations under
123.14paragraph paragraphs (a) and (b), the commissioner may make available for allocation
123.15funds that are unobligated and available from the innovation projects through the end of
123.16the current biennium shall proportionally prorate funds to counties and tribes that qualify
123.17for a bonus under paragraphs (a), clause (1), and (b), clause (2).
123.18    (2) If after the application of clause (1) funds remain insufficient to meet county and
123.19tribal allocations under paragraph (b), the commissioner must proportionally reduce the
123.20allocation of each county and tribe with respect to their maximum allocation available
123.21under paragraph (b).

123.22    Sec. 32. [256J.78] TANF DEMONSTRATION PROJECTS OR WAIVER FROM
123.23FEDERAL RULES AND REGULATIONS.
123.24    Subdivision 1. Duties of the commissioner. The commissioner of human services
123.25may pursue TANF demonstration projects or waivers of TANF requirements from the
123.26United States Department of Health and Human Services as needed to allow the state to
123.27build a more results-oriented Minnesota Family Investment Program to better meet the
123.28needs of Minnesota families.
123.29    Subd. 2. Purpose. The purpose of the TANF demonstration projects or waivers is to:
123.30(1) replace the federal TANF process measure and its complex administrative
123.31requirements with state-developed outcomes measures that track adult employment and
123.32exits from MFIP cash assistance;
123.33(2) simplify programmatic and administrative requirements; and
123.34(3) make other policy or programmatic changes that improve the performance of the
123.35program and the outcomes for participants.
124.1    Subd. 3. Report to legislature. The commissioner shall report to the members of
124.2the legislative committees having jurisdiction over human services issues by March 1,
124.32014, regarding the progress of this waiver or demonstration project.
124.4EFFECTIVE DATE.This section is effective the day following final enactment.

124.5    Sec. 33. Minnesota Statutes 2012, section 256K.45, is amended to read:
124.6256K.45 RUNAWAY AND HOMELESS YOUTH ACT.
124.7    Subdivision 1. Grant program established. The commissioner of human services
124.8shall establish a Homeless Youth Act fund and award grants to providers who are
124.9committed to serving homeless youth and youth at risk of homelessness, to provide
124.10street and community outreach and drop-in programs, emergency shelter programs,
124.11and integrated supportive housing and transitional living programs, consistent with the
124.12program descriptions in this act to reduce the incidence of homelessness among youth.
124.13    Subdivision 1. Subd. 1a. Definitions. (a) The definitions in this subdivision apply
124.14to this section.
124.15(b) "Commissioner" means the commissioner of human services.
124.16(c) "Homeless youth" means a person 21 years of age or younger who is
124.17unaccompanied by a parent or guardian and is without shelter where appropriate care and
124.18supervision are available, whose parent or legal guardian is unable or unwilling to provide
124.19shelter and care, or who lacks a fixed, regular, and adequate nighttime residence. The
124.20following are not fixed, regular, or adequate nighttime residences:
124.21(1) a supervised publicly or privately operated shelter designed to provide temporary
124.22living accommodations;
124.23(2) an institution or a publicly or privately operated shelter designed to provide
124.24temporary living accommodations;
124.25(3) transitional housing;
124.26(4) a temporary placement with a peer, friend, or family member that has not offered
124.27permanent residence, a residential lease, or temporary lodging for more than 30 days; or
124.28(5) a public or private place not designed for, nor ordinarily used as, a regular
124.29sleeping accommodation for human beings.
124.30Homeless youth does not include persons incarcerated or otherwise detained under
124.31federal or state law.
124.32(d) "Youth at risk of homelessness" means a person 21 years of age or younger
124.33whose status or circumstances indicate a significant danger of experiencing homelessness
124.34in the near future. Status or circumstances that indicate a significant danger may include:
125.1(1) youth exiting out-of-home placements; (2) youth who previously were homeless; (3)
125.2youth whose parents or primary caregivers are or were previously homeless; (4) youth
125.3who are exposed to abuse and neglect in their homes; (5) youth who experience conflict
125.4with parents due to chemical or alcohol dependency, mental health disabilities, or other
125.5disabilities; and (6) runaways.
125.6(e) "Runaway" means an unmarried child under the age of 18 years who is absent
125.7from the home of a parent or guardian or other lawful placement without the consent of
125.8the parent, guardian, or lawful custodian.
125.9    Subd. 2. Homeless and runaway youth report. The commissioner shall develop a
125.10 report for homeless youth, youth at risk of homelessness, and runaways. The report shall
125.11include coordination of services as defined under subdivisions 3 to 5 prepare a biennial
125.12report, beginning in February 2015, which provides meaningful information to the
125.13legislative committees having jurisdiction over the issue of homeless youth, that includes,
125.14but is not limited to: (1) a list of the areas of the state with the greatest need for services
125.15and housing for homeless youth, and the level and nature of the needs identified; (2) details
125.16about grants made; (3) the distribution of funds throughout the state based on population
125.17need; (4) follow-up information, if available, on the status of homeless youth and whether
125.18they have stable housing two years after services are provided; and (5) any other outcomes
125.19for populations served to determine the effectiveness of the programs and use of funding.
125.20    Subd. 3. Street and community outreach and drop-in program. Youth drop-in
125.21centers must provide walk-in access to crisis intervention and ongoing supportive services
125.22including one-to-one case management services on a self-referral basis. Street and
125.23community outreach programs must locate, contact, and provide information, referrals,
125.24and services to homeless youth, youth at risk of homelessness, and runaways. Information,
125.25referrals, and services provided may include, but are not limited to:
125.26(1) family reunification services;
125.27(2) conflict resolution or mediation counseling;
125.28(3) assistance in obtaining temporary emergency shelter;
125.29(4) assistance in obtaining food, clothing, medical care, or mental health counseling;
125.30(5) counseling regarding violence, prostitution sexual exploitation, substance abuse,
125.31sexually transmitted diseases, and pregnancy;
125.32(6) referrals to other agencies that provide support services to homeless youth,
125.33youth at risk of homelessness, and runaways;
125.34(7) assistance with education, employment, and independent living skills;
125.35(8) aftercare services;
126.1(9) specialized services for highly vulnerable runaways and homeless youth,
126.2including teen parents, emotionally disturbed and mentally ill youth, and sexually
126.3exploited youth; and
126.4(10) homelessness prevention.
126.5    Subd. 4. Emergency shelter program. (a) Emergency shelter programs must
126.6provide homeless youth and runaways with referral and walk-in access to emergency,
126.7short-term residential care. The program shall provide homeless youth and runaways with
126.8safe, dignified shelter, including private shower facilities, beds, and at least one meal each
126.9day; and shall assist a runaway and homeless youth with reunification with the family or
126.10legal guardian when required or appropriate.
126.11(b) The services provided at emergency shelters may include, but are not limited to:
126.12(1) family reunification services;
126.13(2) individual, family, and group counseling;
126.14(3) assistance obtaining clothing;
126.15(4) access to medical and dental care and mental health counseling;
126.16(5) education and employment services;
126.17(6) recreational activities;
126.18(7) advocacy and referral services;
126.19(8) independent living skills training;
126.20(9) aftercare and follow-up services;
126.21(10) transportation; and
126.22(11) homelessness prevention.
126.23    Subd. 5. Supportive housing and transitional living programs. Transitional
126.24living programs must help homeless youth and youth at risk of homelessness to find and
126.25maintain safe, dignified housing. The program may also provide rental assistance and
126.26related supportive services, or refer youth to other organizations or agencies that provide
126.27such services. Services provided may include, but are not limited to:
126.28(1) educational assessment and referrals to educational programs;
126.29(2) career planning, employment, work skill training, and independent living skills
126.30training;
126.31(3) job placement;
126.32(4) budgeting and money management;
126.33(5) assistance in securing housing appropriate to needs and income;
126.34(6) counseling regarding violence, prostitution sexual exploitation, substance abuse,
126.35sexually transmitted diseases, and pregnancy;
126.36(7) referral for medical services or chemical dependency treatment;
127.1(8) parenting skills;
127.2(9) self-sufficiency support services or life skill training;
127.3(10) aftercare and follow-up services; and
127.4(11) homelessness prevention.
127.5    Subd. 6. Funding. Any Funds appropriated for this section may be expended on
127.6programs described under subdivisions 3 to 5, technical assistance, and capacity building.
127.7Up to four percent of funds appropriated may be used for the purpose of monitoring and
127.8evaluating runaway and homeless youth programs receiving funding under this section.
127.9Funding shall be directed to meet the greatest need, with a significant share of the funding
127.10focused on homeless youth providers in greater Minnesota to meet the greatest need
127.11on a statewide basis.

127.12    Sec. 34. Minnesota Statutes 2012, section 256M.40, subdivision 1, is amended to read:
127.13    Subdivision 1. Formula. The commissioner shall allocate state funds appropriated
127.14under this chapter to each county board on a calendar year basis in an amount determined
127.15according to the formula in paragraphs (a) to (e).
127.16(a) For calendar years 2011 and 2012, the commissioner shall allocate available
127.17funds to each county in proportion to that county's share in calendar year 2010.
127.18(b) For calendar year 2013 and each calendar year thereafter, the commissioner shall
127.19allocate available funds to each county as follows:
127.20(1) 75 percent must be distributed on the basis of the county share in calendar year
127.212012;
127.22(2) five percent must be distributed on the basis of the number of persons residing in
127.23the county as determined by the most recent data of the state demographer;
127.24(3) ten percent must be distributed on the basis of the number of vulnerable children
127.25that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, and in
127.26the county as determined by the most recent data of the commissioner; and
127.27(4) ten percent must be distributed on the basis of the number of vulnerable adults
127.28that are subjects of reports under section 626.557 in the county as determined by the most
127.29recent data of the commissioner.
127.30(c) For calendar year 2014, the commissioner shall allocate available funds to each
127.31county as follows:
127.32(1) 50 percent must be distributed on the basis of the county share in calendar year
127.332012;
127.34(2) Ten percent must be distributed on the basis of the number of persons residing in
127.35the county as determined by the most recent data of the state demographer;
128.1(3) 20 percent must be distributed on the basis of the number of vulnerable children
128.2that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the
128.3county as determined by the most recent data of the commissioner; and
128.4(4) 20 percent must be distributed on the basis of the number of vulnerable adults
128.5that are subjects of reports under section 626.557 in the county as determined by the
128.6most recent data of the commissioner The commissioner is precluded from changing the
128.7formula under this subdivision or recommending a change to the legislature without
128.8public review and input.
128.9(d) For calendar year 2015, the commissioner shall allocate available funds to each
128.10county as follows:
128.11(1) 25 percent must be distributed on the basis of the county share in calendar year
128.122012;
128.13(2) 15 percent must be distributed on the basis of the number of persons residing in
128.14the county as determined by the most recent data of the state demographer;
128.15(3) 30 percent must be distributed on the basis of the number of vulnerable children
128.16that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the
128.17county as determined by the most recent data of the commissioner; and
128.18(4) 30 percent must be distributed on the basis of the number of vulnerable adults
128.19that are subjects of reports under section 626.557 in the county as determined by the most
128.20recent data of the commissioner.
128.21(e) For calendar year 2016 and each calendar year thereafter, the commissioner shall
128.22allocate available funds to each county as follows:
128.23(1) 20 percent must be distributed on the basis of the number of persons residing in
128.24the county as determined by the most recent data of the state demographer;
128.25(2) 40 percent must be distributed on the basis of the number of vulnerable children
128.26that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the
128.27county as determined by the most recent data of the commissioner; and
128.28(3) 40 percent must be distributed on the basis of the number of vulnerable adults
128.29that are subjects of reports under section 626.557 in the county as determined by the most
128.30recent data of the commissioner.

128.31    Sec. 35. Minnesota Statutes 2012, section 257.0755, subdivision 1, is amended to read:
128.32    Subdivision 1. Creation. One Each ombudsperson shall operate independently from
128.33but in collaboration with each of the following groups the community-specific board that
128.34appointed the ombudsperson under section 257.0768: the Indian Affairs Council, the
129.1Council on Affairs of Chicano/Latino people, the Council on Black Minnesotans, and
129.2the Council on Asian-Pacific Minnesotans.

129.3    Sec. 36. Minnesota Statutes 2012, section 259A.20, subdivision 4, is amended to read:
129.4    Subd. 4. Reimbursement for special nonmedical expenses. (a) Reimbursement
129.5for special nonmedical expenses is available to children, except those eligible for adoption
129.6assistance based on being an at-risk child.
129.7(b) Reimbursements under this paragraph shall be made only after the adoptive
129.8parent documents that the requested service was denied by the local social service agency,
129.9community agencies, the local school district, the local public health department, the
129.10parent's insurance provider, or the child's program. The denial must be for an eligible
129.11service or qualified item under the program requirements of the applicable agency or
129.12organization.
129.13(c) Reimbursements must be previously authorized, adhere to the requirements and
129.14procedures prescribed by the commissioner, and be limited to:
129.15(1) child care for a child age 12 and younger, or for a child age 13 or 14 who has a
129.16documented disability that requires special instruction for and services by the child care
129.17provider. Child care reimbursements may be made if all available adult caregivers are
129.18employed, unemployed due to a disability as defined in section 259A.01, subdivision 14,
129.19 or attending educational or vocational training programs. Documentation from a qualified
129.20expert that is dated within the last 12 months must be provided to verify the disability. If a
129.21parent is attending an educational or vocational training program, child care reimbursement
129.22is limited to no more than the time necessary to complete the credit requirements for an
129.23associate or baccalaureate degree as determined by the educational institution. Child
129.24care reimbursement is not limited for an adoptive parent completing basic or remedial
129.25education programs needed to prepare for postsecondary education or employment;
129.26(2) respite care provided for the relief of the child's parent up to 504 hours of respite
129.27care annually;
129.28(3) camping up to 14 days per state fiscal year for a child to attend a special needs
129.29camp. The camp must be accredited by the American Camp Association as a special needs
129.30camp in order to be eligible for camp reimbursement;
129.31(4) postadoption counseling to promote the child's integration into the adoptive
129.32family that is provided by the placing agency during the first year following the date of the
129.33adoption decree. Reimbursement is limited to 12 sessions of postadoption counseling;
129.34(5) family counseling that is required to meet the child's special needs.
129.35Reimbursement is limited to the prorated portion of the counseling fees allotted to the
130.1family when the adoptive parent's health insurance or Medicaid pays for the child's
130.2counseling but does not cover counseling for the rest of the family members;
130.3(6) home modifications to accommodate the child's special needs upon which
130.4eligibility for adoption assistance was approved. Reimbursement is limited to once every
130.5five years per child;
130.6(7) vehicle modifications to accommodate the child's special needs upon which
130.7eligibility for adoption assistance was approved. Reimbursement is limited to once every
130.8five years per family; and
130.9(8) burial expenses up to $1,000, if the special needs, upon which eligibility for
130.10adoption assistance was approved, resulted in the death of the child.
130.11(d) The adoptive parent shall submit statements for expenses incurred between July
130.121 and June 30 of a given fiscal year to the state adoption assistance unit within 60 days
130.13after the end of the fiscal year in order for reimbursement to occur.

130.14    Sec. 37. Minnesota Statutes 2012, section 260B.007, subdivision 6, is amended to read:
130.15    Subd. 6. Delinquent child. (a) Except as otherwise provided in paragraphs (b)
130.16and (c), "delinquent child" means a child:
130.17(1) who has violated any state or local law, except as provided in section 260B.225,
130.18subdivision 1 , and except for juvenile offenders as described in subdivisions 16 to 18;
130.19(2) who has violated a federal law or a law of another state and whose case has been
130.20referred to the juvenile court if the violation would be an act of delinquency if committed
130.21in this state or a crime or offense if committed by an adult;
130.22(3) who has escaped from confinement to a state juvenile correctional facility after
130.23being committed to the custody of the commissioner of corrections; or
130.24(4) who has escaped from confinement to a local juvenile correctional facility after
130.25being committed to the facility by the court.
130.26(b) The term delinquent child does not include a child alleged to have committed
130.27murder in the first degree after becoming 16 years of age, but the term delinquent child
130.28does include a child alleged to have committed attempted murder in the first degree.
130.29(c) The term delinquent child does not include a child under the age of 16 years
130.30 alleged to have engaged in conduct which would, if committed by an adult, violate any
130.31federal, state, or local law relating to being hired, offering to be hired, or agreeing to be
130.32hired by another individual to engage in sexual penetration or sexual conduct.
130.33EFFECTIVE DATE.This section is effective August 1, 2014, and applies to
130.34offenses committed on or after that date.

131.1    Sec. 38. Minnesota Statutes 2012, section 260B.007, subdivision 16, is amended to read:
131.2    Subd. 16. Juvenile petty offender; juvenile petty offense. (a) "Juvenile petty
131.3offense" includes a juvenile alcohol offense, a juvenile controlled substance offense,
131.4a violation of section 609.685, or a violation of a local ordinance, which by its terms
131.5prohibits conduct by a child under the age of 18 years which would be lawful conduct if
131.6committed by an adult.
131.7(b) Except as otherwise provided in paragraph (c), "juvenile petty offense" also
131.8includes an offense that would be a misdemeanor if committed by an adult.
131.9(c) "Juvenile petty offense" does not include any of the following:
131.10(1) a misdemeanor-level violation of section 518B.01, 588.20, 609.224, 609.2242,
131.11609.324 , subdivision 2 or 3, 609.5632, 609.576, 609.66, 609.746, 609.748, 609.79,
131.12or 617.23;
131.13(2) a major traffic offense or an adult court traffic offense, as described in section
131.14260B.225 ;
131.15(3) a misdemeanor-level offense committed by a child whom the juvenile court
131.16previously has found to have committed a misdemeanor, gross misdemeanor, or felony
131.17offense; or
131.18(4) a misdemeanor-level offense committed by a child whom the juvenile court
131.19has found to have committed a misdemeanor-level juvenile petty offense on two or
131.20more prior occasions, unless the county attorney designates the child on the petition
131.21as a juvenile petty offender notwithstanding this prior record. As used in this clause,
131.22"misdemeanor-level juvenile petty offense" includes a misdemeanor-level offense that
131.23would have been a juvenile petty offense if it had been committed on or after July 1, 1995.
131.24(d) A child who commits a juvenile petty offense is a "juvenile petty offender." The
131.25term juvenile petty offender does not include a child under the age of 16 years alleged
131.26to have violated any law relating to being hired, offering to be hired, or agreeing to be
131.27hired by another individual to engage in sexual penetration or sexual conduct which, if
131.28committed by an adult, would be a misdemeanor.
131.29EFFECTIVE DATE.This section is effective August 1, 2014, and applies to
131.30offenses committed on or after that date.

131.31    Sec. 39. Minnesota Statutes 2012, section 260C.007, subdivision 6, is amended to read:
131.32    Subd. 6. Child in need of protection or services. "Child in need of protection or
131.33services" means a child who is in need of protection or services because the child:
131.34    (1) is abandoned or without parent, guardian, or custodian;
132.1    (2)(i) has been a victim of physical or sexual abuse as defined in section 626.556,
132.2subdivision 2, (ii) resides with or has resided with a victim of child abuse as defined in
132.3subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or
132.4would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or
132.5child abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment
132.6as defined in subdivision 15;
132.7    (3) is without necessary food, clothing, shelter, education, or other required care
132.8for the child's physical or mental health or morals because the child's parent, guardian,
132.9or custodian is unable or unwilling to provide that care;
132.10    (4) is without the special care made necessary by a physical, mental, or emotional
132.11condition because the child's parent, guardian, or custodian is unable or unwilling to
132.12provide that care;
132.13    (5) is medically neglected, which includes, but is not limited to, the withholding of
132.14medically indicated treatment from a disabled infant with a life-threatening condition. The
132.15term "withholding of medically indicated treatment" means the failure to respond to the
132.16infant's life-threatening conditions by providing treatment, including appropriate nutrition,
132.17hydration, and medication which, in the treating physician's or physicians' reasonable
132.18medical judgment, will be most likely to be effective in ameliorating or correcting all
132.19conditions, except that the term does not include the failure to provide treatment other
132.20than appropriate nutrition, hydration, or medication to an infant when, in the treating
132.21physician's or physicians' reasonable medical judgment:
132.22    (i) the infant is chronically and irreversibly comatose;
132.23    (ii) the provision of the treatment would merely prolong dying, not be effective in
132.24ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be
132.25futile in terms of the survival of the infant; or
132.26    (iii) the provision of the treatment would be virtually futile in terms of the survival
132.27of the infant and the treatment itself under the circumstances would be inhumane;
132.28    (6) is one whose parent, guardian, or other custodian for good cause desires to be
132.29relieved of the child's care and custody, including a child who entered foster care under a
132.30voluntary placement agreement between the parent and the responsible social services
132.31agency under section 260C.227;
132.32    (7) has been placed for adoption or care in violation of law;
132.33    (8) is without proper parental care because of the emotional, mental, or physical
132.34disability, or state of immaturity of the child's parent, guardian, or other custodian;
133.1    (9) is one whose behavior, condition, or environment is such as to be injurious or
133.2dangerous to the child or others. An injurious or dangerous environment may include, but
133.3is not limited to, the exposure of a child to criminal activity in the child's home;
133.4    (10) is experiencing growth delays, which may be referred to as failure to thrive, that
133.5have been diagnosed by a physician and are due to parental neglect;
133.6    (11) has engaged in prostitution as defined in section 609.321, subdivision 9 is a
133.7sexually exploited youth;
133.8    (12) has committed a delinquent act or a juvenile petty offense before becoming
133.9ten years old;
133.10    (13) is a runaway;
133.11    (14) is a habitual truant;
133.12    (15) has been found incompetent to proceed or has been found not guilty by reason
133.13of mental illness or mental deficiency in connection with a delinquency proceeding, a
133.14certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a
133.15proceeding involving a juvenile petty offense; or
133.16(16) has a parent whose parental rights to one or more other children were
133.17involuntarily terminated or whose custodial rights to another child have been involuntarily
133.18transferred to a relative and there is a case plan prepared by the responsible social services
133.19agency documenting a compelling reason why filing the termination of parental rights
133.20petition under section 260C.301, subdivision 3, is not in the best interests of the child; or.
133.21(17) is a sexually exploited youth.
133.22EFFECTIVE DATE.This section is effective August 1, 2014.

133.23    Sec. 40. Minnesota Statutes 2012, section 260C.007, subdivision 31, is amended to read:
133.24    Subd. 31. Sexually exploited youth. "Sexually exploited youth" means an
133.25individual who:
133.26(1) is alleged to have engaged in conduct which would, if committed by an adult,
133.27violate any federal, state, or local law relating to being hired, offering to be hired, or
133.28agreeing to be hired by another individual to engage in sexual penetration or sexual conduct;
133.29(2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
133.30609.3451 , 609.3453, 609.352, 617.246, or 617.247;
133.31(3) is a victim of a crime described in United States Code, title 18, section 2260;
133.322421; 2422; 2423; 2425; 2425A; or 2256; or
133.33(4) is a sex trafficking victim as defined in section 609.321, subdivision 7b.
133.34EFFECTIVE DATE.This section is effective the day following final enactment.

134.1    Sec. 41. Minnesota Statutes 2012, section 518A.60, is amended to read:
134.2518A.60 COLLECTION; ARREARS ONLY.
134.3(a) Remedies available for the collection and enforcement of support in this chapter
134.4and chapters 256, 257, 518, and 518C also apply to cases in which the child or children
134.5for whom support is owed are emancipated and the obligor owes past support or has an
134.6accumulated arrearage as of the date of the youngest child's emancipation. Child support
134.7arrearages under this section include arrearages for child support, medical support, child
134.8care, pregnancy and birth expenses, and unreimbursed medical expenses as defined in
134.9section 518A.41, subdivision 1, paragraph (h).
134.10(b) This section applies retroactively to any support arrearage that accrued on or
134.11before June 3, 1997, and to all arrearages accruing after June 3, 1997.
134.12(c) Past support or pregnancy and confinement expenses ordered for which the
134.13obligor has specific court ordered terms for repayment may not be enforced using
134.14drivers' and occupational or professional license suspension, credit bureau reporting, and
134.15additional income withholding under section 518A.53, subdivision 10, paragraph (a),
134.16unless the obligor fails to comply with the terms of the court order for repayment.
134.17(d) If an arrearage exists at the time a support order would otherwise terminate
134.18and section 518A.53, subdivision 10, paragraph (c), does not apply to this section, the
134.19arrearage shall be repaid in an amount equal to the current support order until all arrears
134.20have been paid in full, absent a court order to the contrary.
134.21(e) If an arrearage exists according to a support order which fails to establish a
134.22monthly support obligation in a specific dollar amount, the public authority, if it provides
134.23child support services, or the obligee, may establish a payment agreement which shall
134.24equal what the obligor would pay for current support after application of section 518A.34,
134.25plus an additional 20 percent of the current support obligation, until all arrears have been
134.26paid in full. If the obligor fails to enter into or comply with a payment agreement, the
134.27public authority, if it provides child support services, or the obligee, may move the district
134.28court or child support magistrate, if section 484.702 applies, for an order establishing
134.29repayment terms.
134.30(f) If there is no longer a current support order because all of the children of the
134.31order are emancipated, the public authority may discontinue child support services and
134.32close its case under title IV-D of the Social Security Act if:
134.33(1) the arrearage is under $500; or
134.34(2) the arrearage is considered unenforceable by the public authority because there
134.35have been no collections for three years, and all administrative and legal remedies have
134.36been attempted or are determined by the public authority to be ineffective because the
135.1obligor is unable to pay, the obligor has no known income or assets, and there is no
135.2reasonable prospect that the obligor will be able to pay in the foreseeable future.
135.3    (g) At least 60 calendar days before the discontinuation of services under paragraph
135.4(f), the public authority must mail a written notice to the obligee and obligor at the
135.5obligee's and obligor's last known addresses that the public authority intends to close the
135.6child support enforcement case and explaining each party's rights. Seven calendar days
135.7after the first notice is mailed, the public authority must mail a second notice under this
135.8paragraph to the obligee.
135.9    (h) The case must be kept open if the obligee responds before case closure and
135.10provides information that could reasonably lead to collection of arrears. If the case is
135.11closed, the obligee may later request that the case be reopened by completing a new
135.12application for services, if there is a change in circumstances that could reasonably lead to
135.13the collection of arrears.

135.14    Sec. 42. Laws 1998, chapter 407, article 6, section 116, is amended to read:
135.15    Sec. 116. EBT TRANSACTION COSTS; APPROVAL FROM LEGISLATURE.
135.16    The commissioner of human services shall request and receive approval from the
135.17legislature before adjusting the payment to not subsidize retailers for electronic benefit
135.18transfer transaction costs Supplemental Nutrition Assistance Program transactions.
135.19EFFECTIVE DATE.This section is effective 30 days after the commissioner
135.20notifies retailers of the termination of their agreement with the state. The commissioner of
135.21human services must notify the revisor of statutes of that date.

135.22    Sec. 43. Laws 2011, First Special Session chapter 9, article 1, section 3, the effective
135.23date, is amended to read:
135.24EFFECTIVE DATE.This section is effective January 1, 2013 July 1, 2014.
135.25EFFECTIVE DATE.This section is effective retroactively from January 1, 2013.

135.26    Sec. 44. DIRECTION TO COMMISSIONERS; INCOME AND ASSET
135.27EXCLUSION.
135.28(a) The commissioner of human services shall not count conditional cash transfers
135.29made to families participating in a family independence demonstration as income or
135.30assets for purposes of determining or redetermining eligibility for child care assistance
135.31programs under Minnesota Statutes, chapter 119B; general assistance under Minnesota
135.32Statutes, chapter 256D; group residential housing under Minnesota Statutes, chapter 256I;
136.1the Minnesota family investment program, work benefit program, or diversionary work
136.2program under Minnesota Statutes, chapter 256J, during the duration of the demonstration.
136.3(b) The commissioner of human services shall not count conditional cash transfers
136.4made to families participating in a family independence demonstration as income or assets
136.5for purposes of determining or redetermining eligibility for medical assistance under
136.6Minnesota Statutes, chapter 256B, and MinnesotaCare under Minnesota Statutes, chapter
136.7256L, except that for enrollees subject to a modified adjusted gross income calculation to
136.8determine eligibility, the conditional cash transfer payments shall be counted as income if
136.9they are included on the enrollee's federal tax return as income, or if the payments can be
136.10taken into account in the month of receipt as a lump sum payment.
136.11(c) The commissioner of the Minnesota Housing Finance Agency shall not count
136.12conditional cash transfers made to families participating in a family independence
136.13demonstration as income or assets for purposes of determining or redetermining eligibility
136.14for housing assistance programs under Minnesota Statutes, section 462A.201, during
136.15the duration of the demonstration.
136.16(d) For the purposes of this section:
136.17(1) "conditional cash transfer" means a payment made to a participant in a family
136.18independence demonstration by a sponsoring organization to incent, support, or facilitate
136.19participation; and
136.20(2) "family independence demonstration" means an initiative sponsored or
136.21cosponsored by a governmental or nongovernmental organization, the goal of which is
136.22to facilitate individualized goal-setting and peer support for cohorts of no more than 12
136.23families each toward the development of financial and nonfinancial assets that enable the
136.24participating families to achieve financial independence.
136.25(e) The citizens league shall provide a report to the legislative committees having
136.26jurisdiction over human services issues by July 1, 2016, informing the legislature on the
136.27progress and outcomes of the demonstration under this section.

136.28    Sec. 45. REDUCTION OF YOUTH HOMELESSNESS.
136.29(a) The Minnesota Interagency Council on Homelessness established under the
136.30authority of Minnesota Statutes, section 462A.29, as it updates its statewide plan to
136.31prevent and end homelessness, shall make recommendations on strategies to reduce the
136.32number of youth experiencing homelessness and to prevent homelessness for youth who
136.33are at risk of becoming homeless.
136.34(b) Recommended strategies must take into consideration, to the extent feasible,
136.35issues that contribute to or reduce youth homelessness including, but not limited to, mental
137.1health, chemical dependency, trafficking of youth for sex or other purposes, exiting foster
137.2care, and involvement in gangs. The recommended strategies must include supportive
137.3services as outlined in Minnesota Statutes, section 256K.45, subdivision 5.
137.4(c) The council shall provide an update on the status of its work by December 1,
137.52014, to the legislative committees with jurisdiction over housing, homelessness, and
137.6matters pertaining to youth. If the council determines legislative action is required to
137.7implement recommended strategies, the council shall submit proposals to the legislature at
137.8the earliest possible opportunity.

137.9    Sec. 46. HOUSING ASSISTANCE GRANTS; FORECASTED PROGRAM.
137.10Beginning July 1, 2015, housing assistance grants under Minnesota Statutes, section
137.11256J.35, paragraph (a), must be a forecasted program and the commissioner, with the
137.12approval of the commissioner of management and budget, may transfer unencumbered
137.13appropriation balances within fiscal years of each biennium with other forecasted
137.14programs of the Department of Human Services. The commissioner shall inform the
137.15chairs and ranking minority members of the senate Health and Human Services Finance
137.16Division and the house of representatives Health and Human Services Finance committee
137.17quarterly about transfers made under this provision.

137.18    Sec. 47. PLAN FOR GROUP RESIDENTIAL HOUSING SPECIALTY RATE
137.19AND BANKED BEDS.
137.20The commissioner of human services, in consultation with and cooperation of the
137.21counties, shall review the statewide number and status of group residential housing beds
137.22with rates in excess of the MSA equivalent rate, including banked supplemental service
137.23rate beds. The commissioner shall study the type and amount of supplemental services
137.24delivered or planned for development, and develop a plan for rate setting criteria and
137.25an efficient use of these beds. The commissioner shall review the performance of all
137.26programs that receive supplemental service rates. The plan must require that all beds
137.27receiving supplemental service rates address critical service needs and must establish
137.28quality performance requirements for beds receiving supplemental service rates. The
137.29commissioner shall present the written plan no later than February 1, 2014, to the chairs
137.30and ranking minority members of the house of representatives and senate finance and
137.31policy committees and divisions with jurisdiction over the Department of Human Services.

137.32    Sec. 48. REPEALER.
137.33(a) Minnesota Statutes 2012, section 256J.24, is repealed January 1, 2015.
138.1(b) Minnesota Statutes 2012, section 609.093, is repealed effective the day following
138.2final enactment.


138.5    Section 1. Minnesota Statutes 2012, section 245.462, subdivision 20, is amended to read:
138.6    Subd. 20. Mental illness. (a) "Mental illness" means an organic disorder of the brain
138.7or a clinically significant disorder of thought, mood, perception, orientation, memory, or
138.8behavior that is detailed in a diagnostic codes list published by the commissioner, and that
138.9seriously limits a person's capacity to function in primary aspects of daily living such as
138.10personal relations, living arrangements, work, and recreation.
138.11    (b) An "adult with acute mental illness" means an adult who has a mental illness that
138.12is serious enough to require prompt intervention.
138.13    (c) For purposes of case management and community support services, a "person
138.14with serious and persistent mental illness" means an adult who has a mental illness and
138.15meets at least one of the following criteria:
138.16    (1) the adult has undergone two or more episodes of inpatient care for a mental
138.17illness within the preceding 24 months;
138.18    (2) the adult has experienced a continuous psychiatric hospitalization or residential
138.19treatment exceeding six months' duration within the preceding 12 months;
138.20    (3) the adult has been treated by a crisis team two or more times within the preceding
138.2124 months;
138.22    (4) the adult:
138.23    (i) has a diagnosis of schizophrenia, bipolar disorder, major depression,
138.24schizoaffective disorder, or borderline personality disorder;
138.25    (ii) indicates a significant impairment in functioning; and
138.26    (iii) has a written opinion from a mental health professional, in the last three years,
138.27stating that the adult is reasonably likely to have future episodes requiring inpatient or
138.28residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
138.29management or community support services are provided;
138.30    (5) the adult has, in the last three years, been committed by a court as a person who is
138.31mentally ill under chapter 253B, or the adult's commitment has been stayed or continued; or
138.32    (6) the adult (i) was eligible under clauses (1) to (5), but the specified time period
138.33has expired or the adult was eligible as a child under section 245.4871, subdivision 6; and
138.34(ii) has a written opinion from a mental health professional, in the last three years, stating
138.35that the adult is reasonably likely to have future episodes requiring inpatient or residential
139.1treatment, of a frequency described in clause (1) or (2), unless ongoing case management
139.2or community support services are provided; or
139.3    (7) the adult was eligible as a child under section 245.4871, subdivision 6, and is
139.4age 21 or younger.

139.5    Sec. 2. Minnesota Statutes 2012, section 245.4661, subdivision 5, is amended to read:
139.6    Subd. 5. Planning for pilot projects. (a) Each local plan for a pilot project, with
139.7the exception of the placement of a Minnesota specialty treatment facility as defined in
139.8paragraph (c), must be developed under the direction of the county board, or multiple
139.9county boards acting jointly, as the local mental health authority. The planning process
139.10for each pilot shall include, but not be limited to, mental health consumers, families,
139.11advocates, local mental health advisory councils, local and state providers, representatives
139.12of state and local public employee bargaining units, and the department of human services.
139.13As part of the planning process, the county board or boards shall designate a managing
139.14entity responsible for receipt of funds and management of the pilot project.
139.15(b) For Minnesota specialty treatment facilities, the commissioner shall issue a
139.16request for proposal for regions in which a need has been identified for services.
139.17(c) For purposes of this section, "Minnesota specialty treatment facility" is defined
139.18as an intensive rehabilitative mental health service under section 256B.0622, subdivision
139.192, paragraph (b).

139.20    Sec. 3. Minnesota Statutes 2012, section 245.4661, subdivision 6, is amended to read:
139.21    Subd. 6. Duties of commissioner. (a) For purposes of the pilot projects, the
139.22commissioner shall facilitate integration of funds or other resources as needed and
139.23requested by each project. These resources may include:
139.24(1) residential services funds administered under Minnesota Rules, parts 9535.2000
139.25to 9535.3000, in an amount to be determined by mutual agreement between the project's
139.26managing entity and the commissioner of human services after an examination of the
139.27county's historical utilization of facilities located both within and outside of the county
139.28and licensed under Minnesota Rules, parts 9520.0500 to 9520.0690;
139.29(2) community support services funds administered under Minnesota Rules, parts
139.309535.1700 to 9535.1760;
139.31(3) other mental health special project funds;
139.32(4) medical assistance, general assistance medical care, MinnesotaCare and group
139.33residential housing if requested by the project's managing entity, and if the commissioner
139.34determines this would be consistent with the state's overall health care reform efforts; and
140.1(5) regional treatment center resources consistent with section 246.0136, subdivision
140.21 .; and
140.3(6) funds transferred from section 246.18, subdivision 8, for grants to providers to
140.4participate in mental health specialty treatment services, awarded to providers through
140.5a request for proposal process.
140.6(b) The commissioner shall consider the following criteria in awarding start-up and
140.7implementation grants for the pilot projects:
140.8(1) the ability of the proposed projects to accomplish the objectives described in
140.9subdivision 2;
140.10(2) the size of the target population to be served; and
140.11(3) geographical distribution.
140.12(c) The commissioner shall review overall status of the projects initiatives at least
140.13every two years and recommend any legislative changes needed by January 15 of each
140.14odd-numbered year.
140.15(d) The commissioner may waive administrative rule requirements which are
140.16incompatible with the implementation of the pilot project.
140.17(e) The commissioner may exempt the participating counties from fiscal sanctions
140.18for noncompliance with requirements in laws and rules which are incompatible with the
140.19implementation of the pilot project.
140.20(f) The commissioner may award grants to an entity designated by a county board or
140.21group of county boards to pay for start-up and implementation costs of the pilot project.

140.22    Sec. 4. Minnesota Statutes 2012, section 245.4682, subdivision 2, is amended to read:
140.23    Subd. 2. General provisions. (a) In the design and implementation of reforms to
140.24the mental health system, the commissioner shall:
140.25    (1) consult with consumers, families, counties, tribes, advocates, providers, and
140.26other stakeholders;
140.27    (2) bring to the legislature, and the State Advisory Council on Mental Health, by
140.28January 15, 2008, recommendations for legislation to update the role of counties and to
140.29clarify the case management roles, functions, and decision-making authority of health
140.30plans and counties, and to clarify county retention of the responsibility for the delivery of
140.31social services as required under subdivision 3, paragraph (a);
140.32    (3) withhold implementation of any recommended changes in case management
140.33roles, functions, and decision-making authority until after the release of the report due
140.34January 15, 2008;
141.1    (4) ensure continuity of care for persons affected by these reforms including
141.2ensuring client choice of provider by requiring broad provider networks and developing
141.3mechanisms to facilitate a smooth transition of service responsibilities;
141.4    (5) provide accountability for the efficient and effective use of public and private
141.5resources in achieving positive outcomes for consumers;
141.6    (6) ensure client access to applicable protections and appeals; and
141.7    (7) make budget transfers necessary to implement the reallocation of services and
141.8client responsibilities between counties and health care programs that do not increase the
141.9state and county costs and efficiently allocate state funds.
141.10    (b) When making transfers under paragraph (a) necessary to implement movement
141.11of responsibility for clients and services between counties and health care programs,
141.12the commissioner, in consultation with counties, shall ensure that any transfer of state
141.13grants to health care programs, including the value of case management transfer grants
141.14under section 256B.0625, subdivision 20, does not exceed the value of the services being
141.15transferred for the latest 12-month period for which data is available. The commissioner
141.16may make quarterly adjustments based on the availability of additional data during the
141.17first four quarters after the transfers first occur. If case management transfer grants under
141.18section 256B.0625, subdivision 20, are repealed and the value, based on the last year prior
141.19to repeal, exceeds the value of the services being transferred, the difference becomes an
141.20ongoing part of each county's adult and children's mental health grants under sections
141.21245.4661 , 245.4889, and 256E.12.
141.22    (c) This appropriation is not authorized to be expended after December 31, 2010,
141.23unless approved by the legislature.

141.24    Sec. 5. Minnesota Statutes 2012, section 245.4871, subdivision 26, is amended to read:
141.25    Subd. 26. Mental health practitioner. "Mental health practitioner" means a person
141.26providing services to children with emotional disturbances. A mental health practitioner
141.27must have training and experience in working with children. A mental health practitioner
141.28must be qualified in at least one of the following ways:
141.29(1) holds a bachelor's degree in one of the behavioral sciences or related fields from
141.30an accredited college or university and:
141.31(i) has at least 2,000 hours of supervised experience in the delivery of mental health
141.32services to children with emotional disturbances; or
141.33(ii) is fluent in the non-English language of the ethnic group to which at least 50
141.34percent of the practitioner's clients belong, completes 40 hours of training in the delivery
141.35of services to children with emotional disturbances, and receives clinical supervision from
142.1a mental health professional at least once a week until the requirement of 2,000 hours
142.2of supervised experience is met;
142.3(2) has at least 6,000 hours of supervised experience in the delivery of mental
142.4health services to children with emotional disturbances; hours worked as a mental health
142.5behavioral aide I or II under section 256B.0943, subdivision 7, may be included in the
142.66,000 hours of experience;
142.7(3) is a graduate student in one of the behavioral sciences or related fields and is
142.8formally assigned by an accredited college or university to an agency or facility for
142.9clinical training; or
142.10(4) holds a master's or other graduate degree in one of the behavioral sciences or
142.11related fields from an accredited college or university and has less than 4,000 hours
142.12post-master's experience in the treatment of emotional disturbance.

142.13    Sec. 6. Minnesota Statutes 2012, section 245.4875, subdivision 8, is amended to read:
142.14    Subd. 8. Transition services. The county board may continue to provide mental
142.15health services as defined in sections 245.487 to 245.4889 to persons over 18 years of
142.16age, but under 21 years of age, if the person was receiving case management or family
142.17community support services prior to age 18, and if one of the following conditions is met:
142.18(1) the person is receiving special education services through the local school
142.19district; or
142.20(2) it is in the best interest of the person to continue services defined in sections
142.21245.487 to 245.4889; or
142.22(3) the person is requesting services and the services are medically necessary.

142.23    Sec. 7. Minnesota Statutes 2012, section 245.4881, subdivision 1, is amended to read:
142.24    Subdivision 1. Availability of case management services. (a) The county board
142.25shall provide case management services for each child with severe emotional disturbance
142.26who is a resident of the county and the child's family who request or consent to the services.
142.27Case management services may be continued must be offered to be provided for a child with
142.28a serious emotional disturbance who is over the age of 18 consistent with section 245.4875,
142.29subdivision 8 , or the child's legal representative, provided the child's service needs can be
142.30met within the children's service system. Before discontinuing case management services
142.31under this subdivision for children between the ages of 17 and 21, a transition plan
142.32must be developed. The transition plan must be developed with the child and, with the
142.33consent of a child age 18 or over, the child's parent, guardian, or legal representative. The
142.34transition plan should include plans for health insurance, housing, education, employment,
143.1and treatment. Staffing ratios must be sufficient to serve the needs of the clients. The case
143.2manager must meet the requirements in section 245.4871, subdivision 4.
143.3(b) Except as permitted by law and the commissioner under demonstration projects,
143.4case management services provided to children with severe emotional disturbance eligible
143.5for medical assistance must be billed to the medical assistance program under sections
143.6256B.02, subdivision 8 , and 256B.0625.
143.7(c) Case management services are eligible for reimbursement under the medical
143.8assistance program. Costs of mentoring, supervision, and continuing education may be
143.9included in the reimbursement rate methodology used for case management services under
143.10the medical assistance program.

143.11    Sec. 8. Minnesota Statutes 2012, section 246.18, subdivision 8, is amended to read:
143.12    Subd. 8. State-operated services account. (a) The state-operated services account is
143.13established in the special revenue fund. Revenue generated by new state-operated services
143.14listed under this section established after July 1, 2010, that are not enterprise activities must
143.15be deposited into the state-operated services account, unless otherwise specified in law:
143.16(1) intensive residential treatment services;
143.17(2) foster care services; and
143.18(3) psychiatric extensive recovery treatment services.
143.19(b) Funds deposited in the state-operated services account are available to the
143.20commissioner of human services for the purposes of:
143.21(1) providing services needed to transition individuals from institutional settings
143.22within state-operated services to the community when those services have no other
143.23adequate funding source;
143.24(2) grants to providers participating in mental health specialty treatment services
143.25under section 245.4661; and
143.26(3) to fund the operation of the Intensive Residential Treatment Service program in
143.27Willmar.

143.28    Sec. 9. Minnesota Statutes 2012, section 246.18, is amended by adding a subdivision
143.29to read:
143.30    Subd. 9. Transfers. The commissioner may transfer state mental health grant funds
143.31to the account in subdivision 8 for noncovered allowable costs of a provider certified and
143.32licensed under section 256B.0622 and operating under section 246.014.

144.1    Sec. 10. Minnesota Statutes 2012, section 246.54, is amended to read:
144.2246.54 LIABILITY OF COUNTY; REIMBURSEMENT.
144.3    Subdivision 1. County portion for cost of care. (a) Except for chemical
144.4dependency services provided under sections 254B.01 to 254B.09, the client's county
144.5shall pay to the state of Minnesota a portion of the cost of care provided in a regional
144.6treatment center or a state nursing facility to a client legally settled in that county. A
144.7county's payment shall be made from the county's own sources of revenue and payments
144.8shall equal a percentage of the cost of care, as determined by the commissioner, for each
144.9day, or the portion thereof, that the client spends at a regional treatment center or a state
144.10nursing facility according to the following schedule:
144.11    (1) zero percent for the first 30 days;
144.12    (2) 20 percent for days 31 to 60; and
144.13    (3) 50 75 percent for any days over 60.
144.14    (b) The increase in the county portion for cost of care under paragraph (a), clause
144.15(3), shall be imposed when the treatment facility has determined that it is clinically
144.16appropriate for the client to be discharged.
144.17    (c) If payments received by the state under sections 246.50 to 246.53 exceed 80
144.18percent of the cost of care for days 31 to 60, or 50 25 percent for days over 60, the county
144.19shall be responsible for paying the state only the remaining amount. The county shall
144.20not be entitled to reimbursement from the client, the client's estate, or from the client's
144.21relatives, except as provided in section 246.53.
144.22    Subd. 2. Exceptions. (a) Subdivision 1 does not apply to services provided at the
144.23Minnesota Security Hospital or the Minnesota extended treatment options program. For
144.24services at these facilities the Minnesota Security Hospital, a county's payment shall be
144.25made from the county's own sources of revenue and payments shall be paid as follows:.
144.26Excluding the state-operated forensic transition service, payments to the state from the
144.27county shall equal ten percent of the cost of care, as determined by the commissioner, for
144.28each day, or the portion thereof, that the client spends at the facility. For the state-operated
144.29forensic transition service, payments to the state from the county shall equal 50 percent of
144.30the cost of care, as determined by the commissioner, for each day, or the portion thereof,
144.31that the client spends in the program. If payments received by the state under sections
144.32246.50 to 246.53 for services provided at the Minnesota Security Hospital, excluding the
144.33state-operated forensic transition service, exceed 90 percent of the cost of care, the county
144.34shall be responsible for paying the state only the remaining amount. If payments received
144.35by the state under sections 246.50 to 246.53 for the state-operated forensic transition service
144.36exceed 50 percent of the cost of care, the county shall be responsible for paying the state
145.1only the remaining amount. The county shall not be entitled to reimbursement from the
145.2client, the client's estate, or from the client's relatives, except as provided in section 246.53.
145.3    (b) Regardless of the facility to which the client is committed, subdivision 1 does
145.4not apply to the following individuals:
145.5    (1) clients who are committed as mentally ill and dangerous under section 253B.02,
145.6subdivision 17;
145.7    (2) (1) clients who are committed as sexual psychopathic personalities under section
145.8253B.02, subdivision 18b ; and
145.9    (3) (2) clients who are committed as sexually dangerous persons under section
145.10253B.02 , subdivision 18c.
145.11    For each of the individuals in clauses (1) to (3), the payment by the county to the state
145.12shall equal ten percent of the cost of care for each day as determined by the commissioner.

145.13    Sec. 11. Minnesota Statutes 2012, section 253B.10, subdivision 1, is amended to read:
145.14    Subdivision 1. Administrative requirements. (a) When a person is committed,
145.15the court shall issue a warrant or an order committing the patient to the custody of the
145.16head of the treatment facility. The warrant or order shall state that the patient meets the
145.17statutory criteria for civil commitment.
145.18(b) The commissioner shall prioritize patients being admitted from jail or a
145.19correctional institution who are:
145.20(1) ordered confined in a state hospital for an examination under Minnesota Rules of
145.21Criminal Procedure, rules 20.01, subdivision 4, paragraph (a), and 20.02, subdivision 2;
145.22(2) under civil commitment for competency treatment and continuing supervision
145.23under Minnesota Rules of Criminal Procedure, rule 20.01, subdivision 7;
145.24(3) found not guilty by reason of mental illness under Minnesota Rules of Criminal
145.25Procedure, rule 20.02, subdivision 8, and under civil commitment or are ordered to be
145.26detained in a state hospital or other facility pending completion of the civil commitment
145.27proceedings; or
145.28(4) committed under this chapter to the commissioner after dismissal of the patient's
145.29criminal charges.
145.30Patients described in this paragraph must be admitted to a service operated by the
145.31commissioner within 48 hours. The commitment must be ordered by the court as provided
145.32in section 253B.09, subdivision 1, paragraph (c).
145.33(c) Upon the arrival of a patient at the designated treatment facility, the head of the
145.34facility shall retain the duplicate of the warrant and endorse receipt upon the original
145.35warrant or acknowledge receipt of the order. The endorsed receipt or acknowledgment
146.1must be filed in the court of commitment. After arrival, the patient shall be under the
146.2control and custody of the head of the treatment facility.
146.3(d) Copies of the petition for commitment, the court's findings of fact and
146.4conclusions of law, the court order committing the patient, the report of the examiners,
146.5and the prepetition report shall be provided promptly to the treatment facility.

146.6    Sec. 12. Minnesota Statutes 2012, section 254B.13, is amended to read:
146.7254B.13 PILOT PROJECTS; CHEMICAL HEALTH CARE.
146.8    Subdivision 1. Authorization for navigator pilot projects. The commissioner may
146.9approve and implement navigator pilot projects developed under the planning process
146.10required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and
146.11enhance coordination of the delivery of chemical health services required under section
146.12254B.03 .
146.13    Subd. 2. Program design and implementation. (a) The commissioner and
146.14counties participating in the navigator pilot projects shall continue to work in partnership
146.15to refine and implement the navigator pilot projects initiated under Laws 2009, chapter
146.1679, article 7, section 26.
146.17(b) The commissioner and counties participating in the navigator pilot projects shall
146.18complete the planning phase by June 30, 2010, and, if approved by the commissioner for
146.19implementation, enter into agreements governing the operation of the navigator pilot
146.20projects with implementation scheduled no earlier than July 1, 2010.
146.21    Subd. 2a. Eligibility for navigator pilot program. (a) To be considered for
146.22participation in a navigator pilot program, an individual must:
146.23(1) be a resident of a county with an approved navigator program;
146.24(2) be eligible for consolidated chemical dependency treatment fund services;
146.25(3) be a voluntary participant in the navigator program;
146.26(4) satisfy one of the following items:
146.27(i) have at least one severity rating of three or above in dimension four, five, or six in
146.28a comprehensive assessment under Minnesota Rules, part 9530.6422; or
146.29(ii) have at least one severity rating of two or above in dimension four, five, or six in
146.30a comprehensive assessment under Minnesota Rules, part 9530.6422, and be currently
146.31participating in a Rule 31 treatment program under Minnesota Rules, parts 9530.6405 to
146.329530.6505, or be within 60 days following discharge after participation in a Rule 31
146.33treatment program; and
146.34(5) have had at least two treatment episodes in the past two years, not limited
146.35to episodes reimbursed by the consolidated chemical dependency treatment funds. An
147.1admission to an emergency room, a detoxification program, or a hospital may be substituted
147.2for one treatment episode if it resulted from the individual's substance use disorder.
147.3(b) New eligibility criteria may be added as mutually agreed upon by the
147.4commissioner and participating navigator programs.
147.5    Subd. 3. Program evaluation. The commissioner shall evaluate navigator pilot
147.6projects under this section and report the results of the evaluation to the chairs and
147.7ranking minority members of the legislative committees with jurisdiction over chemical
147.8health issues by January 15, 2014. Evaluation of the navigator pilot projects must be
147.9based on outcome evaluation criteria negotiated with the navigator pilot projects prior
147.10to implementation.
147.11    Subd. 4. Notice of navigator pilot project discontinuation. Each county's
147.12participation in the navigator pilot project may be discontinued for any reason by the county
147.13or the commissioner of human services after 30 days' written notice to the other party.
147.14Any unspent funds held for the exiting county's pro rata share in the special revenue fund
147.15under the authority in subdivision 5, paragraph (d), shall be transferred to the consolidated
147.16chemical dependency treatment fund following discontinuation of the pilot project.
147.17    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in
147.18this chapter, the commissioner may authorize navigator pilot projects to use chemical
147.19dependency treatment funds to pay for nontreatment navigator pilot services:
147.20(1) in addition to those authorized under section 254B.03, subdivision 2, paragraph
147.21(a); and
147.22(2) by vendors in addition to those authorized under section 254B.05 when not
147.23providing chemical dependency treatment services.
147.24(b) For purposes of this section, "nontreatment navigator pilot services" include
147.25navigator services, peer support, family engagement and support, housing support, rent
147.26subsidies, supported employment, and independent living skills.
147.27(c) State expenditures for chemical dependency services and nontreatment navigator
147.28pilot services provided by or through the navigator pilot projects must not be greater than
147.29the chemical dependency treatment fund expected share of forecasted expenditures in the
147.30absence of the navigator pilot projects. The commissioner may restructure the schedule of
147.31payments between the state and participating counties under the local agency share and
147.32division of cost provisions under section 254B.03, subdivisions 3 and 4, as necessary to
147.33facilitate the operation of the navigator pilot projects.
147.34(d) To the extent that state fiscal year expenditures within a pilot project are less
147.35than the expected share of forecasted expenditures in the absence of the pilot projects,
147.36the commissioner shall deposit the unexpended funds in a separate account within the
148.1consolidated chemical dependency treatment fund, and make these funds available for
148.2expenditure by the pilot projects the following year. To the extent that treatment and
148.3nontreatment pilot services expenditures within the pilot project exceed the amount
148.4expected in the absence of the pilot projects, the pilot project county or counties are
148.5responsible for the portion of nontreatment pilot services expenditures in excess of the
148.6otherwise expected share of forecasted expenditures.
148.7(e) (d) The commissioner may waive administrative rule requirements that are
148.8incompatible with the implementation of the navigator pilot project, except that any
148.9chemical dependency treatment funded under this section must continue to be provided
148.10by a licensed treatment provider.
148.11(f) (e) The commissioner shall not approve or enter into any agreement related to
148.12navigator pilot projects authorized under this section that puts current or future federal
148.13funding at risk.
148.14(f) The commissioner shall provide participating navigator pilot projects with
148.15transactional data, reports, provider data, and other data generated by county activity to
148.16assess and measure outcomes. This information must be transmitted or made available in
148.17an acceptable form to participating navigator pilot projects at least once every six months
148.18or within a reasonable time following the commissioner's receipt of information from the
148.19counties needed to comply with this paragraph.
148.20    Subd. 6. Duties of county board. The county board, or other county entity that
148.21is approved to administer a navigator pilot project, shall:
148.22(1) administer the navigator pilot project in a manner consistent with the objectives
148.23described in subdivision 2 and the planning process in subdivision 5;
148.24(2) ensure that no one is denied chemical dependency treatment services for which
148.25they would otherwise be eligible under section 254A.03, subdivision 3; and
148.26(3) provide the commissioner with timely and pertinent information as negotiated in
148.27agreements governing operation of the navigator pilot projects.
148.28    Subd. 7. Managed care. An individual who is eligible for the navigator pilot
148.29program under subdivision 2a is excluded from mandatory enrollment in managed care
148.30until these services are included in the health plan's benefit set.
148.31    Subd. 8. Authorization for continuation of navigator pilots. The navigator pilot
148.32projects implemented pursuant to subdivision 1 are authorized to continue operation after
148.33July 1, 2013, under existing agreements governing operation of the pilot projects.
148.34EFFECTIVE DATE.The amendments to subdivisions 1 to 6 and 8 are effective
148.35August 1, 2013. Subdivision 7 is effective July 1, 2013.

149.1    Sec. 13. [254B.14] CONTINUUM OF CARE PILOT PROJECTS; CHEMICAL
149.2HEALTH CARE.
149.3    Subdivision 1. Authorization for continuum of care pilot projects. The
149.4commissioner shall establish chemical dependency continuum of care pilot projects to
149.5begin implementing the measures developed with stakeholder input and identified in the
149.6report completed pursuant to Laws 2012, chapter 247, article 5, section 8. The pilot
149.7projects are intended to improve the effectiveness and efficiency of the service continuum
149.8for chemically dependent individuals in Minnesota while reducing duplication of efforts
149.9and promoting scientifically supported practices.
149.10    Subd. 2. Program implementation. (a) The commissioner, in coordination with
149.11representatives of the Minnesota Association of County Social Service Administrators
149.12and the Minnesota Inter-County Association, shall develop a process for identifying and
149.13selecting interested counties and providers for participation in the continuum of care pilot
149.14projects. There shall be three pilot projects; one representing the northern region, one for
149.15the metro region, and one for the southern region. The selection process of counties and
149.16providers must include consideration of population size, geographic distribution, cultural
149.17and racial demographics, and provider accessibility. The commissioner shall identify
149.18counties and providers that are selected for participation in the continuum of care pilot
149.19projects no later than September 30, 2013.
149.20(b) The commissioner and entities participating in the continuum of care pilot
149.21projects shall enter into agreements governing the operation of the continuum of care pilot
149.22projects. The agreements shall identify pilot project outcomes and include timelines for
149.23implementation and beginning operation of the pilot projects.
149.24(c) Entities that are currently participating in the navigator pilot project are
149.25eligible to participate in the continuum of care pilot project subsequent to or instead of
149.26participating in the navigator pilot project.
149.27(d) The commissioner may waive administrative rule requirements that are
149.28incompatible with implementation of the continuum of care pilot projects.
149.29(e) Notwithstanding section 254A.19, the commissioner may designate noncounty
149.30entities to complete chemical use assessments and placement authorizations required
149.31under section 254A.19 and Minnesota Rules, parts 9530.6600 to 9530.6655. Section
149.32254A.19, subdivision 3, is applicable to the continuum of care pilot projects at the
149.33discretion of the commissioner.
149.34    Subd. 3. Program design. (a) The operation of the pilot projects shall include:
149.35(1) new services that are responsive to the chronic nature of substance use disorder;
149.36(2) telehealth services, when appropriate to address barriers to services;
150.1(3) services that assure integration with the mental health delivery system when
150.2appropriate;
150.3(4) services that address the needs of diverse populations; and
150.4(5) an assessment and access process that permits clients to present directly to a
150.5service provider for a substance use disorder assessment and authorization of services.
150.6(b) Prior to implementation of the continuum of care pilot projects, a utilization
150.7review process must be developed and agreed to by the commissioner, participating
150.8counties, and providers. The utilization review process shall be described in the
150.9agreements governing operation of the continuum of care pilot projects.
150.10    Subd. 4. Notice of project discontinuation. Each entity's participation in the
150.11continuum of care pilot project may be discontinued for any reason by the county or the
150.12commissioner after 30 days' written notice to the entity.
150.13    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in this
150.14chapter, the commissioner may authorize chemical dependency treatment funds to pay for
150.15nontreatment services arranged by continuum of care pilot projects. Individuals who are
150.16currently accessing Rule 31 treatment services are eligible for concurrent participation in
150.17the continuum of care pilot projects.
150.18(b) County expenditures for continuum of care pilot project services shall not
150.19be greater than their expected share of forecasted expenditures in the absence of the
150.20continuum of care pilot projects.
150.21    Subd. 6. Managed care. An individual who is eligible for the continuum of care
150.22pilot project is excluded from mandatory enrollment in managed care unless these services
150.23are included in the health plan's benefit set.
150.24EFFECTIVE DATE.This section is effective August 1, 2013.

150.25    Sec. 14. [256.478] HOME AND COMMUNITY-BASED SERVICES
150.26TRANSITIONS GRANTS.
150.27(a) The commissioner shall make available home and community-based services
150.28transition grants to serve individuals who do not meet eligibility criteria for the medical
150.29assistance program under section 256B.056 or 256B.057, but who otherwise meet the
150.30criteria under section 256B.092, subdivision 13, or 256B.49, subdivision 24.
150.31(b) For the purposes of this section, the commissioner has the authority to transfer
150.32funds between the medical assistance account and the home and community-based
150.33services transitions grants account.
150.34EFFECTIVE DATE.This section is effective July 1, 2013.

151.1    Sec. 15. [256B.0616] MENTAL HEALTH CERTIFIED FAMILY PEER
151.2SPECIALIST.
151.3    Subdivision 1. Scope. Medical assistance covers mental health certified family peer
151.4specialists services, as established in subdivision 2, subject to federal approval, if provided
151.5to recipients who have an emotional disturbance or severe emotional disturbance under
151.6chapter 245, and are provided by a certified family peer specialist who has completed the
151.7training under subdivision 5. A family peer specialist cannot provide services to the
151.8peer specialist's family.
151.9    Subd. 2. Establishment. The commissioner of human services shall establish a
151.10certified family peer specialists program model which:
151.11(1) provides nonclinical family peer support counseling, building on the strengths
151.12of families and helping them achieve desired outcomes;
151.13(2) collaborates with others providing care or support to the family;
151.14(3) provides nonadversarial advocacy;
151.15(4) promotes the individual family culture in the treatment milieu;
151.16(5) links parents to other parents in the community;
151.17(6) offers support and encouragement;
151.18(7) assists parents in developing coping mechanisms and problem-solving skills;
151.19(8) promotes resiliency, self-advocacy, development of natural supports, and
151.20maintenance of skills learned in other support services;
151.21(9) establishes and provides peer led parent support groups; and
151.22(10) increases the child's ability to function better within the child's home, school,
151.23and community by educating parents on community resources, assisting with problem
151.24solving, and educating parents on mental illnesses.
151.25    Subd. 3. Eligibility. Family peer support services may be located in inpatient
151.26hospitalization, partial hospitalization, residential treatment, treatment foster care, day
151.27treatment, children's therapeutic services and supports, or crisis services.
151.28    Subd. 4. Peer support specialist program providers. The commissioner shall
151.29develop a process to certify family peer support specialist programs, in accordance with
151.30the federal guidelines, in order for the program to bill for reimbursable services. Family
151.31peer support programs must operate within an existing mental health community provider
151.32or center.
151.33    Subd. 5. Certified family peer specialist training and certification. The
151.34commissioner shall develop a training and certification process for certified family peer
151.35specialists who must be at least 21 years of age and have a high school diploma or its
151.36equivalent. The candidates must have raised or are currently raising a child with a mental
152.1illness, have had experience navigating the children's mental health system, and must
152.2demonstrate leadership and advocacy skills and a strong dedication to family-driven and
152.3family-focused services. The training curriculum must teach participating family peer
152.4specialists specific skills relevant to providing peer support to other parents. In addition
152.5to initial training and certification, the commissioner shall develop ongoing continuing
152.6educational workshops on pertinent issues related to family peer support counseling.

152.7    Sec. 16. Minnesota Statutes 2012, section 256B.0623, subdivision 2, is amended to read:
152.8    Subd. 2. Definitions. For purposes of this section, the following terms have the
152.9meanings given them.
152.10(a) "Adult rehabilitative mental health services" means mental health services
152.11which are rehabilitative and enable the recipient to develop and enhance psychiatric
152.12stability, social competencies, personal and emotional adjustment, and independent living,
152.13parenting skills, and community skills, when these abilities are impaired by the symptoms
152.14of mental illness. Adult rehabilitative mental health services are also appropriate when
152.15provided to enable a recipient to retain stability and functioning, if the recipient would
152.16be at risk of significant functional decompensation or more restrictive service settings
152.17without these services.
152.18(1) Adult rehabilitative mental health services instruct, assist, and support the
152.19recipient in areas such as: interpersonal communication skills, community resource
152.20utilization and integration skills, crisis assistance, relapse prevention skills, health care
152.21directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking
152.22and nutrition skills, transportation skills, medication education and monitoring, mental
152.23illness symptom management skills, household management skills, employment-related
152.24skills, parenting skills, and transition to community living services.
152.25(2) These services shall be provided to the recipient on a one-to-one basis in the
152.26recipient's home or another community setting or in groups.
152.27(b) "Medication education services" means services provided individually or in
152.28groups which focus on educating the recipient about mental illness and symptoms; the role
152.29and effects of medications in treating symptoms of mental illness; and the side effects of
152.30medications. Medication education is coordinated with medication management services
152.31and does not duplicate it. Medication education services are provided by physicians,
152.32pharmacists, physician's assistants, or registered nurses.
152.33(c) "Transition to community living services" means services which maintain
152.34continuity of contact between the rehabilitation services provider and the recipient and
152.35which facilitate discharge from a hospital, residential treatment program under Minnesota
153.1Rules, chapter 9505, board and lodging facility, or nursing home. Transition to community
153.2living services are not intended to provide other areas of adult rehabilitative mental health
153.3services.

153.4    Sec. 17. Minnesota Statutes 2012, section 256B.0625, subdivision 48, is amended to
153.5read:
153.6    Subd. 48. Psychiatric consultation to primary care practitioners. Effective
153.7January 1, 2006, Medical assistance covers consultation provided by a psychiatrist, a
153.8psychologist, or an advanced practice registered nurse certified in psychiatric mental
153.9health via telephone, e-mail, facsimile, or other means of communication to primary care
153.10practitioners, including pediatricians. The need for consultation and the receipt of the
153.11consultation must be documented in the patient record maintained by the primary care
153.12practitioner. If the patient consents, and subject to federal limitations and data privacy
153.13provisions, the consultation may be provided without the patient present.

153.14    Sec. 18. Minnesota Statutes 2012, section 256B.0625, subdivision 56, is amended to
153.15read:
153.16    Subd. 56. Medical service coordination. (a)(1) Medical assistance covers in-reach
153.17community-based service coordination that is performed through a hospital emergency
153.18department as an eligible procedure under a state healthcare program for a frequent user.
153.19A frequent user is defined as an individual who has frequented the hospital emergency
153.20department for services three or more times in the previous four consecutive months.
153.21In-reach community-based service coordination includes navigating services to address a
153.22client's mental health, chemical health, social, economic, and housing needs, or any other
153.23activity targeted at reducing the incidence of emergency room and other nonmedically
153.24necessary health care utilization.
153.25(2) Medical assistance covers in-reach community-based service coordination that
153.26is performed through a hospital emergency department or inpatient psychiatric unit
153.27for a child or young adult up to age 21 with a serious emotional disturbance who has
153.28frequented the hospital emergency room two or more times in the previous consecutive
153.29three months or been admitted to an inpatient psychiatric unit two or more times in the
153.30previous consecutive four months, or is being discharged to a shelter.
153.31    (b) Reimbursement must be made in 15-minute increments and allowed for up to 60
153.32days posthospital discharge based upon the specific identified emergency department visit
153.33or inpatient admitting event. In-reach community-based service coordination shall seek to
153.34connect frequent users with existing covered services available to them, including, but not
154.1limited to, targeted case management, waiver case management, or care coordination in a
154.2health care home. For children and young adults with a serious emotional disturbance,
154.3in-reach community-based service coordination includes navigating and arranging for
154.4community-based services prior to discharge to address a client's mental health, chemical
154.5health, social, educational, family support and housing needs, or any other activity targeted
154.6at reducing multiple incidents of emergency room use, inpatient readmissions, and other
154.7nonmedically necessary health care utilization. In-reach services shall seek to connect
154.8them with existing covered services, including targeted case management, waiver case
154.9management, care coordination in a health care home, children's therapeutic services and
154.10supports, crisis services, and respite care. Eligible in-reach service coordinators must hold
154.11a minimum of a bachelor's degree in social work, public health, corrections, or a related
154.12field. The commissioner shall submit any necessary application for waivers to the Centers
154.13for Medicare and Medicaid Services to implement this subdivision.
154.14    (c)(1) For the purposes of this subdivision, "in-reach community-based service
154.15coordination" means the practice of a community-based worker with training, knowledge,
154.16skills, and ability to access a continuum of services, including housing, transportation,
154.17chemical and mental health treatment, employment, education, and peer support services,
154.18by working with an organization's staff to transition an individual back into the individual's
154.19living environment. In-reach community-based service coordination includes working
154.20with the individual during their discharge and for up to a defined amount of time in the
154.21individual's living environment, reducing the individual's need for readmittance.
154.22    (2) Hospitals utilizing in-reach service coordinators shall report annually to the
154.23commissioner on the number of adults, children, and adolescents served; the postdischarge
154.24services which they accessed; and emergency department/psychiatric hospitalization
154.25readmissions. The commissioner shall ensure that services and payments provided under
154.26in-reach care coordination do not duplicate services or payments provided under section
154.27256B.0753, 256B.0755, or 256B.0625, subdivision 20.

154.28    Sec. 19. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
154.29subdivision to read:
154.30    Subd. 61. Family psychoeducation services. Effective July 1, 2013, or upon
154.31federal approval, whichever is later, medical assistance covers family psychoeducation
154.32services provided to a child up to age 21 with a diagnosed mental health condition when
154.33identified in the child's individual treatment plan and provided by a licensed mental health
154.34professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a
154.35clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who
155.1has determined it medically necessary to involve family members in the child's care. For
155.2the purposes of this subdivision, "family psychoeducation services" means information
155.3or demonstration provided to an individual or family as part of an individual, family,
155.4multifamily group, or peer group session to explain, educate, and support the child and
155.5family in understanding a child's symptoms of mental illness, the impact on the child's
155.6development, and needed components of treatment and skill development so that the
155.7individual, family, or group can help the child to prevent relapse, prevent the acquisition
155.8of comorbid disorders, and achieve optimal mental health and long-term resilience.

155.9    Sec. 20. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
155.10subdivision to read:
155.11    Subd. 62. Mental health clinical care consultation. Effective July 1, 2013, or upon
155.12federal approval, whichever is later, medical assistance covers clinical care consultation
155.13for a person up to age 21 who is diagnosed with a complex mental health condition or a
155.14mental health condition that co-occurs with other complex and chronic conditions, when
155.15described in the person's individual treatment plan and provided by a licensed mental health
155.16professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical
155.17trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C. For the purposes
155.18of this subdivision, "clinical care consultation" means communication from a treating
155.19mental health professional to other providers or educators not under the clinical supervision
155.20of the treating mental health professional who are working with the same client to inform,
155.21inquire, and instruct regarding the client's symptoms; strategies for effective engagement,
155.22care, and intervention needs; and treatment expectations across service settings; and to
155.23direct and coordinate clinical service components provided to the client and family.

155.24    Sec. 21. Minnesota Statutes 2012, section 256B.092, is amended by adding a
155.25subdivision to read:
155.26    Subd. 13. Waiver allocations for transition populations. (a) The commissioner
155.27shall make available additional waiver allocations and additional necessary resources
155.28to assure timely discharges from the Anoka Metro Regional Treatment Center and the
155.29Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
155.30(1) are otherwise eligible for the developmental disabilities waiver under this section;
155.31(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
155.32the Minnesota Security Hospital;
155.33(3) whose discharge would be significantly delayed without the available waiver
155.34allocation; and
156.1(4) who have met treatment objectives and no longer meet hospital level of care.
156.2(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
156.3requirements of the federal approved waiver plan.
156.4(c) Any corporate foster care home developed under this subdivision must be
156.5considered an exception under section 245A.03, subdivision 7, paragraph (a).
156.6EFFECTIVE DATE.This section is effective July 1, 2013.

156.7    Sec. 22. Minnesota Statutes 2012, section 256B.0943, subdivision 1, is amended to read:
156.8    Subdivision 1. Definitions. For purposes of this section, the following terms have
156.9the meanings given them.
156.10(a) "Children's therapeutic services and supports" means the flexible package of
156.11mental health services for children who require varying therapeutic and rehabilitative
156.12levels of intervention. The services are time-limited interventions that are delivered using
156.13various treatment modalities and combinations of services designed to reach treatment
156.14outcomes identified in the individual treatment plan.
156.15(b) "Clinical supervision" means the overall responsibility of the mental health
156.16professional for the control and direction of individualized treatment planning, service
156.17delivery, and treatment review for each client. A mental health professional who is an
156.18enrolled Minnesota health care program provider accepts full professional responsibility
156.19for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
156.20and oversees or directs the supervisee's work.
156.21(c) "County board" means the county board of commissioners or board established
156.22under sections 402.01 to 402.10 or 471.59.
156.23(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.
156.24(e) "Culturally competent provider" means a provider who understands and can
156.25utilize to a client's benefit the client's culture when providing services to the client. A
156.26provider may be culturally competent because the provider is of the same cultural or
156.27ethnic group as the client or the provider has developed the knowledge and skills through
156.28training and experience to provide services to culturally diverse clients.
156.29(f) "Day treatment program" for children means a site-based structured program
156.30consisting of group psychotherapy for more than three individuals and other intensive
156.31therapeutic services provided by a multidisciplinary team, under the clinical supervision
156.32of a mental health professional.
156.33(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
156.3411 .
157.1(h) "Direct service time" means the time that a mental health professional, mental
157.2health practitioner, or mental health behavioral aide spends face-to-face with a client
157.3and the client's family. Direct service time includes time in which the provider obtains
157.4a client's history or provides service components of children's therapeutic services and
157.5supports. Direct service time does not include time doing work before and after providing
157.6direct services, including scheduling, maintaining clinical records, consulting with others
157.7about the client's mental health status, preparing reports, receiving clinical supervision,
157.8and revising the client's individual treatment plan.
157.9(i) "Direction of mental health behavioral aide" means the activities of a mental
157.10health professional or mental health practitioner in guiding the mental health behavioral
157.11aide in providing services to a client. The direction of a mental health behavioral aide
157.12must be based on the client's individualized treatment plan and meet the requirements in
157.13subdivision 6, paragraph (b), clause (5).
157.14(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
157.1515 . For persons at least age 18 but under age 21, mental illness has the meaning given in
157.16section 245.462, subdivision 20, paragraph (a).
157.17(k) "Individual behavioral plan" means a plan of intervention, treatment, and
157.18services for a child written by a mental health professional or mental health practitioner,
157.19under the clinical supervision of a mental health professional, to guide the work of the
157.20mental health behavioral aide.
157.21(l) "Individual treatment plan" has the meaning given in section 245.4871,
157.22subdivision 21 .
157.23(m) "Mental health behavioral aide services" means medically necessary one-on-one
157.24activities performed by a trained paraprofessional to assist a child retain or generalize
157.25psychosocial skills as taught by a mental health professional or mental health practitioner
157.26and as described in the child's individual treatment plan and individual behavior plan.
157.27Activities involve working directly with the child or child's family as provided in
157.28subdivision 9, paragraph (b), clause (4).
157.29(n) "Mental health professional" means an individual as defined in section 245.4871,
157.30subdivision 27 , clauses (1) to (6), or tribal vendor as defined in section 256B.02,
157.31subdivision 7 , paragraph (b).
157.32    (o) "Mental health service plan development" includes:
157.33    (1) the development, review, and revision of a child's individual treatment plan,
157.34as provided in Minnesota Rules, part 9505.0371, subpart 7, including involvement of
157.35the client or client's parents, primary caregiver, or other person authorized to consent to
158.1mental health services for the client, and including arrangement of treatment and support
158.2activities specified in the individual treatment plan; and
158.3    (2) administering standardized outcome measurement instruments, determined
158.4and updated by the commissioner, as periodically needed to evaluate the effectiveness
158.5of treatment for children receiving clinical services and reporting outcome measures,
158.6as required by the commissioner.
158.7(o) (p) "Preschool program" means a day program licensed under Minnesota Rules,
158.8parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
158.9supports provider to provide a structured treatment program to a child who is at least 33
158.10months old but who has not yet attended the first day of kindergarten.
158.11(p) (q) "Skills training" means individual, family, or group training, delivered
158.12by or under the direction of a mental health professional, designed to facilitate the
158.13acquisition of psychosocial skills that are medically necessary to rehabilitate the child
158.14to an age-appropriate developmental trajectory heretofore disrupted by a psychiatric
158.15illness or to self-monitor, compensate for, cope with, counteract, or replace skills deficits
158.16or maladaptive skills acquired over the course of a psychiatric illness. Skills training
158.17is subject to the following requirements:
158.18(1) a mental health professional or a mental health practitioner must provide skills
158.19training;
158.20(2) the child must always be present during skills training; however, a brief absence
158.21of the child for no more than ten percent of the session unit may be allowed to redirect or
158.22instruct family members;
158.23(3) skills training delivered to children or their families must be targeted to the
158.24specific deficits or maladaptations of the child's mental health disorder and must be
158.25prescribed in the child's individual treatment plan;
158.26(4) skills training delivered to the child's family must teach skills needed by parents
158.27to enhance the child's skill development and to help the child use in daily life the skills
158.28previously taught by a mental health professional or mental health practitioner and to
158.29develop or maintain a home environment that supports the child's progressive use skills;
158.30(5) group skills training may be provided to multiple recipients who, because of the
158.31nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
158.32interaction in a group setting, which must be staffed as follows:
158.33(i) one mental health professional or one mental health practitioner under supervision
158.34of a licensed mental health professional must work with a group of four to eight clients; or
159.1(ii) two mental health professionals or two mental health practitioners under
159.2supervision of a licensed mental health professional, or one professional plus one
159.3practitioner must work with a group of nine to 12 clients.

159.4    Sec. 23. Minnesota Statutes 2012, section 256B.0943, subdivision 2, is amended to read:
159.5    Subd. 2. Covered service components of children's therapeutic services and
159.6supports. (a) Subject to federal approval, medical assistance covers medically necessary
159.7children's therapeutic services and supports as defined in this section that an eligible
159.8provider entity certified under subdivision 4 provides to a client eligible under subdivision
159.93.
159.10(b) The service components of children's therapeutic services and supports are:
159.11(1) individual, family, and group psychotherapy;
159.12(2) individual, family, or group skills training provided by a mental health
159.13professional or mental health practitioner;
159.14(3) crisis assistance;
159.15(4) mental health behavioral aide services; and
159.16(5) direction of a mental health behavioral aide.;
159.17(6) mental health service plan development;
159.18(7) clinical care consultation under section 256B.0625, subdivision 62;
159.19(8) family psychoeducation under section 256B.0625, subdivision 61; and
159.20(9) services provided by a family peer specialist under section 256B.0616.
159.21(c) Service components in paragraph (b) may be combined to constitute therapeutic
159.22programs, including day treatment programs and therapeutic preschool programs.

159.23    Sec. 24. Minnesota Statutes 2012, section 256B.0943, subdivision 7, is amended to read:
159.24    Subd. 7. Qualifications of individual and team providers. (a) An individual
159.25or team provider working within the scope of the provider's practice or qualifications
159.26may provide service components of children's therapeutic services and supports that are
159.27identified as medically necessary in a client's individual treatment plan.
159.28(b) An individual provider must be qualified as:
159.29(1) a mental health professional as defined in subdivision 1, paragraph (n); or
159.30(2) a mental health practitioner as defined in section 245.4871, subdivision 26. The
159.31mental health practitioner must work under the clinical supervision of a mental health
159.32professional; or
160.1(3) a mental health behavioral aide working under the clinical supervision of a
160.2mental health professional to implement the rehabilitative mental health services identified
160.3in the client's individual treatment plan and individual behavior plan.
160.4(A) A level I mental health behavioral aide must:
160.5(i) be at least 18 years old;
160.6(ii) have a high school diploma or general equivalency diploma (GED) or two years
160.7of experience as a primary caregiver to a child with severe emotional disturbance within
160.8the previous ten years; and
160.9(iii) meet preservice and continuing education requirements under subdivision 8.
160.10(B) A level II mental health behavioral aide must:
160.11(i) be at least 18 years old;
160.12(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
160.13clinical services in the treatment of mental illness concerning children or adolescents or
160.14complete a certificate program established under subdivision 8a; and
160.15(iii) meet preservice and continuing education requirements in subdivision 8.
160.16(c) A preschool program multidisciplinary team must include at least one mental
160.17health professional and one or more of the following individuals under the clinical
160.18supervision of a mental health professional:
160.19(i) a mental health practitioner; or
160.20(ii) a program person, including a teacher, assistant teacher, or aide, who meets the
160.21qualifications and training standards of a level I mental health behavioral aide.
160.22(d) A day treatment multidisciplinary team must include at least one mental health
160.23professional and one mental health practitioner.

160.24    Sec. 25. Minnesota Statutes 2012, section 256B.0943, is amended by adding a
160.25subdivision to read:
160.26    Subd. 8a. Level II mental health behavioral aide. The commissioner of human
160.27services, in collaboration with children's mental health providers and the Board of Trustees
160.28of the Minnesota State Colleges and Universities, shall develop a certificate program
160.29for level II mental health behavioral aides.

160.30    Sec. 26. Minnesota Statutes 2012, section 256B.0946, is amended to read:
160.31256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.
160.32    Subdivision 1. Required covered service components. (a) Effective July 1, 2006,
160.33 upon enactment and subject to federal approval, medical assistance covers medically
160.34necessary intensive treatment services described under paragraph (b) that are provided
161.1by a provider entity eligible under subdivision 3 to a client eligible under subdivision 2
161.2who is placed in a treatment foster home licensed under Minnesota Rules, parts 2960.3000
161.3to 2960.3340.
161.4(b) Intensive treatment services to children with severe emotional disturbance mental
161.5illness residing in treatment foster care family settings must meet the relevant standards
161.6for mental health services under sections 245.487 to 245.4889. In addition, that comprise
161.7 specific required service components provided in clauses (1) to (5), are reimbursed by
161.8medical assistance must when they meet the following standards:
161.9(1) case management service component must meet the standards in Minnesota
161.10Rules, parts 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10;
161.11(1) psychotherapy provided by a mental health professional as defined in Minnesota
161.12Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota
161.13Rules, part 9505.0371, subpart 5, item C;
161.14(2) psychotherapy, crisis assistance, and skills training components must meet the
161.15 provided according to standards for children's therapeutic services and supports in section
161.16256B.0943 ; and
161.17(3) individual family, and group psychoeducation services under supervision of,
161.18defined in subdivision 1a, paragraph (q), provided by a mental health professional. or a
161.19clinical trainee;
161.20(4) clinical care consultation, as defined in subdivision 1a, and provided by a mental
161.21health professional or a clinical trainee; and
161.22(5) service delivery payment requirements as provided under subdivision 4.
161.23    Subd. 1a. Definitions. For the purposes of this section, the following terms have
161.24the meanings given them.
161.25(a) "Clinical care consultation" means communication from a treating clinician to
161.26other providers working with the same client to inform, inquire, and instruct regarding
161.27the client's symptoms, strategies for effective engagement, care and intervention needs,
161.28and treatment expectations across service settings, including but not limited to the client's
161.29school, social services, day care, probation, home, primary care, medication prescribers,
161.30disabilities services, and other mental health providers and to direct and coordinate clinical
161.31service components provided to the client and family.
161.32(b) "Clinical supervision" means the documented time a clinical supervisor and
161.33supervisee spend together to discuss the supervisee's work, to review individual client
161.34cases, and for the supervisee's professional development. It includes the documented
161.35oversight and supervision responsibility for planning, implementation, and evaluation of
161.36services for a client's mental health treatment.
162.1(c) "Clinical supervisor" means the mental health professional who is responsible
162.2for clinical supervision.
162.3(d) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371,
162.4subpart 5, item C;
162.5(e) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a,
162.6including the development of a plan that addresses prevention and intervention strategies
162.7to be used in a potential crisis, but does not include actual crisis intervention.
162.8(f) "Culturally appropriate" means providing mental health services in a manner that
162.9incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370,
162.10subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural
162.11strengths and resources to promote overall wellness.
162.12(g) "Culture" means the distinct ways of living and understanding the world that
162.13are used by a group of people and are transmitted from one generation to another or
162.14adopted by an individual.
162.15(h) "Diagnostic assessment" has the meaning given in Minnesota Rules, part
162.169505.0370, subpart 11.
162.17(i) "Family" means a person who is identified by the client or the client's parent or
162.18guardian as being important to the client's mental health treatment. Family may include,
162.19but is not limited to, parents, foster parents, children, spouse, committed partners, former
162.20spouses, persons related by blood or adoption, persons who are a part of the client's
162.21permanency plan, or persons who are presently residing together as a family unit.
162.22(j) "Foster care" has the meaning given in section 260C.007, subdivision 18.
162.23(k) "Foster family setting" means the foster home in which the license holder resides.
162.24(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part
162.259505.0370, subpart 15.
162.26(m) "Mental health practitioner" has the meaning given in Minnesota Rules, part
162.279505.0370, subpart 17.
162.28(n) "Mental health professional" has the meaning given in Minnesota Rules, part
162.299505.0370, subpart 18.
162.30(o) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370,
162.31subpart 20.
162.32(p) "Parent" has the meaning given in section 260C.007, subdivision 25.
162.33(q) "Psychoeducation services" means information or demonstration provided to
162.34an individual, family, or group to explain, educate, and support the individual, family, or
162.35group in understanding a child's symptoms of mental illness, the impact on the child's
162.36development, and needed components of treatment and skill development so that the
163.1individual, family, or group can help the child to prevent relapse, prevent the acquisition
163.2of comorbid disorders, and achieve optimal mental health and long-term resilience.
163.3(r) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370,
163.4subpart 27.
163.5(s) "Team consultation and treatment planning" means the coordination of treatment
163.6plans and consultation among providers in a group concerning the treatment needs of the
163.7child, including disseminating the child's treatment service schedule to all members of the
163.8service team. Team members must include all mental health professionals working with
163.9the child, a parent, the child unless the team lead or parent deem it clinically inappropriate,
163.10and at least two of the following: an individualized education program case manager;
163.11probation agent; children's mental health case manager; child welfare worker, including
163.12adoption or guardianship worker; primary care provider; foster parent; and any other
163.13member of the child's service team.
163.14    Subd. 2. Determination of client eligibility. A client's eligibility to receive
163.15treatment foster care under this section shall be determined by An eligible recipient is an
163.16individual, from birth through age 20, who is currently placed in a foster home licensed
163.17under Minnesota Rules, parts 2960.3000 to 2960.3340, and has received a diagnostic
163.18assessment, and an evaluation of level of care needed, and development of an individual
163.19treatment plan, as defined in paragraphs (a) to (c) and (b).
163.20(a) The diagnostic assessment must:
163.21(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
163.22conducted by a psychiatrist, licensed psychologist, or licensed independent clinical social
163.23worker that is mental health professional or a clinical trainee;
163.24(2) determine whether or not a child meets the criteria for mental illness, as defined
163.25in Minnesota Rules, part 9505.0370, subpart 20;
163.26(3) document that intensive treatment services are medically necessary within a
163.27foster family setting to ameliorate identified symptoms and functional impairments;
163.28(4) be performed within 180 days prior to before the start of service; and
163.29(2) include current diagnoses on all five axes of the client's current mental health
163.30status;
163.31(3) determine whether or not a child meets the criteria for severe emotional
163.32disturbance in section 245.4871, subdivision 6, or for serious and persistent mental illness
163.33in section 245.462, subdivision 20; and
163.34(4) be completed annually until age 18. For individuals between age 18 and 21,
163.35unless a client's mental health condition has changed markedly since the client's most
163.36recent diagnostic assessment, annual updating is necessary. For the purpose of this section,
164.1"updating" means a written summary, including current diagnoses on all five axes, by a
164.2mental health professional of the client's current mental status and service needs.
164.3(5) be completed as either a standard or extended diagnostic assessment annually to
164.4determine continued eligibility for the service.
164.5(b) The evaluation of level of care must be conducted by the placing county with
164.6an instrument, tribe, or case manager in conjunction with the diagnostic assessment as
164.7described by Minnesota Rules, part 9505.0372, subpart 1, item B, using a validated tool
164.8 approved by the commissioner of human services and not subject to the rulemaking
164.9process, consistent with section 245.4885, subdivision 1, paragraph (d), the result of which
164.10evaluation demonstrates that the child requires intensive intervention without 24-hour
164.11medical monitoring. The commissioner shall update the list of approved level of care
164.12instruments tools annually and publish on the department's Web site.
164.13(c) The individual treatment plan must be:
164.14(1) based on the information in the client's diagnostic assessment;
164.15(2) developed through a child-centered, family driven planning process that identifies
164.16service needs and individualized, planned, and culturally appropriate interventions that
164.17contain specific measurable treatment goals and objectives for the client and treatment
164.18strategies for the client's family and foster family;
164.19(3) reviewed at least once every 90 days and revised; and
164.20(4) signed by the client or, if appropriate, by the client's parent or other person
164.21authorized by statute to consent to mental health services for the client.
164.22    Subd. 3. Eligible mental health services providers. (a) Eligible providers for
164.23intensive children's mental health services in a foster family setting must be certified
164.24by the state and have a service provision contract with a county board or a reservation
164.25tribal council and must be able to demonstrate the ability to provide all of the services
164.26required in this section.
164.27(b) For purposes of this section, a provider agency must have an individual
164.28placement agreement for each recipient and must be a licensed child placing agency, under
164.29Minnesota Rules, parts 9543.0010 to 9543.0150, and either be:
164.30(1) a county county-operated entity certified by the state;
164.31(2) an Indian Health Services facility operated by a tribe or tribal organization under
164.32funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
164.33Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
164.34(3) a noncounty entity under contract with a county board.
164.35(c) Certified providers that do not meet the service delivery standards required in
164.36this section shall be subject to a decertification process.
165.1(d) For the purposes of this section, all services delivered to a client must be
165.2provided by a mental health professional or a clinical trainee.
165.3    Subd. 4. Eligible provider responsibilities Service delivery payment
165.4requirements. (a) To be an eligible provider for payment under this section, a provider
165.5must develop and practice written policies and procedures for treatment foster care services
165.6 intensive treatment in foster care, consistent with subdivision 1, paragraph (b), clauses (1),
165.7(2), and (3) and comply with the following requirements in paragraphs (b) to (n).
165.8(b) In delivering services under this section, a treatment foster care provider must
165.9ensure that staff caseload size reasonably enables the provider to play an active role in
165.10service planning, monitoring, delivering, and reviewing for discharge planning to meet
165.11the needs of the client, the client's foster family, and the birth family, as specified in each
165.12client's individual treatment plan.
165.13(b) A qualified clinical supervisor, as defined in and performing in compliance with
165.14Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
165.15provision of services described in this section.
165.16(c) Each client receiving treatment services must receive an extended diagnostic
165.17assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within
165.1830 days of enrollment in this service unless the client has a previous extended diagnostic
165.19assessment that the client, parent, and mental health professional agree still accurately
165.20describes the client's current mental health functioning.
165.21(d) Each previous and current mental health, school, and physical health treatment
165.22provider must be contacted to request documentation of treatment and assessments that
165.23the eligible client has received. This information must be reviewed and incorporated into
165.24the diagnostic assessment and team consultation and treatment planning review process.
165.25(e) Each client receiving treatment must be assessed for a trauma history, and
165.26the client's treatment plan must document how the results of the assessment will be
165.27incorporated into treatment.
165.28(f) Each client receiving treatment services must have an individual treatment plan
165.29that is reviewed, evaluated, and signed every 90 days using the team consultation and
165.30treatment planning process, as defined in subdivision 1a, paragraph (s).
165.31(g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided
165.32in accordance with the client's individual treatment plan.
165.33(h) Each client must have a crisis assistance plan within ten days of initiating
165.34services and must have access to clinical phone support 24 hours per day, seven days per
165.35week, during the course of treatment. The crisis plan must demonstrate coordination with
165.36the local or regional mobile crisis intervention team.
166.1(i) Services must be delivered and documented at least three days per week, equaling
166.2at least six hours of treatment per week, unless reduced units of service are specified on
166.3the treatment plan as part of transition or on a discharge plan to another service or level of
166.4care. Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
166.5(j) Location of service delivery must be in the client's home, day care setting,
166.6school, or other community-based setting that is specified on the client's individualized
166.7treatment plan.
166.8(k) Treatment must be developmentally and culturally appropriate for the client.
166.9(l) Services must be delivered in continual collaboration and consultation with the
166.10client's medical providers and, in particular, with prescribers of psychotropic medications,
166.11including those prescribed on an off-label basis. Members of the service team must be
166.12aware of the medication regimen and potential side effects.
166.13(m) Parents, siblings, foster parents, and members of the child's permanency plan
166.14must be involved in treatment and service delivery unless otherwise noted in the treatment
166.15plan.
166.16(n) Transition planning for the child must be conducted starting with the first
166.17treatment plan and must be addressed throughout treatment to support the child's
166.18permanency plan and postdischarge mental health service needs.
166.19    Subd. 5. Service authorization. The commissioner will administer authorizations
166.20for services under this section in compliance with section 256B.0625, subdivision 25.
166.21    Subd. 6. Excluded services. (a) Services in clauses (1) to (4) (7) are not covered
166.22under this section and are not eligible for medical assistance payment as components of
166.23intensive treatment in foster care services, but may be billed separately:
166.24(1) treatment foster care services provided in violation of medical assistance policy
166.25in Minnesota Rules, part 9505.0220;
166.26(2) service components of children's therapeutic services and supports
166.27simultaneously provided by more than one treatment foster care provider;
166.28(3) home and community-based waiver services; and
166.29(4) treatment foster care services provided to a child without a level of care
166.30determination according to section 245.4885, subdivision 1.
166.31(1) inpatient psychiatric hospital treatment;
166.32(2) mental health targeted case management;
166.33(3) partial hospitalization;
166.34(4) medication management;
166.35(5) children's mental health day treatment services;
166.36(6) crisis response services under section 256B.0944; and
167.1(7) transportation.
167.2(b) Children receiving intensive treatment in foster care services are not eligible for
167.3medical assistance reimbursement for the following services while receiving intensive
167.4treatment in foster care:
167.5(1) mental health case management services under section 256B.0625, subdivision
167.620 ; and
167.7(2) (1) psychotherapy and skill skills training components of children's therapeutic
167.8services and supports under section 256B.0625, subdivision 35b.;
167.9(2) mental health behavioral aide services as defined in section 256B.0943,
167.10subdivision 1, paragraph (m);
167.11(3) home and community-based waiver services;
167.12(4) mental health residential treatment; and
167.13(5) room and board costs as defined in section 256I.03, subdivision 6.
167.14    Subd. 7. Medical assistance payment and rate setting. The commissioner shall
167.15establish a single daily per-client encounter rate for intensive treatment in foster care
167.16services. The rate must be constructed to cover only eligible services delivered to an
167.17eligible recipient by an eligible provider, as prescribed in subdivision 1, paragraph (b).

167.18    Sec. 27. Minnesota Statutes 2012, section 256B.49, is amended by adding a
167.19subdivision to read:
167.20    Subd. 24. Waiver allocations for transition populations. (a) The commissioner
167.21shall make available additional waiver allocations and additional necessary resources
167.22to assure timely discharges from the Anoka Metro Regional Treatment Center and the
167.23Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
167.24(1) are otherwise eligible for the brain injury, community alternatives for disabled
167.25individuals, or community alternative care waivers under this section;
167.26(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
167.27the Minnesota Security Hospital;
167.28(3) whose discharge would be significantly delayed without the available waiver
167.29allocation; and
167.30(4) who have met treatment objectives and no longer meet hospital level of care.
167.31(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
167.32requirements of the federal approved waiver plan.
167.33(c) Any corporate foster care home developed under this subdivision must be
167.34considered an exception under section 245A.03, subdivision 7, paragraph (a).
167.35EFFECTIVE DATE.This section is effective July 1, 2013.

168.1    Sec. 28. Minnesota Statutes 2012, section 256B.761, is amended to read:
168.2256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
168.3(a) Effective for services rendered on or after July 1, 2001, payment for medication
168.4management provided to psychiatric patients, outpatient mental health services, day
168.5treatment services, home-based mental health services, and family community support
168.6services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
168.750th percentile of 1999 charges.
168.8(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
168.9services provided by an entity that operates: (1) a Medicare-certified comprehensive
168.10outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
168.111993, with at least 33 percent of the clients receiving rehabilitation services in the most
168.12recent calendar year who are medical assistance recipients, will be increased by 38 percent,
168.13when those services are provided within the comprehensive outpatient rehabilitation
168.14facility and provided to residents of nursing facilities owned by the entity.
168.15(c) The commissioner shall establish three levels of payment for mental health
168.16diagnostic assessment, based on three levels of complexity. The aggregate payment under
168.17the tiered rates must not exceed the projected aggregate payments for mental health
168.18diagnostic assessment under the previous single rate. The new rate structure is effective
168.19January 1, 2011, or upon federal approval, whichever is later.
168.20(d) In addition to rate increases otherwise provided, the commissioner may
168.21restructure coverage policy and rates to improve access to adult rehabilitative mental
168.22health services under section 256B.0623 and related mental health support services under
168.23section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and
168.242016, the projected state share of increased costs due to this paragraph is transferred
168.25from adult mental health grants under sections 245.4661 and 256E.12. The transfer for
168.26fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments
168.27made to managed care plans and county-based purchasing plans under sections 256B.69,
168.28256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.

168.29    Sec. 29. CHILD AND ADOLESCENT BEHAVIORAL HEALTH SERVICES.
168.30The commissioner of human services shall, in consultation with children's mental
168.31health community providers, hospitals providing care to children, children's mental health
168.32advocates, and other interested parties, develop recommendations and legislation, if
168.33necessary, for the state-operated child and adolescent behavioral health services facility
168.34to ensure that:
169.1(1) the facility and the services provided meet the needs of children with serious
169.2emotional disturbances, autism spectrum disorders, reactive attachment disorder, PTSD,
169.3serious emotional disturbance co-occurring with a developmental disability, borderline
169.4personality disorder, schizophrenia, fetal alcohol spectrum disorders, brain injuries,
169.5violent tendencies, and complex medical issues;
169.6(2) qualified personnel and staff can be recruited who have specific expertise and
169.7training to treat the children in the facility; and
169.8(3) the treatment provided at the facility is high-quality, effective treatment.

169.9    Sec. 30. PILOT PROVIDER INPUT SURVEY OF PEDIATRIC SERVICES AND
169.10CHILDREN'S MENTAL HEALTH SERVICES.
169.11(a) To assess the efficiency and other operational issues in the management of the
169.12health care delivery system, the commissioner of human services shall initiate a provider
169.13survey. The pilot survey shall consist of an electronic survey of providers of pediatric
169.14home health care services and children's mental health services to identify and measure
169.15issues that arise in dealing with the management of medical assistance. To the maximum
169.16degree possible, existing technology shall be used and interns sought to analyze the results.
169.17(b) The survey questions must focus on seven key business functions provided
169.18by medical assistance contractors: provider inquiries; provider outreach and education;
169.19claims processing; appeals; provider enrollment; medical review; and provider audit and
169.20reimbursement. The commissioner must consider the results of the survey in evaluating
169.21and renewing managed care and fee-for-service management contracts.
169.22(c) The commissioner shall report by January 15, 2014, the results of the survey to
169.23the chairs of the health and human services policy and finance committees and shall
169.24make recommendations on the value of implementing an annual survey with a rotating
169.25list of provider groups as a component of the continuous quality improvement system for
169.26medical assistance.

169.27    Sec. 31. MENTALLY ILL AND DANGEROUS COMMITMENTS
169.28STAKEHOLDERS GROUP.
169.29(a) The commissioner of human services, in consultation with the state court
169.30administrator, shall convene a stakeholder group to develop recommendations for the
169.31legislature that address issues raised in the February 2013 Office of the Legislative
169.32Auditor report on State-Operated Services for persons committed to the commissioner as
169.33mentally ill and dangerous under Minnesota Statutes, section 253B.18. Stakeholders must
169.34include representatives from the Department of Human Services, county human services,
170.1county attorneys, commitment defense attorneys, the ombudsman for mental health and
170.2developmental disabilities, the federal protection and advocacy system, and consumers
170.3and advocates for persons with mental illnesses.
170.4(b) The stakeholder group shall provide recommendations in the following areas:
170.5(1) the role of the special review board, including the scope of authority of the
170.6special review board and the authority of the commissioner to accept or reject special
170.7review board recommendations;
170.8(2) review of special review board decisions by the district court;
170.9(3) annual district court review of commitment, scope of court authority, and
170.10appropriate review criteria;
170.11(4) options, including annual court hearing and review, as alternatives to
170.12indeterminate commitment under Minnesota Statutes, section 253B.18; and
170.13(5) extension of the right to petition the court under Minnesota Statutes,
170.14section 253B.17, to those committed under Minnesota Statutes, section 253B.18.
170.15The commissioner of human services and the state court administrator shall provide
170.16relevant data for the group's consideration in developing these recommendations,
170.17including numbers of proceedings in each category and costs associated with court and
170.18administrative proceedings under Minnesota Statutes, section 253B.18.
170.19(c) By January 15, 2014, the commissioner of human services shall submit the
170.20recommendations of the stakeholder group to the chairs and ranking minority members
170.21of the committees of the legislature with jurisdiction over civil commitment and human
170.22services issues.

170.23    Sec. 32. STATE ASSISTANCE TO COUNTIES; TRANSITIONS FOR HIGH
170.24NEEDS POPULATIONS.
170.25(a) Effective immediately, the commissioner of human services shall work with
170.26counties that request assistance to assure timely discharge from Anoka Metro Regional
170.27Treatment Center and the Minnesota Security Hospital for individuals who are ready
170.28for discharge but for whom the county may not have provider resources or appropriate
170.29placement available. Special consideration must be given to uninsured individuals who are
170.30not eligible for medical assistance and who may need continued treatment, and individuals
170.31with complex needs and other factors that hinder county efforts to place the individual in a
170.32safe, affordable setting.
170.33(b) The commissioner shall assure that, given Olmstead court directives and the
170.34role family and friends play in treatment progress, metropolitan area residents are asked
170.35whether they wished to be placed in an Intensive Residential Treatment Service program
171.1at Willmar or Cambridge or to be placed in a location more accessible to family, friends,
171.2and health providers.


171.5    Section 1. Minnesota Statutes 2012, section 13.461, is amended by adding a
171.6subdivision to read:
171.7    Subd. 7b. Child care provider and recipient fraud investigations. Data related
171.8to child care fraud and recipient fraud investigations are governed by section 245E.01,
171.9subdivision 15.

171.10    Sec. 2. Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:
171.11    Subd. 7. Use of data. (a) Except as otherwise provided in subdivision 7a or sections
171.12244.052 and 299C.093, the data provided under this section is private data on individuals
171.13under section 13.02, subdivision 12.
171.14(b) The data may be used only for by law enforcement and corrections agencies for
171.15 law enforcement and corrections purposes.
171.16(c) The commissioner of human services is authorized to have access to the data for:
171.17(1) state-operated services, as defined in section 246.014, are also authorized to
171.18have access to the data for the purposes described in section 246.13, subdivision 2,
171.19paragraph (b); and
171.20(2) purposes of completing background studies under chapter 245C.

171.21    Sec. 3. Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision
171.22to read:
171.23    Subd. 4a. Agency background studies. (a) The commissioner shall develop and
171.24implement an electronic process for the regular transfer of new criminal case information
171.25that is added to the Minnesota court information system. The commissioner's system
171.26must include for review only information that relates to individuals who have been the
171.27subject of a background study under this chapter that remain affiliated with the agency
171.28that initiated the background study. For purposes of this paragraph, an individual remains
171.29affiliated with an agency that initiated the background study until the agency informs the
171.30commissioner that the individual is no longer affiliated. When any individual no longer
171.31affiliated according to this paragraph returns to a position requiring a background study
171.32under this chapter, the agency with whom the individual is again affiliated shall initiate
172.1a new background study regardless of the length of time the individual was no longer
172.2affiliated with the agency.
172.3(b) The commissioner shall develop and implement an online system for agencies that
172.4initiate background studies under this chapter to access and maintain records of background
172.5studies initiated by that agency. The system must show all active background study subjects
172.6affiliated with that agency and the status of each individual's background study. Each
172.7agency that initiates background studies must use this system to notify the commissioner
172.8of discontinued affiliation for purposes of the processes required under paragraph (a).

172.9    Sec. 4. Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:
172.10    Subdivision 1. Background studies conducted by Department of Human
172.11Services. (a) For a background study conducted by the Department of Human Services,
172.12the commissioner shall review:
172.13    (1) information related to names of substantiated perpetrators of maltreatment of
172.14vulnerable adults that has been received by the commissioner as required under section
172.15626.557, subdivision 9c , paragraph (j);
172.16    (2) the commissioner's records relating to the maltreatment of minors in licensed
172.17programs, and from findings of maltreatment of minors as indicated through the social
172.18service information system;
172.19    (3) information from juvenile courts as required in subdivision 4 for individuals
172.20listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
172.21    (4) information from the Bureau of Criminal Apprehension, including information
172.22regarding a background study subject's registration in Minnesota as a predatory offender
172.23under section 243.166;
172.24    (5) except as provided in clause (6), information from the national crime information
172.25system when the commissioner has reasonable cause as defined under section 245C.05,
172.26subdivision 5; and
172.27    (6) for a background study related to a child foster care application for licensure or
172.28adoptions, the commissioner shall also review:
172.29    (i) information from the child abuse and neglect registry for any state in which the
172.30background study subject has resided for the past five years; and
172.31    (ii) information from national crime information databases, when the background
172.32study subject is 18 years of age or older.
172.33    (b) Notwithstanding expungement by a court, the commissioner may consider
172.34information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
173.1received notice of the petition for expungement and the court order for expungement is
173.2directed specifically to the commissioner.
173.3    (c) The commissioner shall also review criminal case information received according
173.4to section 245C.04, subdivision 4a, from the Minnesota court information system that
173.5relates to individuals who have already been studied under this chapter and who remain
173.6affiliated with the agency that initiated the background study.

173.7    Sec. 5. [245E.01] CHILD CARE PROVIDER AND RECIPIENT FRAUD
173.8INVESTIGATIONS WITHIN THE CHILD CARE ASSISTANCE PROGRAM.
173.9    Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in this
173.10subdivision have the meanings given them.
173.11(b) "Applicant" has the meaning given in section 119B.011, subdivision 2.
173.12(c) "Child care assistance program" means any of the assistance programs under
173.13chapter 119B.
173.14(d) "Commissioner" means the commissioner of human services.
173.15(e) "Controlling individual" has the meaning given in section 245A.02, subdivision
173.165a.
173.17(f) "County" means a local county child care assistance program staff or
173.18subcontracted staff, or a county investigator acting on behalf of the commissioner.
173.19(g) "Department" means the Department of Human Services.
173.20(h) "Financial misconduct" or "misconduct" means an entity's or individual's acts or
173.21omissions that result in fraud and abuse or error against the Department of Human Services.
173.22(i) "Identify" means to furnish the full name, current or last known address, phone
173.23number, and e-mail address of the individual or business entity.
173.24(j) "License holder" has the meaning given in section 245A.02, subdivision 9.
173.25(k) "Mail" means the use of any mail service with proof of delivery and receipt.
173.26(l) "Provider" means either a provider as defined in section 119B.011, subdivision
173.2719, or a legal unlicensed provider as defined in section 119B.011, subdivision 16.
173.28(m) "Recipient" means a family receiving assistance as defined under section
173.29119B.011, subdivision 13.
173.30(n) "Terminate" means revocation of participation in the child care assistance
173.31program.
173.32    Subd. 2. Investigating provider or recipient financial misconduct. The
173.33department shall investigate alleged or suspected financial misconduct by providers and
173.34errors related to payments issued by the child care assistance program under this chapter.
173.35Recipients, employees, and staff may be investigated when the evidence shows that their
174.1conduct is related to the financial misconduct of a provider, license holder, or controlling
174.2individual.
174.3    Subd. 3. Scope of investigations. (a) The department may contact any person,
174.4agency, organization, or other entity that is necessary to an investigation.
174.5(b) The department may examine or interview any individual, document, or piece of
174.6evidence that may lead to information that is relevant to child care assistance program
174.7benefits, payments, and child care provider authorizations. This includes, but is not
174.8limited to:
174.9(1) child care assistance program payments;
174.10(2) services provided by the program or related to child care assistance program
174.11recipients;
174.12(3) services provided to a provider;
174.13(4) provider financial records of any type;
174.14(5) daily attendance records of the children receiving services from the provider;
174.15(6) billings; and
174.16(7) verification of the credentials of a license holder, controlling individual,
174.17employee, staff person, contractor, subcontractor, and entities under contract with the
174.18provider to provide services or maintain service and the provider's financial records
174.19related to those services.
174.20    Subd. 4. Determination of investigation. After completing its investigation, the
174.21department shall issue one of the following determinations:
174.22(1) no violation of child care assistance requirements occurred;
174.23(2) there is insufficient evidence to show that a violation of child care assistance
174.24requirements occurred;
174.25(3) a preponderance of evidence shows a violation of child care assistance program
174.26law, rule, or policy; or
174.27(4) there exists a credible allegation of fraud.
174.28    Subd. 5. Actions or administrative sanctions. (a) After completing the
174.29determination under subdivision 4, the department may take one or more of the actions
174.30or sanctions specified in this subdivision.
174.31(b) The department may take the following actions:
174.32(1) refer the investigation to law enforcement or a county attorney for possible
174.33criminal prosecution;
174.34(2) refer relevant information to the department's licensing division, the child care
174.35assistance program, the Department of Education, the federal child and adult care food
174.36program, or appropriate child or adult protection agency;
175.1(3) enter into a settlement agreement with a provider, license holder, controlling
175.2individual, or recipient; or
175.3(4) refer the matter for review by a prosecutorial agency with appropriate jurisdiction
175.4for possible civil action under the Minnesota False Claims Act, chapter 15C.
175.5(c) In addition to section 256.98, the department may impose sanctions by:
175.6(1) pursuing administrative disqualification through hearings or waivers;
175.7(2) establishing and seeking monetary recovery or recoupment; or
175.8(3) issuing an order of corrective action that states the practices that are violations of
175.9child care assistance program policies, laws, or regulations, and that they must be corrected.
175.10    Subd. 6. Duty to provide access. (a) A provider, license holder, controlling
175.11individual, employee, staff person, or recipient has an affirmative duty to provide access
175.12upon request to information specified under subdivision 8 or the program facility.
175.13(b) Failure to provide access may result in denial or termination of authorizations for
175.14or payments to a recipient, provider, license holder, or controlling individual in the child
175.15care assistance program.
175.16(c) When a provider fails to provide access, a 15-day notice of denial or termination
175.17must be issued to the provider, which prohibits the provider from participating in the child
175.18care assistance program. Notice must be sent to recipients whose children are under the
175.19provider's care pursuant to Minnesota Rules, part 3400.0185.
175.20(d) If the provider continues to fail to provide access at the expiration of the 15-day
175.21notice period, child care assistance program payments to the provider must be denied
175.22beginning the 16th day following notice of the initial failure or refusal to provide access.
175.23The department may rescind the denial based upon good cause if the provider submits in
175.24writing a good cause basis for having failed or refused to provide access. The writing must
175.25be postmarked no later than the 15th day following the provider's notice of initial failure
175.26to provide access. Additionally, the provider, license holder, or controlling individual
175.27must immediately provide complete, ongoing access to the department. Repeated failures
175.28to provide access must, after the initial failure or for any subsequent failure, result in
175.29termination from participation in the child care assistance program.
175.30(e) The department, at its own expense, may photocopy or otherwise duplicate
175.31records referenced in subdivision 8. Photocopying must be done on the provider's
175.32premises on the day of the request or other mutually agreeable time, unless removal of
175.33records is specifically permitted by the provider. If requested, a provider, license holder,
175.34or controlling individual, or a designee, must assist the investigator in duplicating any
175.35record, including a hard copy or electronically stored data, on the day of the request.
176.1(f) A provider, license holder, controlling individual, employee, or staff person must
176.2grant the department access during the department's normal business hours, and any hours
176.3that the program is operated, to examine the provider's program or the records listed in
176.4subdivision 8. A provider shall make records available at the provider's place of business
176.5on the day for which access is requested, unless the provider and the department both agree
176.6otherwise. The department's normal business hours are 8:00 a.m. to 5:00 p.m., Monday
176.7through Friday, excluding state holidays as defined in section 645.44, subdivision 5.
176.8    Subd. 7. Honest and truthful statements. It shall be unlawful for a provider,
176.9license holder, controlling individual, or recipient to:
176.10(1) falsify, conceal, or cover up by any trick, scheme, or device a material fact;
176.11(2) make any materially false, fictitious, or fraudulent statement or representation; or
176.12(3) make or use any false writing or document knowing the same to contain any
176.13materially false, fictitious, or fraudulent statement or entry related to any child care
176.14assistance program services that the provider, license holder, or controlling individual
176.15supplies or in relation to any child care assistance payments received by a provider, license
176.16holder, or controlling individual or to any fraud investigator or law enforcement officer
176.17conducting a financial misconduct investigation.
176.18    Subd. 8. Record retention. (a) The following records must be maintained,
176.19controlled, and made immediately accessible to license holders, providers, and controlling
176.20individuals. The records must be organized and labeled to correspond to categories that
176.21make them easy to identify so that they can be made available immediately upon request
176.22to an investigator acting on behalf of the commissioner at the provider's place of business:
176.23(1) payroll ledgers, canceled checks, bank deposit slips, and any other accounting
176.24records;
176.25(2) daily attendance records required by and that comply with section 119B.125,
176.26subdivision 6;
176.27(3) billing transmittal forms requesting payments from the child care assistance
176.28program and billing adjustments related to child care assistance program payments;
176.29(4) records identifying all persons, corporations, partnerships, and entities with an
176.30ownership or controlling interest in the provider's child care business;
176.31(5) employee records identifying those persons currently employed by the provider's
176.32child care business or who have been employed by the business at any time within the
176.33previous five years. The records must include each employee's name, hourly and annual
176.34salary, qualifications, position description, job title, and dates of employment. In addition,
176.35employee records that must be made available include the employee's time sheets, current
177.1home address of the employee or last known address of any former employee, and
177.2documentation of background studies required under chapter 119B or 245C;
177.3(6) records related to transportation of children in care, including but not limited to:
177.4(i) the dates and times that transportation is provided to children for transportation to
177.5and from the provider's business location for any purpose. For transportation related to
177.6field trips or locations away from the provider's business location, the names and addresses
177.7of those field trips and locations must also be provided;
177.8(ii) the name, business address, phone number, and Web site address, if any, of the
177.9transportation service utilized; and
177.10(iii) all billing or transportation records related to the transportation.
177.11(b) A provider, license holder, or controlling individual must retain all records in
177.12paragraph (a) for at least six years after the last date of service. Microfilm or electronically
177.13stored records satisfy the record keeping requirements of this subdivision.
177.14(c) A provider, license holder, or controlling individual who withdraws or is
177.15terminated from the child care assistance program must retain the records required under
177.16this subdivision and make them available to the department on demand.
177.17(d) If the ownership of a provider changes, the transferor, unless otherwise provided
177.18by law or by written agreement with the transferee, is responsible for maintaining,
177.19preserving, and upon request from the department, making available the records related to
177.20the provider that were generated before the date of the transfer. Any written agreement
177.21affecting this provision must be held in the possession of the transferor and transferee.
177.22The written agreement must be provided to the department or county immediately upon
177.23request, and the written agreement must be retained by the transferor and transferee for six
177.24years after the agreement is fully executed.
177.25(e) In the event of an appealed case, the provider must retain all records required in
177.26this subdivision for the duration of the appeal or six years, whichever is longer.
177.27(f) A provider's use of electronic record keeping or electronic signatures is governed
177.28by chapter 325L.
177.29    Subd. 9. Factors regarding imposition of administrative sanctions. (a) The
177.30department shall consider the following factors in determining the administrative sanctions
177.31to be imposed:
177.32(1) nature and extent of financial misconduct;
177.33(2) history of financial misconduct;
177.34(3) actions taken or recommended by other state agencies, other divisions of the
177.35department, and court and administrative decisions;
177.36(4) prior imposition of sanctions;
178.1(5) size and type of provider;
178.2(6) information obtained through an investigation from any source;
178.3(7) convictions or pending criminal charges; and
178.4(8) any other information relevant to the acts or omissions related to the financial
178.5misconduct.
178.6(b) Any single factor under paragraph (a) may be determinative of the department's
178.7decision of whether and what sanctions are imposed.
178.8    Subd. 10. Written notice of department sanction. (a) The department shall give
178.9notice in writing to a person of an administrative sanction that is to be imposed. The notice
178.10shall be sent by mail as defined in subdivision 1, paragraph (k).
178.11(b) The notice shall state:
178.12(1) the factual basis for the department's determination;
178.13(2) the sanction the department intends to take;
178.14(3) the dollar amount of the monetary recovery or recoupment, if any;
178.15(4) how the dollar amount was computed;
178.16(5) the right to dispute the department's determination and to provide evidence;
178.17(6) the right to appeal the department's proposed sanction; and
178.18(7) the option to meet informally with department staff, and to bring additional
178.19documentation or information, to resolve the issues.
178.20(c) In cases of determinations resulting in denial or termination of payments, in
178.21addition to the requirements of paragraph (b), the notice must state:
178.22(1) the length of the denial or termination;
178.23(2) the requirements and procedures for reinstatement; and
178.24(3) the provider's right to submit documents and written arguments against the
178.25denial or termination of payments for review by the department before the effective date
178.26of denial or termination.
178.27(d) The submission of documents and written argument for review by the department
178.28under paragraph (b), clause (5) or (7), or paragraph (c), clause (3), does not stay the
178.29deadline for filing an appeal.
178.30(e) Unless timely appealed, the effective date of the proposed sanction shall be 30
178.31days after the license holder's, provider's, controlling individual's, or recipient's receipt of
178.32the notice. If a timely appeal is made, the proposed sanction shall be delayed pending
178.33the final outcome of the appeal. Implementation of a proposed sanction following the
178.34resolution of a timely appeal may be postponed if, in the opinion of the department, the
178.35delay of sanction is necessary to protect the health or safety of children in care. The
178.36department may consider the economic hardship of a person in implementing the proposed
179.1sanction, but economic hardship shall not be a determinative factor in implementing the
179.2proposed sanction.
179.3(f) Requests for an informal meeting to attempt to resolve issues and requests
179.4for appeals must be sent or delivered to the department's Office of Inspector General,
179.5Financial Fraud and Abuse Division.
179.6    Subd. 11. Appeal of department sanction under this section. (a) If the department
179.7does not pursue a criminal action against a provider, license holder, controlling individual,
179.8or recipient for financial misconduct, but the department imposes an administrative
179.9sanction under subdivision 5, paragraph (c), any individual or entity against whom the
179.10sanction was imposed may appeal the department's administrative sanction under this
179.11section pursuant to section 119B.16 or 256.045 with the additional requirements in clauses
179.12(1) to (4). An appeal must specify:
179.13(1) each disputed item, the reason for the dispute, and an estimate of the dollar
179.14amount involved for each disputed item, if appropriate;
179.15(2) the computation that is believed to be correct, if appropriate;
179.16(3) the authority in the statute or rule relied upon for each disputed item; and
179.17(4) the name, address, and phone number of the person at the provider's place of
179.18business with whom contact may be made regarding the appeal.
179.19(b) An appeal is considered timely only if postmarked or received by the department's
179.20Appeals Division within 30 days after receiving a notice of department sanction.
179.21(c) Before the appeal hearing, the department may deny or terminate authorizations
179.22or payment to the entity or individual if the department determines that the action is
179.23necessary to protect the public welfare or the interests of the child care assistance program.
179.24    Subd. 12. Consolidated hearings with licensing sanction. If a financial
179.25misconduct sanction has an appeal hearing right and it is timely appealed, and a licensing
179.26sanction exists for which there is an appeal hearing right and the sanction is timely
179.27appealed, and the overpayment recovery action and licensing sanction involve the same
179.28set of facts, the overpayment recovery action and licensing sanction must be consolidated
179.29in the contested case hearing related to the licensing sanction.
179.30    Subd. 13. Grounds for and methods of monetary recovery. (a) The department
179.31may obtain monetary recovery from a provider who has been improperly paid by the
179.32child care assistance program, regardless of whether the error was intentional or county
179.33error. The department does not need to establish a pattern as a precondition of monetary
179.34recovery of erroneous or false billing claims, duplicate billing claims, or billing claims
179.35based on false statements or financial misconduct.
180.1(b) The department shall obtain monetary recovery from providers by the following
180.2means:
180.3(1) permitting voluntary repayment of money, either in lump-sum payment or
180.4installment payments;
180.5(2) using any legal collection process;
180.6(3) deducting or withholding program payments; or
180.7(4) utilizing the means set forth in chapter 16D.
180.8    Subd. 14. Reporting of suspected fraudulent activity. (a) A person who, in
180.9good faith, makes a report of or testifies in any action or proceeding in which financial
180.10misconduct is alleged, and who is not involved in, has not participated in, or has not aided
180.11and abetted, conspired, or colluded in the financial misconduct, shall have immunity from
180.12any liability, civil or criminal, that results by reason of the person's report or testimony.
180.13For the purpose of any proceeding, the good faith of any person reporting or testifying
180.14under this provision shall be presumed.
180.15(b) If a person that is or has been involved in, participated in, aided and abetted,
180.16conspired, or colluded in the financial misconduct reports the financial misconduct,
180.17the department may consider that person's report and assistance in investigating the
180.18misconduct as a mitigating factor in the department's pursuit of civil, criminal, or
180.19administrative remedies.
180.20    Subd. 15. Data privacy. Data of any kind obtained or created in relation to a provider
180.21or recipient investigation under this section is defined, classified, and protected the same as
180.22all other data under section 13.46, and this data has the same classification as licensing data.
180.23    Subd. 16. Monetary recovery; random sample extrapolation. The department is
180.24authorized to calculate the amount of monetary recovery from a provider, license holder, or
180.25controlling individual based upon extrapolation from a statistical random sample of claims
180.26submitted by the provider, license holder, or controlling individual and paid by the child
180.27care assistance program. The department's random sample extrapolation shall constitute a
180.28rebuttable presumption of the accuracy of the calculation of monetary recovery. If the
180.29presumption is not rebutted by the provider, license holder, or controlling individual in the
180.30appeal process, the department shall use the extrapolation as the monetary recovery figure.
180.31The department may use sampling and extrapolation to calculate the amount of monetary
180.32recovery if the claims to be reviewed represent services to 50 or more children in care.
180.33    Subd. 17. Effect of department's monetary penalty determination. Unless a
180.34timely and proper appeal is received by the department, the department's administrative
180.35determination or sanction shall be considered a final department determination.
181.1    Subd. 18. Office of Inspector General recoveries. Overpayment recoveries
181.2resulting from child care provider fraud investigations initiated by the department's Office
181.3of Inspector General's fraud investigations staff are excluded from the county recovery
181.4provision in section 119B.11, subdivision 3.

181.5    Sec. 6. Minnesota Statutes 2012, section 256B.04, subdivision 21, is amended to read:
181.6    Subd. 21. Provider enrollment. (a) If the commissioner or the Centers for
181.7Medicare and Medicaid Services determines that a provider is designated "high-risk," the
181.8commissioner may withhold payment from providers within that category upon initial
181.9enrollment for a 90-day period. The withholding for each provider must begin on the date
181.10of the first submission of a claim.
181.11(b) An enrolled provider that is also licensed by the commissioner under chapter
181.12245A must designate an individual as the entity's compliance officer. The compliance
181.13officer must:
181.14(1) develop policies and procedures to assure adherence to medical assistance laws
181.15and regulations and to prevent inappropriate claims submissions;
181.16(2) train the employees of the provider entity, and any agents or subcontractors of
181.17the provider entity including billers, on the policies and procedures under clause (1);
181.18(3) respond to allegations of improper conduct related to the provision or billing of
181.19medical assistance services, and implement action to remediate any resulting problems;
181.20(4) use evaluation techniques to monitor compliance with medical assistance laws
181.21and regulations;
181.22(5) promptly report to the commissioner any identified violations of medical
181.23assistance laws or regulations; and
181.24    (6) within 60 days of discovery by the provider of a medical assistance
181.25reimbursement overpayment, report the overpayment to the commissioner and make
181.26arrangements with the commissioner for the commissioner's recovery of the overpayment.
181.27The commissioner may require, as a condition of enrollment in medical assistance, that a
181.28provider within a particular industry sector or category establish a compliance program that
181.29contains the core elements established by the Centers for Medicare and Medicaid Services.
181.30(c) The commissioner may revoke the enrollment of an ordering or rendering
181.31provider for a period of not more than one year, if the provider fails to maintain and, upon
181.32request from the commissioner, provide access to documentation relating to written orders
181.33or requests for payment for durable medical equipment, certifications for home health
181.34services, or referrals for other items or services written or ordered by such provider, when
181.35the commissioner has identified a pattern of a lack of documentation. A pattern means a
182.1failure to maintain documentation or provide access to documentation on more than one
182.2occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
182.3provider under the provisions of section 256B.064.
182.4(d) The commissioner shall terminate or deny the enrollment of any individual or
182.5entity if the individual or entity has been terminated from participation in Medicare or
182.6under the Medicaid program or Children's Health Insurance Program of any other state.
182.7(e) As a condition of enrollment in medical assistance, the commissioner shall
182.8require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
182.9and Medicaid Services or the Minnesota Department of Human Services commissioner
182.10 permit the Centers for Medicare and Medicaid Services, its agents, or its designated
182.11contractors and the state agency, its agents, or its designated contractors to conduct
182.12unannounced on-site inspections of any provider location. The commissioner shall publish
182.13in the Minnesota Health Care Program Provider Manual a list of provider types designated
182.14"limited," "moderate," or "high-risk," based on the criteria and standards used to designate
182.15Medicare providers in Code of Federal Regulations, title 42, section 424.518. The list and
182.16criteria are not subject to the requirements of chapter 14. The commissioner's designations
182.17are not subject to administrative appeal.
182.18(f) As a condition of enrollment in medical assistance, the commissioner shall
182.19require that a high-risk provider, or a person with a direct or indirect ownership interest in
182.20the provider of five percent or higher, consent to criminal background checks, including
182.21fingerprinting, when required to do so under state law or by a determination by the
182.22commissioner or the Centers for Medicare and Medicaid Services that a provider is
182.23designated high-risk for fraud, waste, or abuse.
182.24(g)(1) Upon initial enrollment, reenrollment, and revalidation, all durable medical
182.25equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers operating in
182.26Minnesota and receiving Medicaid funds, must purchase a surety bond that is annually
182.27renewed and designates the Minnesota Department of Human Services as the obligee, and
182.28must be submitted in a form approved by the commissioner.
182.29(2) At the time of initial enrollment or reenrollment, the provider agency must
182.30purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
182.31in the previous calendar year is up to and including $300,000, the provider agency must
182.32purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
182.33in the previous calendar year is over $300,000, the provider agency must purchase a
182.34performance bond of $100,000. The performance bond must allow for recovery of costs
182.35and fees in pursuing a claim on the bond.
183.1(h) The Department of Human Services may require a provider to purchase a
183.2performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
183.3or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
183.4department determines there is significant evidence of or potential for fraud and abuse by
183.5the provider, or (3) the provider or category of providers is designated high-risk pursuant
183.6to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450. The
183.7performance bond must be in an amount of $100,000 or ten percent of the provider's
183.8payments from Medicaid during the immediately preceding 12 months, whichever is
183.9greater. The performance bond must name the Department of Human Services as an
183.10obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.
183.11EFFECTIVE DATE.This section is effective the day following final enactment.

183.12    Sec. 7. Minnesota Statutes 2012, section 256B.04, is amended by adding a subdivision
183.13to read:
183.14    Subd. 22. Application fee. (a) The commissioner must collect and retain federally
183.15required nonrefundable application fees to pay for provider screening activities in
183.16accordance with Code of Federal Regulations, title 42, section 455, subpart E. The
183.17enrollment application must be made under the procedures specified by the commissioner,
183.18in the form specified by the commissioner, and accompanied by an application fee
183.19described in paragraph (b), or a request for a hardship exception as described in the
183.20specified procedures. Application fees must be deposited in the provider screening account
183.21in the special revenue fund. Amounts in the provider screening account are appropriated
183.22to the commissioner for costs associated with the provider screening activities required
183.23in Code of Federal Regulations, title 42, section 455, subpart E. The commissioner
183.24shall conduct screening activities as required by Code of Federal Regulations, title 42,
183.25section 455, subpart E, and as otherwise provided by law, to include database checks,
183.26unannounced pre- and postenrollment site visits, fingerprinting, and criminal background
183.27studies. The commissioner must revalidate all providers under this subdivision at least
183.28once every five years.
183.29(b) The application fee under this subdivision is $532 for the calendar year 2013.
183.30For calendar year 2014 and subsequent years, the fee:
183.31(1) is adjusted by the percentage change to the consumer price index for all urban
183.32consumers, United States city average, for the 12-month period ending with June of the
183.33previous year. The resulting fee must be announced in the Federal Register;
183.34(2) is effective from January 1 to December 31 of a calendar year;
184.1(3) is required on the submission of an initial application, an application to establish
184.2a new practice location, an application for re-enrollment when the provider is not enrolled
184.3at the time of application of re-enrollment, or at revalidation when required by federal
184.4regulation; and
184.5(4) must be in the amount in effect for the calendar year during which the application
184.6for enrollment, new practice location, or re-enrollment is being submitted.
184.7(c) The application fee under this subdivision cannot be charged to:
184.8(1) providers who are enrolled in Medicare or who provide documentation of
184.9payment of the fee to, and enrollment with, another state, unless the commissioner is
184.10required to rescreen the provider;
184.11(2) providers who are enrolled but are required to submit new applications for
184.12purposes of reenrollment;
184.13(3) a provider who enrolls as an individual; and
184.14(4) group practices and clinics that bill on behalf of individually enrolled providers
184.15within the practice who have reassigned their billing privileges to the group practice
184.16or clinic.
184.17EFFECTIVE DATE.This section is effective the day following final enactment.

184.18    Sec. 8. Minnesota Statutes 2012, section 256B.064, subdivision 1a, is amended to read:
184.19    Subd. 1a. Grounds for sanctions against vendors. The commissioner may
184.20impose sanctions against a vendor of medical care for any of the following: (1) fraud,
184.21theft, or abuse in connection with the provision of medical care to recipients of public
184.22assistance; (2) a pattern of presentment of false or duplicate claims or claims for services
184.23not medically necessary; (3) a pattern of making false statements of material facts for
184.24the purpose of obtaining greater compensation than that to which the vendor is legally
184.25entitled; (4) suspension or termination as a Medicare vendor; (5) refusal to grant the state
184.26agency access during regular business hours to examine all records necessary to disclose
184.27the extent of services provided to program recipients and appropriateness of claims for
184.28payment; (6) failure to repay an overpayment or a fine finally established under this
184.29section; and (7) failure to correct errors in the maintenance of health service or financial
184.30records for which a fine was imposed or after issuance of a warning by the commissioner;
184.31and (8) any reason for which a vendor could be excluded from participation in the
184.32Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act.
184.33The determination of services not medically necessary may be made by the commissioner
184.34in consultation with a peer advisory task force appointed by the commissioner on the
185.1recommendation of appropriate professional organizations. The task force expires as
185.2provided in section 15.059, subdivision 5.

185.3    Sec. 9. Minnesota Statutes 2012, section 256B.064, subdivision 1b, is amended to read:
185.4    Subd. 1b. Sanctions available. The commissioner may impose the following
185.5sanctions for the conduct described in subdivision 1a: suspension or withholding of
185.6payments to a vendor and suspending or terminating participation in the program, or
185.7imposition of a fine under subdivision 2, paragraph (f). When imposing sanctions under
185.8this section, the commissioner shall consider the nature, chronicity, or severity of the
185.9conduct and the effect of the conduct on the health and safety of persons served by the
185.10vendor. Regardless of imposition of sanctions, the commissioner may make a referral
185.11to the appropriate state licensing board.

185.12    Sec. 10. Minnesota Statutes 2012, section 256B.064, subdivision 2, is amended to read:
185.13    Subd. 2. Imposition of monetary recovery and sanctions. (a) The commissioner
185.14shall determine any monetary amounts to be recovered and sanctions to be imposed upon
185.15a vendor of medical care under this section. Except as provided in paragraphs (b) and
185.16(d), neither a monetary recovery nor a sanction will be imposed by the commissioner
185.17without prior notice and an opportunity for a hearing, according to chapter 14, on the
185.18commissioner's proposed action, provided that the commissioner may suspend or reduce
185.19payment to a vendor of medical care, except a nursing home or convalescent care facility,
185.20after notice and prior to the hearing if in the commissioner's opinion that action is
185.21necessary to protect the public welfare and the interests of the program.
185.22(b) Except when the commissioner finds good cause not to suspend payments under
185.23Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
185.24withhold or reduce payments to a vendor of medical care without providing advance
185.25notice of such withholding or reduction if either of the following occurs:
185.26(1) the vendor is convicted of a crime involving the conduct described in subdivision
185.271a; or
185.28(2) the commissioner determines there is a credible allegation of fraud for which an
185.29investigation is pending under the program. A credible allegation of fraud is an allegation
185.30which has been verified by the state, from any source, including but not limited to:
185.31(i) fraud hotline complaints;
185.32(ii) claims data mining; and
185.33(iii) patterns identified through provider audits, civil false claims cases, and law
185.34enforcement investigations.
186.1Allegations are considered to be credible when they have an indicia of reliability
186.2and the state agency has reviewed all allegations, facts, and evidence carefully and acts
186.3judiciously on a case-by-case basis.
186.4(c) The commissioner must send notice of the withholding or reduction of payments
186.5under paragraph (b) within five days of taking such action unless requested in writing by a
186.6law enforcement agency to temporarily withhold the notice. The notice must:
186.7(1) state that payments are being withheld according to paragraph (b);
186.8(2) set forth the general allegations as to the nature of the withholding action, but
186.9need not disclose any specific information concerning an ongoing investigation;
186.10(3) except in the case of a conviction for conduct described in subdivision 1a, state
186.11that the withholding is for a temporary period and cite the circumstances under which
186.12withholding will be terminated;
186.13(4) identify the types of claims to which the withholding applies; and
186.14(5) inform the vendor of the right to submit written evidence for consideration by
186.15the commissioner.
186.16The withholding or reduction of payments will not continue after the commissioner
186.17determines there is insufficient evidence of fraud by the vendor, or after legal proceedings
186.18relating to the alleged fraud are completed, unless the commissioner has sent notice of
186.19intention to impose monetary recovery or sanctions under paragraph (a).
186.20(d) The commissioner shall suspend or terminate a vendor's participation in the
186.21program without providing advance notice and an opportunity for a hearing when the
186.22suspension or termination is required because of the vendor's exclusion from participation
186.23in Medicare. Within five days of taking such action, the commissioner must send notice of
186.24the suspension or termination. The notice must:
186.25(1) state that suspension or termination is the result of the vendor's exclusion from
186.26Medicare;
186.27(2) identify the effective date of the suspension or termination; and
186.28(3) inform the vendor of the need to be reinstated to Medicare before reapplying
186.29for participation in the program.
186.30(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or
186.31sanction is to be imposed, a vendor may request a contested case, as defined in section
186.3214.02, subdivision 3 , by filing with the commissioner a written request of appeal. The
186.33appeal request must be received by the commissioner no later than 30 days after the date
186.34the notification of monetary recovery or sanction was mailed to the vendor. The appeal
186.35request must specify:
187.1(1) each disputed item, the reason for the dispute, and an estimate of the dollar
187.2amount involved for each disputed item;
187.3(2) the computation that the vendor believes is correct;
187.4(3) the authority in statute or rule upon which the vendor relies for each disputed item;
187.5(4) the name and address of the person or entity with whom contacts may be made
187.6regarding the appeal; and
187.7(5) other information required by the commissioner.
187.8(f) The commissioner may order a vendor to forfeit a fine for failure to fully document
187.9services according to standards in this chapter and Minnesota Rules, chapter 9505. The
187.10commissioner may assess fines if specific required components of documentation are
187.11missing. The fine for incomplete documentation shall equal 20 percent of the amount paid
187.12on the claims for reimbursement submitted by the vendor, or up to $5,000, whichever is less.
187.13(g) The vendor shall pay the fine assessed on or before the payment date specified. If
187.14the vendor fails to pay the fine, the commissioner may withhold or reduce payments and
187.15recover the amount of the fine. A timely appeal shall stay payment of the fine until the
187.16commissioner issues a final order.

187.17    Sec. 11. Minnesota Statutes 2012, section 256B.0659, subdivision 21, is amended to
187.18read:
187.19    Subd. 21. Requirements for initial provider enrollment of personal care
187.20assistance provider agencies. (a) All personal care assistance provider agencies must
187.21provide, at the time of enrollment, reenrollment, and revalidation as a personal care
187.22assistance provider agency in a format determined by the commissioner, information and
187.23documentation that includes, but is not limited to, the following:
187.24    (1) the personal care assistance provider agency's current contact information
187.25including address, telephone number, and e-mail address;
187.26    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
187.27provider's payments from Medicaid in the previous year, whichever is less;
187.28    (2) proof of surety bond coverage. Upon new enrollment, or if the provider's
187.29Medicaid revenue in the previous calendar year is up to and including $300,000,
187.30the provider agency must purchase a performance bond of $50,000. If the Medicaid
187.31revenue in the previous year is over $300,000, the provider agency must purchase a
187.32performance bond of $100,000. The performance bond must be in a form approved by the
187.33commissioner, must be renewed annually, and must allow for recovery of costs and fees
187.34in pursuing a claim on the bond;
187.35    (3) proof of fidelity bond coverage in the amount of $20,000;
188.1    (4) proof of workers' compensation insurance coverage;
188.2    (5) proof of liability insurance;
188.3    (6) a description of the personal care assistance provider agency's organization
188.4identifying the names of all owners, managing employees, staff, board of directors, and
188.5the affiliations of the directors, owners, or staff to other service providers;
188.6    (7) a copy of the personal care assistance provider agency's written policies and
188.7procedures including: hiring of employees; training requirements; service delivery;
188.8and employee and consumer safety including process for notification and resolution
188.9of consumer grievances, identification and prevention of communicable diseases, and
188.10employee misconduct;
188.11    (8) copies of all other forms the personal care assistance provider agency uses in
188.12the course of daily business including, but not limited to:
188.13    (i) a copy of the personal care assistance provider agency's time sheet if the time
188.14sheet varies from the standard time sheet for personal care assistance services approved
188.15by the commissioner, and a letter requesting approval of the personal care assistance
188.16provider agency's nonstandard time sheet;
188.17    (ii) the personal care assistance provider agency's template for the personal care
188.18assistance care plan; and
188.19    (iii) the personal care assistance provider agency's template for the written
188.20agreement in subdivision 20 for recipients using the personal care assistance choice
188.21option, if applicable;
188.22    (9) a list of all training and classes that the personal care assistance provider agency
188.23requires of its staff providing personal care assistance services;
188.24    (10) documentation that the personal care assistance provider agency and staff have
188.25successfully completed all the training required by this section;
188.26    (11) documentation of the agency's marketing practices;
188.27    (12) disclosure of ownership, leasing, or management of all residential properties
188.28that is used or could be used for providing home care services;
188.29    (13) documentation that the agency will use the following percentages of revenue
188.30generated from the medical assistance rate paid for personal care assistance services
188.31for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
188.32personal care assistance choice option and 72.5 percent of revenue from other personal
188.33care assistance providers. The revenue generated by the qualified professional and the
188.34reasonable costs associated with the qualified professional shall not be used in making
188.35this calculation; and
189.1    (14) effective May 15, 2010, documentation that the agency does not burden
189.2recipients' free exercise of their right to choose service providers by requiring personal
189.3care assistants to sign an agreement not to work with any particular personal care
189.4assistance recipient or for another personal care assistance provider agency after leaving
189.5the agency and that the agency is not taking action on any such agreements or requirements
189.6regardless of the date signed.
189.7    (b) Personal care assistance provider agencies shall provide the information specified
189.8in paragraph (a) to the commissioner at the time the personal care assistance provider
189.9agency enrolls as a vendor or upon request from the commissioner. The commissioner
189.10shall collect the information specified in paragraph (a) from all personal care assistance
189.11providers beginning July 1, 2009.
189.12    (c) All personal care assistance provider agencies shall require all employees in
189.13management and supervisory positions and owners of the agency who are active in the
189.14day-to-day management and operations of the agency to complete mandatory training
189.15as determined by the commissioner before enrollment of the agency as a provider.
189.16Employees in management and supervisory positions and owners who are active in
189.17the day-to-day operations of an agency who have completed the required training as
189.18an employee with a personal care assistance provider agency do not need to repeat
189.19the required training if they are hired by another agency, if they have completed the
189.20training within the past three years. By September 1, 2010, the required training must
189.21be available with meaningful access according to title VI of the Civil Rights Act and
189.22federal regulations adopted under that law or any guidance from the United States Health
189.23and Human Services Department. The required training must be available online or by
189.24electronic remote connection. The required training must provide for competency testing.
189.25Personal care assistance provider agency billing staff shall complete training about
189.26personal care assistance program financial management. This training is effective July 1,
189.272009. Any personal care assistance provider agency enrolled before that date shall, if it
189.28has not already, complete the provider training within 18 months of July 1, 2009. Any new
189.29owners or employees in management and supervisory positions involved in the day-to-day
189.30operations are required to complete mandatory training as a requisite of working for the
189.31agency. Personal care assistance provider agencies certified for participation in Medicare
189.32as home health agencies are exempt from the training required in this subdivision. When
189.33available, Medicare-certified home health agency owners, supervisors, or managers must
189.34successfully complete the competency test.
189.35EFFECTIVE DATE.This section is effective the day following final enactment.

190.1    Sec. 12. Minnesota Statutes 2012, section 299C.093, is amended to read:
190.2299C.093 DATABASE OF REGISTERED PREDATORY OFFENDERS.
190.3The superintendent of the Bureau of Criminal Apprehension shall maintain a
190.4computerized data system relating to individuals required to register as predatory offenders
190.5under section 243.166. To the degree feasible, the system must include the data required
190.6to be provided under section 243.166, subdivisions 4 and 4a, and indicate the time period
190.7that the person is required to register. The superintendent shall maintain this data in a
190.8manner that ensures that it is readily available to law enforcement agencies. This data is
190.9private data on individuals under section 13.02, subdivision 12, but may be used for law
190.10enforcement and corrections purposes. The commissioner of human services has access
190.11to the data for state-operated services, as defined in section 246.014, are also authorized
190.12to have access to the data for the purposes described in section 246.13, subdivision 2,
190.13paragraph (b), and for purposes of conducting background studies under chapter 245C.

190.14    Sec. 13. Minnesota Statutes 2012, section 402A.10, is amended to read:
190.15402A.10 DEFINITIONS.
190.16    Subdivision 1. Terms defined. For the purposes of this chapter, the terms defined
190.17in this section have the meanings given.
190.18    Subd. 1a. Balanced set of program measures. A "balanced set of program
190.19measures" is a set of measures that, together, adequately quantify achievement toward a
190.20particular program's outcome. As directed by section 402A.16, the Human Services
190.21Performance Council must recommend to the commissioner when a particular program
190.22has a balanced set of program measures.
190.23    Subd. 2. Commissioner. "Commissioner" means the commissioner of human
190.24services.
190.25    Subd. 3. Council. "Council" means the State-County Results, Accountability, and
190.26Service Delivery Redesign Council established in section 402A.20.
190.27    Subd. 4. Essential human services or essential services. "Essential human
190.28services" or "essential services" means assistance and services to recipients or potential
190.29recipients of public welfare and other services delivered by counties or tribes that are
190.30mandated in federal and state law that are to be available in all counties of the state.
190.31    Subd. 4a. Essential human services program. An "essential human services
190.32program" for the purposes of remedies under section 402A.18 means the following
190.33programs:
190.34(1) child welfare, including protection, truancy, minor parent, guardianship, and
190.35adoption;
191.1(2) children's mental health;
191.2(3) children's disability services;
191.3(4) public assistance eligibility, including measures related to processing timelines
191.4across information services programs;
191.5(5) MFIP;
191.6(6) child support;
191.7(7) chemical dependency;
191.8(8) adult disability;
191.9(9) adult mental health;
191.10(10) adult services such as long-term care; and
191.11(11) adult protection.
191.12    Subd. 4b. Measure. A "measure" means a quantitative indicator of a performance
191.13outcome.
191.14    Subd. 4c. Performance improvement plan. A "performance improvement plan"
191.15means a plan developed by a county or service delivery authority that describes steps the
191.16county or service delivery authority must take to improve performance on a specific
191.17measure or set of measures. The performance improvement plan must be negotiated
191.18with and approved by the commissioner. The performance improvement plan must
191.19require a specific numerical improvement in the measure or measures on which the plan
191.20is based and may include specific programmatic best practices or specific performance
191.21management practices that the county must implement.
191.22    Subd. 4d. Performance management system for human services. A "performance
191.23management system for human services" means a process by which performance data for
191.24essential human services is collected from counties or service delivery authorities and used
191.25to inform a variety of stakeholders and to improve performance over time.
191.26    Subd. 5. Service delivery authority. "Service delivery authority" means a single
191.27county, or consortium of counties operating by execution of a joint powers agreement
191.28under section 471.59 or other contractual agreement, that has voluntarily chosen by
191.29resolution of the county board of commissioners to participate in the redesign under this
191.30chapter or has been assigned by the commissioner pursuant to section 402A.18. A service
191.31delivery authority includes an Indian tribe or group of tribes that have voluntarily chosen
191.32by resolution of tribal government to participate in redesign under this chapter.
191.33    Subd. 6. Steering committee. "Steering committee" means the Steering Committee
191.34on Performance and Outcome Reforms.

192.1    Sec. 14. [402A.12] ESTABLISHMENT OF A PERFORMANCE MANAGEMENT
192.2SYSTEM FOR HUMAN SERVICES.
192.3By January 1, 2014, the commissioner shall implement a performance management
192.4system for essential human services as described in sections 402A.15 to 402A.18 that
192.5includes initial performance measures and standards consistent with the recommendations
192.6of the Steering Committee on Performance and Outcome Reforms in the December 2012
192.7report to the legislature.

192.8    Sec. 15. [402A.16] HUMAN SERVICES PERFORMANCE COUNCIL.
192.9    Subdivision 1. Establishment. By October 1, 2013, the commissioner shall convene
192.10a Human Services Performance Council to advise the commissioner on the implementation
192.11and operation of the performance management system for human services.
192.12    Subd. 2. Duties. The Human Services Performance Council shall:
192.13(1) hold meetings at least quarterly that are in compliance with Minnesota's Open
192.14Meeting Law under chapter 13D;
192.15(2) annually review the annual performance data submitted by counties or service
192.16delivery authorities;
192.17(3) review and advise the commissioner on department procedures related to the
192.18implementation of the performance management system and system process requirements
192.19and on barriers to process improvement in human services delivery;
192.20(4) advise the commissioner on the training and technical assistance needs of county
192.21or service delivery authority and department personnel;
192.22(5) review instances in which a county or service delivery authority has not made
192.23adequate progress on a performance improvement plan and make recommendations to
192.24the commissioner under section 402A.18;
192.25(6) consider appeals from counties or service delivery authorities that are in the
192.26remedies process and make recommendations to the commissioner on resolving the issue;
192.27(7) convene working groups to update and develop outcomes, measures, and
192.28performance standards for the performance management system and, on an annual basis,
192.29present these recommendations to the commissioner, including recommendations on when
192.30a particular essential human service program has a balanced set of program measures
192.31in place;
192.32(8) make recommendations on human services administrative rules or statutes that
192.33could be repealed in order to improve service delivery;
192.34(9) provide information to stakeholders on the council's role and regularly collect
192.35stakeholder input on performance management system performance; and
193.1(10) submit an annual report to the legislature and the commissioner, which
193.2includes a comprehensive report on the performance of individual counties or service
193.3delivery authorities as it relates to system measures; a list of counties or service delivery
193.4authorities that have been required to create performance improvement plans and the areas
193.5identified for improvement as part of the remedies process; a summary of performance
193.6improvement training and technical assistance activities offered to the county personnel
193.7by the department; recommendations on administrative rules or state statutes that could be
193.8repealed in order to improve service delivery; recommendations for system improvements,
193.9including updates to system outcomes, measures, and standards; and a response from
193.10the commissioner.
193.11    Subd. 3. Membership. (a) Human Services Performance Council membership shall
193.12be equally balanced among the following five stakeholder groups: the Association of
193.13Minnesota Counties, the Minnesota Association of County Social Service Administrators,
193.14the Department of Human Services, tribes and communities of color, and service providers
193.15and advocates for persons receiving human services. The Association of Minnesota
193.16Counties and the Minnesota Association of County Social Service Administrators shall
193.17appoint their own respective representatives. The commissioner of human services shall
193.18appoint representatives of the Department of Human Services, tribes and communities of
193.19color, and social services providers and advocates. Minimum council membership shall
193.20be 15 members, with at least three representatives from each stakeholder group, and
193.21maximum council membership shall be 20 members, with four representatives from
193.22each stakeholder group.
193.23(b) Notwithstanding section 15.059, Human Services Performance Council members
193.24shall be appointed for a minimum of two years, but may serve longer terms at the
193.25discretion of their appointing authority.
193.26(c) Notwithstanding section 15.059, members of the council shall receive no
193.27compensation for their services.
193.28(d) A commissioner's representative and a county representative from either the
193.29Association of Minnesota Counties or the Minnesota Association of County Social Service
193.30Administrators shall serve as Human Services Performance Council cochairs.
193.31    Subd. 4. Commissioner duties. The commissioner shall:
193.32(1) implement and maintain the performance management system for human services;
193.33(2) establish and regularly update the system's outcomes, measures, and standards,
193.34including the minimum performance standard for each performance measure;
193.35(3) determine when a particular program has a balanced set of measures;
194.1(4) receive reports from counties or service delivery authorities at least annually on
194.2their performance against system measures, provide counties with data needed to assess
194.3performance and monitor progress, and provide timely feedback to counties or service
194.4delivery authorities on their performance;
194.5(5) implement and monitor the remedies process in section 402A.18;
194.6(6) report to the Human Services Performance Council on county or service delivery
194.7authority performance on a semiannual basis;
194.8(7) provide general training and technical assistance to counties or service delivery
194.9authorities on topics related to performance measurement and performance improvement;
194.10(8) provide targeted training and technical assistance to counties or service delivery
194.11authorities that supports their performance improvement plans; and
194.12(9) provide staff support for the Human Services Performance Council.
194.13    Subd. 5. County or service delivery authority duties. The counties or service
194.14delivery authorities shall:
194.15(1) report performance data to meet performance management system requirements;
194.16and
194.17(2) provide training to personnel on basic principles of performance measurement
194.18and improvement and participate in training provided by the department.

194.19    Sec. 16. Minnesota Statutes 2012, section 402A.18, is amended to read:
194.20402A.18 COMMISSIONER POWER TO REMEDY FAILURE TO MEET
194.21PERFORMANCE OUTCOMES.
194.22    Subdivision 1. Underperforming county; specific service. If the commissioner
194.23determines that a county or service delivery authority is deficient in achieving minimum
194.24performance outcomes standards for a specific essential service human services program,
194.25the commissioner may impose the following remedies and adjust state and federal
194.26program allocations accordingly:
194.27(1) voluntary incorporation of the administration and operation of the specific
194.28essential service human services program with an existing service delivery authority or
194.29another county. A service delivery authority or county incorporating an underperforming
194.30county shall not be financially liable for the costs associated with remedying performance
194.31outcome deficiencies;
194.32(2) mandatory incorporation of the administration and operation of the specific
194.33essential service human services program with an existing service delivery authority or
194.34another county. A service delivery authority or county incorporating an underperforming
195.1county shall not be financially liable for the costs associated with remedying performance
195.2outcome deficiencies; or
195.3(3) transfer of authority for program administration and operation of the specific
195.4essential service human services program to the commissioner.
195.5    Subd. 2. Underperforming county; more than one-half of services. If the
195.6commissioner determines that a county or service delivery authority is deficient in
195.7achieving minimum performance outcomes standards for more than one-half of the defined
195.8essential human services programs, the commissioner may impose the following remedies:
195.9(1) voluntary incorporation of the administration and operation of essential human
195.10services programs with an existing service delivery authority or another county. A
195.11service delivery authority or county incorporating an underperforming county shall
195.12not be financially liable for the costs associated with remedying performance outcome
195.13deficiencies;
195.14(2) mandatory incorporation of the administration and operation of essential human
195.15services programs with an existing service delivery authority or another county. A
195.16service delivery authority or county incorporating an underperforming county shall
195.17not be financially liable for the costs associated with remedying performance outcome
195.18deficiencies; or
195.19(3) transfer of authority for program administration and operation of essential human
195.20services programs to the commissioner.
195.21    Subd. 2a. Financial responsibility of underperforming county. A county subject
195.22to remedies under subdivision 1 or 2 shall provide to the entity assuming administration
195.23of the essential service or essential human services program or programs the amount of
195.24nonfederal and nonstate funding needed to remedy performance outcome deficiencies.
195.25    Subd. 3. Conditions prior to imposing remedies. Before the commissioner may
195.26impose the remedies authorized under this section, the following conditions must be met:
195.27(1) the county or service delivery authority determined by the commissioner
195.28to be deficient in achieving minimum performance outcomes has the opportunity, in
195.29coordination with the council, to develop a program outcome improvement plan. The
195.30program outcome improvement plan must be developed no later than six months from the
195.31date of the deficiency determination; and
195.32(2) the council has conducted an assessment of the program outcome improvement
195.33plan to determine if the county or service delivery authority has made satisfactory progress
195.34toward performance outcomes and has made a recommendation about remedies to the
195.35commissioner. The assessment and recommendation must be made to the commissioner
195.36within 12 months from the date of the deficiency determination. (a) The commissioner
196.1shall notify a county or service delivery authority that it must submit a performance
196.2improvement plan if:
196.3(1) the county or service delivery authority does not meet the minimum performance
196.4standard for a measure; or
196.5(2) the county or service delivery authority does not meet the minimum performance
196.6standard for one or more racial or ethnic subgroup for which there is a statistically valid
196.7population size for three or more measures, even if the county or service delivery authority
196.8met the standard for the overall population.
196.9The commissioner must approve the performance improvement plan. The county or
196.10service delivery authority may negotiate the terms of the performance improvement plan
196.11with the commissioner.
196.12(b) When the department determines that a county or service delivery authority does
196.13not meet the minimum performance standard for a given measure, the commissioner
196.14must advise the county or service delivery authority that fiscal penalties may result if the
196.15performance does not improve. The department must offer technical assistance to the
196.16county or service delivery authority. Within 30 days of the initial advisement from the
196.17department, the county or service delivery authority may claim and the department may
196.18approve an extenuating circumstance that relieves the county or service delivery authority
196.19of any further remedy. If a county or service delivery authority has a small number of
196.20participants in an essential human services program such that reliable measurement is
196.21not possible, the commissioner may approve extenuating circumstances or may average
196.22performance over three years.
196.23(c) If there are no extenuating circumstances, the county or service delivery authority
196.24must submit a performance improvement plan to the commissioner within 60 days of the
196.25initial advisement from the department. The term of the performance improvement plan
196.26must be two years, starting with the date the plan is approved by the commissioner. This
196.27plan must include a target level for improvement for each measure that did not meet
196.28the minimum performance standard. The commissioner must approve the performance
196.29improvement plan within 60 days of submittal.
196.30(d) The department must monitor the performance improvement plan for two
196.31years. After two years, if the county or service delivery authority meets the minimum
196.32performance standard, there is no further remedy. If the county or service delivery
196.33authority fails to meet the minimum performance standard, but meets the improvement
196.34target in the performance improvement plan, the county or service delivery authority shall
196.35modify the performance improvement plan for further improvement and the department
196.36shall continue to monitor the plan.
197.1(e) If, after two years of monitoring, the county or service delivery authority fails to
197.2meet both the minimum performance standard and the improvement target identified in
197.3the performance improvement plan, the next step of the remedies process shall be invoked
197.4by the commissioner. This phase of the remedies process may include:
197.5(1) fiscal penalties for the county or service delivery authority that do not exceed
197.6one percent of the county's human services expenditures and that are negotiated in the
197.7performance improvement plan, based on what is needed to improve outcomes. Counties
197.8or service delivery authorities must reinvest the amount of the fiscal penalty into the
197.9essential human services program that was underperforming. A county or service delivery
197.10authority shall not be required to pay more than three fiscal penalties in a year; and
197.11(2) the department's provision of technical assistance to the county or service
197.12delivery authority that is targeted to address the specific performance issues.
197.13The commissioner shall continue monitoring the performance improvement plan for a
197.14third year.
197.15(f) If, after the third year of monitoring, the county or service delivery authority
197.16meets the minimum performance standard, there is no further remedy. If the county or
197.17service delivery authority fails to meet the minimum performance standard, but meets the
197.18improvement target for the performance improvement plan, the county or service delivery
197.19authority shall modify the performance improvement plan for further improvement and
197.20the department shall continue to monitor the plan.
197.21(g) If, after the third year of monitoring, the county or service delivery authority fails
197.22to meet the minimum performance standard and the improvement target identified in the
197.23performance improvement plan, the Human Services Performance Council shall review
197.24the situation and recommend a course of action to the commissioner.
197.25(h) If the commissioner has determined that a program has a balanced set of program
197.26measures and a county or service delivery authority is subject to fiscal penalties for more
197.27than one-half of the measures for that program, the commissioner may apply further
197.28remedies as described in subdivisions 1 and 2.

197.29    Sec. 17. INSTRUCTIONS TO THE COMMISSIONER.
197.30    In collaboration with labor organizations, the commissioner of human services shall
197.31develop clear and consistent standards for state-operated services programs to:
197.32    (1) address direct service staffing shortages;
197.33    (2) identify and help resolve workplace safety issues; and
197.34    (3) elevate the use and visibility of performance measures and objectives related to
197.35overtime use.


198.3    Section 1. Minnesota Statutes 2012, section 245.03, subdivision 1, is amended to read:
198.4    Subdivision 1. Establishment. There is created a Department of Human Services.
198.5A commissioner of human services shall be appointed by the governor under the
198.6provisions of section 15.06. The commissioner shall be selected on the basis of ability and
198.7experience in welfare and without regard to political affiliations. The commissioner shall
198.8 may appoint a up to two deputy commissioner commissioners.

198.9    Sec. 2. Minnesota Statutes 2012, section 256.9657, subdivision 3, is amended to read:
198.10    Subd. 3. Surcharge on HMOs and community integrated service networks. (a)
198.11Effective October 1, 1992, each health maintenance organization with a certificate of
198.12authority issued by the commissioner of health under chapter 62D and each community
198.13integrated service network licensed by the commissioner under chapter 62N shall pay to
198.14the commissioner of human services a surcharge equal to six-tenths of one percent of the
198.15total premium revenues of the health maintenance organization or community integrated
198.16service network as reported to the commissioner of health according to the schedule in
198.17subdivision 4.
198.18(b) For purposes of this subdivision, total premium revenue means:
198.19(1) premium revenue recognized on a prepaid basis from individuals and groups
198.20for provision of a specified range of health services over a defined period of time which
198.21is normally one month, excluding premiums paid to a health maintenance organization
198.22or community integrated service network from the Federal Employees Health Benefit
198.23Program;
198.24(2) premiums from Medicare wraparound subscribers for health benefits which
198.25supplement Medicare coverage;
198.26(3) Medicare revenue, as a result of an arrangement between a health maintenance
198.27organization or a community integrated service network and the Centers for Medicare
198.28and Medicaid Services of the federal Department of Health and Human Services, for
198.29services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited
198.30from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social
198.31Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and
198.321395w-24, respectively, as they may be amended from time to time; and
199.1(4) medical assistance revenue, as a result of an arrangement between a health
199.2maintenance organization or community integrated service network and a Medicaid state
199.3agency, for services to a medical assistance beneficiary.
199.4If advance payments are made under clause (1) or (2) to the health maintenance
199.5organization or community integrated service network for more than one reporting period,
199.6the portion of the payment that has not yet been earned must be treated as a liability.
199.7(c) When a health maintenance organization or community integrated service
199.8network merges or consolidates with or is acquired by another health maintenance
199.9organization or community integrated service network, the surviving corporation or the
199.10new corporation shall be responsible for the annual surcharge originally imposed on
199.11each of the entities or corporations subject to the merger, consolidation, or acquisition,
199.12regardless of whether one of the entities or corporations does not retain a certificate of
199.13authority under chapter 62D or a license under chapter 62N.
199.14(d) Effective July 1 June 15 of each year, the surviving corporation's or the new
199.15corporation's surcharge shall be based on the revenues earned in the second previous
199.16calendar year by all of the entities or corporations subject to the merger, consolidation,
199.17or acquisition regardless of whether one of the entities or corporations does not retain a
199.18certificate of authority under chapter 62D or a license under chapter 62N until the total
199.19premium revenues of the surviving corporation include the total premium revenues of all
199.20the merged entities as reported to the commissioner of health.
199.21(e) When a health maintenance organization or community integrated service
199.22network, which is subject to liability for the surcharge under this chapter, transfers,
199.23assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability
199.24for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer
199.25of the health maintenance organization or community integrated service network.
199.26(f) In the event a health maintenance organization or community integrated service
199.27network converts its licensure to a different type of entity subject to liability for the
199.28surcharge under this chapter, but survives in the same or substantially similar form, the
199.29surviving entity remains liable for the surcharge regardless of whether one of the entities
199.30or corporations does not retain a certificate of authority under chapter 62D or a license
199.31under chapter 62N.
199.32(g) The surcharge assessed to a health maintenance organization or community
199.33integrated service network ends when the entity ceases providing services for premiums
199.34and the cessation is not connected with a merger, consolidation, acquisition, or conversion.

199.35    Sec. 3. Minnesota Statutes 2012, section 256.9657, subdivision 4, is amended to read:
200.1    Subd. 4. Payments into the account. (a) Payments to the commissioner under
200.2subdivisions subdivision 1 to 3 must be paid in monthly installments due on the 15th of
200.3the month beginning October 15, 1992. The monthly payment must be equal to the annual
200.4surcharge divided by 12. Payments to the commissioner under subdivisions 2 and 3 for
200.5fiscal year 1993 must be based on calendar year 1990 revenues. Effective July 1 of each
200.6year, beginning in 1993, payments under subdivisions 2 and 3 must be based on revenues
200.7earned in the second previous calendar year.
200.8(b) Effective October 15, 2014, payment to the commissioner under subdivision 2
200.9must be paid in nine monthly installments due on the 15th of the month beginning October
200.1015, 2014, through June 15 of the following year. The monthly payment must be equal
200.11to the annual surcharge divided by nine.
200.12(b) (c) Effective October 1, 1995 2014, and each October 1 thereafter, the payments
200.13in subdivisions subdivision 2 and 3 must be based on revenues earned in the previous
200.14calendar year.
200.15(c) (d) If the commissioner of health does not provide by August 15 of any year data
200.16needed to update the base year for the hospital and or April 15 of any year data needed to
200.17update the base year for the health maintenance organization surcharges, the commissioner
200.18of human services may estimate base year revenue and use that estimate for the purposes
200.19of this section until actual data is provided by the commissioner of health.
200.20(d) (e) Payments to the commissioner under subdivision 3a must be paid in monthly
200.21installments due on the 15th of the month beginning July 15, 2003. The monthly payment
200.22must be equal to the annual surcharge divided by 12.
200.23(f) Payments due in July through September 2014 under subdivision 3 for revenue
200.24earned in calendar year 2012 shall be paid in a lump sum on June 15, 2014. On June
200.2515, 2014, each health maintenance organization and community-integrated service
200.26network shall pay all payments under subdivision 3 in a lump sum for revenue earned in
200.27calendar year 2013. Effective June 15, 2015, and each June 15 thereafter, the payments in
200.28subdivision 3 shall be based on revenues earned in the previous calendar year and paid
200.29in a lump sum on June 15 of each year.

200.30    Sec. 4. Minnesota Statutes 2012, section 256.969, subdivision 29, is amended to read:
200.31    Subd. 29. Reimbursement for the fee increase for the early hearing detection
200.32and intervention program. (a) For admissions occurring on or after July 1, 2010,
200.33payment rates shall be adjusted to include the increase to the fee that is effective on July 1,
200.342010, for the early hearing detection and intervention program recipients under section
200.35144.125, subdivision 1 , that is paid by the hospital for public program recipients. This
201.1payment increase shall be in effect until the increase is fully recognized in the base year
201.2cost under subdivision 2b. This payment shall be included in payments to contracted
201.3managed care organizations.
201.4    (b) For admissions occurring on or after July 1, 2013, payment rates shall be adjusted
201.5to include the increase to the fee that is effective July 1, 2013, for the early hearing
201.6detection and intervention program under section 144.125, subdivision 1, paragraph (d),
201.7that is paid by the hospital for medical assistance and MinnesotaCare program enrollees.
201.8This payment increase shall be in effect until the increase is fully recognized in the
201.9base-year cost under subdivision 2b. This payment shall be included in payments to
201.10managed care plans and county-based purchasing plans.

201.11    Sec. 5. Minnesota Statutes 2012, section 256B.04, is amended by adding a subdivision
201.12to read:
201.13    Subd. 22. Medical assistance costs for certain inmates. The commissioner shall
201.14execute an interagency agreement with the commissioner of corrections to recover the
201.15state cost attributable to medical assistance eligibility for inmates of public institutions
201.16admitted to a medical institution on an inpatient basis. The annual amount to be transferred
201.17from the Department of Corrections under the agreement must include all eligible state
201.18medical assistance costs, including administrative costs incurred by the Department of
201.19Human Services, attributable to inmates under state and county jurisdiction admitted to
201.20medical institutions on an inpatient basis that are related to the implementation of section
201.21256B.055, subdivision 14, paragraph (c).

201.22    Sec. 6. Minnesota Statutes 2012, section 256B.055, subdivision 14, is amended to read:
201.23    Subd. 14. Persons detained by law. (a) Medical assistance may be paid for an
201.24inmate of a correctional facility who is conditionally released as authorized under section
201.25241.26 , 244.065, or 631.425, if the individual does not require the security of a public
201.26detention facility and is housed in a halfway house or community correction center, or
201.27under house arrest and monitored by electronic surveillance in a residence approved
201.28by the commissioner of corrections, and if the individual meets the other eligibility
201.29requirements of this chapter.
201.30    (b) An individual who is enrolled in medical assistance, and who is charged with a
201.31crime and incarcerated for less than 12 months shall be suspended from eligibility at the
201.32time of incarceration until the individual is released. Upon release, medical assistance
201.33eligibility is reinstated without reapplication using a reinstatement process and form, if the
201.34individual is otherwise eligible.
202.1    (c) An individual, regardless of age, who is considered an inmate of a public
202.2institution as defined in Code of Federal Regulations, title 42, section 435.1010, and
202.3who meets the eligibility requirements in section 256B.056, is not eligible for medical
202.4assistance, except for covered services received while an inpatient in a medical institution
202.5as defined in Code of Federal Regulations, title 42, section 435.1010. Security issues,
202.6including costs, related to the inpatient treatment of an inmate are the responsibility of the
202.7entity with jurisdiction over the inmate.
202.8EFFECTIVE DATE.This section is effective January 1, 2014.

202.9    Sec. 7. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
202.10    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
202.11to citizens of the United States, qualified noncitizens as defined in this subdivision, and
202.12other persons residing lawfully in the United States. Citizens or nationals of the United
202.13States must cooperate in obtaining satisfactory documentary evidence of citizenship or
202.14nationality according to the requirements of the federal Deficit Reduction Act of 2005,
202.15Public Law 109-171.
202.16(b) "Qualified noncitizen" means a person who meets one of the following
202.17immigration criteria:
202.18(1) admitted for lawful permanent residence according to United States Code, title 8;
202.19(2) admitted to the United States as a refugee according to United States Code,
202.20title 8, section 1157;
202.21(3) granted asylum according to United States Code, title 8, section 1158;
202.22(4) granted withholding of deportation according to United States Code, title 8,
202.23section 1253(h);
202.24(5) paroled for a period of at least one year according to United States Code, title 8,
202.25section 1182(d)(5);
202.26(6) granted conditional entrant status according to United States Code, title 8,
202.27section 1153(a)(7);
202.28(7) determined to be a battered noncitizen by the United States Attorney General
202.29according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
202.30title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
202.31(8) is a child of a noncitizen determined to be a battered noncitizen by the United
202.32States Attorney General according to the Illegal Immigration Reform and Immigrant
202.33Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
202.34Public Law 104-200; or
203.1(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
203.2Law 96-422, the Refugee Education Assistance Act of 1980.
203.3(c) All qualified noncitizens who were residing in the United States before August
203.422, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
203.5medical assistance with federal financial participation.
203.6(d) Beginning December 1, 1996, qualified noncitizens who entered the United
203.7States on or after August 22, 1996, and who otherwise meet the eligibility requirements
203.8of this chapter are eligible for medical assistance with federal participation for five years
203.9if they meet one of the following criteria:
203.10(1) refugees admitted to the United States according to United States Code, title 8,
203.11section 1157;
203.12(2) persons granted asylum according to United States Code, title 8, section 1158;
203.13(3) persons granted withholding of deportation according to United States Code,
203.14title 8, section 1253(h);
203.15(4) veterans of the United States armed forces with an honorable discharge for
203.16a reason other than noncitizen status, their spouses and unmarried minor dependent
203.17children; or
203.18(5) persons on active duty in the United States armed forces, other than for training,
203.19their spouses and unmarried minor dependent children.
203.20 Beginning July 1, 2010, children and pregnant women who are noncitizens
203.21described in paragraph (b) or who are lawfully present in the United States as defined
203.22in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
203.23eligibility requirements of this chapter, are eligible for medical assistance with federal
203.24financial participation as provided by the federal Children's Health Insurance Program
203.25Reauthorization Act of 2009, Public Law 111-3.
203.26(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
203.27are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
203.28subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
203.29Code, title 8, section 1101(a)(15).
203.30(f) Payment shall also be made for care and services that are furnished to noncitizens,
203.31regardless of immigration status, who otherwise meet the eligibility requirements of
203.32this chapter, if such care and services are necessary for the treatment of an emergency
203.33medical condition.
203.34(g) For purposes of this subdivision, the term "emergency medical condition" means
203.35a medical condition that meets the requirements of United States Code, title 42, section
203.361396b(v).
204.1(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
204.2of an emergency medical condition are limited to the following:
204.3(i) services delivered in an emergency room or by an ambulance service licensed
204.4under chapter 144E that are directly related to the treatment of an emergency medical
204.5condition;
204.6(ii) services delivered in an inpatient hospital setting following admission from an
204.7emergency room or clinic for an acute emergency condition; and
204.8(iii) follow-up services that are directly related to the original service provided
204.9to treat the emergency medical condition and are covered by the global payment made
204.10to the provider.
204.11    (2) Services for the treatment of emergency medical conditions do not include:
204.12(i) services delivered in an emergency room or inpatient setting to treat a
204.13nonemergency condition;
204.14(ii) organ transplants, stem cell transplants, and related care;
204.15(iii) services for routine prenatal care;
204.16(iv) continuing care, including long-term care, nursing facility services, home health
204.17care, adult day care, day training, or supportive living services;
204.18(v) elective surgery;
204.19(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
204.20part of an emergency room visit;
204.21(vii) preventative health care and family planning services;
204.22(viii) dialysis;
204.23(ix) chemotherapy or therapeutic radiation services;
204.24(x) (viii) rehabilitation services;
204.25(xi) (ix) physical, occupational, or speech therapy;
204.26(xii) (x) transportation services;
204.27(xiii) (xi) case management;
204.28(xiv) (xii) prosthetics, orthotics, durable medical equipment, or medical supplies;
204.29(xv) (xiii) dental services;
204.30(xvi) (xiv) hospice care;
204.31(xvii) (xv) audiology services and hearing aids;
204.32(xviii) (xvi) podiatry services;
204.33(xix) (xvii) chiropractic services;
204.34(xx) (xviii) immunizations;
204.35(xxi) (xix) vision services and eyeglasses;
204.36(xxii) (xx) waiver services;
205.1(xxiii) (xxi) individualized education programs; or
205.2(xxiv) (xxii) chemical dependency treatment.
205.3(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
205.4nonimmigrants, or lawfully present in the United States as defined in Code of Federal
205.5Regulations, title 8, section 103.12, are not covered by a group health plan or health
205.6insurance coverage according to Code of Federal Regulations, title 42, section 457.310,
205.7and who otherwise meet the eligibility requirements of this chapter, are eligible for
205.8medical assistance through the period of pregnancy, including labor and delivery, and 60
205.9days postpartum, to the extent federal funds are available under title XXI of the Social
205.10Security Act, and the state children's health insurance program.
205.11(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
205.12services from a nonprofit center established to serve victims of torture and are otherwise
205.13ineligible for medical assistance under this chapter are eligible for medical assistance
205.14without federal financial participation. These individuals are eligible only for the period
205.15during which they are receiving services from the center. Individuals eligible under this
205.16paragraph shall not be required to participate in prepaid medical assistance.
205.17(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
205.18emergency medical conditions under paragraph (f) except where coverage is prohibited
205.19under federal law:
205.20(1) dialysis services provided in a hospital or freestanding dialysis facility; and
205.21(2) surgery and the administration of chemotherapy, radiation, and related services
205.22necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission
205.23and requires surgery, chemotherapy, or radiation treatment.
205.24(l) Effective July 1, 2013, recipients of emergency medical assistance under this
205.25subdivision are eligible for coverage of the elderly waiver services provided under section
205.26256B.0915, and coverage of rehabilitative services provided in a nursing facility. The
205.27age limit for elderly waiver services does not apply. In order to qualify for coverage, a
205.28recipient of emergency medical assistance is subject to the assessment and reassessment
205.29requirements of section 256B.0911. Initial and continued enrollment under this paragraph
205.30is subject to the limits of available funding.
205.31EFFECTIVE DATE.This section is effective July 1, 2013.

205.32    Sec. 8. Minnesota Statutes 2012, section 256B.0625, subdivision 9, is amended to read:
205.33    Subd. 9. Dental services. (a) Medical assistance covers dental services.
205.34(b) Medical assistance dental coverage for nonpregnant adults is limited to the
205.35following services:
206.1(1) comprehensive exams, limited to once every five years;
206.2(2) periodic exams, limited to one per year;
206.3(3) limited exams;
206.4(4) bitewing x-rays, limited to one per year;
206.5(5) periapical x-rays;
206.6(6) panoramic x-rays, limited to one every five years except (1) when medically
206.7necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
206.8or (2) once every two years for patients who cannot cooperate for intraoral film due to
206.9a developmental disability or medical condition that does not allow for intraoral film
206.10placement;
206.11(7) prophylaxis, limited to one per year;
206.12(8) application of fluoride varnish, limited to one per year;
206.13(9) posterior fillings, all at the amalgam rate;
206.14(10) anterior fillings;
206.15(11) endodontics, limited to root canals on the anterior and premolars only;
206.16(12) removable prostheses, each dental arch limited to one every six years;
206.17(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
206.18abscesses;
206.19(14) palliative treatment and sedative fillings for relief of pain; and
206.20(15) full-mouth debridement, limited to one every five years.
206.21(c) In addition to the services specified in paragraph (b), medical assistance
206.22covers the following services for adults, if provided in an outpatient hospital setting or
206.23freestanding ambulatory surgical center as part of outpatient dental surgery:
206.24(1) periodontics, limited to periodontal scaling and root planing once every two years;
206.25(2) general anesthesia; and
206.26(3) full-mouth survey once every five years.
206.27(d) Medical assistance covers medically necessary dental services for children and
206.28pregnant women. The following guidelines apply:
206.29(1) posterior fillings are paid at the amalgam rate;
206.30(2) application of sealants are covered once every five years per permanent molar for
206.31children only;
206.32(3) application of fluoride varnish is covered once every six months; and
206.33(4) orthodontia is eligible for coverage for children only.
206.34(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
206.35covers the following services for adults:
206.36(1) house calls or extended care facility calls for on-site delivery of covered services;
207.1(2) behavioral management when additional staff time is required to accommodate
207.2behavioral challenges and sedation is not used;
207.3(3) oral or IV sedation, if the covered dental service cannot be performed safely
207.4without it or would otherwise require the service to be performed under general anesthesia
207.5in a hospital or surgical center; and
207.6(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
207.7no more than four times per year.

207.8    Sec. 9. Minnesota Statutes 2012, section 256B.0625, subdivision 13, is amended to read:
207.9    Subd. 13. Drugs. (a) Medical assistance covers drugs, except for fertility drugs
207.10when specifically used to enhance fertility, if prescribed by a licensed practitioner and
207.11dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance
207.12program as a dispensing physician, or by a physician, physician assistant, or a nurse
207.13practitioner employed by or under contract with a community health board as defined in
207.14section 145A.02, subdivision 5, for the purposes of communicable disease control.
207.15(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
207.16unless authorized by the commissioner.
207.17(c) For the purpose of this subdivision and subdivision 13d, an "active
207.18pharmaceutical ingredient" is defined as a substance that is represented for use in a drug
207.19and when used in the manufacturing, processing, or packaging of a drug becomes an
207.20active ingredient of the drug product. An "excipient" is defined as an inert substance
207.21used as a diluent or vehicle for a drug. The commissioner shall establish a list of active
207.22pharmaceutical ingredients and excipients which are included in the medical assistance
207.23formulary. Medical assistance covers selected active pharmaceutical ingredients and
207.24excipients used in compounded prescriptions when the compounded combination is
207.25specifically approved by the commissioner or when a commercially available product:
207.26(1) is not a therapeutic option for the patient;
207.27(2) does not exist in the same combination of active ingredients in the same strengths
207.28as the compounded prescription; and
207.29(3) cannot be used in place of the active pharmaceutical ingredient in the
207.30compounded prescription.
207.31(d) Medical assistance covers the following over-the-counter drugs when prescribed
207.32by a licensed practitioner or by a licensed pharmacist who meets standards established by
207.33the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen,
207.34family planning products, aspirin, insulin, products for the treatment of lice, vitamins for
207.35adults with documented vitamin deficiencies, vitamins for children under the age of seven
208.1and pregnant or nursing women, and any other over-the-counter drug identified by the
208.2commissioner, in consultation with the formulary committee, as necessary, appropriate,
208.3and cost-effective for the treatment of certain specified chronic diseases, conditions,
208.4or disorders, and this determination shall not be subject to the requirements of chapter
208.514. A pharmacist may prescribe over-the-counter medications as provided under this
208.6paragraph for purposes of receiving reimbursement under Medicaid. When prescribing
208.7over-the-counter drugs under this paragraph, licensed pharmacists must consult with
208.8the recipient to determine necessity, provide drug counseling, review drug therapy
208.9for potential adverse interactions, and make referrals as needed to other health care
208.10professionals. Over-the-counter medications must be dispensed in a quantity that is the
208.11lower of: (1) the number of dosage units contained in the manufacturer's original package;
208.12and (2) the number of dosage units required to complete the patient's course of therapy.
208.13(e) Effective January 1, 2006, medical assistance shall not cover drugs that
208.14are coverable under Medicare Part D as defined in the Medicare Prescription Drug,
208.15Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e),
208.16for individuals eligible for drug coverage as defined in the Medicare Prescription
208.17Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section
208.181860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the
208.19drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this
208.20subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code,
208.21title 42, section 1396r-8(d)(2)(E), shall not be covered.
208.22(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
208.23Program and dispensed by 340B covered entities and ambulatory pharmacies under
208.24common ownership of the 340B covered entity. Medical assistance does not cover drugs
208.25acquired through the federal 340B Drug Pricing Program and dispensed by 340B contract
208.26pharmacies.

208.27    Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 13e, is amended to
208.28read:
208.29    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment
208.30shall be the lower of the actual acquisition costs of the drugs or the maximum allowable
208.31cost by the commissioner plus the fixed dispensing fee; or the usual and customary price
208.32charged to the public. The amount of payment basis must be reduced to reflect all discount
208.33amounts applied to the charge by any provider/insurer agreement or contract for submitted
208.34charges to medical assistance programs. The net submitted charge may not be greater
208.35than the patient liability for the service. The pharmacy dispensing fee shall be $3.65,
209.1except that the dispensing fee for intravenous solutions which must be compounded by
209.2the pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and
209.3$30 per bag for total parenteral nutritional products dispensed in one liter quantities,
209.4or $44 per bag for total parenteral nutritional products dispensed in quantities greater
209.5than one liter. Actual acquisition cost includes quantity and other special discounts
209.6except time and cash discounts. The actual acquisition cost of a drug shall be estimated
209.7by the commissioner at wholesale acquisition cost plus four percent for independently
209.8owned pharmacies located in a designated rural area within Minnesota, and at wholesale
209.9acquisition cost plus two percent for all other pharmacies. A pharmacy is "independently
209.10owned" if it is one of four or fewer pharmacies under the same ownership nationally. A
209.11"designated rural area" means an area defined as a small rural area or isolated rural area
209.12according to the four-category classification of the Rural Urban Commuting Area system
209.13developed for the United States Health Resources and Services Administration. Effective
209.14January 1, 2014, the actual acquisition cost of a drug acquired through the federal 340B
209.15Drug Pricing Program shall be estimated by the commissioner at wholesale acquisition
209.16cost minus 40 percent. Wholesale acquisition cost is defined as the manufacturer's list
209.17price for a drug or biological to wholesalers or direct purchasers in the United States, not
209.18including prompt pay or other discounts, rebates, or reductions in price, for the most
209.19recent month for which information is available, as reported in wholesale price guides or
209.20other publications of drug or biological pricing data. The maximum allowable cost of a
209.21multisource drug may be set by the commissioner and it shall be comparable to, but no
209.22higher than, the maximum amount paid by other third-party payors in this state who have
209.23maximum allowable cost programs. Establishment of the amount of payment for drugs
209.24shall not be subject to the requirements of the Administrative Procedure Act.
209.25    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
209.26to pharmacists for legend drug prescriptions dispensed to residents of long-term care
209.27facilities when a unit dose blister card system, approved by the department, is used. Under
209.28this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. The
209.29National Drug Code (NDC) from the drug container used to fill the blister card must be
209.30identified on the claim to the department. The unit dose blister card containing the drug
209.31must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, that
209.32govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider will
209.33be required to credit the department for the actual acquisition cost of all unused drugs that
209.34are eligible for reuse. The commissioner may permit the drug clozapine to be dispensed in
209.35a quantity that is less than a 30-day supply.
210.1    (c) Whenever a maximum allowable cost has been set for a multisource drug,
210.2payment shall be the lower of the usual and customary price charged to the public or the
210.3maximum allowable cost established by the commissioner unless prior authorization
210.4for the brand name product has been granted according to the criteria established by
210.5the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the
210.6prescriber has indicated "dispense as written" on the prescription in a manner consistent
210.7with section 151.21, subdivision 2.
210.8    (d) The basis for determining the amount of payment for drugs administered in an
210.9outpatient setting shall be the lower of the usual and customary cost submitted by the
210.10provider or, 106 percent of the average sales price as determined by the United States
210.11Department of Health and Human Services pursuant to title XVIII, section 1847a of the
210.12federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
210.13set by the commissioner. If average sales price is unavailable, the amount of payment
210.14must be lower of the usual and customary cost submitted by the provider or, the wholesale
210.15acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the
210.16commissioner. Effective January 1, 2014, the commissioner shall discount the payment
210.17rate for drugs obtained through the federal 340B Drug Pricing Program by 20 percent. The
210.18payment for drugs administered in an outpatient setting shall be made to the administering
210.19facility or practitioner. A retail or specialty pharmacy dispensing a drug for administration
210.20in an outpatient setting is not eligible for direct reimbursement.
210.21    (e) The commissioner may negotiate lower reimbursement rates for specialty
210.22pharmacy products than the rates specified in paragraph (a). The commissioner may
210.23require individuals enrolled in the health care programs administered by the department
210.24to obtain specialty pharmacy products from providers with whom the commissioner has
210.25negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
210.26used by a small number of recipients or recipients with complex and chronic diseases
210.27that require expensive and challenging drug regimens. Examples of these conditions
210.28include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
210.29C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
210.30of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
210.31biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies
210.32that require complex care. The commissioner shall consult with the formulary committee
210.33to develop a list of specialty pharmacy products subject to this paragraph. In consulting
210.34with the formulary committee in developing this list, the commissioner shall take into
210.35consideration the population served by specialty pharmacy products, the current delivery
211.1system and standard of care in the state, and access to care issues. The commissioner shall
211.2have the discretion to adjust the reimbursement rate to prevent access to care issues.
211.3(f) Home infusion therapy services provided by home infusion therapy pharmacies
211.4must be paid at rates according to subdivision 8d.
211.5EFFECTIVE DATE.This section is effective July 1, 2013.

211.6    Sec. 11. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
211.7subdivision to read:
211.8    Subd. 28b. Doula services. Medical assistance covers doula services provided by a
211.9certified doula as defined in section 148.995, subdivision 2, of the mother's choice. For
211.10purposes of this section, "doula services" means childbirth education and support services,
211.11including emotional and physical support provided during pregnancy, labor, birth, and
211.12postpartum.
211.13EFFECTIVE DATE.This section is effective July 1, 2014, or upon federal
211.14approval, whichever is later, and applies to services provided on or after the effective date.

211.15    Sec. 12. Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to
211.16read:
211.17    Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical
211.18supplies and equipment. Separate payment outside of the facility's payment rate shall
211.19be made for wheelchairs and wheelchair accessories for recipients who are residents
211.20of intermediate care facilities for the developmentally disabled. Reimbursement for
211.21wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
211.22conditions and limitations as coverage for recipients who do not reside in institutions. A
211.23wheelchair purchased outside of the facility's payment rate is the property of the recipient.
211.24The commissioner may set reimbursement rates for specified categories of medical
211.25supplies at levels below the Medicare payment rate.
211.26(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
211.27must enroll as a Medicare provider.
211.28(c) When necessary to ensure access to durable medical equipment, prosthetics,
211.29orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
211.30enrollment requirement if:
211.31(1) the vendor supplies only one type of durable medical equipment, prosthetic,
211.32orthotic, or medical supply;
211.33(2) the vendor serves ten or fewer medical assistance recipients per year;
212.1(3) the commissioner finds that other vendors are not available to provide same or
212.2similar durable medical equipment, prosthetics, orthotics, or medical supplies; and
212.3(4) the vendor complies with all screening requirements in this chapter and Code of
212.4Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
212.5the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
212.6and Medicaid Services approved national accreditation organization as complying with
212.7the Medicare program's supplier and quality standards and the vendor serves primarily
212.8pediatric patients.
212.9(d) Durable medical equipment means a device or equipment that:
212.10(1) can withstand repeated use;
212.11(2) is generally not useful in the absence of an illness, injury, or disability; and
212.12(3) is provided to correct or accommodate a physiological disorder or physical
212.13condition or is generally used primarily for a medical purpose.
212.14(e) Electronic tablets may be considered durable medical equipment if the electronic
212.15tablet will be used as an augmentative and alternative communication system as defined
212.16under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
212.17must be locked in order to prevent use not related to communication.

212.18    Sec. 13. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
212.19subdivision to read:
212.20    Subd. 31b. Preferred diabetic testing supply program. (a) The commissioner
212.21shall implement a point-of-sale preferred diabetic testing supply program by January 1,
212.222014. Medical assistance coverage for diabetic testing supplies shall conform to the
212.23limitations established under the program. The commissioner may enter into a contract
212.24with a vendor for the purpose of participating in a preferred diabetic testing supply list and
212.25supplemental rebate program. The commissioner shall ensure that any contract meets all
212.26federal requirements and maximizes federal financial participation. The commissioner
212.27shall maintain an accurate and up-to-date list on the department's Web site.
212.28(b) The commissioner may add to, delete from, and otherwise modify the preferred
212.29diabetic testing supply program drug list after consulting with the Drug Formulary
212.30Committee and appropriate medical specialists and providing public notice and the
212.31opportunity for public comment.
212.32(c) The commissioner shall adopt and administer the preferred diabetic testing
212.33supply program as part of the administration of the diabetic testing supply rebate program.
212.34Reimbursement for diabetic testing supplies not on the preferred diabetic testing supply
212.35list may be subject to prior authorization.
213.1(d) All claims for diabetic testing supplies in categories on the preferred diabetic
213.2testing supply list must be submitted by enrolled pharmacy providers using the most
213.3current National Council of Prescription Drug Plans electronic claims standard.
213.4(e) For purposes of this subdivision, "preferred diabetic testing supply list" means a
213.5list of diabetic testing supplies selected by the commissioner, for which prior authorization
213.6is not required.
213.7(f) The commissioner shall seek any federal waivers or approvals necessary to
213.8implement this subdivision.

213.9    Sec. 14. Minnesota Statutes 2012, section 256B.0625, subdivision 39, is amended to
213.10read:
213.11    Subd. 39. Childhood immunizations. Providers who administer pediatric vaccines
213.12within the scope of their licensure, and who are enrolled as a medical assistance provider,
213.13must enroll in the pediatric vaccine administration program established by section 13631
213.14of the Omnibus Budget Reconciliation Act of 1993. Medical assistance shall pay an
213.15$8.50 fee per dose for administration of the vaccine to children eligible for medical
213.16assistance. Medical assistance does not pay for vaccines that are available at no cost from
213.17the pediatric vaccine administration program.

213.18    Sec. 15. Minnesota Statutes 2012, section 256B.0625, subdivision 58, is amended to
213.19read:
213.20    Subd. 58. Early and periodic screening, diagnosis, and treatment services.
213.21Medical assistance covers early and periodic screening, diagnosis, and treatment services
213.22(EPSDT). The payment amount for a complete EPSDT screening shall not include charges
213.23for vaccines that are available at no cost to the provider and shall not exceed the rate
213.24established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.

213.25    Sec. 16. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
213.26subdivision to read:
213.27    Subd. 61. Payment for multiple services provided on the same day. The
213.28commissioner shall not prohibit payment, including supplemental payments, for mental
213.29health services or dental services provided to a patient by a clinic or health care
213.30professional solely because the mental health or dental services were provided on the same
213.31day as other covered health services furnished by the same provider.

213.32    Sec. 17. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to read:
214.1    Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
214.2assistance benefit plan shall include the following cost-sharing for all recipients, effective
214.3for services provided on or after September 1, 2011:
214.4    (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
214.5of this subdivision, a visit means an episode of service which is required because of
214.6a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
214.7ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
214.8midwife, advanced practice nurse, audiologist, optician, or optometrist;
214.9    (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
214.10this co-payment shall be increased to $20 upon federal approval;
214.11    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
214.12subject to a $12 per month maximum for prescription drug co-payments. No co-payments
214.13shall apply to antipsychotic drugs when used for the treatment of mental illness;
214.14(4) effective January 1, 2012, a family deductible equal to the maximum amount
214.15allowed under Code of Federal Regulations, title 42, part 447.54; and
214.16    (5) for individuals identified by the commissioner with income at or below 100
214.17percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
214.18percent of family income. For purposes of this paragraph, family income is the total
214.19earned and unearned income of the individual and the individual's spouse, if the spouse is
214.20enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
214.21    (b) Recipients of medical assistance are responsible for all co-payments and
214.22deductibles in this subdivision.
214.23(c) Notwithstanding paragraph (b), the commissioner, through the contracting
214.24process under sections 256B.69 and 256B.692, may allow managed care plans and
214.25county-based purchasing plans to waive the family deductible under paragraph (a),
214.26clause (4). The value of the family deductible shall not be included in the capitation
214.27payment to managed care plans and county-based purchasing plans. Managed care plans
214.28and county-based purchasing plans shall certify annually to the commissioner the dollar
214.29value of the family deductible.
214.30(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
214.31the family deductible described under paragraph (a), clause (4), from individuals and
214.32allow long-term care and waivered service providers to assume responsibility for payment.
214.33(e) Notwithstanding paragraph (b), the commissioner, through the contracting
214.34process under section 256B.0756 shall allow the pilot program in Hennepin County to
214.35waive co-payments. The value of the co-payments shall not be included in the capitation
214.36payment amount to the integrated health care delivery networks under the pilot program.

215.1    Sec. 18. Minnesota Statutes 2012, section 256B.0756, is amended to read:
215.2256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
215.3(a) The commissioner, upon federal approval of a new waiver request or amendment
215.4of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey
215.5County, or both, to test alternative and innovative integrated health care delivery networks.
215.6(b) Individuals eligible for the pilot program shall be individuals who are eligible for
215.7medical assistance under section 256B.055, subdivision 15, and who reside in Hennepin
215.8County or Ramsey County. The commissioner may identify individuals to be enrolled in
215.9the Hennepin County pilot program based on zip code in Hennepin County or whether the
215.10individuals would benefit from an integrated health care delivery network.
215.11(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
215.12health care delivery network in their county of residence. The integrated health care
215.13delivery network in Hennepin County shall be a network, such as an accountable care
215.14organization or a community-based collaborative care network, created by or including
215.15Hennepin County Medical Center. The integrated health care delivery network in Ramsey
215.16County shall be a network, such as an accountable care organization or community-based
215.17collaborative care network, created by or including Regions Hospital.
215.18(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for
215.19Hennepin County and 3,500 enrollees for Ramsey County.
215.20(e) (d) In developing a payment system for the pilot programs, the commissioner
215.21shall establish a total cost of care for the recipients enrolled in the pilot programs that
215.22equals the cost of care that would otherwise be spent for these enrollees in the prepaid
215.23medical assistance program.
215.24(f) Counties may transfer funds necessary to support the nonfederal share of
215.25payments for integrated health care delivery networks in their county. Such transfers per
215.26county shall not exceed 15 percent of the expected expenses for county enrollees.
215.27(g) (e) The commissioner shall apply to the federal government for, or as appropriate,
215.28cooperate with counties, providers, or other entities that are applying for any applicable
215.29grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
215.30Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
215.31111-152, that would further the purposes of or assist in the creation of an integrated health
215.32care delivery network for the purposes of this subdivision, including, but not limited to, a
215.33global payment demonstration or the community-based collaborative care network grants.

215.34    Sec. 19. Minnesota Statutes 2012, section 256B.196, subdivision 2, is amended to read:
216.1    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and
216.2subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
216.3services upper payment limit for nonstate government hospitals. The commissioner shall
216.4then determine the amount of a supplemental payment to Hennepin County Medical
216.5Center and Regions Hospital for these services that would increase medical assistance
216.6spending in this category to the aggregate upper payment limit for all nonstate government
216.7hospitals in Minnesota. In making this determination, the commissioner shall allot the
216.8available increases between Hennepin County Medical Center and Regions Hospital
216.9based on the ratio of medical assistance fee-for-service outpatient hospital payments to
216.10the two facilities. The commissioner shall adjust this allotment as necessary based on
216.11federal approvals, the amount of intergovernmental transfers received from Hennepin and
216.12Ramsey Counties, and other factors, in order to maximize the additional total payments.
216.13The commissioner shall inform Hennepin County and Ramsey County of the periodic
216.14intergovernmental transfers necessary to match federal Medicaid payments available
216.15under this subdivision in order to make supplementary medical assistance payments to
216.16Hennepin County Medical Center and Regions Hospital equal to an amount that when
216.17combined with existing medical assistance payments to nonstate governmental hospitals
216.18would increase total payments to hospitals in this category for outpatient services to
216.19the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
216.20receipt of these periodic transfers, the commissioner shall make supplementary payments
216.21to Hennepin County Medical Center and Regions Hospital.
216.22    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall
216.23determine an upper payment limit for physicians and other billing professionals affiliated
216.24with Hennepin County Medical Center and with Regions Hospital. The upper payment
216.25limit shall be based on the average commercial rate or be determined using another method
216.26acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
216.27inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
216.28necessary to match the federal Medicaid payments available under this subdivision in order
216.29to make supplementary payments to physicians and other billing professionals affiliated
216.30with Hennepin County Medical Center and to make supplementary payments to physicians
216.31and other billing professionals affiliated with Regions Hospital through HealthPartners
216.32Medical Group equal to the difference between the established medical assistance
216.33payment for physician and other billing professional services and the upper payment limit.
216.34Upon receipt of these periodic transfers, the commissioner shall make supplementary
216.35payments to physicians and other billing professionals affiliated with Hennepin County
217.1Medical Center and shall make supplementary payments to physicians and other billing
217.2professionals affiliated with Regions Hospital through HealthPartners Medical Group.
217.3    (c) Beginning January 1, 2010, Hennepin County and Ramsey County may make
217.4monthly voluntary intergovernmental transfers to the commissioner in amounts not to
217.5exceed $12,000,000 per year from Hennepin County and $6,000,000 per year from
217.6Ramsey County. The commissioner shall increase the medical assistance capitation
217.7payments to any licensed health plan under contract with the medical assistance program
217.8that agrees to make enhanced payments to Hennepin County Medical Center or Regions
217.9Hospital. The increase shall be in an amount equal to the annual value of the monthly
217.10transfers plus federal financial participation, with each health plan receiving its pro rata
217.11share of the increase based on the pro rata share of medical assistance admissions to
217.12Hennepin County Medical Center and Regions Hospital by those plans. Upon the request
217.13of the commissioner, health plans shall submit individual-level cost data for verification
217.14purposes. The commissioner may ratably reduce these payments on a pro rata basis in
217.15order to satisfy federal requirements for actuarial soundness. If payments are reduced,
217.16transfers shall be reduced accordingly. Any licensed health plan that receives increased
217.17medical assistance capitation payments under the intergovernmental transfer described in
217.18this paragraph shall increase its medical assistance payments to Hennepin County Medical
217.19Center and Regions Hospital by the same amount as the increased payments received in
217.20the capitation payment described in this paragraph.
217.21    (d) For the purposes of this subdivision and subdivision 3, the commissioner shall
217.22determine an upper payment limit for ambulance services affiliated with Hennepin County
217.23Medical Center and the city of St. Paul. The upper payment limit shall be based on
217.24the average commercial rate or be determined using another method acceptable to the
217.25Centers for Medicare and Medicaid Services. The commissioner shall inform Hennepin
217.26County and the city of St. Paul of the periodic intergovernmental transfers necessary to
217.27match the federal Medicaid payments available under this subdivision in order to make
217.28supplementary payments to Hennepin County Medical Center and the city of St. Paul
217.29equal to the difference between the established medical assistance payment for ambulance
217.30services and the upper payment limit. Upon receipt of these periodic transfers, the
217.31commissioner shall make supplementary payments to Hennepin County Medical Center
217.32and the city of St. Paul.
217.33    (e) The commissioner shall inform the transferring governmental entities on an
217.34ongoing basis of the need for any changes needed in the intergovernmental transfers in
217.35order to continue the payments under paragraphs (a) to (c) (d), at their maximum level,
218.1including increases in upper payment limits, changes in the federal Medicaid match, and
218.2other factors.
218.3    (e) (f) The payments in paragraphs (a) to (c) (d) shall be implemented independently
218.4of each other, subject to federal approval and to the receipt of transfers under subdivision 3.

218.5    Sec. 20. Minnesota Statutes 2012, section 256B.69, subdivision 5c, is amended to read:
218.6    Subd. 5c. Medical education and research fund. (a) The commissioner of human
218.7services shall transfer each year to the medical education and research fund established
218.8under section 62J.692, an amount specified in this subdivision. The commissioner shall
218.9calculate the following:
218.10(1) an amount equal to the reduction in the prepaid medical assistance payments as
218.11specified in this clause. Until January 1, 2002, the county medical assistance capitation
218.12base rate prior to plan specific adjustments and after the regional rate adjustments under
218.13subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
218.14metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
218.15January 1, 2002, the county medical assistance capitation base rate prior to plan specific
218.16adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
218.17metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
218.18facility and elderly waiver payments and demonstration project payments operating
218.19under subdivision 23 are excluded from this reduction. The amount calculated under
218.20this clause shall not be adjusted for periods already paid due to subsequent changes to
218.21the capitation payments;
218.22(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
218.23section;
218.24(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
218.25paid under this section; and
218.26(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
218.27under this section.
218.28(b) This subdivision shall be effective upon approval of a federal waiver which
218.29allows federal financial participation in the medical education and research fund. The
218.30amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount
218.31transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under
218.32paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally
218.33reduce the amount specified under paragraph (a), clause (1).
218.34(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
218.35shall transfer $21,714,000 each fiscal year to the medical education and research fund.
219.1(d) Beginning September 1, 2011, of the amount in paragraph (a), following the
219.2transfer under paragraph (c), the commissioner shall transfer to the medical education
219.3research fund $23,936,000 in fiscal years 2012 and 2013 and $36,744,000 $49,552,000 in
219.4fiscal year 2014 and thereafter.

219.5    Sec. 21. Minnesota Statutes 2012, section 256B.69, subdivision 5i, is amended to read:
219.6    Subd. 5i. Administrative expenses. (a) Managed care plan and county-based
219.7purchasing plan administrative costs for a prepaid health plan provided under this section
219.8or section 256B.692 must not exceed by more than five percent that prepaid health plan's
219.9or county-based purchasing plan's actual calculated administrative spending for the
219.10previous calendar year as a percentage of total revenue. The penalty for exceeding this
219.11limit must be the amount of administrative spending in excess of 105 percent of the actual
219.12calculated amount. The commissioner may waive this penalty if the excess administrative
219.13spending is the result of unexpected shifts in enrollment or member needs or new program
219.14requirements.
219.15    (b) Expenses listed under section 62D.12, subdivision 9a, clause (4), are not
219.16allowable administrative expenses for rate-setting purposes under this section, unless
219.17approved by the commissioner. The following expenses are not allowable administrative
219.18expenses for rate-setting purposes under this section:
219.19    (1) charitable contributions made by the managed care plan or the county-based
219.20purchasing plan;
219.21    (2) any portion of an individual's compensation in excess of $200,000 paid by the
219.22managed care plan or county-based purchasing plan;
219.23    (3) any penalties or fines assessed against the managed care plan or county-based
219.24purchasing plan; and
219.25    (4) any indirect marketing or advertising expenses of the managed care plan or
219.26county-based purchasing plan.
219.27For the purposes of this subdivision, compensation includes salaries, bonuses and
219.28incentives, other reportable compensation on an IRS 990 form, retirement and other
219.29deferred compensation, and nontaxable benefits.

219.30    Sec. 22. Minnesota Statutes 2012, section 256B.69, subdivision 9c, is amended to read:
219.31    Subd. 9c. Managed care financial reporting. (a) The commissioner shall collect
219.32detailed data regarding financials, provider payments, provider rate methodologies, and
219.33other data as determined by the commissioner and managed care and county-based
219.34purchasing plans that are required to be submitted under this section. The commissioner,
220.1in consultation with the commissioners of health and commerce, and in consultation
220.2with managed care plans and county-based purchasing plans, shall set uniform criteria,
220.3definitions, and standards for the data to be submitted, and shall require managed care and
220.4county-based purchasing plans to comply with these criteria, definitions, and standards
220.5when submitting data under this section. In carrying out the responsibilities of this
220.6subdivision, the commissioner shall ensure that the data collection is implemented in an
220.7integrated and coordinated manner that avoids unnecessary duplication of effort. To the
220.8extent possible, the commissioner shall use existing data sources and streamline data
220.9collection in order to reduce public and private sector administrative costs. Nothing in
220.10this subdivision shall allow release of information that is nonpublic data pursuant to
220.11section 13.02.
220.12(b) Effective January 1, 2014, each managed care and county-based purchasing plan
220.13must annually quarterly provide to the commissioner the following information on state
220.14public programs, in the form and manner specified by the commissioner, according to
220.15guidelines developed by the commissioner in consultation with managed care plans and
220.16county-based purchasing plans under contract:
220.17(1) an income statement by program;
220.18(2) financial statement footnotes;
220.19(3) quarterly profitability by program and population group;
220.20(4) a medical liability summary by program and population group;
220.21(5) received but unpaid claims report by program;
220.22(6) services versus payment lags by program for hospital services, outpatient
220.23services, physician services, other medical services, and pharmaceutical benefits;
220.24(7) utilization reports that summarize utilization and unit cost information by
220.25program for hospitalization services, outpatient services, physician services, and other
220.26medical services;
220.27(8) pharmaceutical statistics by program and population group for measures of price
220.28and utilization of pharmaceutical services;
220.29(9) subcapitation expenses by population group;
220.30(10) third-party payments by program;
220.31(11) all new, active, and closed subrogation cases by program;
220.32(12) all new, active, and closed fraud and abuse cases by program;
220.33(13) medical loss ratios by program;
220.34(1) (14) administrative expenses by category and subcategory consistent with
220.35administrative expense reporting by program that reconcile to other state and federal
220.36regulatory agencies, by program;
221.1(2) (15) revenues by program, including investment income;
221.2(3) (16) nonadministrative service payments, provider payments, and reimbursement
221.3rates by provider type or service category, by program, paid by the managed care plan
221.4under this section or the county-based purchasing plan under section 256B.692 to
221.5providers and vendors for administrative services under contract with the plan, including
221.6but not limited to:
221.7(i) individual-level provider payment and reimbursement rate data;
221.8(ii) provider reimbursement rate methodologies by provider type, by program,
221.9including a description of alternative payment arrangements and payments outside the
221.10claims process;
221.11(iii) data on implementation of legislatively mandated provider rate changes; and
221.12(iv) individual-level provider payment and reimbursement rate data and plan-specific
221.13provider reimbursement rate methodologies by provider type, by program, including
221.14alternative payment arrangements and payments outside the claims process, provided to
221.15the commissioner under this subdivision are nonpublic data as defined in section 13.02;
221.16(4) (17) data on the amount of reinsurance or transfer of risk by program; and
221.17(5) (18) contribution to reserve, by program.
221.18(c) In the event a report is published or released based on data provided under
221.19this subdivision, the commissioner shall provide the report to managed care plans and
221.20county-based purchasing plans 30 15 days prior to the publication or release of the report.
221.21Managed care plans and county-based purchasing plans shall have 30 15 days to review
221.22the report and provide comment to the commissioner.
221.23The quarterly reports shall be submitted to the commissioner no later than 60 days after the
221.24end of the previous quarter, except the fourth-quarter report, which shall be submitted by
221.25April 1 of each year. The fourth-quarter report shall include audited financial statements,
221.26parent company audited financial statements, an income statement reconciliation report,
221.27and any other documentation necessary to reconcile the detailed reports to the audited
221.28financial statements.

221.29    Sec. 23. Minnesota Statutes 2012, section 256B.69, subdivision 31, is amended to read:
221.30    Subd. 31. Payment reduction. (a) Beginning September 1, 2011, the commissioner
221.31shall reduce payments and limit future rate increases paid to managed care plans and
221.32county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved
221.33on a statewide aggregate basis by program. The commissioner may use competitive
221.34bidding, payment reductions, or other reductions to achieve the reductions and limits
221.35in this subdivision.
222.1(b) Beginning September 1, 2011, the commissioner shall reduce payments to
222.2managed care plans and county-based purchasing plans as follows:
222.3(1) 2.0 percent for medical assistance elderly basic care. This shall not apply
222.4to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
222.5services;
222.6(2) 2.82 percent for medical assistance families and children;
222.7(3) 10.1 percent for medical assistance adults without children; and
222.8(4) 6.0 percent for MinnesotaCare families and children.
222.9(c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed
222.10care plans and county-based purchasing plans for calendar year 2012 to a percentage of
222.11the rates in effect on August 31, 2011, as follows:
222.12(1) 98 percent for medical assistance elderly basic care. This shall not apply to
222.13Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
222.14services;
222.15(2) 97.18 percent for medical assistance families and children;
222.16(3) 89.9 percent for medical assistance adults without children; and
222.17(4) 94 percent for MinnesotaCare families and children.
222.18(d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit
222.19the maximum annual trend increases to rates paid to managed care plans and county-based
222.20purchasing plans as follows:
222.21(1) 7.5 percent for medical assistance elderly basic care. This shall not apply
222.22to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
222.23services;
222.24(2) 5.0 percent for medical assistance special needs basic care;
222.25(3) 2.0 percent for medical assistance families and children;
222.26(4) 3.0 percent for medical assistance adults without children;
222.27(5) 3.0 percent for MinnesotaCare families and children; and
222.28(6) 3.0 percent for MinnesotaCare adults without children.
222.29(e) The commissioner may limit trend increases to less than the maximum.
222.30Beginning July 1, 2014, the commissioner shall limit the maximum annual trend increases
222.31to rates paid to managed care plans and county-based purchasing plans as follows for
222.32calendar years 2014 and 2015:
222.33(1) 7.5 percent for medical assistance elderly basic care. This shall not apply
222.34to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
222.35services;
222.36(2) 5.0 percent for medical assistance special needs basic care;
223.1(3) 2.0 percent for medical assistance families and children;
223.2(4) 3.0 percent for medical assistance adults without children;
223.3(5) 3.0 percent for MinnesotaCare families and children; and
223.4(6) 4.0 percent for MinnesotaCare adults without children.
223.5The commissioner may limit trend increases to less than the maximum. For calendar
223.6year 2014, the commissioner shall reduce the maximum aggregate trend increases by
223.7$47,000,000 in state and federal funds to account for the reductions in administrative
223.8expenses in subdivision 5i.

223.9    Sec. 24. Minnesota Statutes 2012, section 256B.69, is amended by adding a
223.10subdivision to read:
223.11    Subd. 35. Supplemental recovery program. The commissioner shall conduct a
223.12supplemental recovery program for third-party liabilities not recovered by managed care
223.13plans and county-based purchasing plans for state public health programs. Any third-party
223.14liability identified and recovered by the commissioner more than six months after the date
223.15a managed care plan or county-based purchasing plan receives a health care claim shall
223.16be retained by the commissioner and deposited in the general fund. The commissioner
223.17shall establish a mechanism for managed care plans and county-based purchasing plans to
223.18coordinate third-party liability collections efforts with the commissioner to ensure there
223.19is no duplication of efforts. The coordination mechanism must be consistent with the
223.20reporting requirements in subdivision 9c.

223.21    Sec. 25. Minnesota Statutes 2012, section 256B.76, subdivision 1, is amended to read:
223.22    Subdivision 1. Physician reimbursement. (a) Effective for services rendered on
223.23or after October 1, 1992, the commissioner shall make payments for physician services
223.24as follows:
223.25    (1) payment for level one Centers for Medicare and Medicaid Services' common
223.26procedural coding system codes titled "office and other outpatient services," "preventive
223.27medicine new and established patient," "delivery, antepartum, and postpartum care,"
223.28"critical care," cesarean delivery and pharmacologic management provided to psychiatric
223.29patients, and level three codes for enhanced services for prenatal high risk, shall be paid
223.30at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
223.3130, 1992. If the rate on any procedure code within these categories is different than the
223.32rate that would have been paid under the methodology in section 256B.74, subdivision 2,
223.33then the larger rate shall be paid;
224.1    (2) payments for all other services shall be paid at the lower of (i) submitted charges,
224.2or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
224.3    (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
224.4percentile of 1989, less the percent in aggregate necessary to equal the above increases
224.5except that payment rates for home health agency services shall be the rates in effect
224.6on September 30, 1992.
224.7    (b) Effective for services rendered on or after January 1, 2000, payment rates for
224.8physician and professional services shall be increased by three percent over the rates
224.9in effect on December 31, 1999, except for home health agency and family planning
224.10agency services. The increases in this paragraph shall be implemented January 1, 2000,
224.11for managed care.
224.12(c) Effective for services rendered on or after July 1, 2009, payment rates for
224.13physician and professional services shall be reduced by five percent, except that for the
224.14period July 1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent
224.15for the medical assistance and general assistance medical care programs, over the rates in
224.16effect on June 30, 2009. This reduction and the reductions in paragraph (d) do not apply
224.17to office or other outpatient visits, preventive medicine visits and family planning visits
224.18billed by physicians, advanced practice nurses, or physician assistants in a family planning
224.19agency or in one of the following primary care practices: general practice, general internal
224.20medicine, general pediatrics, general geriatrics, and family medicine. This reduction
224.21and the reductions in paragraph (d) do not apply to federally qualified health centers,
224.22rural health centers, and Indian health services. Effective October 1, 2009, payments
224.23made to managed care plans and county-based purchasing plans under sections 256B.69,
224.24256B.692 , and 256L.12 shall reflect the payment reduction described in this paragraph.
224.25(d) Effective for services rendered on or after July 1, 2010, payment rates for
224.26physician and professional services shall be reduced an additional seven percent over
224.27the five percent reduction in rates described in paragraph (c). This additional reduction
224.28does not apply to physical therapy services, occupational therapy services, and speech
224.29pathology and related services provided on or after July 1, 2010. This additional reduction
224.30does not apply to physician services billed by a psychiatrist or an advanced practice nurse
224.31with a specialty in mental health. Effective October 1, 2010, payments made to managed
224.32care plans and county-based purchasing plans under sections 256B.69, 256B.692, and
224.33256L.12 shall reflect the payment reduction described in this paragraph.
224.34(e) Effective for services rendered on or after September 1, 2011, through June 30,
224.352013, payment rates for physician and professional services shall be reduced three percent
225.1from the rates in effect on August 31, 2011. This reduction does not apply to physical
225.2therapy services, occupational therapy services, and speech pathology and related services.
225.3(f) Effective for services rendered on or after September 1, 2014, payment rates for
225.4physician and professional services, including physical therapy, occupational therapy,
225.5speech pathology, and mental health services shall be increased by five percent from the
225.6rates in effect on August 31, 2014. In calculating this rate increase, the commissioner
225.7shall not include in the base rate for August 31, 2014, the rate increase provided under
225.8section 256B.76, subdivision 7. This increase does not apply to federally qualified health
225.9centers, rural health centers, and Indian health services. Payments made to managed
225.10care plans and county-based purchasing plans shall not be adjusted to reflect payments
225.11under this paragraph.

225.12    Sec. 26. Minnesota Statutes 2012, section 256B.76, subdivision 2, is amended to read:
225.13    Subd. 2. Dental reimbursement. (a) Effective for services rendered on or after
225.14October 1, 1992, the commissioner shall make payments for dental services as follows:
225.15    (1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
225.16percent above the rate in effect on June 30, 1992; and
225.17    (2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
225.18percentile of 1989, less the percent in aggregate necessary to equal the above increases.
225.19    (b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
225.20shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.
225.21    (c) Effective for services rendered on or after January 1, 2000, payment rates for
225.22dental services shall be increased by three percent over the rates in effect on December
225.2331, 1999.
225.24    (d) Effective for services provided on or after January 1, 2002, payment for
225.25diagnostic examinations and dental x-rays provided to children under age 21 shall be the
225.26lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.
225.27    (e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
225.282000, for managed care.
225.29(f) Effective for dental services rendered on or after October 1, 2010, by a
225.30state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
225.31on the Medicare principles of reimbursement. This payment shall be effective for services
225.32rendered on or after January 1, 2011, to recipients enrolled in managed care plans or
225.33county-based purchasing plans.
225.34(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics
225.35in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal
226.1year, a supplemental state payment equal to the difference between the total payments
226.2in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated
226.3services for the operation of the dental clinics.
226.4(h) If the cost-based payment system for state-operated dental clinics described in
226.5paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
226.6designated as critical access dental providers under subdivision 4, paragraph (b), and shall
226.7receive the critical access dental reimbursement rate as described under subdivision 4,
226.8paragraph (a).
226.9(i) Effective for services rendered on or after September 1, 2011, through June 30,
226.102013, payment rates for dental services shall be reduced by three percent. This reduction
226.11does not apply to state-operated dental clinics in paragraph (f).
226.12(j) Effective for services rendered on or after January 1, 2014, payment rates for
226.13dental services shall be increased by five percent from the rates in effect on December
226.1431, 2013. This increase does not apply to state-operated dental clinics in paragraph (f),
226.15federally qualified health centers, rural health centers, and Indian health services. Effective
226.16January 1, 2014, payments made to managed care plans and county-based purchasing
226.17plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
226.18described in this paragraph.

226.19    Sec. 27. Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:
226.20    Subd. 4. Critical access dental providers. (a) Effective for dental services rendered
226.21on or after January 1, 2002, the commissioner shall increase reimbursements to dentists
226.22and dental clinics deemed by the commissioner to be critical access dental providers.
226.23For dental services rendered on or after July 1, 2007, the commissioner shall increase
226.24reimbursement by 30 35 percent above the reimbursement rate that would otherwise be
226.25paid to the critical access dental provider. The commissioner shall pay the managed
226.26care plans and county-based purchasing plans in amounts sufficient to reflect increased
226.27reimbursements to critical access dental providers as approved by the commissioner.
226.28(b) The commissioner shall designate the following dentists and dental clinics as
226.29critical access dental providers:
226.30    (1) nonprofit community clinics that:
226.31(i) have nonprofit status in accordance with chapter 317A;
226.32(ii) have tax exempt status in accordance with the Internal Revenue Code, section
226.33501(c)(3);
226.34(iii) are established to provide oral health services to patients who are low income,
226.35uninsured, have special needs, and are underserved;
227.1(iv) have professional staff familiar with the cultural background of the clinic's
227.2patients;
227.3(v) charge for services on a sliding fee scale designed to provide assistance to
227.4low-income patients based on current poverty income guidelines and family size;
227.5(vi) do not restrict access or services because of a patient's financial limitations
227.6or public assistance status; and
227.7(vii) have free care available as needed;
227.8    (2) federally qualified health centers, rural health clinics, and public health clinics;
227.9    (3) city or county owned and operated hospital-based dental clinics;
227.10(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
227.11accordance with chapter 317A with more than 10,000 patient encounters per year with
227.12patients who are uninsured or covered by medical assistance, general assistance medical
227.13care, or MinnesotaCare; and
227.14(5) a dental clinic owned and operated by the University of Minnesota or the
227.15Minnesota State Colleges and Universities system.; and
227.16(6) private practicing dentists if:
227.17(i) the dentist's office is located within a health professional shortage area as defined
227.18under Code of Federal Regulations, title 42, part 5, and United States Code, title 42,
227.19section 254E;
227.20(ii) more than 50 percent of the dentist's patient encounters per year are with patients
227.21who are uninsured or covered by medical assistance or MinnesotaCare;
227.22(iii) the dentist does not restrict access or services because of a patient's financial
227.23limitations or public assistance status; and
227.24(iv) the level of service provided by the dentist is critical to maintaining adequate
227.25levels of patient access within the service area in which the dentist operates.
227.26    (c) The commissioner may designate a dentist or dental clinic as a critical access
227.27dental provider if the dentist or dental clinic is willing to provide care to patients covered
227.28by medical assistance, general assistance medical care, or MinnesotaCare at a level which
227.29significantly increases access to dental care in the service area.
227.30(d) (c) A designated critical access clinic shall receive the reimbursement rate
227.31specified in paragraph (a) for dental services provided off site at a private dental office if
227.32the following requirements are met:
227.33(1) the designated critical access dental clinic is located within a health professional
227.34shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
227.35States Code, title 42, section 254E, and is located outside the seven-county metropolitan
227.36area;
228.1(2) the designated critical access dental clinic is not able to provide the service
228.2and refers the patient to the off-site dentist;
228.3(3) the service, if provided at the critical access dental clinic, would be reimbursed
228.4at the critical access reimbursement rate;
228.5(4) the dentist and allied dental professionals providing the services off site are
228.6licensed and in good standing under chapter 150A;
228.7(5) the dentist providing the services is enrolled as a medical assistance provider;
228.8(6) the critical access dental clinic submits the claim for services provided off site
228.9and receives the payment for the services; and
228.10(7) the critical access dental clinic maintains dental records for each claim submitted
228.11under this paragraph, including the name of the dentist, the off-site location, and the
228.12license number of the dentist and allied dental professionals providing the services.

228.13    Sec. 28. Minnesota Statutes 2012, section 256B.76, is amended by adding a
228.14subdivision to read:
228.15    Subd. 7. Payment for certain primary care services and immunization
228.16administration. Payment for certain primary care services and immunization
228.17administration services rendered on or after January 1, 2013, through December 31, 2014,
228.18shall be made in accordance with section 1902(a)(13) of the Social Security Act.

228.19    Sec. 29. Minnesota Statutes 2012, section 256B.764, is amended to read:
228.20256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
228.21    (a) Effective for services rendered on or after July 1, 2007, payment rates for family
228.22planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
228.23when these services are provided by a community clinic as defined in section 145.9268,
228.24subdivision 1.
228.25    (b) Effective for services rendered on or after July 1, 2013, payment rates for
228.26family planning services shall be increased by 20 percent over the rates in effect June
228.2730, 2013, when these services are provided by a community clinic as defined in section
228.28145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care
228.29and county-based purchasing plans to reflect this increase, and shall require plans to pass
228.30on the full amount of the rate increase to eligible community clinics, in the form of higher
228.31payment rates for family planning services.

228.32    Sec. 30. Minnesota Statutes 2012, section 256B.766, is amended to read:
228.33256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
229.1(a) Effective for services provided on or after July 1, 2009, total payments for basic
229.2care services, shall be reduced by three percent, except that for the period July 1, 2009,
229.3through June 30, 2011, total payments shall be reduced by 4.5 percent for the medical
229.4assistance and general assistance medical care programs, prior to third-party liability and
229.5spenddown calculation. Effective July 1, 2010, the commissioner shall classify physical
229.6therapy services, occupational therapy services, and speech-language pathology and
229.7related services as basic care services. The reduction in this paragraph shall apply to
229.8physical therapy services, occupational therapy services, and speech-language pathology
229.9and related services provided on or after July 1, 2010.
229.10(b) Payments made to managed care plans and county-based purchasing plans shall
229.11be reduced for services provided on or after October 1, 2009, to reflect the reduction
229.12effective July 1, 2009, and payments made to the plans shall be reduced effective October
229.131, 2010, to reflect the reduction effective July 1, 2010.
229.14(c) Effective for services provided on or after September 1, 2011, through June 30,
229.152013, total payments for outpatient hospital facility fees shall be reduced by five percent
229.16from the rates in effect on August 31, 2011.
229.17(d) Effective for services provided on or after September 1, 2011, through June
229.1830, 2013, total payments for ambulatory surgery centers facility fees, medical supplies
229.19and durable medical equipment not subject to a volume purchase contract, prosthetics
229.20and orthotics, renal dialysis services, laboratory services, public health nursing services,
229.21physical therapy services, occupational therapy services, speech therapy services,
229.22eyeglasses not subject to a volume purchase contract, hearing aids not subject to a volume
229.23purchase contract, and anesthesia services, and hospice services shall be reduced by three
229.24percent from the rates in effect on August 31, 2011.
229.25(e) Effective for services provided on or after September 1, 2014, payments for
229.26ambulatory surgery centers facility fees, medical supplies and durable medical equipment
229.27not subject to a volume purchase contract, prosthetics and orthotics, hospice services, renal
229.28dialysis services, laboratory services, public health nursing services, eyeglasses not subject
229.29to a volume purchase contract, and hearing aids not subject to a volume purchase contract
229.30shall be increased by three percent and payments for outpatient hospital facility fees shall
229.31be increased by three percent. Payments made to managed care plans and county-based
229.32purchasing plans shall not be adjusted to reflect payments under this paragraph.
229.33(e) (f) This section does not apply to physician and professional services, inpatient
229.34hospital services, family planning services, mental health services, dental services,
229.35prescription drugs, medical transportation, federally qualified health centers, rural health
229.36centers, Indian health services, and Medicare cost-sharing.

230.1    Sec. 31. Minnesota Statutes 2012, section 256B.767, is amended to read:
230.2256B.767 MEDICARE PAYMENT LIMIT.
230.3(a) Effective for services rendered on or after July 1, 2010, fee-for-service payment
230.4rates for physician and professional services under section 256B.76, subdivision 1, and
230.5basic care services subject to the rate reduction specified in section 256B.766, shall not
230.6exceed the Medicare payment rate for the applicable service, as adjusted for any changes
230.7in Medicare payment rates after July 1, 2010. The commissioner shall implement this
230.8section after any other rate adjustment that is effective July 1, 2010, and shall reduce rates
230.9under this section by first reducing or eliminating provider rate add-ons.
230.10(b) This section does not apply to services provided by advanced practice certified
230.11nurse midwives licensed under chapter 148 or traditional midwives licensed under chapter
230.12147D. Notwithstanding this exemption, medical assistance fee-for-service payment rates
230.13for advanced practice certified nurse midwives and licensed traditional midwives shall
230.14equal and shall not exceed the medical assistance payment rate to physicians for the
230.15applicable service.
230.16(c) This section does not apply to mental health services or physician services billed
230.17by a psychiatrist or an advanced practice registered nurse with a specialty in mental health.
230.18(d) Effective for durable medical equipment, prosthetics, orthotics, or supplies
230.19provided on or after July 1, 2013, through June 30, 2014, the payment rate for items
230.20that are subject to the rates established under Medicare's National Competitive Bidding
230.21Program shall be equal to the rate that applies to the same item when not subject to the
230.22rate established under Medicare's National Competitive Bidding Program. This paragraph
230.23does not apply to mail order diabetic supplies and does not apply to items provided to
230.24dually eligible recipients when Medicare is the primary payer of the item.

230.25    Sec. 32. Laws 2013, chapter 1, section 6, is amended to read:
230.26    Sec. 6. TRANSFER.
230.27(a) The commissioner of management and budget shall transfer from the health care
230.28access fund to the general fund up to $21,319,000 in fiscal year 2014; up to $42,314,000
230.29in fiscal year 2015; up to $56,147,000 in fiscal year 2016; and up to $64,683,000 in fiscal
230.30year 2017.
230.31(b) The commissioner of human services shall determine the difference between the
230.32actual or forecasted cost to the medical assistance program of adding 19- and 20-year-olds
230.33and parents and relative caretaker populations with income between 100 and 138 percent of
230.34the federal poverty guidelines and the cost of adding those populations that was estimated
230.35during the 2013 legislative session based on the data from the February 2013 forecast.
231.1(c) For each fiscal year from 2014 to 2017, the commissioner of human services
231.2shall certify and report to the commissioner of management and budget the actual
231.3or forecasted cost difference of adding 19- and 20-year-olds and parents and relative
231.4caretaker populations with income between 100 and 138 percent of the federal poverty
231.5guidelines, as determined under paragraph (b), to the commissioner of management and
231.6budget at least four weeks prior to the release of a forecast under Minnesota Statutes,
231.7section 16A.103, of each fiscal year.
231.8(d) No later than three weeks before the release of the forecast under Minnesota
231.9Statutes, section 16A.103, the commissioner of management and budget shall reduce the
231.10health care access fund transfer in paragraph (a), by the cumulative differences in costs
231.11reported by the commissioner of human services under paragraph (c). If, for any fiscal
231.12year, the amount of the cumulative cost differences determined under paragraph (b) is
231.13positive, no change is made to the appropriation. If, for any fiscal year, the amount of the
231.14cumulative cost differences determined under paragraph (b) is less than the amount of the
231.15original appropriation, the appropriation for that year must be zero.

231.16    Sec. 33. REQUEST FOR INFORMATION; EMERGENCY MEDICAL
231.17ASSISTANCE AND THE UNINSURED STUDY.
231.18(a) The commissioner of human services, in consultation with safety net hospitals,
231.19nonprofit health care coverage programs, nonprofit community clinics, counties, and other
231.20interested parties, shall identify alternatives and make recommendations for providing
231.21coordinated and cost-effective health care and coverage to individuals who:
231.22(1) meet eligibility standards for emergency medical assistance; or
231.23(2) are uninsured and ineligible for other state public health care programs, have
231.24incomes below 400 percent of the federal poverty level, and are ineligible for premium
231.25credits through the Minnesota Insurance Marketplace as defined under Minnesota Statutes,
231.26section 62V.02.
231.27(b) The commissioner of human services shall issue a request for information
231.28to help identify options for coverage of medically necessary services not eligible for
231.29federal financial participation for emergency medical assistance recipients and medically
231.30necessary services for individuals who are uninsured and ineligible for other state public
231.31health care programs or coverage through the Minnesota Insurance Marketplace. The
231.32request for information shall provide:
231.33(1) the identification of services, including community-based medical, dental, and
231.34behavioral health services, necessary to reduce emergency department and inpatient
231.35hospital utilization for these recipients;
232.1(2) delivery system options, including for each option how the system would be
232.2organized to promote care coordination and cost-effectiveness, and how the system would
232.3be available statewide;
232.4(3) funding options and payment mechanisms to encourage providers to manage
232.5the delivery of care to these populations at a lower cost of care and with better patient
232.6outcomes than the current system;
232.7(4) how the funding and delivery of services will be coordinated with the services
232.8covered under emergency medical assistance;
232.9(5) options for administration of eligibility determination and service delivery; and
232.10(6) evaluation methods to measure cost-effectiveness and health outcomes that take
232.11into consideration the social determinants of health care for recipients participating in
232.12this alternative coverage option.
232.13(c) The commissioner shall issue a request for information by August 1, 2013, and
232.14respondents to the request must submit information to the commissioner by October
232.151, 2013.
232.16(d) The commissioner shall incorporate the information obtained through the request
232.17for information described in paragraph (b) and information collected by the commissioner
232.18of health and other relevant sources related to the uninsured in this state when developing
232.19recommendations.
232.20(e) The commissioner shall submit recommendations to the chairs and ranking
232.21minority members of the legislative committees and divisions with jurisdiction over health
232.22and human services and finance by January 15, 2014.
232.23EFFECTIVE DATE.This section is effective the day following final enactment.

232.24    Sec. 34. REQUEST FOR INFORMATION; EMERGENCY MEDICAL
232.25ASSISTANCE.
232.26(a) The commissioner of human services shall issue a request for information (RFI)
232.27to identify and develop options for a program to provide emergency medical assistance
232.28recipients with coverage for medically necessary services not eligible for federal financial
232.29participation. The RFI must focus on providing coverage for nonemergent services
232.30for recipients who have two or more chronic conditions and have had two or more
232.31hospitalizations covered by emergency medical assistance in a one-year period.
232.32(b) The RFI must be issued by August 1, 2013, and require respondents to submit
232.33information to the commissioner by November 1, 2013. The RFI must request information
232.34on:
233.1(1) services necessary to reduce emergency department and inpatient hospital use for
233.2emergency medical assistance recipients;
233.3(2) methods of service delivery that promote efficiency and cost-effectiveness, and
233.4provide statewide access;
233.5(3) funding options for the services to be covered under the program;
233.6(4) coordination of service delivery and funding with services covered under
233.7emergency medical assistance;
233.8(5) options for program administration; and
233.9(6) methods to evaluate the program, including evaluation of cost-effectiveness and
233.10health outcomes for those emergency medical assistance recipients eligible for coverage
233.11of additional services under the program.
233.12(c) The commissioner shall make information submitted in response to the RFI
233.13available on the agency Web site. The commissioner, based on the responses to the RFI,
233.14shall submit recommendations on providing emergency medical assistance recipients
233.15with coverage for nonemergent services, as described in paragraph (a), to the chairs and
233.16ranking minority members of the legislative committees with jurisdiction over health and
233.17human services policy and finance by January 15, 2014.

233.18    Sec. 35. DENTAL ACCESS AND REIMBURSEMENT REPORT.
233.19    Subdivision 1. Study. (a) The commissioner of human services shall study
233.20the current oral health and dental services delivery system for state public health
233.21care programs to improve access and ensure cost-effective delivery of services. The
233.22commissioner shall make recommendations on modifying the delivery of services and
233.23reimbursement methods, including modifications to the critical access dental provider
233.24payments under Minnesota Statutes, section 256B.76, subdivision 4.
233.25(b) The commissioner shall consult with dental providers enrolled in Minnesota
233.26health care programs, including providers who serve substantial numbers of low-income
233.27and uninsured patients and are currently receiving enhanced critical access dental provider
233.28payments.
233.29    Subd. 2. Service delivery and reimbursement methods. The recommendations
233.30must address:
233.31(1) targeting state funding and critical access dental payments to improve access
233.32to oral health services for individuals enrolled in Minnesota health care programs who
233.33are not receiving timely and appropriate dental services;
234.1(2) encouraging the use of cost-effective service delivery methods, workforce
234.2innovations, and the delivery of preventive services, including, but not limited to, dental
234.3sealants that will reduce dental disease and future costs of treatment;
234.4(3) improving access in all geographic areas of the state;
234.5(4) encouraging the use of tele-dentistry and mobile dental equipment to serve
234.6underserved patients and communities;
234.7(5) evaluating the use of a single administrator delivery model;
234.8(6) compensating providers for the added costs to providers of serving low-income
234.9and underserved patients and populations who experience the greatest oral health
234.10disparities in terms of incidence of oral health disease and access to and utilization of
234.11needed oral health services;
234.12(7) encouraging coordination of oral health care with other health care services;
234.13(8) preventing overtreatment, fraud, and abuse; and
234.14(9) reducing administrative costs for the state and for dental providers.
234.15    Subd. 3. Report. The commissioner shall submit a report on the recommendations to
234.16the chairs and ranking minority members of the of the legislative committees and divisions
234.17with jurisdiction over health and human services policy and finance by December 15, 2013.


234.20    Section 1. Minnesota Statutes 2012, section 144.0724, subdivision 6, is amended to read:
234.21    Subd. 6. Penalties for late or nonsubmission. (a) A facility that fails to complete
234.22or submit an assessment for a RUG-III or RUG-IV classification within seven days of the
234.23time requirements in subdivisions 4 and 5 is subject to a reduced rate for that resident.
234.24The reduced rate shall be the lowest rate for that facility. The reduced rate is effective on
234.25the day of admission for new admission assessments or on the day that the assessment
234.26was due for all other assessments and continues in effect until the first day of the month
234.27following the date of submission of the resident's assessment.
234.28    (b) If loss of revenue due to penalties incurred by a facility for any period of 92 days
234.29are equal to or greater than 1.0 percent of the total operating costs on the facility's most
234.30recent annual statistical and cost report, a facility may apply to the commissioner of
234.31human services for a reduction in the total penalty amount. The commissioner of human
234.32services, in consultation with the commissioner of health, may, at the sole discretion of
234.33the commissioner of human services, limit the penalty for residents covered by medical
234.34assistance to 15 days.

235.1    Sec. 2. Minnesota Statutes 2012, section 144A.071, subdivision 4b, is amended to read:
235.2    Subd. 4b. Licensed beds on layaway status. A licensed and certified nursing
235.3facility may lay away, upon prior written notice to the commissioner of health, licensed
235.4and certified beds. A nursing facility may not discharge a resident in order to lay away
235.5a bed. Notice to the commissioner shall be given 60 days prior to the effective date of
235.6the layaway. Beds on layaway shall have the same status as voluntarily delicensed and
235.7decertified beds and shall not be subject to license fees and license surcharge fees. In
235.8addition, beds on layaway may be removed from layaway at any time on or after one year
235.9 six months after the effective date of layaway in the facility of origin, with a 60-day notice
235.10to the commissioner. A nursing facility that removes beds from layaway may not place
235.11beds on layaway status for one year six months after the effective date of the removal from
235.12layaway. The commissioner may approve the immediate removal of beds from layaway if
235.13necessary to provide access to those nursing home beds to residents relocated from other
235.14nursing homes due to emergency situations or closure. In the event approval is granted,
235.15the one-year six-month restriction on placing beds on layaway after a removal of beds
235.16from layaway shall not apply. Beds may remain on layaway for up to ten years. The
235.17commissioner may approve placing and removing beds on layaway at any time during
235.18renovation or construction related to a moratorium project approved under this section
235.19or section 144A.073. Nursing facilities are not required to comply with any licensure or
235.20certification requirements for beds on layaway status.

235.21    Sec. 3. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
235.22    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
235.23initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
235.242960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
235.259555.6265, under this chapter for a physical location that will not be the primary residence
235.26of the license holder for the entire period of licensure. If a license is issued during this
235.27moratorium, and the license holder changes the license holder's primary residence away
235.28from the physical location of the foster care license, the commissioner shall revoke the
235.29license according to section 245A.07. Exceptions to the moratorium include:
235.30(1) foster care settings that are required to be registered under chapter 144D;
235.31(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
235.32and determined to be needed by the commissioner under paragraph (b);
235.33(3) new foster care licenses determined to be needed by the commissioner under
235.34paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center,
235.35or; restructuring of state-operated services that limits the capacity of state-operated
236.1facilities; or, allowing movement to the community for people who no longer require the
236.2level of care provided in state-operated facilities as provided under section 256B.092,
236.3subdivision 13, or 256B.49, subdivision 24;
236.4(4) new foster care licenses determined to be needed by the commissioner under
236.5paragraph (b) for persons requiring hospital level care; or
236.6(5) new foster care licenses determined to be needed by the commissioner for the
236.7transition of people from personal care assistance to the home and community-based
236.8services.
236.9(b) The commissioner shall determine the need for newly licensed foster care homes
236.10as defined under this subdivision. As part of the determination, the commissioner shall
236.11consider the availability of foster care capacity in the area in which the licensee seeks to
236.12operate, and the recommendation of the local county board. The determination by the
236.13commissioner must be final. A determination of need is not required for a change in
236.14ownership at the same address.
236.15(c) The commissioner shall study the effects of the license moratorium under this
236.16subdivision and shall report back to the legislature by January 15, 2011. This study shall
236.17include, but is not limited to the following:
236.18(1) the overall capacity and utilization of foster care beds where the physical location
236.19is not the primary residence of the license holder prior to and after implementation
236.20of the moratorium;
236.21(2) the overall capacity and utilization of foster care beds where the physical
236.22location is the primary residence of the license holder prior to and after implementation
236.23of the moratorium; and
236.24(3) the number of licensed and occupied ICF/MR beds prior to and after
236.25implementation of the moratorium.
236.26(d) (c) When a foster care recipient moves out of a foster home that is not the primary
236.27residence of the license holder according to section 256B.49, subdivision 15, paragraph
236.28(f), the county shall immediately inform the Department of Human Services Licensing
236.29Division. The department shall decrease the statewide licensed capacity for foster care
236.30settings where the physical location is not the primary residence of the license holder, if
236.31the voluntary changes described in paragraph (f) (e) are not sufficient to meet the savings
236.32required by reductions in licensed bed capacity under Laws 2011, First Special Session
236.33chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide long-term
236.34care residential services capacity within budgetary limits. Implementation of the statewide
236.35licensed capacity reduction shall begin on July 1, 2013. The commissioner shall delicense
236.36up to 128 beds by June 30, 2014, using the needs determination process. Under this
237.1paragraph, the commissioner has the authority to reduce unused licensed capacity of a
237.2current foster care program to accomplish the consolidation or closure of settings. Under
237.3this paragraph, the commissioner has the authority to manage statewide capacity, including
237.4adjusting the capacity available to each county and adjusting statewide available capacity,
237.5to meet the statewide needs identified through the process in paragraph (e). A decreased
237.6licensed capacity according to this paragraph is not subject to appeal under this chapter.
237.7(e) (d) Residential settings that would otherwise be subject to the decreased license
237.8capacity established in paragraph (d) (c) shall be exempt under the following circumstances:
237.9(1) until August 1, 2013, the license holder's beds occupied by residents whose
237.10primary diagnosis is mental illness and the license holder is:
237.11(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
237.12health services (ARMHS) as defined in section 256B.0623;
237.13(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
237.149520.0870;
237.15(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
237.169520.0870; or
237.17(iv) a provider of intensive residential treatment services (IRTS) licensed under
237.18Minnesota Rules, parts 9520.0500 to 9520.0670; or
237.19(2) the license holder's beds occupied by residents whose primary diagnosis is
237.20mental illness and the license holder is certified under the requirements in subdivision 6a.
237.21(f) (e) A resource need determination process, managed at the state level, using the
237.22available reports required by section 144A.351, and other data and information shall
237.23be used to determine where the reduced capacity required under paragraph (d) (c) will
237.24be implemented. The commissioner shall consult with the stakeholders described in
237.25section 144A.351, and employ a variety of methods to improve the state's capacity to
237.26meet long-term care service needs within budgetary limits, including seeking proposals
237.27from service providers or lead agencies to change service type, capacity, or location to
237.28improve services, increase the independence of residents, and better meet needs identified
237.29by the long-term care services reports and statewide data and information. By February
237.301 of each, 2013, and August 1, 2014, and each following year, the commissioner shall
237.31provide information and data on the overall capacity of licensed long-term care services,
237.32actions taken under this subdivision to manage statewide long-term care services and
237.33supports resources, and any recommendations for change to the legislative committees
237.34with jurisdiction over health and human services budget.
237.35    (g) (f) At the time of application and reapplication for licensure, the applicant and the
237.36license holder that are subject to the moratorium or an exclusion established in paragraph
238.1(a) are required to inform the commissioner whether the physical location where the foster
238.2care will be provided is or will be the primary residence of the license holder for the entire
238.3period of licensure. If the primary residence of the applicant or license holder changes, the
238.4applicant or license holder must notify the commissioner immediately. The commissioner
238.5shall print on the foster care license certificate whether or not the physical location is the
238.6primary residence of the license holder.
238.7    (h) (g) License holders of foster care homes identified under paragraph (g) (f) that
238.8are not the primary residence of the license holder and that also provide services in the
238.9foster care home that are covered by a federally approved home and community-based
238.10services waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must
238.11inform the human services licensing division that the license holder provides or intends to
238.12provide these waiver-funded services. These license holders must be considered registered
238.13under section 256B.092, subdivision 11, paragraph (c), and this registration status must
238.14be identified on their license certificates.

238.15    Sec. 4. Minnesota Statutes 2012, section 252.291, is amended by adding a subdivision
238.16to read:
238.17    Subd. 2b. Nicollet County facility project. The commissioner of health shall
238.18certify one additional bed in an intermediate care facility for persons with developmental
238.19disabilities in Nicollet County.

238.20    Sec. 5. Minnesota Statutes 2012, section 256.9657, subdivision 3a, is amended to read:
238.21    Subd. 3a. ICF/MR ICF/DD license surcharge. (a) Effective July 1, 2003, each
238.22non-state-operated facility as defined under section 256B.501, subdivision 1, shall pay
238.23to the commissioner an annual surcharge according to the schedule in subdivision 4,
238.24paragraph (d). The annual surcharge shall be $1,040 per licensed bed. If the number of
238.25licensed beds is reduced, the surcharge shall be based on the number of remaining licensed
238.26beds the second month following the receipt of timely notice by the commissioner of
238.27human services that beds have been delicensed. The facility must notify the commissioner
238.28of health in writing when beds are delicensed. The commissioner of health must notify
238.29the commissioner of human services within ten working days after receiving written
238.30notification. If the notification is received by the commissioner of human services by
238.31the 15th of the month, the invoice for the second following month must be reduced to
238.32recognize the delicensing of beds. The commissioner may reduce, and may subsequently
238.33restore, the surcharge under this subdivision based on the commissioner's determination of
238.34a permissible surcharge.
239.1(b) Effective July 1, 2013, the surcharge under paragraph (a) is increased to$3,679
239.2per licensed bed.
239.3EFFECTIVE DATE.This section is effective July 1, 2013.

239.4    Sec. 6. Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to read:
239.5    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of
239.6waivered services to an individual elderly waiver client except for individuals described in
239.7paragraph paragraphs (b) and (d) shall be the weighted average monthly nursing facility
239.8rate of the case mix resident class to which the elderly waiver client would be assigned
239.9under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance
239.10needs allowance as described in subdivision 1d, paragraph (a), until the first day of the
239.11state fiscal year in which the resident assessment system as described in section 256B.438
239.12for nursing home rate determination is implemented. Effective on the first day of the state
239.13fiscal year in which the resident assessment system as described in section 256B.438 for
239.14nursing home rate determination is implemented and the first day of each subsequent state
239.15fiscal year, the monthly limit for the cost of waivered services to an individual elderly
239.16waiver client shall be the rate of the case mix resident class to which the waiver client
239.17would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on
239.18the last day of the previous state fiscal year, adjusted by any legislatively adopted home
239.19and community-based services percentage rate adjustment.
239.20    (b) The monthly limit for the cost of waivered services to an individual elderly
239.21waiver client assigned to a case mix classification A under paragraph (a) with:
239.22(1) no dependencies in activities of daily living; or
239.23(2) up to two dependencies in bathing, dressing, grooming, walking, and eating
239.24when the dependency score in eating is three or greater as determined by an assessment
239.25performed under section 256B.0911 shall be $1,750 per month effective on July 1, 2011,
239.26for all new participants enrolled in the program on or after July 1, 2011. This monthly
239.27limit shall be applied to all other participants who meet this criteria at reassessment. This
239.28monthly limit shall be increased annually as described in paragraph (a).
239.29(c) If extended medical supplies and equipment or environmental modifications are
239.30or will be purchased for an elderly waiver client, the costs may be prorated for up to
239.3112 consecutive months beginning with the month of purchase. If the monthly cost of a
239.32recipient's waivered services exceeds the monthly limit established in paragraph (a) or
239.33(b), the annual cost of all waivered services shall be determined. In this event, the annual
239.34cost of all waivered services shall not exceed 12 times the monthly limit of waivered
239.35services as described in paragraph (a) or (b).
240.1(d) Effective July 1, 2013, the monthly cost limit of waiver services, including
240.2any necessary home care services described in section 256B.0651, subdivision 2, for
240.3individuals who meet the criteria as ventilator-dependent given in section 256B.0651,
240.4subdivision 1, paragraph (g), shall be the average of the monthly medical assistance
240.5amount established for home care services as described in section 256B.0652, subdivision
240.67, and the annual average contracted amount established by the commissioner for nursing
240.7facility services for ventilator-dependent individuals. This monthly limit shall be increased
240.8annually as described in paragraph (a).

240.9    Sec. 7. Minnesota Statutes 2012, section 256B.0915, is amended by adding a
240.10subdivision to read:
240.11    Subd. 3j. Individual community living support. Upon federal approval, there
240.12is established a new service called individual community living support (ICLS) that is
240.13available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor
240.14have any interest in the recipient's housing. ICLS must be delivered in a single-family
240.15home or apartment where the service recipient or their family owns or rents, as
240.16demonstrated by a lease agreement, and maintains control over the individual unit. Case
240.17managers or care coordinators must develop individual ICLS plans in consultation with
240.18the client using a tool developed by the commissioner. The commissioner shall establish
240.19payment rates and mechanisms to align payments with the type and amount of service
240.20provided, assure statewide uniformity for payment rates, and assure cost-effectiveness.
240.21Licensing standards for ICLS shall be reviewed jointly by the Departments of Health and
240.22Human Services to avoid conflict with provider regulatory standards pursuant to section
240.23144A.43 and chapter 245D.

240.24    Sec. 8. Minnesota Statutes 2012, section 256B.0916, is amended by adding a
240.25subdivision to read:
240.26    Subd. 11. Excess spending. County and tribal agencies are responsible for spending
240.27in excess of the allocation made by the commissioner. In the event a county or tribal
240.28agency spends in excess of the allocation made by the commissioner for a given allocation
240.29period, they must submit a corrective action plan to the commissioner. The plan must state
240.30the actions the agency will take to correct their overspending for the year following the
240.31period when the overspending occurred. Failure to correct overspending shall result in
240.32recoupment of spending in excess of the allocation. Nothing in this subdivision shall be
240.33construed as reducing the county's responsibility to offer and make available feasible
241.1home and community-based options to eligible waiver recipients within the resources
241.2allocated to them for that purpose.

241.3    Sec. 9. Minnesota Statutes 2012, section 256B.092, subdivision 7, is amended to read:
241.4    Subd. 7. Screening teams. (a) For persons with developmental disabilities, screening
241.5teams shall be established which shall evaluate the need for the level of care provided
241.6by residential-based habilitation services, residential services, training and habilitation
241.7services, and nursing facility services. The evaluation shall address whether home and
241.8community-based services are appropriate for persons who are at risk of placement in an
241.9intermediate care facility for persons with developmental disabilities, or for whom there is
241.10reasonable indication that they might require this level of care. The screening team shall
241.11make an evaluation of need within 60 working days of a request for service by a person
241.12with a developmental disability, and within five working days of an emergency admission
241.13of a person to an intermediate care facility for persons with developmental disabilities.
241.14(b) The screening team shall consist of the case manager for persons with
241.15developmental disabilities, the person, the person's legal guardian or conservator, or the
241.16parent if the person is a minor, and a qualified developmental disability professional, as
241.17defined in Code of Federal Regulations, title 42, section 483.430, as amended through
241.18June 3, 1988. The case manager may also act as the qualified developmental disability
241.19professional if the case manager meets the federal definition.
241.20(c) County social service agencies may contract with a public or private agency
241.21or individual who is not a service provider for the person for the public guardianship
241.22representation required by the screening or individual service planning process. The
241.23contract shall be limited to public guardianship representation for the screening and
241.24individual service planning activities. The contract shall require compliance with the
241.25commissioner's instructions and may be for paid or voluntary services.
241.26(d) For persons determined to have overriding health care needs and are
241.27seeking admission to a nursing facility or an ICF/MR, or seeking access to home and
241.28community-based waivered services, a registered nurse must be designated as either the
241.29case manager or the qualified developmental disability professional.
241.30(e) For persons under the jurisdiction of a correctional agency, the case manager
241.31must consult with the corrections administrator regarding additional health, safety, and
241.32supervision needs.
241.33(f) The case manager, with the concurrence of the person, the person's legal guardian
241.34or conservator, or the parent if the person is a minor, may invite other individuals to
241.35attend meetings of the screening team. With the permission of the person being screened
242.1or the person's designated legal representative, the person's current provider of services
242.2may submit a written report outlining their recommendations regarding the person's care
242.3needs prepared by a direct service employee with at least 20 hours of service to that client.
242.4The screening team must notify the provider of the date by which this information is to
242.5be submitted. This information must be provided to the screening team and the person
242.6or the person's legal representative and must be considered prior to the finalization of
242.7the screening.
242.8(g) Upon federal approval, if during an assessment or reassessment the recipient
242.9is determined to be able to have the recipient's needs met through alternative services
242.10in a less restrictive setting, the case manager shall help the recipient develop a plan to
242.11transition to an appropriate less restrictive setting.
242.12(g) (h) No member of the screening team shall have any direct or indirect service
242.13provider interest in the case.
242.14(h) (i) Nothing in this section shall be construed as requiring the screening team
242.15meeting to be separate from the service planning meeting.
242.16EFFECTIVE DATE.This section is effective January 1, 2014.

242.17    Sec. 10. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
242.18    Subd. 11. Residential support services. (a) Upon federal approval, there is
242.19established a new service called residential support that is available on the community
242.20alternative care, community alternatives for disabled individuals, developmental
242.21disabilities, and brain injury waivers. Existing waiver service descriptions must be
242.22modified to the extent necessary to ensure there is no duplication between other services.
242.23Residential support services must be provided by vendors licensed as a community
242.24residential setting as defined in section 245A.11, subdivision 8.
242.25    (b) Residential support services must meet the following criteria:
242.26    (1) providers of residential support services must own or control the residential site;
242.27    (2) the residential site must not be the primary residence of the license holder;
242.28    (3) the residential site must have a designated program supervisor responsible for
242.29program oversight, development, and implementation of policies and procedures;
242.30    (4) the provider of residential support services must provide supervision, training,
242.31and assistance as described in the person's coordinated service and support plan; and
242.32    (5) the provider of residential support services must meet the requirements of
242.33licensure and additional requirements of the person's coordinated service and support plan.
242.34    (c) Providers of residential support services that meet the definition in paragraph
242.35(a) must be registered using a process determined by the commissioner beginning July
243.11, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
243.22960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
243.39555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
243.47 , paragraph (g) (f), are considered registered under this section.

243.5    Sec. 11. Minnesota Statutes 2012, section 256B.092, subdivision 12, is amended to read:
243.6    Subd. 12. Waivered services statewide priorities. (a) The commissioner shall
243.7establish statewide priorities for individuals on the waiting list for developmental
243.8disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must
243.9include, but are not limited to, individuals who continue to have a need for waiver services
243.10after they have maximized the use of state plan services and other funding resources,
243.11including natural supports, prior to accessing waiver services, and who meet at least one
243.12of the following criteria:
243.13(1) no longer require the intensity of services provided where they are currently
243.14living; or
243.15(2) make a request to move from an institutional setting.
243.16(b) After the priorities in paragraph (a) are met, priority must also be given to
243.17individuals who meet at least one of the following criteria:
243.18(1) have unstable living situations due to the age, incapacity, or sudden loss of
243.19the primary caregivers;
243.20(2) are moving from an institution due to bed closures;
243.21(3) experience a sudden closure of their current living arrangement;
243.22(4) require protection from confirmed abuse, neglect, or exploitation;
243.23(5) experience a sudden change in need that can no longer be met through state plan
243.24services or other funding resources alone; or
243.25(6) meet other priorities established by the department.
243.26(b) (c) When allocating resources to lead agencies, the commissioner must take into
243.27consideration the number of individuals waiting who meet statewide priorities and the
243.28lead agencies' current use of waiver funds and existing service options. The commissioner
243.29has the authority to transfer funds between counties, groups of counties, and tribes to
243.30accommodate statewide priorities and resource needs while accounting for a necessary
243.31base level reserve amount for each county, group of counties, and tribe.
243.32(c) The commissioner shall evaluate the impact of the use of statewide priorities and
243.33provide recommendations to the legislature on whether to continue the use of statewide
243.34priorities in the November 1, 2011, annual report required by the commissioner in sections
243.35256B.0916, subdivision 7, and 256B.49, subdivision 21.

244.1    Sec. 12. Minnesota Statutes 2012, section 256B.092, is amended by adding a
244.2subdivision to read:
244.3    Subd. 14. Reduce avoidable behavioral crisis emergency room admissions,
244.4psychiatric inpatient hospitalizations, and commitments to institutions. (a) Persons
244.5receiving home and community-based services authorized under this section who have
244.6had two or more admissions within a calendar year to an emergency room, psychiatric
244.7unit, or institution must receive consultation from a mental health professional as defined
244.8in section 245.462, subdivision 18, or a behavioral professional as defined in the home
244.9and community-based services state plan within 30 days of discharge. The mental health
244.10professional or behavioral professional must:
244.11(1) conduct a functional assessment of the crisis incident as defined in section
244.12245D.02, subdivision 11, which led to the hospitalization with the goal of developing
244.13proactive strategies as well as necessary reactive strategies to reduce the likelihood of
244.14future avoidable hospitalizations due to a behavioral crisis;
244.15(2) use the results of the functional assessment to amend the coordinated service and
244.16support plan set forth in section 245D.02, subdivision 4b, to address the potential need
244.17for additional staff training, increased staffing, access to crisis mobility services, mental
244.18health services, use of technology, and crisis stabilization services in section 256B.0624,
244.19subdivision 7; and
244.20(3) identify the need for additional consultation, testing, and mental health crisis
244.21intervention team services as defined in section 245D.02, subdivision 20, psychotropic
244.22medication use and monitoring under section 245D.051, and the frequency and duration
244.23of ongoing consultation.
244.24(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
244.25the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

244.26    Sec. 13. [256B.0922] ESSENTIAL COMMUNITY SUPPORTS.
244.27    Subdivision 1. Essential community supports. (a) The purpose of the essential
244.28community supports program is to provide targeted services to persons age 65 and older
244.29who need essential community support, but whose needs do not meet the level of care
244.30required for nursing facility placement under section 144.0724, subdivision 11.
244.31(b) Essential community supports are available not to exceed $400 per person per
244.32month. Essential community supports may be used as authorized within an authorization
244.33period not to exceed 12 months. Services must be available to a person who:
244.34(1) is age 65 or older;
244.35(2) is not eligible for medical assistance;
245.1(3) has received a community assessment under section 256B.0911, subdivision 3a
245.2or 3b, and does not require the level of care provided in a nursing facility;
245.3(4) meets the financial eligibility criteria for the alternative care program under
245.4section 256B.0913, subdivision 4;
245.5(5) has a community support plan; and
245.6(6) has been determined by a community assessment under section 256B.0911,
245.7subdivision 3a or 3b, to be a person who would require provision of at least one of the
245.8following services, as defined in the approved elderly waiver plan, in order to maintain
245.9their community residence:
245.10(i) caregiver support;
245.11(ii) homemaker support;
245.12(iii) chores;
245.13(iv) a personal emergency response device or system;
245.14(v) home-delivered meals; or
245.15(vi) community living assistance as defined by the commissioner.
245.16(c) The person receiving any of the essential community supports in this subdivision
245.17must also receive service coordination, not to exceed $600 in a 12-month authorization
245.18period, as part of their community support plan.
245.19(d) A person who has been determined to be eligible for essential community
245.20supports must be reassessed at least annually and continue to meet the criteria in paragraph
245.21(b) to remain eligible for essential community supports.
245.22(e) The commissioner is authorized to use federal matching funds for essential
245.23community supports as necessary and to meet demand for essential community supports
245.24as outlined in subdivision 2, and that amount of federal funds is appropriated to the
245.25commissioner for this purpose.
245.26    Subd. 2. Essential community supports for people in transition. (a) Essential
245.27community supports under subdivision 1 are also available to an individual who:
245.28(1) is receiving nursing facility services or home and community-based long-term
245.29services and supports under section 256B.0915 or 256B.49 on the effective date of
245.30implementation of the revised nursing facility level of care under section 144.0724,
245.31subdivision 11;
245.32(2) meets one of the following criteria:
245.33(i) due to the implementation of the revised nursing facility level of care, loses
245.34eligibility for continuing medical assistance payment of nursing facility services at the
245.35first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or
246.1after the effective date of the revised nursing facility level of care criteria under section
246.2144.0724, subdivision 11; or
246.3(ii) due to the implementation of the revised nursing facility level of care, loses
246.4eligibility for continuing medical assistance payment of home and community-based
246.5long-term services and supports under section 256B.0915 or 256B.49 at the first
246.6reassessment required under those sections that occurs on or after the effective date of
246.7implementation of the revised nursing facility level of care under section 144.0724,
246.8subdivision 11;
246.9(3) is not eligible for personal care attendant services; and
246.10(4) has an assessed need for one or more of the supportive services offered under
246.11essential community supports under subdivision 1, paragraph (b), clause (6).
246.12Individuals eligible under this paragraph includes individuals who continue to be
246.13eligible for medical assistance state plan benefits and those who are not or are no longer
246.14financially eligible for medical assistance.
246.15(b) Additional onetime case management is available for participants under
246.16paragraph (a), not to exceed $600 per person to be used within one authorization period
246.17not to exceed 12 months. This service is provided in addition to the essential community
246.18supports benefit described under subdivision 1, paragraph (b).
246.19EFFECTIVE DATE.This section is effective January 1, 2014.

246.20    Sec. 14. [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
246.21    Subdivision 1. Purpose. This section creates a new benefit to provide early
246.22intensive intervention to a child with an autism spectrum disorder diagnosis. This benefit
246.23must provide coverage for diagnosis, multidisciplinary assessment, ongoing progress
246.24evaluation, and medically necessary treatment of autism spectrum disorder.
246.25    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
246.26this subdivision have the meanings given.
246.27    (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
246.28current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
246.29    (c) "Child" means a person under the age of 18.
246.30    (d) "Commissioner" means the commissioner of human services, unless otherwise
246.31specified.
246.32    (e) "Early intensive intervention benefit" means autism treatment options based in
246.33behavioral and developmental science, which may include modalities such as applied
246.34behavior analysis, developmental treatment approaches, and naturalistic and parent
246.35training models.
247.1    (f) "Generalizable goals" means results or gains that are observed during a variety
247.2of activities with different people, such as providers, family members, other adults, and
247.3children, and in different environments including, but not limited to, clinics, homes,
247.4schools, and the community.
247.5    (g) "Mental health professional" has the meaning given in section 245.4871,
247.6subdivision 27, clauses (1) to (6).
247.7    Subd. 3. Initial eligibility. This benefit is available to a child enrolled in medical
247.8assistance who:
247.9    (1) has an autism spectrum disorder diagnosis;
247.10    (2) has had a diagnostic assessment described in subdivision 5, which recommends
247.11early intensive intervention services; and
247.12    (3) meets the criteria for medically necessary autism early intensive intervention
247.13services.
247.14    Subd. 4. Diagnosis. (a) A diagnosis must:
247.15    (1) be based upon current DSM criteria including direct observations of the child
247.16and reports from parents or primary caregivers; and
247.17    (2) be completed by both a licensed physician or advanced practice registered nurse
247.18and a mental health professional.
247.19    (b) Additional diagnostic assessment information may be considered including from
247.20special education evaluations and licensed school personnel, and from professionals
247.21licensed in the fields of medicine, speech and language, psychology, occupational therapy,
247.22and physical therapy.
247.23(c) If the commissioner determines there are access problems or delays in diagnosis
247.24for a geographic area due to the lack of qualified professionals, the commissioner shall
247.25waive the requirement in paragraph (a), clause (2), for two professionals and allow a
247.26diagnosis to be made by one professional for that geographic area. This exception must be
247.27limited to a specific period of time until, with stakeholder input as described in subdivision
247.288, there is a determination of an adequate number of professionals available to require two
247.29professionals for each diagnosis.
247.30    Subd. 5. Diagnostic assessment. The following information and assessments must
247.31be performed, reviewed, and relied upon for the eligibility determination, treatment and
247.32services recommendations, and treatment plan development for the child:
247.33    (1) an assessment of the child's developmental skills, functional behavior, needs, and
247.34capacities based on direct observation of the child which must be administered by a licensed
247.35mental health professional and may also include observations from family members,
247.36school personnel, child care providers, or other caregivers, as well as any medical or
248.1assessment information from other licensed professionals such as the child's physician,
248.2rehabilitation therapists, licensed school personnel, or mental health professionals; and
248.3    (2) an assessment of parental or caregiver capacity to participate in therapy including
248.4the type and level of parental or caregiver involvement and training recommended.
248.5    Subd. 6. Treatment plan. (a) Each child's treatment plan must be:
248.6    (1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
248.7    (2) coordinated with medically necessary occupational, physical, and speech and
248.8language therapies, special education, and other services the child and family are receiving;
248.9    (3) family-centered;
248.10    (4) culturally sensitive; and
248.11    (5) individualized based on the child's developmental status and the child's and
248.12family's identified needs.
248.13    (b) The treatment plan must specify the:
248.14    (1) child's goals which are developmentally appropriate, functional, and
248.15generalizable;
248.16    (2) treatment modality;
248.17    (3) treatment intensity;
248.18    (4) setting; and
248.19    (5) level and type of parental or caregiver involvement.
248.20    (c) The treatment must be supervised by a professional with expertise and training in
248.21autism and child development who is a licensed physician, advanced practice registered
248.22nurse, or mental health professional.
248.23    (d) The treatment plan must be submitted to the commissioner for approval in a
248.24manner determined by the commissioner for this purpose.
248.25    (e) Services authorized must be consistent with the child's approved treatment plan.
248.26Services included in the treatment plan must meet all applicable requirements for
248.27medical necessity and coverage.
248.28    Subd. 7. Ongoing eligibility. (a) An independent progress evaluation conducted
248.29by a licensed mental health professional with expertise and training in autism spectrum
248.30disorder and child development must be completed after each six months of treatment,
248.31or more frequently as determined by the commissioner, to determine if progress is being
248.32made toward achieving generalizable goals and meeting functional goals contained in
248.33the treatment plan.
248.34    (b) The progress evaluation must include:
248.35    (1) the treating provider's report;
248.36    (2) parental or caregiver input;
249.1    (3) an independent observation of the child which can be performed by the child's
249.2licensed special education staff;
249.3    (4) any treatment plan modifications; and
249.4    (5) recommendations for continued treatment services.
249.5    (c) Progress evaluations must be submitted to the commissioner in a manner
249.6determined by the commissioner for this purpose.
249.7    (d) A child who continues to achieve generalizable goals and treatment goals as
249.8specified in the treatment plan is eligible to continue receiving this benefit.
249.9    (e) A child's treatment shall continue during the progress evaluation using the
249.10process determined under subdivision 8, clause (8). Treatment may continue during an
249.11appeal pursuant to section 256.045.
249.12    Subd. 8. Refining the benefit with stakeholders. The commissioner must develop
249.13the implementation details of the benefit in consultation with stakeholders and consider
249.14recommendations from the Health Services Advisory Council, the Department of Human
249.15Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum
249.16Disorder Task Force, and the Interagency Task Force of the Departments of Health,
249.17Education, and Human Services. The commissioner must release these details for a 30-day
249.18public comment period prior to submission to the federal government for approval. The
249.19implementation details must include, but are not limited to, the following components:
249.20    (1) a definition of the qualifications, standards, and roles of the treatment team,
249.21including recommendations after stakeholder consultation on whether board-certified
249.22behavior analysts and other types of professionals trained in autism spectrum disorder and
249.23child development should be added as mental health or other professionals for treatment
249.24supervision or other functions under medical assistance;
249.25    (2) development of initial, uniform parameters for comprehensive multidisciplinary
249.26diagnostic assessment information and progress evaluation standards;
249.27    (3) the design of an effective and consistent process for assessing parent and
249.28caregiver capacity to participate in the child's early intervention treatment and methods of
249.29involving the parents and caregivers in the treatment of the child;
249.30    (4) formulation of a collaborative process in which professionals have opportunities
249.31to collectively inform a comprehensive, multidisciplinary diagnostic assessment and
249.32progress evaluation processes and standards to support quality improvement of early
249.33intensive intervention services;
249.34    (5) coordination of this benefit and its interaction with other services provided by the
249.35Departments of Human Services, Health, and Education;
250.1    (6) evaluation, on an ongoing basis, of research regarding the program and treatment
250.2modalities provided to children under this benefit;
250.3    (7) determination of the availability of licensed physicians, nurse practitioners,
250.4and mental health professionals with expertise and training in autism spectrum disorder
250.5throughout the state to assess whether there are sufficient professionals to require
250.6involvement of both a physician or nurse practitioner and a mental health professional to
250.7provide access and prevent delay in the diagnosis and treatment of young children, so as to
250.8implement subdivision 4, and to ensure treatment is effective, timely, and accessible; and
250.9(8) development of the process for the progress evaluation that will be used to
250.10determine the ongoing eligibility, including necessary documentation, timelines, and
250.11responsibilities of all parties.
250.12    Subd. 9. Revision of treatment options. (a) The commissioner may revise covered
250.13treatment options as needed based on outcome data and other evidence.
250.14    (b) Before the changes become effective, the commissioner must provide public
250.15notice of the changes, the reasons for the change, and a 30-day public comment period
250.16to those who request notice through an electronic list accessible to the public on the
250.17department's Web site.
250.18    Subd. 10. Coordination between agencies. The commissioners of human services
250.19and education must develop the capacity to coordinate services and information including
250.20diagnostic, functional, developmental, medical, and educational assessments; service
250.21delivery; and progress evaluations across health and education sectors.
250.22    Subd. 11. Federal approval of the autism benefit. The provisions of subdivision 9
250.23shall apply to state plan services under Title XIX of the Social Security Act when federal
250.24approval is granted under a 1915(i) waiver or other authority which allows children
250.25eligible for medical assistance through the TEFRA option under section 256B.055,
250.26subdivision 12, to qualify and includes children eligible for medical assistance in families
250.27over 150 percent of the federal poverty guidelines.
250.28EFFECTIVE DATE.Subdivisions 1 to 7 and 9, are effective upon federal approval
250.29consistent with subdivision 11, but no earlier than March 1, 2014. Subdivisions 8, 10,
250.30and 11 are effective July 1, 2013.

250.31    Sec. 15. Minnesota Statutes 2012, section 256B.095, is amended to read:
250.32256B.095 QUALITY ASSURANCE SYSTEM ESTABLISHED.
250.33    (a) Effective July 1, 1998, a quality assurance system for persons with developmental
250.34disabilities, which includes an alternative quality assurance licensing system for programs,
251.1is established in Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice,
251.2Steele, Wabasha, and Winona Counties for the purpose of improving the quality of
251.3services provided to persons with developmental disabilities. A county, at its option, may
251.4choose to have all programs for persons with developmental disabilities located within
251.5the county licensed under chapter 245A using standards determined under the alternative
251.6quality assurance licensing system or may continue regulation of these programs under the
251.7licensing system operated by the commissioner. The project expires on June 30, 2014.
251.8    (b) Effective July 1, 2003, a county not listed in paragraph (a) may apply to
251.9participate in the quality assurance system established under paragraph (a). The
251.10commission established under section 256B.0951 may, at its option, allow additional
251.11counties to participate in the system.
251.12    (c) Effective July 1, 2003, any county or group of counties not listed in paragraph (a)
251.13may establish a quality assurance system under this section. A new system established
251.14under this section shall have the same rights and duties as the system established
251.15under paragraph (a). A new system shall be governed by a commission under section
251.16256B.0951 . The commissioner shall appoint the initial commission members based
251.17on recommendations from advocates, families, service providers, and counties in the
251.18geographic area included in the new system. Counties that choose to participate in a
251.19new system shall have the duties assigned under section 256B.0952. The new system
251.20shall establish a quality assurance process under section 256B.0953. The provisions of
251.21section 256B.0954 shall apply to a new system established under this paragraph. The
251.22commissioner shall delegate authority to a new system established under this paragraph
251.23according to section 256B.0955.
251.24    (d) Effective July 1, 2007, the quality assurance system may be expanded to include
251.25programs for persons with disabilities and older adults.
251.26(e) Effective July 1, 2013, a provider of service located in a county listed in
251.27paragraph (a) that is a non-opted-in county may opt in to the quality assurance system
251.28provided the county where services are provided indicates its agreement with a county
251.29with a delegation agreement with the Department of Human Services.
251.30EFFECTIVE DATE.This section is effective July 1, 2013.

251.31    Sec. 16. Minnesota Statutes 2012, section 256B.0951, subdivision 1, is amended to read:
251.32    Subdivision 1. Membership. The Quality Assurance Commission is established.
251.33The commission consists of at least 14 but not more than 21 members as follows: at
251.34least three but not more than five members representing advocacy organizations; at
251.35least three but not more than five members representing consumers, families, and their
252.1legal representatives; at least three but not more than five members representing service
252.2providers; at least three but not more than five members representing counties; and the
252.3commissioner of human services or the commissioner's designee. The first commission
252.4shall establish membership guidelines for the transition and recruitment of membership for
252.5the commission's ongoing existence. Members of the commission who do not receive a
252.6salary or wages from an employer for time spent on commission duties may receive a per
252.7diem payment when performing commission duties and functions. All members may be
252.8reimbursed for expenses related to commission activities. Notwithstanding the provisions
252.9of section 15.059, subdivision 5, the commission expires on June 30, 2014.

252.10    Sec. 17. Minnesota Statutes 2012, section 256B.0951, subdivision 4, is amended to read:
252.11    Subd. 4. Commission's authority to recommend variances of licensing
252.12standards. The commission may recommend to the commissioners of human services
252.13and health variances from the standards governing licensure of programs for persons with
252.14developmental disabilities in order to improve the quality of services by implementing
252.15an alternative developmental disabilities licensing system if the commission determines
252.16that the alternative licensing system does not adversely affect the health or safety of
252.17persons being served by the licensed program nor compromise the qualifications of staff
252.18to provide services.

252.19    Sec. 18. Minnesota Statutes 2012, section 256B.0952, subdivision 1, is amended to read:
252.20    Subdivision 1. Notification. Counties or providers shall give notice to the
252.21commission and commissioners of human services and health of intent to join the
252.22alternative quality assurance licensing system. A county or provider choosing to participate
252.23in the alternative quality assurance licensing system commits to participate for three years.

252.24    Sec. 19. Minnesota Statutes 2012, section 256B.0952, subdivision 5, is amended to read:
252.25    Subd. 5. Quality assurance teams. Quality assurance teams shall be comprised
252.26of county staff; providers; consumers, families, and their legal representatives; members
252.27of advocacy organizations; and other involved community members. Team members
252.28must satisfactorily complete the training program approved by the commission and must
252.29demonstrate performance-based competency. Team members are not considered to be
252.30county employees for purposes of workers' compensation, unemployment insurance, or
252.31state retirement laws solely on the basis of participation on a quality assurance team. The
252.32county may pay A per diem may be paid to team members for time spent on alternative
253.1quality assurance process matters. All team members may be reimbursed for expenses
253.2related to their participation in the alternative process.

253.3    Sec. 20. Minnesota Statutes 2012, section 256B.0955, is amended to read:
253.4256B.0955 DUTIES OF THE COMMISSIONER OF HUMAN SERVICES.
253.5(a) Effective July 1, 1998, the commissioner of human services shall delegate
253.6authority to perform licensing functions and activities, in accordance with section
253.7245A.16 , to counties participating in the alternative quality assurance licensing system.
253.8The commissioner shall not license or reimburse a facility, program, or service for persons
253.9with developmental disabilities in a county that participates in the alternative quality
253.10assurance licensing system if the commissioner has received from the appropriate county
253.11notification that the facility, program, or service has been reviewed by a quality assurance
253.12team and has failed to qualify for licensure.
253.13(b) The commissioner may conduct random licensing inspections based on outcomes
253.14adopted under section 256B.0951 at facilities, programs, and services governed by the
253.15alternative quality assurance licensing system. The role of such random inspections shall
253.16be to verify that the alternative quality assurance licensing system protects the safety
253.17and well-being of consumers and maintains the availability of high-quality services for
253.18persons with developmental disabilities.
253.19EFFECTIVE DATE.This section is effective July 1, 2013.

253.20    Sec. 21. Minnesota Statutes 2012, section 256B.097, subdivision 1, is amended to read:
253.21    Subdivision 1. Scope. (a) In order to improve the quality of services provided to
253.22Minnesotans with disabilities and to meet the requirements of the federally approved home
253.23and community-based waivers under section 1915c of the Social Security Act, a State
253.24Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving
253.25disability services is enacted. This system is a partnership between the Department of
253.26Human Services and the State Quality Council established under subdivision 3.
253.27    (b) This system is a result of the recommendations from the Department of Human
253.28Services' licensing and alternative quality assurance study mandated under Laws 2005,
253.29First Special Session chapter 4, article 7, section 57, and presented to the legislature
253.30in February 2007.
253.31    (c) The disability services eligible under this section include:
253.32    (1) the home and community-based services waiver programs for persons with
253.33developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
254.1including brain injuries and services for those who qualify for nursing facility level of care
254.2or hospital facility level of care and any other services licensed under chapter 245D;
254.3    (2) home care services under section 256B.0651;
254.4    (3) family support grants under section 252.32;
254.5    (4) consumer support grants under section 256.476;
254.6    (5) semi-independent living services under section 252.275; and
254.7    (6) services provided through an intermediate care facility for the developmentally
254.8disabled.
254.9    (d) For purposes of this section, the following definitions apply:
254.10    (1) "commissioner" means the commissioner of human services;
254.11    (2) "council" means the State Quality Council under subdivision 3;
254.12    (3) "Quality Assurance Commission" means the commission under section
254.13256B.0951 ; and
254.14    (4) "system" means the State Quality Assurance, Quality Improvement and
254.15Licensing System under this section.

254.16    Sec. 22. Minnesota Statutes 2012, section 256B.097, subdivision 3, is amended to read:
254.17    Subd. 3. State Quality Council. (a) There is hereby created a State Quality
254.18Council which must define regional quality councils, and carry out a community-based,
254.19person-directed quality review component, and a comprehensive system for effective
254.20incident reporting, investigation, analysis, and follow-up.
254.21    (b) By August 1, 2011, the commissioner of human services shall appoint the
254.22members of the initial State Quality Council. Members shall include representatives
254.23from the following groups:
254.24    (1) disability service recipients and their family members;
254.25    (2) during the first two four years of the State Quality Council, there must be at least
254.26three members from the Region 10 stakeholders. As regional quality councils are formed
254.27under subdivision 4, each regional quality council shall appoint one member;
254.28    (3) disability service providers;
254.29    (4) disability advocacy groups; and
254.30    (5) county human services agencies and staff from the Department of Human
254.31Services and Ombudsman for Mental Health and Developmental Disabilities.
254.32    (c) Members of the council who do not receive a salary or wages from an employer
254.33for time spent on council duties may receive a per diem payment when performing council
254.34duties and functions.
254.35    (d) The State Quality Council shall:
255.1    (1) assist the Department of Human Services in fulfilling federally mandated
255.2obligations by monitoring disability service quality and quality assurance and
255.3improvement practices in Minnesota;
255.4    (2) establish state quality improvement priorities with methods for achieving results
255.5and provide an annual report to the legislative committees with jurisdiction over policy
255.6and funding of disability services on the outcomes, improvement priorities, and activities
255.7undertaken by the commission during the previous state fiscal year;
255.8(3) identify issues pertaining to financial and personal risk that impede Minnesotans
255.9with disabilities from optimizing choice of community-based services; and
255.10(4) recommend to the chairs and ranking minority members of the legislative
255.11committees with jurisdiction over human services and civil law by January 15, 2013
255.12 2014, statutory and rule changes related to the findings under clause (3) that promote
255.13individualized service and housing choices balanced with appropriate individualized
255.14protection.
255.15    (e) The State Quality Council, in partnership with the commissioner, shall:
255.16    (1) approve and direct implementation of the community-based, person-directed
255.17system established in this section;
255.18    (2) recommend an appropriate method of funding this system, and determine the
255.19feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;
255.20    (3) approve measurable outcomes in the areas of health and safety, consumer
255.21evaluation, education and training, providers, and systems;
255.22    (4) establish variable licensure periods not to exceed three years based on outcomes
255.23achieved; and
255.24    (5) in cooperation with the Quality Assurance Commission, design a transition plan
255.25for licensed providers from Region 10 into the alternative licensing system by July 1, 2013.
255.26    (f) The State Quality Council shall notify the commissioner of human services that a
255.27facility, program, or service has been reviewed by quality assurance team members under
255.28subdivision 4, paragraph (b), clause (13), and qualifies for a license.
255.29    (g) The State Quality Council, in partnership with the commissioner, shall establish
255.30an ongoing review process for the system. The review shall take into account the
255.31comprehensive nature of the system which is designed to evaluate the broad spectrum of
255.32licensed and unlicensed entities that provide services to persons with disabilities. The
255.33review shall address efficiencies and effectiveness of the system.
255.34    (h) The State Quality Council may recommend to the commissioner certain
255.35variances from the standards governing licensure of programs for persons with disabilities
255.36in order to improve the quality of services so long as the recommended variances do
256.1not adversely affect the health or safety of persons being served or compromise the
256.2qualifications of staff to provide services.
256.3    (i) The safety standards, rights, or procedural protections referenced under
256.4subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make
256.5recommendations to the commissioner or to the legislature in the report required under
256.6paragraph (c) regarding alternatives or modifications to the safety standards, rights, or
256.7procedural protections referenced under subdivision 2, paragraph (c).
256.8    (j) The State Quality Council may hire staff to perform the duties assigned in this
256.9subdivision.

256.10    Sec. 23. Minnesota Statutes 2012, section 256B.431, subdivision 44, is amended to read:
256.11    Subd. 44. Property rate increase increases for a facility in Bloomington effective
256.12November 1, 2010 certain nursing facilities. (a) Notwithstanding any other law to the
256.13contrary, money available for moratorium projects under section 144A.073, subdivision
256.1411 , shall be used, effective November 1, 2010, to fund an approved moratorium exception
256.15project for a nursing facility in Bloomington licensed for 137 beds as of November 1,
256.162010, up to a total property rate adjustment of $19.33.
256.17(b) Effective June 1, 2012, any nursing facility in McLeod County licensed for 110
256.18beds shall have its replacement-cost-new limit under subdivision 17e adjusted to allow
256.19$1,129,463 of a completed construction project to increase the property payment rate.
256.20Notwithstanding any other law to the contrary, money available under section 144A.073,
256.21subdivision 11, after the completion of the moratorium exception approval process in 2013
256.22under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to the
256.23medical assistance budget for the increase in the replacement-cost-new limit.
256.24(c) Effective July 1, 2012, any nursing facility in Dakota County licensed for
256.2561 beds shall have their replacement-cost-new limit under subdivision 17e adjusted to
256.26allow $1,407,624 of a completed construction project to increase their property payment
256.27rate. Effective September 1, 2013, or later, their replacement-cost-new limit under
256.28subdivision 17e shall be adjusted to allow $1,244,599 of a completed construction project
256.29to increase the property payment rate. Notwithstanding any other law to the contrary,
256.30money available under section 144A.073, subdivision 11, after the completion of the
256.31moratorium exception approval process in 2013 under section 144A.073, subdivision 3,
256.32shall be used to reduce the fiscal impact to the medical assistance budget for the increase
256.33in the replacement-cost-new limit.
256.34    (d) Effective July 1, 2013, or later, any boarding care facility in Hennepin
256.35County licensed for 101 beds shall be allowed to receive a property rate adjustment
257.1for a construction project that takes action to come into compliance with Minnesota
257.2Department of Labor and Industry elevator upgrade requirements, with costs below the
257.3minimum threshold under subdivision 16. Only costs related to the construction project
257.4that brings the facility into compliance with the elevator requirements shall be allowed.
257.5Notwithstanding any other law to the contrary, money available under section 144A.073,
257.6subdivision 11, after the completion of the moratorium exception approval process in
257.72013 under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to
257.8the medical assistance program.
257.9EFFECTIVE DATE.Paragraph (b) is effective retroactively from June 1, 2012.
257.10Paragraph (c) is effective retroactively from July 1, 2012.

257.11    Sec. 24. Minnesota Statutes 2012, section 256B.434, subdivision 4, is amended to read:
257.12    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which
257.13have their payment rates determined under this section rather than section 256B.431, the
257.14commissioner shall establish a rate under this subdivision. The nursing facility must enter
257.15into a written contract with the commissioner.
257.16    (b) A nursing facility's case mix payment rate for the first rate year of a facility's
257.17contract under this section is the payment rate the facility would have received under
257.18section 256B.431.
257.19    (c) A nursing facility's case mix payment rates for the second and subsequent years
257.20of a facility's contract under this section are the previous rate year's contract payment
257.21rates plus an inflation adjustment and, for facilities reimbursed under this section or
257.22section 256B.431, an adjustment to include the cost of any increase in Health Department
257.23licensing fees for the facility taking effect on or after July 1, 2001. The index for the
257.24inflation adjustment must be based on the change in the Consumer Price Index-All Items
257.25(United States City average) (CPI-U) forecasted by the commissioner of management and
257.26budget's national economic consultant, as forecasted in the fourth quarter of the calendar
257.27year preceding the rate year. The inflation adjustment must be based on the 12-month
257.28period from the midpoint of the previous rate year to the midpoint of the rate year for
257.29which the rate is being determined. For the rate years beginning on July 1, 1999, July 1,
257.302000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006,
257.31July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall
257.32apply only to the property-related payment rate. For the rate years beginning on October
257.331, 2011, and October 1, 2012, October 1, 2013, October 1, 2014, October 1, 2015, and
257.34October 1, 2016, the rate adjustment under this paragraph shall be suspended. Beginning
257.35in 2005, adjustment to the property payment rate under this section and section 256B.431
258.1shall be effective on October 1. In determining the amount of the property-related payment
258.2rate adjustment under this paragraph, the commissioner shall determine the proportion of
258.3the facility's rates that are property-related based on the facility's most recent cost report.
258.4    (d) The commissioner shall develop additional incentive-based payments of up to
258.5five percent above a facility's operating payment rate for achieving outcomes specified
258.6in a contract. The commissioner may solicit contract amendments and implement those
258.7which, on a competitive basis, best meet the state's policy objectives. The commissioner
258.8shall limit the amount of any incentive payment and the number of contract amendments
258.9under this paragraph to operate the incentive payments within funds appropriated for this
258.10purpose. The contract amendments may specify various levels of payment for various
258.11levels of performance. Incentive payments to facilities under this paragraph may be in the
258.12form of time-limited rate adjustments or onetime supplemental payments. In establishing
258.13the specified outcomes and related criteria, the commissioner shall consider the following
258.14state policy objectives:
258.15    (1) successful diversion or discharge of residents to the residents' prior home or other
258.16community-based alternatives;
258.17    (2) adoption of new technology to improve quality or efficiency;
258.18    (3) improved quality as measured in the Nursing Home Report Card;
258.19    (4) reduced acute care costs; and
258.20    (5) any additional outcomes proposed by a nursing facility that the commissioner
258.21finds desirable.
258.22    (e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
258.23take action to come into compliance with existing or pending requirements of the life
258.24safety code provisions or federal regulations governing sprinkler systems must receive
258.25reimbursement for the costs associated with compliance if all of the following conditions
258.26are met:
258.27    (1) the expenses associated with compliance occurred on or after January 1, 2005,
258.28and before December 31, 2008;
258.29    (2) the costs were not otherwise reimbursed under subdivision 4f or section
258.30144A.071 or 144A.073; and
258.31    (3) the total allowable costs reported under this paragraph are less than the minimum
258.32threshold established under section 256B.431, subdivision 15, paragraph (e), and
258.33subdivision 16.
258.34The commissioner shall use money appropriated for this purpose to provide to qualifying
258.35nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
258.362008. Nursing facilities that have spent money or anticipate the need to spend money
259.1to satisfy the most recent life safety code requirements by (1) installing a sprinkler
259.2system or (2) replacing all or portions of an existing sprinkler system may submit to the
259.3commissioner by June 30, 2007, on a form provided by the commissioner the actual
259.4costs of a completed project or the estimated costs, based on a project bid, of a planned
259.5project. The commissioner shall calculate a rate adjustment equal to the allowable
259.6costs of the project divided by the resident days reported for the report year ending
259.7September 30, 2006. If the costs from all projects exceed the appropriation for this
259.8purpose, the commissioner shall allocate the money appropriated on a pro rata basis to the
259.9qualifying facilities by reducing the rate adjustment determined for each facility by an
259.10equal percentage. Facilities that used estimated costs when requesting the rate adjustment
259.11shall report to the commissioner by January 31, 2009, on the use of this money on a
259.12form provided by the commissioner. If the nursing facility fails to provide the report, the
259.13commissioner shall recoup the money paid to the facility for this purpose. If the facility
259.14reports expenditures allowable under this subdivision that are less than the amount received
259.15in the facility's annualized rate adjustment, the commissioner shall recoup the difference.

259.16    Sec. 25. Minnesota Statutes 2012, section 256B.434, is amended by adding a
259.17subdivision to read:
259.18    Subd. 19a. Nursing facility rate adjustments beginning September 1, 2013. A
259.19total of a five percent average rate adjustment shall be provided as described under this
259.20subdivision and under section 256B.441, subdivision 46b.
259.21(a) Beginning September 1, 2013, the commissioner shall make available to each
259.22nursing facility reimbursed under this section a 3.75 percent operating payment rate
259.23increase, in accordance with paragraphs (b) to (g).
259.24(b) Seventy-five percent of the money resulting from the rate adjustment under
259.25paragraph (a) must be used for increases in compensation-related costs for employees
259.26directly employed by the nursing facility on or after the effective date of the rate
259.27adjustment, except:
259.28(1) the administrator;
259.29(2) persons employed in the central office of a corporation that has an ownership
259.30interest in the nursing facility or exercises control over the nursing facility; and
259.31(3) persons paid by the nursing facility under a management contract.
259.32(c) The commissioner shall allow as compensation-related costs all costs for:
259.33(1) wage and salary increases effective after May 25, 2013;
259.34(2) the employer's share of FICA taxes, Medicare taxes, state and federal
259.35unemployment taxes, and workers' compensation;
260.1(3) the employer's share of health and dental insurance, life insurance, disability
260.2insurance, long-term care insurance, uniform allowance, and pensions; and
260.3(4) other benefits provided and workforce needs, including the recruiting and
260.4training of employees, subject to the approval of the commissioner.
260.5(d) The portion of the rate adjustment under paragraph (a) that is not subject to the
260.6requirements of paragraph (b) shall be provided to nursing facilities effective September 1,
260.72013. Nursing facilities may apply for the portion of the rate adjustment under paragraph
260.8(a) that is subject to the requirements in paragraph (b). The application must be submitted
260.9to the commissioner within six months of the effective date of the rate adjustment, and
260.10the nursing facility must provide additional information required by the commissioner
260.11within nine months of the effective date of the rate adjustment. The commissioner must
260.12respond to all applications within three weeks of receipt. The commissioner may waive
260.13the deadlines in this paragraph under extraordinary circumstances, to be determined at the
260.14sole discretion of the commissioner. The application must contain:
260.15(1) an estimate of the amounts of money that must be used as specified in paragraph
260.16(b);
260.17(2) a detailed distribution plan specifying the allowable compensation-related
260.18increases the nursing facility will implement to use the funds available in clause (1);
260.19(3) a description of how the nursing facility will notify eligible employees of
260.20the contents of the approved application, which must provide for giving each eligible
260.21employee a copy of the approved application, excluding the information required in clause
260.22(1), or posting a copy of the approved application, excluding the information required in
260.23clause (1), for a period of at least six weeks in an area of the nursing facility to which all
260.24eligible employees have access; and
260.25(4) instructions for employees who believe they have not received the
260.26compensation-related increases specified in clause (2), as approved by the commissioner,
260.27and which must include a mailing address, e-mail address, and the telephone number
260.28that may be used by the employee to contact the commissioner or the commissioner's
260.29representative.
260.30(e) The commissioner shall ensure that cost increases in distribution plans under
260.31paragraph (d), clause (2), that may be included in approved applications, comply with the
260.32following requirements:
260.33(1) a portion of the costs resulting from tenure-related wage or salary increases
260.34may be considered to be allowable wage increases, according to formulas that the
260.35commissioner shall provide, where employee retention is above the average statewide
260.36rate of retention of direct-care employees;
261.1(2) the annualized amount of increases in costs for the employer's share of health
261.2and dental insurance, life insurance, disability insurance, and workers' compensation
261.3shall be allowable compensation-related increases if they are effective on or after April
261.41, 2013, and prior to April 1, 2014; and
261.5(3) for nursing facilities in which employees are represented by an exclusive
261.6bargaining representative, the commissioner shall approve the application only upon
261.7receipt of a letter of acceptance of the distribution plan, in regard to members of the
261.8bargaining unit, signed by the exclusive bargaining agent, and dated after May 25, 2013.
261.9Upon receipt of the letter of acceptance, the commissioner shall deem all requirements of
261.10this provision as having been met in regard to the members of the bargaining unit.
261.11(f) The commissioner shall review applications received under paragraph (d) and
261.12shall provide the portion of the rate adjustment under paragraph (b) if the requirements
261.13of this statute have been met. The rate adjustment shall be effective September 1, 2013.
261.14Notwithstanding paragraph (a), if the approved application distributes less money than is
261.15available, the amount of the rate adjustment shall be reduced so that the amount of money
261.16made available is equal to the amount to be distributed.
261.17(g) The increase in this subdivision shall be applied as a percentage to operating
261.18payment rates in effect on August 31, 2013. For each facility, the commissioner shall
261.19determine the operating payment rate, not including any rate components resulting from
261.20equitable cost-sharing for publicly owned nursing facility program participation under
261.21section 256B.441, subdivision 55a, critical access nursing facility program participation
261.22under section 256B.441, subdivision 63, or performance-based incentive payment
261.23program participation under subdivision 4, paragraph (d), for a RUG class with a weight
261.24of 1.00 in effect on August 31, 2013.

261.25    Sec. 26. Minnesota Statutes 2012, section 256B.434, is amended by adding a
261.26subdivision to read:
261.27    Subd. 19b. Nursing facility rate adjustments beginning October 1, 2015. A
261.28total of a 3.2 percent average rate adjustment shall be provided as described under this
261.29subdivision and under section 256B.441, subdivision 46c.
261.30(a) Beginning October 1, 2015, the commissioner shall make available to each
261.31nursing facility reimbursed under this section a 2.4 percent operating payment rate
261.32increase, in accordance with paragraphs (b) to (g).
261.33(b) Seventy-five percent of the money resulting from the rate adjustment under
261.34paragraph (a) must be used for increases in compensation-related costs for employees
262.1directly employed by the nursing facility on or after the effective date of the rate
262.2adjustment, except:
262.3(1) the administrator;
262.4(2) persons employed in the central office of a corporation that has an ownership
262.5interest in the nursing facility or exercises control over the nursing facility; and
262.6(3) persons paid by the nursing facility under a management contract.
262.7(c) The commissioner shall allow as compensation-related costs all costs for:
262.8(1) wage and salary increases effective after May 25, 2015;
262.9(2) the employer's share of FICA taxes, Medicare taxes, state and federal
262.10unemployment taxes, and workers' compensation;
262.11(3) the employer's share of health and dental insurance, life insurance, disability
262.12insurance, long-term care insurance, uniform allowance, and pensions; and
262.13(4) other benefits provided and workforce needs, including the recruiting and
262.14training of employees, subject to the approval of the commissioner.
262.15(d) The portion of the rate adjustment under paragraph (a) that is not subject to the
262.16requirements of paragraph (b) shall be provided to nursing facilities effective October 1,
262.172015. Nursing facilities may apply for the portion of the rate adjustment under paragraph
262.18(a) that is subject to the requirements in paragraph (b). The application must be submitted
262.19to the commissioner within six months of the effective date of the rate adjustment, and
262.20the nursing facility must provide additional information required by the commissioner
262.21within nine months of the effective date of the rate adjustment. The commissioner must
262.22respond to all applications within three weeks of receipt. The commissioner may waive
262.23the deadlines in this paragraph under extraordinary circumstances, to be determined at the
262.24sole discretion of the commissioner. The application must contain:
262.25(1) an estimate of the amounts of money that must be used as specified in paragraph
262.26(b);
262.27(2) a detailed distribution plan specifying the allowable compensation-related
262.28increases the nursing facility will implement to use the funds available in clause (1);
262.29(3) a description of how the nursing facility will notify eligible employees of
262.30the contents of the approved application, which must provide for giving each eligible
262.31employee a copy of the approved application, excluding the information required in clause
262.32(1), or posting a copy of the approved application, excluding the information required in
262.33clause (1), for a period of at least six weeks in an area of the nursing facility to which all
262.34eligible employees have access; and
262.35(4) instructions for employees who believe they have not received the
262.36compensation-related increases specified in clause (2), as approved by the commissioner,
263.1and which must include a mailing address, e-mail address, and the telephone number
263.2that may be used by the employee to contact the commissioner or the commissioner's
263.3representative.
263.4(e) The commissioner shall ensure that cost increases in distribution plans under
263.5paragraph (d), clause (2), that may be included in approved applications, comply with the
263.6following requirements:
263.7(1) a portion of the costs resulting from tenure-related wage or salary increases
263.8may be considered to be allowable wage increases, according to formulas that the
263.9commissioner shall provide, where employee retention is above the average statewide
263.10rate of retention of direct-care employees;
263.11(2) the annualized amount of increases in costs for the employer's share of health
263.12and dental insurance, life insurance, disability insurance, and workers' compensation
263.13shall be allowable compensation-related increases if they are effective on or after April
263.141, 2015, and prior to April 1, 2016; and
263.15(3) for nursing facilities in which employees are represented by an exclusive
263.16bargaining representative, the commissioner shall approve the application only upon
263.17receipt of a letter of acceptance of the distribution plan, in regard to members of the
263.18bargaining unit, signed by the exclusive bargaining agent and dated after May 25, 2015.
263.19Upon receipt of the letter of acceptance, the commissioner shall deem all requirements of
263.20this provision as having been met in regard to the members of the bargaining unit.
263.21(f) The commissioner shall review applications received under paragraph (d) and
263.22shall provide the portion of the rate adjustment under paragraph (b) if the requirements
263.23of this statute have been met. The rate adjustment shall be effective October 1, 2015.
263.24Notwithstanding paragraph (a), if the approved application distributes less money than is
263.25available, the amount of the rate adjustment shall be reduced so that the amount of money
263.26made available is equal to the amount to be distributed.
263.27(g) The increase in this subdivision shall be applied as a percentage to operating
263.28payment rates in effect on September 30, 2015. For each facility, the commissioner shall
263.29determine the operating payment rate, not including any rate components resulting from
263.30equitable cost-sharing for publicly owned nursing facility program participation under
263.31section 256B.441, subdivision 55a, critical access nursing facility program participation
263.32under section 256B.441, subdivision 63, or performance-based incentive payment
263.33program participation under subdivision 4, paragraph (d), for a RUG class with a weight
263.34of 1.00 in effect on September 30, 2015.

263.35    Sec. 27. Minnesota Statutes 2012, section 256B.437, subdivision 6, is amended to read:
264.1    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human
264.2services shall calculate the amount of the planned closure rate adjustment available under
264.3subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):
264.4(1) the amount available is the net reduction of nursing facility beds multiplied
264.5by $2,080;
264.6(2) the total number of beds in the nursing facility or facilities receiving the planned
264.7closure rate adjustment must be identified;
264.8(3) capacity days are determined by multiplying the number determined under
264.9clause (2) by 365; and
264.10(4) the planned closure rate adjustment is the amount available in clause (1), divided
264.11by capacity days determined under clause (3).
264.12(b) A planned closure rate adjustment under this section is effective on the first day
264.13of the month following completion of closure of the facility designated for closure in
264.14the application and becomes part of the nursing facility's total operating external fixed
264.15 payment rate.
264.16(c) Applicants may use the planned closure rate adjustment to allow for a property
264.17payment for a new nursing facility or an addition to an existing nursing facility or as an
264.18operating payment rate adjustment. Applications approved under this subdivision are
264.19exempt from other requirements for moratorium exceptions under section 144A.073,
264.20subdivisions 2 and 3.
264.21(d) (c) Upon the request of a closing facility, the commissioner must allow the
264.22facility a closure rate adjustment as provided under section 144A.161, subdivision 10.
264.23(e) (d) A facility that has received a planned closure rate adjustment may reassign it
264.24to another facility that is under the same ownership at any time within three years of its
264.25effective date. The amount of the adjustment shall be computed according to paragraph (a).
264.26(f) (e) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
264.27the commissioner shall recalculate planned closure rate adjustments for facilities that
264.28delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
264.29bed dollar amount. The recalculated planned closure rate adjustment shall be effective
264.30from the date the per bed dollar amount is increased.
264.31(g) (f) For planned closures approved after June 30, 2009, the commissioner of
264.32human services shall calculate the amount of the planned closure rate adjustment available
264.33under subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).
264.34(h) Beginning (g) Between July 16, 2011, and June 30, 2013, the commissioner shall
264.35no longer not accept applications for planned closure rate adjustments under subdivision 3.

265.1    Sec. 28. Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:
265.2    Subdivision 1. Development and implementation of quality profiles. (a) The
265.3commissioner of human services, in cooperation with the commissioner of health,
265.4shall develop and implement a quality profile system profiles for nursing facilities and,
265.5beginning not later than July 1, 2004, other providers of long-term care services 2014, for
265.6home and community-based services providers, except when the quality profile system
265.7would duplicate requirements under section 256B.5011, 256B.5012, or 256B.5013. For
265.8purposes of this section, home and community-based services providers are defined as
265.9providers of home and community-based services under sections 256B.0913, 256B.0915,
265.10256B.092, and 256B.49, and intermediate care facilities for persons with developmental
265.11disabilities providers under section 256B.5013. To the extent possible, quality profiles
265.12must be developed for providers of services to older adults and people with disabilities,
265.13regardless of payor source, for the purposes of providing information to consumers. The
265.14system quality profiles must be developed and implemented to the extent possible without
265.15the collection of significant amounts of new data. To the extent possible, the system
265.16 using existing data sets maintained by the commissioners of health and human services
265.17to the extent possible. The profiles must incorporate or be coordinated with information
265.18on quality maintained by area agencies on aging, long-term care trade associations, the
265.19ombudsman offices, counties, tribes, health plans, and other entities and the long-term
265.20care database maintained under section 256.975, subdivision 7. The system profiles must
265.21be designed to provide information on quality to:
265.22(1) consumers and their families to facilitate informed choices of service providers;
265.23(2) providers to enable them to measure the results of their quality improvement
265.24efforts and compare quality achievements with other service providers; and
265.25(3) public and private purchasers of long-term care services to enable them to
265.26purchase high-quality care.
265.27(b) The system profiles must be developed in consultation with the long-term care
265.28task force, area agencies on aging, and representatives of consumers, providers, and labor
265.29unions. Within the limits of available appropriations, the commissioners may employ
265.30consultants to assist with this project.

265.31    Sec. 29. Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:
265.32    Subd. 2. Quality measurement tools for nursing facilities. The commissioners
265.33shall identify and apply existing quality measurement tools to:
265.34(1) emphasize quality of care and its relationship to quality of life; and
266.1(2) address the needs of various users of long-term care services, including, but not
266.2limited to, short-stay residents, persons with behavioral problems, persons with dementia,
266.3and persons who are members of minority groups.
266.4    The tools must be identified and applied, to the extent possible, without requiring
266.5providers to supply information beyond current state and federal requirements.

266.6    Sec. 30. Minnesota Statutes 2012, section 256B.439, is amended by adding a
266.7subdivision to read:
266.8    Subd. 2a. Quality measurement tools for home and community-based services.
266.9 (a) The commissioners shall identify and apply quality measurement tools to:
266.10(1) emphasize service quality and its relationship to quality of life; and
266.11(2) address the needs of various users of home and community-based services.
266.12(b) The tools must include, but not be limited to, surveys of consumers of home
266.13and community-based services. The tools must be identified and applied, to the extent
266.14possible, without requiring providers to supply information beyond state and federal
266.15requirements, for purposes of this subdivision.

266.16    Sec. 31. Minnesota Statutes 2012, section 256B.439, is amended by adding a
266.17subdivision to read:
266.18    Subd. 3a. Consumer surveys for home and community-based services.
266.19 Following identification of the quality measurement tool, and within the limits of the
266.20appropriation, the commissioner shall conduct surveys of home and community-based
266.21services consumers to develop quality profiles of providers. To the extent possible, surveys
266.22must be conducted face-to-face by state employees or contractors. At the discretion of
266.23the commissioner, surveys may be conducted by an alternative method. Surveys must be
266.24conducted periodically to update quality profiles of individual service providers.

266.25    Sec. 32. Minnesota Statutes 2012, section 256B.439, is amended by adding a
266.26subdivision to read:
266.27    Subd. 5. Implementation of home and community-based services
266.28performance-based incentive payment program. By April 1, 2014, the commissioner
266.29shall develop incentive-based grants for home and community-based services providers
266.30for achieving outcomes specified in a contract. The commissioner may solicit proposals
266.31from home and community-based services providers and implement those that, on
266.32a competitive basis, best meet the state's policy objectives. The commissioner shall
266.33determine the types of home and community-based services providers that will participate
267.1in the program. The determination of participating provider types may be revised annually
267.2by the commissioner. The commissioner shall limit the amount of any incentive-based
267.3grants and the number of grants under this subdivision to operate the incentive payments
267.4within funds appropriated for this purpose. The grant agreements may specify various
267.5levels of payment for various levels of performance. In establishing the specified outcomes
267.6and related criteria, the commissioner shall consider the following state policy objectives:
267.7(1) provide more efficient, higher quality services;
267.8(2) encourage home and community-based services providers to innovate;
267.9(3) equip home and community-based services providers with organizational tools
267.10and expertise to improve their quality;
267.11(4) incentivize home and community-based services providers to invest in better
267.12services; and
267.13(5) disseminate successful performance improvement strategies statewide.

267.14    Sec. 33. Minnesota Statutes 2012, section 256B.439, is amended by adding a
267.15subdivision to read:
267.16    Subd. 6. Calculation of home and community-based services quality score.
267.17 (a) The commissioner shall determine a quality score for each participating home and
267.18community-based services provider using quality measures established in subdivisions
267.191 and 2a, according to methods determined by the commissioner in consultation
267.20with stakeholders and experts. These methods shall be exempt from the rulemaking
267.21requirements under chapter 14.
267.22(b) For each quality measure, a score shall be determined with a maximum number
267.23of points available and number of points assigned as determined by the commissioner
267.24using the methodology established according to this subdivision. The determination of
267.25the quality measures to be used and the methods of calculating scores may be revised
267.26annually be the commissioner.

267.27    Sec. 34. Minnesota Statutes 2012, section 256B.439, is amended by adding a
267.28subdivision to read:
267.29    Subd. 7. Calculation of home and community-based services quality add-on.
267.30 Effective July 1, 2015, the commissioner shall determine the quality add-on payment
267.31for participating home and community-based services providers. The payment rate for
267.32the quality add-on shall be a variable amount based on each provider's quality score as
267.33determined in subdivisions 1 and 2a. The commissioner shall limit the types of home and
267.34community-based services providers that may receive the quality add-on and the amount
268.1of the quality add-on payments to operate the quality add-on within funds appropriated for
268.2this purpose and based on the availability of the quality measures.

268.3    Sec. 35. Minnesota Statutes 2012, section 256B.441, subdivision 44, is amended to read:
268.4    Subd. 44. Calculation of a quality score. (a) The commissioner shall determine
268.5a quality score for each nursing facility using quality measures established in section
268.6256B.439 , according to methods determined by the commissioner in consultation
268.7with stakeholders and experts. These methods shall be exempt from the rulemaking
268.8requirements under chapter 14.
268.9(b) For each quality measure, a score shall be determined with a maximum number
268.10of points available and number of points assigned as determined by the commissioner
268.11using the methodology established according to this subdivision. The scores determined
268.12for all quality measures shall be totaled. The determination of the quality measures to be
268.13used and the methods of calculating scores may be revised annually by the commissioner.
268.14(c) For the initial rate year under the new payment system, the quality measures
268.15shall include:
268.16(1) staff turnover;
268.17(2) staff retention;
268.18(3) use of pool staff;
268.19(4) quality indicators from the minimum data set; and
268.20(5) survey deficiencies.
268.21(d) For rate years beginning after October 1, 2006, when making revisions to the
268.22quality measures or method for calculating scores, the commissioner shall publish the
268.23methodology in the State Register at least 15 months prior to the start of the rate year for
268.24which the revised methodology is to be used for rate-setting purposes. The quality score
268.25used to determine payment rates shall be established for a rate year using data submitted
268.26in the statistical and cost report from the associated reporting year, and using data from
268.27other sources related to a period beginning no more than six months prior to the associated
268.28reporting year Beginning July 1, 2013, the quality score shall be a value between zero and
268.29100, using data as provided in the Minnesota nursing home report card, with 50 percent
268.30derived from the Minnesota quality indicators score, 40 percent derived from the resident
268.31quality of life score, and ten percent derived from the state inspection results score.
268.32(e) The commissioner, in cooperation with the commissioner of health, may adjust
268.33the formula in paragraph (d), or the methodology for computing the total quality score,
268.34effective July 1 of any year beginning in 2014, with five months advance public notice.
269.1In changing the formula, the commissioner shall consider quality measure priorities
269.2registered by report card users, advise of stakeholders, and available research.

269.3    Sec. 36. Minnesota Statutes 2012, section 256B.441, is amended by adding a
269.4subdivision to read:
269.5    Subd. 46b. Calculation of quality add-on, with an average value of 1.25 percent,
269.6effective September 1, 2013. (a) The commissioner shall determine quality add-ons to
269.7the operating payment rates for each facility. The increase in this subdivision shall be
269.8applied as a percentage to operating payment rates in effect on August 31, 2013. For each
269.9facility, the commissioner shall determine the operating payment rate, not including any
269.10rate components resulting from equitable cost-sharing for publicly owned nursing facility
269.11program participation under subdivision 55a, critical access nursing facility program
269.12participation under subdivision 63, or performance-based incentive payment program
269.13participation under section 256B.434, subdivision 4, paragraph (d), for a RUG class with a
269.14weight of 1.00 in effect on August 31, 2013.
269.15(b) For each facility, the commissioner shall compute a quality factor by subtracting
269.1640 from the most recent quality score computed under subdivision 44, and then dividing
269.17by 60. If the quality factor is less than zero, the commissioner shall use the value zero.
269.18(c) The quality add-ons shall be the operating payment rates determined in paragraph
269.19(a), multiplied by the quality factor determined in paragraph (b), and then multiplied by
269.203.2 percent. The commissioner shall implement the quality add-ons effective September
269.211, 2013.

269.22    Sec. 37. Minnesota Statutes 2012, section 256B.441, is amended by adding a
269.23subdivision to read:
269.24    Subd. 46c. Quality improvement incentive system beginning October 1, 2015.
269.25 The commissioner shall develop a quality improvement incentive program in consultation
269.26with stakeholders. The annual funding pool available for quality improvement incentive
269.27payments shall be equal to 0.8 percent of all operating payments, not including any rate
269.28components resulting from equitable cost-sharing for publicly owned nursing facility
269.29program participation under subdivision 55a, critical access nursing facility program
269.30participation under subdivision 63, or performance-based incentive payment program
269.31participation under section 256B.434, subdivision 4, paragraph (d). Beginning October 1,
269.322015, annual rate adjustments provided under this subdivision shall be effective for one
269.33year, starting October 1 and ending the following September 30.

270.1    Sec. 38. Minnesota Statutes 2012, section 256B.49, subdivision 11a, is amended to read:
270.2    Subd. 11a. Waivered services statewide priorities. (a) The commissioner shall
270.3establish statewide priorities for individuals on the waiting list for community alternative
270.4care, community alternatives for disabled individuals, and brain injury waiver services,
270.5as of January 1, 2010. The statewide priorities must include, but are not limited to,
270.6individuals who continue to have a need for waiver services after they have maximized the
270.7use of state plan services and other funding resources, including natural supports, prior to
270.8accessing waiver services, and who meet at least one of the following criteria:
270.9(1) no longer require the intensity of services provided where they are currently
270.10living; or
270.11(2) make a request to move from an institutional setting.
270.12(b) After the priorities in paragraph (a) are met, priority must also be given to
270.13individuals who meet at least one of the following criteria:
270.14(1) have unstable living situations due to the age, incapacity, or sudden loss of
270.15the primary caregivers;
270.16(2) are moving from an institution due to bed closures;
270.17(3) experience a sudden closure of their current living arrangement;
270.18(4) require protection from confirmed abuse, neglect, or exploitation;
270.19(5) experience a sudden change in need that can no longer be met through state plan
270.20services or other funding resources alone; or
270.21(6) meet other priorities established by the department.
270.22(b) (c) When allocating resources to lead agencies, the commissioner must take into
270.23consideration the number of individuals waiting who meet statewide priorities and the
270.24lead agencies' current use of waiver funds and existing service options. The commissioner
270.25has the authority to transfer funds between counties, groups of counties, and tribes to
270.26accommodate statewide priorities and resource needs while accounting for a necessary
270.27base level reserve amount for each county, group of counties, and tribe.
270.28(c) The commissioner shall evaluate the impact of the use of statewide priorities and
270.29provide recommendations to the legislature on whether to continue the use of statewide
270.30priorities in the November 1, 2011, annual report required by the commissioner in sections
270.31256B.0916, subdivision 7, and 256B.49, subdivision 21.

270.32    Sec. 39. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
270.33    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
270.34shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
270.35With the permission of the recipient or the recipient's designated legal representative,
271.1the recipient's current provider of services may submit a written report outlining their
271.2recommendations regarding the recipient's care needs prepared by a direct service
271.3employee with at least 20 hours of service to that client. The person conducting the
271.4assessment or reassessment must notify the provider of the date by which this information
271.5is to be submitted. This information shall be provided to the person conducting the
271.6assessment and the person or the person's legal representative and must be considered
271.7prior to the finalization of the assessment or reassessment.
271.8(b) There must be a determination that the client requires a hospital level of care or a
271.9nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
271.10(d), at initial and subsequent assessments to initiate and maintain participation in the
271.11waiver program.
271.12(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
271.13appropriate to determine nursing facility level of care for purposes of medical assistance
271.14payment for nursing facility services, only face-to-face assessments conducted according
271.15to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
271.16determination or a nursing facility level of care determination must be accepted for
271.17purposes of initial and ongoing access to waiver services payment.
271.18(d) Recipients who are found eligible for home and community-based services under
271.19this section before their 65th birthday may remain eligible for these services after their
271.2065th birthday if they continue to meet all other eligibility factors.
271.21(e) The commissioner shall develop criteria to identify recipients whose level of
271.22functioning is reasonably expected to improve and reassess these recipients to establish
271.23a baseline assessment. Recipients who meet these criteria must have a comprehensive
271.24transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
271.25reassessed every six months until there has been no significant change in the recipient's
271.26functioning for at least 12 months. After there has been no significant change in the
271.27recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
271.28informal support systems, and need for services shall be conducted at least every 12
271.29months and at other times when there has been a significant change in the recipient's
271.30functioning. Counties, case managers, and service providers are responsible for
271.31conducting these reassessments and shall complete the reassessments out of existing funds.

271.32    Sec. 40. Minnesota Statutes 2012, section 256B.49, subdivision 15, is amended to read:
271.33    Subd. 15. Coordinated service and support plan; comprehensive transitional
271.34service plan; maintenance service plan. (a) Each recipient of home and community-based
272.1waivered services shall be provided a copy of the written coordinated service and support
272.2plan which meets the requirements in section 256B.092, subdivision 1b.
272.3(b) In developing the comprehensive transitional service plan, the individual
272.4receiving services, the case manager, and the guardian, if applicable, will identify the
272.5transitional service plan fundamental service outcome and anticipated timeline to achieve
272.6this outcome. Within the first 20 days following a recipient's request for an assessment or
272.7reassessment, the transitional service planning team must be identified. A team leader must
272.8be identified who will be responsible for assigning responsibility and communicating with
272.9team members to ensure implementation of the transition plan and ongoing assessment and
272.10communication process. The team leader should be an individual, such as the case manager
272.11or guardian, who has the opportunity to follow the recipient to the next level of service.
272.12Within ten days following an assessment, a comprehensive transitional service plan
272.13must be developed incorporating elements of a comprehensive functional assessment and
272.14including short-term measurable outcomes and timelines for achievement of and reporting
272.15on these outcomes. Functional milestones must also be identified and reported according
272.16to the timelines agreed upon by the transitional service planning team. In addition, the
272.17comprehensive transitional service plan must identify additional supports that may assist
272.18in the achievement of the fundamental service outcome such as the development of greater
272.19natural community support, increased collaboration among agencies, and technological
272.20supports.
272.21The timelines for reporting on functional milestones will prompt a reassessment of
272.22services provided, the units of services, rates, and appropriate service providers. It is
272.23the responsibility of the transitional service planning team leader to review functional
272.24milestone reporting to determine if the milestones are consistent with observable skills
272.25and that milestone achievement prompts any needed changes to the comprehensive
272.26transitional service plan.
272.27For those whose fundamental transitional service outcome involves the need to
272.28procure housing, a plan for the recipient to seek the resources necessary to secure the least
272.29restrictive housing possible should be incorporated into the plan, including employment
272.30and public supports such as housing access and shelter needy funding.
272.31(c) Counties and other agencies responsible for funding community placement and
272.32ongoing community supportive services are responsible for the implementation of the
272.33comprehensive transitional service plans. Oversight responsibilities include both ensuring
272.34effective transitional service delivery and efficient utilization of funding resources.
272.35(d) Following one year of transitional services, the transitional services planning team
272.36will make a determination as to whether or not the individual receiving services requires
273.1the current level of continuous and consistent support in order to maintain the recipient's
273.2current level of functioning. Recipients who are determined to have not had a significant
273.3change in functioning for 12 months must move from a transitional to a maintenance
273.4service plan. Recipients on a maintenance service plan must be reassessed to determine if
273.5the recipient would benefit from a transitional service plan at least every 12 months and at
273.6other times when there has been a significant change in the recipient's functioning. This
273.7assessment should consider any changes to technological or natural community supports.
273.8(e) When a county is evaluating denials, reductions, or terminations of home and
273.9community-based services under section 256B.49 for an individual, the case manager
273.10shall offer to meet with the individual or the individual's guardian in order to discuss
273.11the prioritization of service needs within the coordinated service and support plan,
273.12comprehensive transitional service plan, or maintenance service plan. The reduction in
273.13the authorized services for an individual due to changes in funding for waivered services
273.14may not exceed the amount needed to ensure medically necessary services to meet the
273.15individual's health, safety, and welfare.
273.16(f) At the time of reassessment, local agency case managers shall assess each recipient
273.17of community alternatives for disabled individuals or brain injury waivered services
273.18currently residing in a licensed adult foster home that is not the primary residence of the
273.19license holder, or in which the license holder is not the primary caregiver, to determine if
273.20that recipient could appropriately be served in a community-living setting. If appropriate
273.21for the recipient, the case manager shall offer the recipient, through a person-centered
273.22planning process, the option to receive alternative housing and service options. In the
273.23event that the recipient chooses to transfer from the adult foster home, the vacated bed
273.24shall not be filled with another recipient of waiver services and group residential housing
273.25and the licensed capacity shall be reduced accordingly, unless the savings required by the
273.26licensed bed closure reductions under Laws 2011, First Special Session chapter 9, article 7,
273.27sections 1 and 40, paragraph (f), for foster care settings where the physical location is not
273.28the primary residence of the license holder are met through voluntary changes described
273.29in section 245A.03, subdivision 7, paragraph (f) (e), or as provided under paragraph (a),
273.30clauses (3) and (4). If the adult foster home becomes no longer viable due to these transfers,
273.31the county agency, with the assistance of the department, shall facilitate a consolidation of
273.32settings or closure. This reassessment process shall be completed by July 1, 2013.

273.33    Sec. 41. Minnesota Statutes 2012, section 256B.49, is amended by adding a
273.34subdivision to read:
274.1    Subd. 25. Reduce avoidable behavioral crisis emergency room admissions,
274.2psychiatric inpatient hospitalizations, and commitments to institutions. (a) Persons
274.3receiving home and community-based services authorized under this section who have
274.4two or more admissions within a calendar year to an emergency room, psychiatric unit,
274.5or institution must receive consultation from a mental health professional as defined in
274.6section 245.462, subdivision 18, or a behavioral professional as defined in the home and
274.7community-based services state plan within 30 days of discharge. The mental health
274.8professional or behavioral professional must:
274.9(1) conduct a functional assessment of the crisis incident as defined in section
274.10245D.02, subdivision 11, which led to the hospitalization with the goal of developing
274.11proactive strategies as well as necessary reactive strategies to reduce the likelihood of
274.12future avoidable hospitalizations due to a behavioral crisis;
274.13(2) use the results of the functional assessment to amend the coordinated service and
274.14support plan in section 245D.02, subdivision 4b, to address the potential need for additional
274.15staff training, increased staffing, access to crisis mobility services, mental health services,
274.16use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and
274.17(3) identify the need for additional consultation, testing, mental health crisis
274.18intervention team services as defined in section 245D.02, subdivision 20, psychotropic
274.19medication use and monitoring under section 245D.051, and the frequency and duration
274.20of ongoing consultation.
274.21(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
274.22the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

274.23    Sec. 42. Minnesota Statutes 2012, section 256B.49, is amended by adding a
274.24subdivision to read:
274.25    Subd. 26. Excess allocations. County and tribal agencies will be responsible for
274.26authorizations in excess of the allocation made by the commissioner. In the event a county
274.27or tribal agency authorizes in excess of the allocation made by the commissioner for a
274.28given allocation period, the county or tribal agency must submit a corrective action plan to
274.29the commissioner. The plan must state the actions the agency will take to correct their
274.30overspending for the year following the period when the overspending occurred. Failure
274.31to correct overauthorizations shall result in recoupment of authorizations in excess of
274.32the allocation. Nothing in this subdivision shall be construed as reducing the county's
274.33responsibility to offer and make available feasible home and community-based options to
274.34eligible waiver recipients within the resources allocated to them for that purpose.

275.1    Sec. 43. Minnesota Statutes 2012, section 256B.492, is amended to read:
275.2256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
275.3WITH DISABILITIES.
275.4(a) Individuals receiving services under a home and community-based waiver under
275.5section 256B.092 or 256B.49 may receive services in the following settings:
275.6(1) an individual's own home or family home;
275.7(2) a licensed adult foster care setting of up to five people; and
275.8(3) community living settings as defined in section 256B.49, subdivision 23, where
275.9individuals with disabilities may reside in all of the units in a building of four or fewer
275.10units, and no more than the greater of four or 25 percent of the units in a multifamily
275.11building of more than four units, unless required by the Housing Opportunities for Persons
275.12with AIDS Program.
275.13(b) The settings in paragraph (a) must not:
275.14(1) be located in a building that is a publicly or privately operated facility that
275.15provides institutional treatment or custodial care;
275.16(2) be located in a building on the grounds of or adjacent to a public or private
275.17institution;
275.18(3) be a housing complex designed expressly around an individual's diagnosis or
275.19disability, unless required by the Housing Opportunities for Persons with AIDS Program;
275.20(4) be segregated based on a disability, either physically or because of setting
275.21characteristics, from the larger community; and
275.22(5) have the qualities of an institution which include, but are not limited to:
275.23regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
275.24agreed to and documented in the person's individual service plan shall not result in a
275.25residence having the qualities of an institution as long as the restrictions for the person are
275.26not imposed upon others in the same residence and are the least restrictive alternative,
275.27imposed for the shortest possible time to meet the person's needs.
275.28(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
275.29individuals receive services under a home and community-based waiver as of July 1,
275.302012, and the setting does not meet the criteria of this section.
275.31(d) Notwithstanding paragraph (c), a program in Hennepin County established as
275.32part of a Hennepin County demonstration project is qualified for the exception allowed
275.33under paragraph (c).
275.34(e) The commissioner shall submit an amendment to the waiver plan no later than
275.35December 31, 2012.

276.1    Sec. 44. Minnesota Statutes 2012, section 256B.493, subdivision 2, is amended to read:
276.2    Subd. 2. Planned closure process needs determination. The commissioner shall
276.3announce and implement a program for planned closure of adult foster care homes. Planned
276.4closure shall be the preferred method for achieving necessary budgetary savings required by
276.5the licensed bed closure budget reduction in section 245A.03, subdivision 7, paragraph (d)
276.6 (c). If additional closures are required to achieve the necessary savings, the commissioner
276.7shall use the process and priorities in section 245A.03, subdivision 7, paragraph (d) (c).

276.8    Sec. 45. Minnesota Statutes 2012, section 256B.501, is amended by adding a
276.9subdivision to read:
276.10    Subd. 14. Rate adjustment for ICF/DD in Cottonwood County. The
276.11commissioner of health shall decertify three beds in an intermediate care facility for
276.12persons with developmental disabilities with 21 certified beds located in Cottonwood
276.13County. The total payment rate shall be $282.62 per bed, per day.

276.14    Sec. 46. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
276.15subdivision to read:
276.16    Subd. 14. Rate increase effective June 1, 2013. For rate periods beginning on or
276.17after June 1, 2013, the commissioner shall increase the total operating payment rate for
276.18each facility reimbursed under this section by $7.81 per day. The increase shall not be
276.19subject to any annual percentage increase.
276.20EFFECTIVE DATE.This section is effective June 1, 2013.

276.21    Sec. 47. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
276.22subdivision to read:
276.23    Subd. 15. ICF/DD rate increases effective April 1, 2014. (a) Notwithstanding
276.24subdivision 12, for each facility reimbursed under this section, for the rate period
276.25beginning April 1, 2014, the commissioner shall increase operating payments equal to one
276.26percent of the operating payment rates in effect on March 31, 2014.
276.27(b) For each facility, the commissioner shall apply the rate increase based on
276.28occupied beds, using the percentage specified in this subdivision multiplied by the total
276.29payment rate, including the variable rate, but excluding the property-related payment
276.30rate in effect on the preceding date. The total rate increase shall include the adjustment
276.31provided in section 256B.501, subdivision 12.

277.1    Sec. 48. Minnesota Statutes 2012, section 256B.69, is amended by adding a
277.2subdivision to read:
277.3    Subd. 32a. Initiatives to improve early screening, diagnosis, and treatment of
277.4children with autism spectrum disorder and other developmental conditions. (a) The
277.5commissioner shall require managed care plans and county-based purchasing plans, as
277.6a condition of contract, to implement strategies that facilitate access for young children
277.7between the ages of one and three years to periodic developmental and social-emotional
277.8screenings, as recommended by the Minnesota Interagency Developmental Screening
277.9Task Force, and that those children who do not meet milestones are provided access to
277.10appropriate evaluation and assessment, including treatment recommendations, expected to
277.11improve the child's functioning, with the goal of meeting milestones by age five.
277.12    (b) The following information from encounter data provided to the commissioner
277.13shall be reported on the department's public Web site for each managed care plan and
277.14county-based purchasing plan annually by July 31 of each year beginning in 2014:
277.15    (1) the number of children who received a diagnostic assessment;
277.16    (2) the total number of children ages one to six with a diagnosis of autism spectrum
277.17disorder who received treatments;
277.18    (3) the number of children identified under clause (2) reported by each 12-month age
277.19group beginning with age one and ending with age six; and
277.20    (4) the types of treatments provided to children identified under clause (2) listed by
277.21billing code, including the number of units billed for each child.
277.22    (c) The managed care plans and county-based purchasing plans shall also report on
277.23any barriers to providing screening, diagnosis, and treatment of young children between
277.24the ages of one and three years, any strategies implemented to address those barriers,
277.25and make recommendations on how to measure and report on the effectiveness of the
277.26strategies implemented to facilitate access for young children to provide developmental
277.27and social-emotional screening, diagnosis, and treatment as described in paragraph (a).

277.28    Sec. 49. [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
277.29    Subdivision 1. Basis and scope. (a) Upon federal approval, the commissioner
277.30shall establish a medical assistance state plan option for the provision of home and
277.31community-based personal assistance service and supports called "community first
277.32services and supports (CFSS)."
277.33(b) CFSS is a participant-controlled method of selecting and providing services
277.34and supports that allows the participant maximum control of the services and supports.
277.35Participants may choose the degree to which they direct and manage their supports by
278.1choosing to have a significant and meaningful role in the management of services and
278.2supports including by directly employing support workers with the necessary supports
278.3to perform that function.
278.4(c) CFSS is available statewide to eligible individuals to assist with accomplishing
278.5activities of daily living (ADLs), instrumental activities of daily living (IADLs), and
278.6health-related procedures and tasks through hands-on assistance to accomplish the task
278.7or constant supervision and cueing to accomplish the task; and to assist with acquiring,
278.8maintaining, and enhancing the skills necessary to accomplish ADLs, IADLs, and
278.9health-related procedures and tasks. CFSS allows payment for certain supports and goods
278.10such as environmental modifications and technology that are intended to replace or
278.11decrease the need for human assistance.
278.12(d) Upon federal approval, CFSS will replace the personal care assistance program
278.13under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
278.14    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
278.15this subdivision have the meanings given.
278.16(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
278.17dressing, bathing, mobility, positioning, and transferring.
278.18(c) "Agency-provider model" means a method of CFSS under which a qualified
278.19agency provides services and supports through the agency's own employees and policies.
278.20The agency must allow the participant to have a significant role in the selection and
278.21dismissal of support workers of their choice for the delivery of their specific services
278.22and supports.
278.23(d) "Behavior" means a description of a need for services and supports used to
278.24determine the home care rating and additional service units. The presence of Level I
278.25behavior is used to determine the home care rating. "Level I behavior" means physical
278.26aggression towards self or others or destruction of property that requires the immediate
278.27response of another person. If qualified for a home care rating as described in subdivision
278.288, additional service units can be added as described in subdivision 8, paragraph (f), for
278.29the following behaviors:
278.30(1) Level I behavior;
278.31(2) increased vulnerability due to cognitive deficits or socially inappropriate
278.32behavior; or
278.33(3) increased need for assistance for recipients who are verbally aggressive or
278.34resistive to care so that time needed to perform activities of daily living is increased.
279.1(e) "Complex health-related needs" means an intervention listed in clauses (1) to
279.2(8) that has been ordered by a physician, and is specified in a community support plan,
279.3including:
279.4(1) tube feedings requiring:
279.5(i) a gastrojejunostomy tube; or
279.6(ii) continuous tube feeding lasting longer than 12 hours per day;
279.7(2) wounds described as:
279.8(i) stage III or stage IV;
279.9(ii) multiple wounds;
279.10(iii) requiring sterile or clean dressing changes or a wound vac; or
279.11(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
279.12specialized care;
279.13(3) parenteral therapy described as:
279.14(i) IV therapy more than two times per week lasting longer than four hours for
279.15each treatment; or
279.16(ii) total parenteral nutrition (TPN) daily;
279.17(4) respiratory interventions, including:
279.18(i) oxygen required more than eight hours per day;
279.19(ii) respiratory vest more than one time per day;
279.20(iii) bronchial drainage treatments more than two times per day;
279.21(iv) sterile or clean suctioning more than six times per day;
279.22(v) dependence on another to apply respiratory ventilation augmentation devices
279.23such as BiPAP and CPAP; and
279.24(vi) ventilator dependence under section 256B.0652;
279.25(5) insertion and maintenance of catheter, including:
279.26(i) sterile catheter changes more than one time per month;
279.27(ii) clean intermittent catheterization, and including self-catheterization more than
279.28six times per day; or
279.29(iii) bladder irrigations;
279.30(6) bowel program more than two times per week requiring more than 30 minutes to
279.31perform each time;
279.32(7) neurological intervention, including:
279.33(i) seizures more than two times per week and requiring significant physical
279.34assistance to maintain safety; or
279.35(ii) swallowing disorders diagnosed by a physician and requiring specialized
279.36assistance from another on a daily basis; and
280.1(8) other congenital or acquired diseases creating a need for significantly increased
280.2direct hands-on assistance and interventions in six to eight activities of daily living.
280.3(f) "Community first services and supports" or "CFSS" means the assistance and
280.4supports program under this section needed for accomplishing activities of daily living,
280.5instrumental activities of daily living, and health-related tasks through hands-on assistance
280.6to accomplish the task or constant supervision and cueing to accomplish the task, or the
280.7purchase of goods as defined in subdivision 7, paragraph (a), clause (3), that replace
280.8the need for human assistance.
280.9(g) "Community first services and supports service delivery plan" or "service delivery
280.10plan" means a written summary of the services and supports, that is based on the community
280.11support plan identified in section 256B.0911 and coordinated services and support plan
280.12and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
280.13by the participant to meet the assessed needs, using a person-centered planning process.
280.14(h) "Critical activities of daily living" means transferring, mobility, eating, and
280.15toileting.
280.16(i) "Dependency" in activities of daily living means a person requires hands-on
280.17assistance or constant supervision and cueing to accomplish one or more of the activities
280.18of daily living every day or on the days during the week that the activity is performed;
280.19however, a child may not be found to be dependent in an activity of daily living if,
280.20because of the child's age, an adult would either perform the activity for the child or assist
280.21the child with the activity and the assistance needed is the assistance appropriate for
280.22a typical child of the same age.
280.23(j) "Extended CFSS" means CFSS services and supports under the agency–provider
280.24model included in a service plan through one of the home and community-based services
280.25waivers authorized under sections 256B.0915; 256B.092, subdivision 5; and 256B.49,
280.26which exceed the amount, duration, and frequency of the state plan CFSS services for
280.27participants.
280.28(k) "Financial management services contractor or vendor" means a qualified
280.29organization having a written contract with the department to provide services necessary to
280.30use the budget model under subdivision 13, that include but are not limited to: participant
280.31education and technical assistance; CFSS service delivery planning and budgeting; billing,
280.32making payments, and monitoring of spending; and assisting the participant in fulfilling
280.33employer-related requirements in accordance with Section 3504 of the IRS code and
280.34the IRS Revenue Procedure 70-6.
280.35(l) "Budget model" means a service delivery method of CFSS that allows the use of
280.36an individualized CFSS service delivery plan and service budget and provides assistance
281.1from the financial management services contractor to facilitate participant employment of
281.2support workers and the acquisition of supports and goods.
281.3(m) "Health-related procedures and tasks" means procedures and tasks related to
281.4the specific needs of an individual that can be delegated or assigned by a state-licensed
281.5healthcare or mental health professional and performed by a support worker.
281.6(n) "Instrumental activities of daily living" means activities related to living
281.7independently in the community, including but not limited to: meal planning, preparation,
281.8and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning;
281.9assistance with medications; managing finances; communicating needs and preferences
281.10during activities; arranging supports; and assistance with traveling around and
281.11participating in the community.
281.12(o) "Legal representative" means parent of a minor, a court-appointed guardian, or
281.13another representative with legal authority to make decisions about services and supports
281.14for the participant. Other representatives with legal authority to make decisions include
281.15but are not limited to a health care agent or an attorney-in-fact authorized through a health
281.16care directive or power of attorney.
281.17(p) "Medication assistance" means providing verbal or visual reminders to take
281.18regularly scheduled medication, and includes any of the following supports listed in clauses
281.19(1) to (3) and other types of assistance, except that a support worker may not determine
281.20medication dose or time for medication or inject medications into veins, muscles, or skin:
281.21(1) under the direction of the participant or the participant's representative, bringing
281.22medications to the participant including medications given through a nebulizer, opening a
281.23container of previously set-up medications, emptying the container into the participant's
281.24hand, opening and giving the medication in the original container to the participant, or
281.25bringing to the participant liquids or food to accompany the medication;
281.26(2) organizing medications as directed by the participant or the participant's
281.27representative; and
281.28(3) providing verbal or visual reminders to perform regularly scheduled medications.
281.29(q) "Participant's representative" means a parent, family member, advocate, or
281.30other adult authorized by the participant to serve as a representative in connection with
281.31the provision of CFSS. This authorization must be in writing or by another method
281.32that clearly indicates the participant's free choice. The participant's representative must
281.33have no financial interest in the provision of any services included in the participant's
281.34service delivery plan and must be capable of providing the support necessary to assist
281.35the participant in the use of CFSS. If through the assessment process described in
281.36subdivision 5 a participant is determined to be in need of a participant's representative, one
282.1must be selected. If the participant is unable to assist in the selection of a participant's
282.2representative, the legal representative shall appoint one. Two persons may be designated
282.3as a participant's representative for reasons such as divided households and court-ordered
282.4custodies. Duties of a participant's representatives may include:
282.5(1) being available while care is provided in a method agreed upon by the participant
282.6or the participant's legal representative and documented in the participant's CFSS service
282.7delivery plan;
282.8(2) monitoring CFSS services to ensure the participant's CFSS service delivery
282.9plan is being followed; and
282.10(3) reviewing and signing CFSS time sheets after services are provided to provide
282.11verification of the CFSS services.
282.12(r) "Person-centered planning process" means a process that is directed by the
282.13participant to plan for services and supports. The person-centered planning process must:
282.14(1) include people chosen by the participant;
282.15(2) provide necessary information and support to ensure that the participant directs
282.16the process to the maximum extent possible, and is enabled to make informed choices
282.17and decisions;
282.18(3) be timely and occur at time and locations of convenience to the participant;
282.19(4) reflect cultural considerations of the participant;
282.20(5) include strategies for solving conflict or disagreement within the process,
282.21including clear conflict-of-interest guidelines for all planning;
282.22(6) provide the participant choices of the services and supports they receive and the
282.23staff providing those services and supports;
282.24(7) include a method for the participant to request updates to the plan; and
282.25(8) record the alternative home and community-based settings that were considered
282.26by the participant.
282.27(s) "Shared services" means the provision of CFSS services by the same CFSS
282.28support worker to two or three participants who voluntarily enter into an agreement to
282.29receive services at the same time and in the same setting by the same provider.
282.30(t) "Support specialist" means a professional with the skills and ability to assist the
282.31participant using either the agency provider model under subdivision 11 or the flexible
282.32spending model under subdivision 13, in services including but not limited to assistance
282.33regarding:
282.34(1) the development, implementation, and evaluation of the CFSS service delivery
282.35plan under subdivision 6;
283.1(2) recruitment, training, or supervision, including supervision of health-related tasks
283.2or behavioral supports appropriately delegated or assigned by a health care professional,
283.3and evaluation of support workers; and
283.4(3) facilitating the use of informal and community supports, goods, or resources.
283.5(u) "Support worker" means an employee of the agency provider or of the participant
283.6who has direct contact with the participant and provides services as specified within the
283.7participant's service delivery plan.
283.8(v) "Wages and benefits" means the hourly wages and salaries, the employer's
283.9share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
283.10compensation, mileage reimbursement, health and dental insurance, life insurance,
283.11disability insurance, long-term care insurance, uniform allowance, contributions to
283.12employee retirement accounts, or other forms of employee compensation and benefits.
283.13    Subd. 3. Eligibility. (a) CFSS is available to a person who meets one of the
283.14following:
283.15(1) is a recipient of medical assistance as determined under section 256B.055,
283.16256B.056, or 256B.057, subdivisions 5 and 9;
283.17(2) is a recipient of the alternative care program under section 256B.0913;
283.18(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
283.19or 256B.49; or
283.20(4) has medical services identified in a participant's individualized education
283.21program and is eligible for services as determined in section 256B.0625, subdivision 26.
283.22(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
283.23meet all of the following:
283.24(1) require assistance and be determined dependent in one activity of daily living or
283.25Level I behavior based on assessment under section 256B.0911;
283.26(2) is not a recipient under the family support grant under section 252.32;
283.27(3) lives in the person's own apartment or home including a family foster care setting
283.28licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
283.29noncertified boarding care or boarding and lodging establishments under chapter 157.
283.30    Subd. 4. Eligibility for other services. Selection of CFSS by a participant must not
283.31restrict access to other medically necessary care and services furnished under the state
283.32plan medical assistance benefit or other services available through alternative care.
283.33    Subd. 5. Assessment requirements. (a) The assessment of functional need must:
283.34(1) be conducted by a certified assessor according to the criteria established in
283.35section 256B.0911, subdivision 3a;
284.1(2) be conducted face-to-face, initially and at least annually thereafter, or when there
284.2is a significant change in the participant's condition or a change in the need for services
284.3and supports; and
284.4(3) be completed using the format established by the commissioner.
284.5(b) A participant who is residing in a facility may be assessed and choose CFSS for
284.6the purpose of using CFSS to return to the community as described in subdivisions 3
284.7and 7, paragraph (a), clause (5).
284.8(c) The results of the assessment and any recommendations and authorizations for
284.9CFSS must be determined and communicated in writing by the lead agency's certified
284.10assessor as defined in section 256B.0911 to the participant and the agency-provider or
284.11financial management services provider chosen by the participant within 40 calendar days
284.12and must include the participant's right to appeal under section 256.045, subdivision 3.
284.13(d) The lead agency assessor may request a temporary authorization for CFSS
284.14services. Authorization for a temporary level of CFSS services is limited to the time
284.15specified by the commissioner, but shall not exceed 45 days. The level of services
284.16authorized under this provision shall have no bearing on a future authorization.
284.17    Subd. 6. Community first services and support service delivery plan. (a) The
284.18CFSS service delivery plan must be developed, implemented, and evaluated through a
284.19person-centered planning process by the participant, or the participant's representative
284.20or legal representative who may be assisted by a support specialist. The CFSS service
284.21delivery plan must reflect the services and supports that are important to the participant
284.22and for the participant to meet the needs assessed by the certified assessor and identified in
284.23the community support plan under section 256B.0911, subdivision 3, or the coordinated
284.24services and support plan identified in section 256B.0915, subdivision 6, if applicable. The
284.25CFSS service delivery plan must be reviewed by the participant and the agency-provider
284.26or financial management services contractor at least annually upon reassessment, or
284.27when there is a significant change in the participant's condition, or a change in the need
284.28for services and supports.
284.29(b) The commissioner shall establish the format and criteria for the CFSS service
284.30delivery plan.
284.31(c) The CFSS service delivery plan must be person-centered and:
284.32(1) specify the agency-provider or financial management services contractor selected
284.33by the participant;
284.34(2) reflect the setting in which the participant resides that is chosen by the participant;
284.35(3) reflect the participant's strengths and preferences;
285.1(4) include the means to address the clinical and support needs as identified through
285.2an assessment of functional needs;
285.3(5) include individually identified goals and desired outcomes;
285.4(6) reflect the services and supports, paid and unpaid, that will assist the participant
285.5to achieve identified goals, and the providers of those services and supports, including
285.6natural supports;
285.7(7) identify the amount and frequency of face-to-face supports and amount and
285.8frequency of remote supports and technology that will be used;
285.9(8) identify risk factors and measures in place to minimize them, including
285.10individualized backup plans;
285.11(9) be understandable to the participant and the individuals providing support;
285.12(10) identify the individual or entity responsible for monitoring the plan;
285.13(11) be finalized and agreed to in writing by the participant and signed by all
285.14individuals and providers responsible for its implementation;
285.15(12) be distributed to the participant and other people involved in the plan; and
285.16(13) prevent the provision of unnecessary or inappropriate care.
285.17(d) The total units of agency-provider services or the budget allocation amount for
285.18the budget model include both annual totals and a monthly average amount that cover
285.19the number of months of the service authorization. The amount used each month may
285.20vary, but additional funds must not be provided above the annual service authorization
285.21amount unless a change in condition is assessed and authorized by the certified assessor
285.22and documented in the community support plan, coordinated services and supports plan,
285.23and service delivery plan.
285.24    Subd. 7. Community first services and supports; covered services. Within the
285.25service unit authorization or budget allocation, services and supports covered under
285.26CFSS include:
285.27(1) assistance to accomplish activities of daily living (ADLs), instrumental activities
285.28of daily living (IADLs), and health-related procedures and tasks through hands-on
285.29assistance to accomplish the task or constant supervision and cueing to accomplish the task;
285.30(2) assistance to acquire, maintain, or enhance the skills necessary for the participant
285.31to accomplish activities of daily living, instrumental activities of daily living, or
285.32health-related tasks;
285.33(3) expenditures for items, services, supports, environmental modifications, or
285.34goods, including assistive technology. These expenditures must:
285.35(i) relate to a need identified in a participant's CFSS service delivery plan;
286.1(ii) increase independence or substitute for human assistance to the extent that
286.2expenditures would otherwise be made for human assistance for the participant's assessed
286.3needs;
286.4(4) observation and redirection for behavior or symptoms where there is a need for
286.5assistance. An assessment of behaviors must meet the criteria in this clause. A recipient
286.6qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
286.7assistance at least four times per week and shows one or more of the following behaviors:
286.8(i) physical aggression towards self or others, or destruction of property that requires
286.9the immediate response of another person;
286.10(ii) increased vulnerability due to cognitive deficits or socially inappropriate
286.11behavior; or
286.12(iii) increased need for assistance for recipients who are verbally aggressive or
286.13resistive to care so that time needed to perform activities of daily living is increased;
286.14(5) back-up systems or mechanisms, such as the use of pagers or other electronic
286.15devices, to ensure continuity of the participant's services and supports;
286.16(6) transition costs, including:
286.17(i) deposits for rent and utilities;
286.18(ii) first month's rent and utilities;
286.19(iii) bedding;
286.20(iv) basic kitchen supplies;
286.21(v) other necessities, to the extent that these necessities are not otherwise covered
286.22under any other funding that the participant is eligible to receive; and
286.23(vi) other required necessities for an individual to make the transition from a nursing
286.24facility, institution for mental diseases, or intermediate care facility for persons with
286.25developmental disabilities to a community-based home setting where the participant
286.26resides; and
286.27(7) services by a support specialist defined under subdivision 2 that are chosen
286.28by the participant.
286.29    Subd. 8. Determination of CFSS service methodology. (a) All community first
286.30services and supports must be authorized by the commissioner or the commissioner's
286.31designee before services begin, except for the assessments established in section
286.32256B.0911. The authorization for CFSS must be completed as soon as possible following
286.33an assessment but no later than 40 calendar days from the date of the assessment.
286.34(b) The amount of CFSS authorized must be based on the recipient's home care
286.35rating described in subdivision 8, paragraphs (d) and (e), and any additional service units
286.36for which the person qualifies as described in subdivision 8, paragraph (f).
287.1(c) The home care rating shall be determined by the commissioner or the
287.2commissioner's designee based on information submitted to the commissioner identifying
287.3the following for a recipient:
287.4(1) the total number of dependencies of activities of daily living as defined in
287.5subdivision 2, paragraph (b);
287.6(2) the presence of complex health-related needs as defined in subdivision 2,
287.7paragraph (e); and
287.8(3) the presence of Level I behavior as defined in subdivision 2, paragraph (d),
287.9clause (1).
287.10(d) The methodology to determine the total service units for CFSS for each home
287.11care rating is based on the median paid units per day for each home care rating from
287.12fiscal year 2007 data for the PCA program.
287.13(e) Each home care rating is designated by the letters P through Z and EN and has
287.14the following base number of service units assigned:
287.15(i) P home care rating requires Level 1 behavior or one to three dependencies in
287.16ADLs and qualifies one for five service units;
287.17(ii) Q home care rating requires Level 1 behavior and one to three dependencies in
287.18ADLs and qualifies one for six service units;
287.19(iii) R home care rating requires a complex health-related need and one to three
287.20dependencies in ADLs and qualifies one for seven service units;
287.21(iv) S home care rating requires four to six dependencies in ADLs and qualifies
287.22one for ten service units;
287.23(v) T home care rating requires four to six dependencies in ADLs and Level 1
287.24behavior and qualifies one for 11 service units;
287.25(vi) U home care rating requires four to six dependencies in ADLs and a complex
287.26health need and qualifies one for 14 service units;
287.27(vii) V home care rating requires seven to eight dependencies in ADLs and qualifies
287.28one for 17 service units;
287.29(viii) W home care rating requires seven to eight dependencies in ADLs and Level 1
287.30behavior and qualifies one for 20 service units;
287.31(ix) Z home care rating requires seven to eight dependencies in ADLs and a complex
287.32health related need and qualifies one for 30 service units; and
287.33(x) EN home care rating includes ventilator dependency as defined in section
287.34256B.0651, subdivision 1, paragraph (g). Recipients who meet the definition of
287.35ventilator-dependent and the EN home care rating and utilize a combination of CFSS
287.36and other home care services are limited to a total of 96 service units per day for those
288.1services in combination. Additional units may be authorized when a recipient's assessment
288.2indicates a need for two staff to perform activities. Additional time is limited to 16 service
288.3units per day.
288.4(f) Additional service units are provided through the assessment and identification of
288.5the following:
288.6(1) 30 additional minutes per day for a dependency in each critical activity of daily
288.7living as defined in subdivision 2, paragraph (h);
288.8(2) 30 additional minutes per day for each complex health-related function as
288.9defined in subdivision 2, paragraph (e); and
288.10(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2,
288.11paragraph (d).
288.12    Subd. 9. Noncovered services. (a) Services or supports that are not eligible for
288.13payment under this section include those that:
288.14(1) are not authorized by the certified assessor or included in the written service
288.15delivery plan;
288.16(2) are provided prior to the authorization of services and the approval of the written
288.17CFSS service delivery plan;
288.18(3) are duplicative of other paid services in the written service delivery plan;
288.19(4) supplant natural unpaid supports that appropriately meet a need in the service
288.20plan, are provided voluntarily to the participant and are selected by the participant in lieu
288.21of other services and supports;
288.22(5) are not effective means to meet the participant's needs; and
288.23(6) are available through other funding sources, including, but not limited to, funding
288.24through Title IV-E of the Social Security Act.
288.25(b) Additional services, goods, or supports that are not covered include:
288.26(1) those that are not for the direct benefit of the participant, except that services for
288.27caregivers such as training to improve the ability to provide CFSS are considered to directly
288.28benefit the participant if chosen by the participant and approved in the support plan;
288.29(2) any fees incurred by the participant, such as Minnesota health care programs fees
288.30and co-pays, legal fees, or costs related to advocate agencies;
288.31(3) insurance, except for insurance costs related to employee coverage;
288.32(4) room and board costs for the participant with the exception of allowable
288.33transition costs in subdivision 7, clause (6);
288.34(5) services, supports, or goods that are not related to the assessed needs;
289.1(6) special education and related services provided under the Individuals with
289.2Disabilities Education Act and vocational rehabilitation services provided under the
289.3Rehabilitation Act of 1973;
289.4(7) assistive technology devices and assistive technology services other than those
289.5for back-up systems or mechanisms to ensure continuity of service and supports listed in
289.6subdivision 7;
289.7(8) medical supplies and equipment;
289.8(9) environmental modifications, except as specified in subdivision 7;
289.9(10) expenses for travel, lodging, or meals related to training the participant, the
289.10participant's representative, legal representative, or paid or unpaid caregivers that exceed
289.11$500 in a 12-month period;
289.12(11) experimental treatments;
289.13(12) any service or good covered by other medical assistance state plan services,
289.14including prescription and over-the-counter medications, compounds, and solutions and
289.15related fees, including premiums and co-payments;
289.16(13) membership dues or costs, except when the service is necessary and appropriate
289.17to treat a physical condition or to improve or maintain the participant's physical condition.
289.18The condition must be identified in the participant's CFSS plan and monitored by a
289.19physician enrolled in a Minnesota health care program;
289.20(14) vacation expenses other than the cost of direct services;
289.21(15) vehicle maintenance or modifications not related to the disability, health
289.22condition, or physical need; and
289.23(16) tickets and related costs to attend sporting or other recreational or entertainment
289.24events.
289.25    Subd. 10. Provider qualifications and general requirements. Agency-providers
289.26delivering services under the agency-provider model under subdivision 11 or financial
289.27management service (FMS) contractors under subdivision 13 shall:
289.28(1) enroll as a medical assistance Minnesota health care programs provider and meet
289.29all applicable provider standards;
289.30(2) comply with medical assistance provider enrollment requirements;
289.31(3) demonstrate compliance with law and policies of CFSS as determined by the
289.32commissioner;
289.33(4) comply with background study requirements under chapter 245C;
289.34(5) verify and maintain records of all services and expenditures by the participant,
289.35including hours worked by support workers and support specialists;
290.1(6) not engage in any agency-initiated direct contact or marketing in person, by
290.2telephone, or other electronic means to potential participants, guardians, family member,
290.3or participants' representatives;
290.4(7) pay support workers and support specialists based upon actual hours of services
290.5provided;
290.6(8) withhold and pay all applicable federal and state payroll taxes;
290.7(9) make arrangements and pay unemployment insurance, taxes, workers'
290.8compensation, liability insurance, and other benefits, if any;
290.9(10) enter into a written agreement with the participant, participant's representative,
290.10or legal representative that assigns roles and responsibilities to be performed before
290.11services, supports, or goods are provided using a format established by the commissioner;
290.12(11) report maltreatment as required under sections 626.556 and 626.557; and
290.13(12) provide the participant with a copy of the service-related rights under
290.14subdivision 19 at the start of services and supports.
290.15    Subd. 11. Agency-provider model. (a) The agency-provider model is limited to
290.16the services provided by support workers and support specialists who are employed by
290.17an agency-provider that is licensed according to chapter 245A or meets other criteria
290.18established by the commissioner, including required training.
290.19(b) The agency-provider shall allow the participant to have a significant role in the
290.20selection and dismissal of the support workers for the delivery of the services and supports
290.21specified in the participant's service delivery plan.
290.22(c) A participant may use authorized units of CFSS services as needed within a
290.23service authorization that is not greater than 12 months. Using authorized units in a
290.24flexible manner in either the agency-provider model or the budget model does not increase
290.25the total amount of services and supports authorized for a participant or included in the
290.26participant's service delivery plan.
290.27(d) A participant may share CFSS services. Two or three CFSS participants may
290.28share services at the same time provided by the same support worker.
290.29(e) The agency-provider must use a minimum of 72.5 percent of the revenue
290.30generated by the medical assistance payment for CFSS for support worker wages and
290.31benefits. The agency-provider must document how this requirement is being met. The
290.32revenue generated by the support specialist and the reasonable costs associated with the
290.33support specialist must not be used in making this calculation.
290.34(f) The agency-provider model must be used by individuals who have been restricted
290.35by the Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160
290.36to 9505.2245.
291.1    Subd. 12. Requirements for enrollment of CFSS provider agencies. (a) All CFSS
291.2provider agencies must provide, at the time of enrollment, reenrollment, and revalidation
291.3as a CFSS provider agency in a format determined by the commissioner, information and
291.4documentation that includes, but is not limited to, the following:
291.5(1) the CFSS provider agency's current contact information including address,
291.6telephone number, and e-mail address;
291.7(2) proof of surety bond coverage. Upon new enrollment, or if the provider agency's
291.8Medicaid revenue in the previous calendar year is less than or equal to $300,000, the
291.9provider agency must purchase a performance bond of $50,000. If the provider agency's
291.10Medicaid revenue in the previous calendar year is greater than $300,000, the provider
291.11agency must purchase a performance bond of $100,000. The performance bond must be
291.12in a form approved by the commissioner, must be renewed annually, and must allow for
291.13recovery of costs and fees in pursuing a claim on the bond;
291.14(3) proof of fidelity bond coverage in the amount of $20,000;
291.15(4) proof of workers' compensation insurance coverage;
291.16(5) proof of liability insurance;
291.17(6) a description of the CFSS provider agency's organization identifying the names
291.18or all owners, managing employees, staff, board of directors, and the affiliations of the
291.19directors, owners, or staff to other service providers;
291.20(7) a copy of the CFSS provider agency's written policies and procedures including:
291.21hiring of employees; training requirements; service delivery; and employee and consumer
291.22safety including process for notification and resolution of consumer grievances,
291.23identification and prevention of communicable diseases, and employee misconduct;
291.24(8) copies of all other forms the CFSS provider agency uses in the course of daily
291.25business including, but not limited to:
291.26(i) a copy of the CFSS provider agency's time sheet if the time sheet varies from
291.27the standard time sheet for CFSS services approved by the commissioner, and a letter
291.28requesting approval of the CFSS provider agency's nonstandard time sheet; and
291.29(ii) the CFSS provider agency's template for the CFSS care plan;
291.30(9) a list of all training and classes that the CFSS provider agency requires of its
291.31staff providing CFSS services;
291.32(10) documentation that the CFSS provider agency and staff have successfully
291.33completed all the training required by this section;
291.34(11) documentation of the agency's marketing practices;
291.35(12) disclosure of ownership, leasing, or management of all residential properties
291.36that are used or could be used for providing home care services;
292.1(13) documentation that the agency will use at least the following percentages of
292.2revenue generated from the medical assistance rate paid for CFSS services for employee
292.3personal care assistant wages and benefits: 72.5 percent of revenue from CFSS providers.
292.4The revenue generated by the support specialist and the reasonable costs associated with
292.5the support specialist shall not be used in making this calculation; and
292.6(14) documentation that the agency does not burden recipients' free exercise of their
292.7right to choose service providers by requiring personal care assistants to sign an agreement
292.8not to work with any particular CFSS recipient or for another CFSS provider agency after
292.9leaving the agency and that the agency is not taking action on any such agreements or
292.10requirements regardless of the date signed.
292.11(b) CFSS provider agencies shall provide to the commissioner the information
292.12specified in paragraph (a).
292.13(c) All CFSS provider agencies shall require all employees in management and
292.14supervisory positions and owners of the agency who are active in the day-to-day
292.15management and operations of the agency to complete mandatory training as determined
292.16by the commissioner. Employees in management and supervisory positions and owners
292.17who are active in the day-to-day operations of an agency who have completed the required
292.18training as an employee with a CFSS provider agency do not need to repeat the required
292.19training if they are hired by another agency, if they have completed the training within
292.20the past three years. CFSS provider agency billing staff shall complete training about
292.21CFSS program financial management. Any new owners or employees in management
292.22and supervisory positions involved in the day-to-day operations are required to complete
292.23mandatory training as a requisite of working for the agency. CFSS provider agencies
292.24certified for participation in Medicare as home health agencies are exempt from the
292.25training required in this subdivision.
292.26    Subd. 13. Budget model. (a) Under the budget model participants can exercise
292.27more responsibility and control over the services and supports described and budgeted
292.28within the CFSS service delivery plan. Under this model, participants may use their
292.29budget allocation to:
292.30(1) directly employ support workers;
292.31(2) obtain supports and goods as defined in subdivision 7; and
292.32(3) choose a range of support assistance services from the financial management
292.33services (FMS) contractor related to:
292.34(i) assistance in managing the budget to meet the service delivery plan needs,
292.35consistent with federal and state laws and regulations;
293.1(ii) the employment, training, supervision, and evaluation of workers by the
293.2participant;
293.3(iii) acquisition and payment for supports and goods; and
293.4(iv) evaluation of individual service outcomes as needed for the scope of the
293.5participant's degree of control and responsibility.
293.6(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
293.7may authorize a legal representative or participant's representative to do so on their behalf.
293.8(c) The FMS contractor shall not provide CFSS services and supports under the
293.9agency-provider service model. The FMS contractor shall provide service functions as
293.10determined by the commissioner that include but are not limited to:
293.11(1) information and consultation about CFSS;
293.12(2) assistance with the development of the service delivery plan and budget model
293.13as requested by the participant;
293.14(3) billing and making payments for budget model expenditures;
293.15(4) assisting participants in fulfilling employer-related requirements according to
293.16Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability,
293.17regulation 137036-08, which includes assistance with filing and paying payroll taxes, and
293.18obtaining worker compensation coverage;
293.19(5) data recording and reporting of participant spending; and
293.20(6) other duties established in the contract with the department, including with
293.21respect to providing assistance to the participant, participant's representative, or legal
293.22representative in performing their employer responsibilities regarding support workers.
293.23The support worker shall not be considered the employee of the financial management
293.24services contractor.
293.25(d) A participant who requests to purchase goods and supports along with support
293.26worker services under the agency-provider model must use the budget model with
293.27a service delivery plan that specifies the amount of services to be authorized to the
293.28agency-provider and the expenditures to be paid by the FMS contractor.
293.29(e) The FMS contractor shall:
293.30(1) not limit or restrict the participant's choice of service or support providers or
293.31service delivery models consistent with any applicable state and federal requirements;
293.32(2) provide the participant and the targeted case manager, if applicable, with a
293.33monthly written summary of the spending for services and supports that were billed
293.34against the spending budget;
293.35(3) be knowledgeable of state and federal employment regulations, including those
293.36under the Fair Labor Standards Act of 1938, and comply with the requirements under the
294.1Internal Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer
294.2Tax Liability for vendor or fiscal employer agent, and any requirements necessary to
294.3process employer and employee deductions, provide appropriate and timely submission of
294.4employer tax liabilities, and maintain documentation to support medical assistance claims;
294.5(4) have current and adequate liability insurance and bonding and sufficient cash
294.6flow as determined by the commissioner and have on staff or under contract a certified
294.7public accountant or an individual with a baccalaureate degree in accounting;
294.8(5) assume fiscal accountability for state funds designated for the program; and
294.9(6) maintain documentation of receipts, invoices, and bills to track all services and
294.10supports expenditures for any goods purchased and maintain time records of support
294.11workers. The documentation and time records must be maintained for a minimum of
294.12five years from the claim date and be available for audit or review upon request by the
294.13commissioner. Claims submitted by the FMS contractor to the commissioner for payment
294.14must correspond with services, amounts, and time periods as authorized in the participant's
294.15spending budget and service plan.
294.16(f) The commissioner of human services shall:
294.17(1) establish rates and payment methodology for the FMS contractor;
294.18(2) identify a process to ensure quality and performance standards for the FMS
294.19contractor and ensure statewide access to FMS contractors; and
294.20(3) establish a uniform protocol for delivering and administering CFSS services
294.21to be used by eligible FMS contractors.
294.22(g) The commissioner of human services shall disenroll or exclude participants from
294.23the budget model and transfer them to the agency-provider model under the following
294.24circumstances that include but are not limited to:
294.25(1) when a participant has been restricted by the Minnesota restricted recipient
294.26program, the participant may be excluded for a specified time period under Minnesota
294.27Rules, parts 9505.2160 to 9505.2245;
294.28(2) when a participant exits the budget model during the participant's service plan
294.29year. Upon transfer, the participant shall not access the budget model for the remainder of
294.30that service plan year; or
294.31(3) when the department determines that the participant or participant's representative
294.32or legal representative cannot manage participant responsibilities under the budget model.
294.33The commissioner must develop policies for determining if a participant is unable to
294.34manage responsibilities under a budget model.
295.1(h) A participant may appeal under section 256.045, subdivision 3, in writing to the
295.2department to contest the department's decision under paragraph (c), clause (3), to remove
295.3or exclude the participant from the budget model.
295.4    Subd. 14. Participant's responsibilities under budget model. (a) A participant
295.5using the budget model must use an FMS contractor or vendor that is under contract with
295.6the department. Upon a determination of eligibility and completion of the assessment and
295.7community support plan, the participant shall choose a FMS contractor from a list of
295.8eligible vendors maintained by the department.
295.9(b) When the participant, participant's representative, or legal representative
295.10chooses to be the employer of the support worker, they are responsible for the hiring and
295.11supervision of the support worker, including, but not limited to, recruiting, interviewing,
295.12training, scheduling, and discharging the support worker consistent with federal and
295.13state laws and regulations.
295.14(c) In addition to the employer responsibilities in paragraph (b), the participant,
295.15participant's representative, or legal representative is responsible for:
295.16(1) tracking the services provided and all expenditures for goods or other supports;
295.17(2) preparing and submitting time sheets, signed by both the participant and support
295.18worker, to the FMS contractor on a regular basis and in a timely manner according to
295.19the FMS contractor's procedures;
295.20(3) notifying the FMS contractor within ten days of any changes in circumstances
295.21affecting the CFSS service plan or in the participant's place of residence including, but
295.22not limited to, any hospitalization of the participant or change in the participant's address,
295.23telephone number, or employment;
295.24(4) notifying the FMS contractor of any changes in the employment status of each
295.25participant support worker; and
295.26(5) reporting any problems resulting from the quality of services rendered by the
295.27support worker to the FMS contractor. If the participant is unable to resolve any problems
295.28resulting from the quality of service rendered by the support worker with the assistance of
295.29the FMS contractor, the participant shall report the situation to the department.
295.30    Subd. 15. Documentation of support services provided. (a) Support services
295.31provided to a participant by a support worker employed by either an agency-provider
295.32or the participant acting as the employer must be documented daily by each support
295.33worker, on a time sheet form approved by the commissioner. All documentation may be
295.34Web-based, electronic, or paper documentation. The completed form must be submitted
295.35on a monthly basis to the provider or the participant and the FMS contractor selected by
296.1the participant to provide assistance with meeting the participant's employer obligations
296.2and kept in the recipient's health record.
296.3(b) The activity documentation must correspond to the written service delivery plan
296.4and be reviewed by the agency provider or the participant and the FMS contractor when
296.5the participant is acting as the employer of the support worker.
296.6(c) The time sheet must be on a form approved by the commissioner documenting
296.7time the support worker provides services in the home. The following criteria must be
296.8included in the time sheet:
296.9(1) full name of the support worker and individual provider number;
296.10(2) provider name and telephone numbers, if an agency-provider is responsible for
296.11delivery services under the written service plan;
296.12(3) full name of the participant;
296.13(4) consecutive dates, including month, day, and year, and arrival and departure
296.14times with a.m. or p.m. notations;
296.15(5) signatures of the participant or the participant's representative;
296.16(6) personal signature of the support worker;
296.17(7) any shared care provided, if applicable;
296.18(8) a statement that it is a federal crime to provide false information on CFSS
296.19billings for medical assistance payments; and
296.20(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
296.21    Subd. 16. Support workers requirements. (a) Support workers shall:
296.22(1) enroll with the department as a support worker after a background study under
296.23chapter 245C has been completed and the support worker has received a notice from the
296.24commissioner that:
296.25(i) the support worker is not disqualified under section 245C.14; or
296.26(ii) is disqualified, but the support worker has received a set-aside of the
296.27disqualification under section 245C.22;
296.28(2) have the ability to effectively communicate with the participant or the
296.29participant's representative;
296.30(3) have the skills and ability to provide the services and supports according to the
296.31person's CFSS service delivery plan and respond appropriately to the participant's needs;
296.32(4) not be a participant of CFSS, unless the support services provided by the support
296.33worker differ from those provided to the support worker;
296.34(5) complete the basic standardized training as determined by the commissioner
296.35before completing enrollment. The training must be available in languages other than
296.36English and to those who need accommodations due to disabilities. Support worker
297.1training must include successful completion of the following training components: basic
297.2first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
297.3and responsibilities of support workers including information about basic body mechanics,
297.4emergency preparedness, orientation to positive behavioral practices, orientation to
297.5responding to a mental health crisis, fraud issues, time cards and documentation, and an
297.6overview of person-centered planning and self-direction. Upon completion of the training
297.7components, the support worker must pass the certification test to provide assistance
297.8to participants;
297.9(6) complete training and orientation on the participant's individual needs; and
297.10(7) maintain the privacy and confidentiality of the participant, and not independently
297.11determine the medication dose or time for medications for the participant.
297.12(b) The commissioner may deny or terminate a support worker's provider enrollment
297.13and provider number if the support worker:
297.14(1) lacks the skills, knowledge, or ability to adequately or safely perform the
297.15required work;
297.16(2) fails to provide the authorized services required by the participant employer;
297.17(3) has been intoxicated by alcohol or drugs while providing authorized services to
297.18the participant or while in the participant's home;
297.19(4) has manufactured or distributed drugs while providing authorized services to the
297.20participant or while in the participant's home; or
297.21(5) has been excluded as a provider by the commissioner of human services, or the
297.22United States Department of Health and Human Services, Office of Inspector General,
297.23from participation in Medicaid, Medicare, or any other federal health care program.
297.24(c) A support worker may appeal in writing to the commissioner to contest the
297.25decision to terminate the support worker's provider enrollment and provider number.
297.26    Subd. 17. Support specialist requirements and payments. The commissioner
297.27shall develop qualifications, scope of functions, and payment rates and service limits for a
297.28support specialist that may provide additional or specialized assistance necessary to plan,
297.29implement, arrange, augment, or evaluate services and supports.
297.30    Subd. 18. Service unit and budget allocation requirements and limits. (a) For the
297.31agency-provider model, services will be authorized in units of service. The total service
297.32unit amount must be established based upon the assessed need for CFSS services, and must
297.33not exceed the maximum number of units available as determined under subdivision 8.
297.34(b) For the budget model, the budget allocation allowed for services and supports
297.35is established by multiplying the number of units authorized under subdivision 8 by the
297.36payment rate established by the commissioner.
298.1    Subd. 19. Support system. (a) The commissioner shall provide information,
298.2consultation, training, and assistance to ensure the participant is able to manage the
298.3services and supports and budgets, if applicable. This support shall include individual
298.4consultation on how to select and employ workers, manage responsibilities under CFSS,
298.5and evaluate personal outcomes.
298.6(b) The commissioner shall provide assistance with the development of risk
298.7management agreements.
298.8    Subd. 20. Service-related rights. (a) Participants must be provided with adequate
298.9information, counseling, training, and assistance, as needed, to ensure that the participant
298.10is able to choose and manage services, models, and budgets. This support shall include
298.11information regarding:
298.12(1) person-centered planning;
298.13(2) the range and scope of individual choices;
298.14(3) the process for changing plans, services and budgets;
298.15(4) the grievance process;
298.16(5) individual rights;
298.17(6) identifying and assessing appropriate services;
298.18(7) risks and responsibilities; and
298.19(8) risk management.
298.20(b) The commissioner must ensure that the participant has a copy of the most recent
298.21community support plan and service delivery plan.
298.22(c) A participant who appeals a reduction in previously authorized CFSS services
298.23may continue previously authorized services pending an appeal in accordance with section
298.24256.045.
298.25(d) If the units of service or budget allocation for CFSS are reduced, denied, or
298.26terminated, the commissioner must provide notice of the reasons for the reduction in the
298.27participant's notice of denial, termination, or reduction.
298.28(e) If all or part of a service delivery plan is denied approval, the commissioner must
298.29provide a notice that describes the basis of the denial.
298.30    Subd. 21. Development and Implementation Council. The commissioner
298.31shall establish a Development and Implementation Council of which the majority of
298.32members are individuals with disabilities, elderly individuals, and their representatives.
298.33The commissioner shall consult and collaborate with the council when developing and
298.34implementing this section for at least the first five years of operation. The commissioner,
298.35in consultation with the council, shall provide recommendations on how to improve the
298.36quality and integrity of CFSS, reduce the paper documentation required in subdivisions
299.110, 12, and 15, make use of electronic means of documentation and online reporting in
299.2order to reduce administrative costs and improve training to the legislative chairs of the
299.3health and human services policy and finance committees by February 1, 2014.
299.4    Subd. 22. Quality assurance and risk management system. (a) The commissioner
299.5shall establish quality assurance and risk management measures for use in developing and
299.6implementing CFSS, including those that (1) recognize the roles and responsibilities of
299.7those involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and
299.8budgets based upon a recipient's resources and capabilities. Risk management measures
299.9must include background studies, and backup and emergency plans, including disaster
299.10planning.
299.11(b) The commissioner shall provide ongoing technical assistance and resource and
299.12educational materials for CFSS participants.
299.13(c) Performance assessment measures, such as a participant's satisfaction with the
299.14services and supports, and ongoing monitoring of health and well-being shall be identified
299.15in consultation with the council established in subdivision 21.
299.16(d) Data reporting requirements will be developed in consultation with the council
299.17established in subdivision 21.
299.18    Subd. 23. Commissioner's access. When the commissioner is investigating a
299.19possible overpayment of Medicaid funds, the commissioner must be given immediate
299.20access without prior notice to the agency provider or FMS contractor's office during
299.21regular business hours and to documentation and records related to services provided and
299.22submission of claims for services provided. Denying the commissioner access to records
299.23is cause for immediate suspension of payment and terminating the agency provider's
299.24enrollment according to section 256B.064 or terminating the FMS contract.
299.25    Subd. 24. CFSS agency-providers; background studies. CFSS agency-providers
299.26enrolled to provide personal care assistance services under the medical assistance program
299.27shall comply with the following:
299.28(1) owners who have a five percent interest or more and all managing employees
299.29are subject to a background study as provided in chapter 245C. This applies to currently
299.30enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
299.31agency-provider. "Managing employee" has the same meaning as Code of Federal
299.32Regulations, title 42, section 455. An organization is barred from enrollment if:
299.33(i) the organization has not initiated background studies on owners managing
299.34employees; or
299.35(ii) the organization has initiated background studies on owners and managing
299.36employees, but the commissioner has sent the organization a notice that an owner or
300.1managing employee of the organization has been disqualified under section 245C.14, and
300.2the owner or managing employee has not received a set-aside of the disqualification
300.3under section 245C.22;
300.4(2) a background study must be initiated and completed for all support specialists; and
300.5(3) a background study must be initiated and completed for all support workers.
300.6    Subd. 25. Commissioner recommendations required. In consultation with
300.7the Development and Implementation Council described in subdivision 21 and other
300.8stakeholders, the commissioner shall develop recommendations for revisions to
300.9subdivisions 12, 15, and 16, that promote self-direction in the following areas:
300.10(1) CFSS provider and support worker enrollment, qualification, and disqualification
300.11criteria;
300.12(2) documentation requirements that are consistent with state and federal
300.13requirements; and
300.14(3) provisions to maintain program integrity and assure fiscal accountability for
300.15goods and services purchased through CFSS.
300.16The recommendations shall be provided to the chairs and ranking minority members
300.17of the legislative committees and divisions with jurisdiction over health and human
300.18services policy and finance by November 15, 2013.
300.19EFFECTIVE DATE.This section is effective upon federal approval but no earlier
300.20than April 1, 2014. The service will begin 90 days after federal approval or April 1,
300.212014, whichever is later. The commissioner of human services shall notify the revisor of
300.22statutes when this occurs.

300.23    Sec. 50. Minnesota Statutes 2012, section 256D.44, subdivision 5, is amended to read:
300.24    Subd. 5. Special needs. In addition to the state standards of assistance established in
300.25subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
300.26Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
300.27center, or a group residential housing facility.
300.28    (a) The county agency shall pay a monthly allowance for medically prescribed
300.29diets if the cost of those additional dietary needs cannot be met through some other
300.30maintenance benefit. The need for special diets or dietary items must be prescribed by
300.31a licensed physician. Costs for special diets shall be determined as percentages of the
300.32allotment for a one-person household under the thrifty food plan as defined by the United
300.33States Department of Agriculture. The types of diets and the percentages of the thrifty
300.34food plan that are covered are as follows:
300.35    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
301.1    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
301.2of thrifty food plan;
301.3    (3) controlled protein diet, less than 40 grams and requires special products, 125
301.4percent of thrifty food plan;
301.5    (4) low cholesterol diet, 25 percent of thrifty food plan;
301.6    (5) high residue diet, 20 percent of thrifty food plan;
301.7    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;
301.8    (7) gluten-free diet, 25 percent of thrifty food plan;
301.9    (8) lactose-free diet, 25 percent of thrifty food plan;
301.10    (9) antidumping diet, 15 percent of thrifty food plan;
301.11    (10) hypoglycemic diet, 15 percent of thrifty food plan; or
301.12    (11) ketogenic diet, 25 percent of thrifty food plan.
301.13    (b) Payment for nonrecurring special needs must be allowed for necessary home
301.14repairs or necessary repairs or replacement of household furniture and appliances using
301.15the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
301.16as long as other funding sources are not available.
301.17    (c) A fee for guardian or conservator service is allowed at a reasonable rate
301.18negotiated by the county or approved by the court. This rate shall not exceed five percent
301.19of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
301.20guardian or conservator is a member of the county agency staff, no fee is allowed.
301.21    (d) The county agency shall continue to pay a monthly allowance of $68 for
301.22restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
301.231990, and who eats two or more meals in a restaurant daily. The allowance must continue
301.24until the person has not received Minnesota supplemental aid for one full calendar month
301.25or until the person's living arrangement changes and the person no longer meets the criteria
301.26for the restaurant meal allowance, whichever occurs first.
301.27    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
301.28is allowed for representative payee services provided by an agency that meets the
301.29requirements under SSI regulations to charge a fee for representative payee services. This
301.30special need is available to all recipients of Minnesota supplemental aid regardless of
301.31their living arrangement.
301.32    (f)(1) Notwithstanding the language in this subdivision, an amount equal to the
301.33maximum allotment authorized by the federal Food Stamp Program for a single individual
301.34which is in effect on the first day of July of each year will be added to the standards of
301.35assistance established in subdivisions 1 to 4 for adults under the age of 65 who qualify
301.36as shelter needy and are: (i) relocating from an institution, or an adult mental health
302.1residential treatment program under section 256B.0622; (ii) eligible for the self-directed
302.2supports option as defined under section 256B.0657, subdivision 2; or (iii) home and
302.3community-based waiver recipients living in their own home or rented or leased apartment
302.4which is not owned, operated, or controlled by a provider of service not related by blood
302.5or marriage, unless allowed under paragraph (g).
302.6    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the
302.7shelter needy benefit under this paragraph is considered a household of one. An eligible
302.8individual who receives this benefit prior to age 65 may continue to receive the benefit
302.9after the age of 65.
302.10    (3) "Shelter needy" means that the assistance unit incurs monthly shelter costs that
302.11exceed 40 percent of the assistance unit's gross income before the application of this
302.12special needs standard. "Gross income" for the purposes of this section is the applicant's or
302.13recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
302.14in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or
302.15state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be
302.16considered shelter needy for purposes of this paragraph.
302.17(g) Notwithstanding this subdivision, to access housing and services as provided
302.18in paragraph (f), the recipient may choose housing that may be owned, operated, or
302.19controlled by the recipient's service provider. In a multifamily building of more than four
302.20units, the maximum number of units that may be used by recipients of this program shall
302.21be the greater of four units or 25 percent of the units in the building, unless required by the
302.22Housing Opportunities for Persons with AIDS Program. In multifamily buildings of four
302.23or fewer units, all of the units may be used by recipients of this program. When housing is
302.24controlled by the service provider, the individual may choose the individual's own service
302.25provider as provided in section 256B.49, subdivision 23, clause (3). When the housing is
302.26controlled by the service provider, the service provider shall implement a plan with the
302.27recipient to transition the lease to the recipient's name. Within two years of signing the
302.28initial lease, the service provider shall transfer the lease entered into under this subdivision
302.29to the recipient. In the event the landlord denies this transfer, the commissioner may
302.30approve an exception within sufficient time to ensure the continued occupancy by the
302.31recipient. This paragraph expires June 30, 2016.

302.32    Sec. 51. Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision
302.333, as amended by Laws 2012, chapter 247, article 4, section 43, is amended to read:

302.34

Subd. 3.Forecasted Programs

303.1The amounts that may be spent from this
303.2appropriation for each purpose are as follows:

303.3

(a) MFIP/DWP Grants

303.4	Appropriations by Fund
303.5	General	84,680,000	91,978,000
303.6	Federal TANF	84,425,000	75,417,000

303.7

(b) MFIP Child Care Assistance Grants

55,456,000

30,923,000

303.8

(c) General Assistance Grants

49,192,000

46,938,000

303.9General Assistance Standard. The
303.10commissioner shall set the monthly standard
303.11of assistance for general assistance units
303.12consisting of an adult recipient who is
303.13childless and unmarried or living apart
303.14from parents or a legal guardian at $203.
303.15The commissioner may reduce this amount
303.16according to Laws 1997, chapter 85, article
303.173, section 54.
303.18Emergency General Assistance. The
303.19amount appropriated for emergency general
303.20assistance funds is limited to no more than
303.21$6,689,812 in fiscal year 2012 and $6,729,812
303.22in fiscal year 2013. Funds to counties shall
303.23be allocated by the commissioner using the
303.24allocation method specified in Minnesota
303.25Statutes, section 256D.06.

303.26

(d) Minnesota Supplemental Aid Grants

38,095,000

39,120,000

303.27

(e) Group Residential Housing Grants

121,080,000

129,238,000

303.28

(f) MinnesotaCare Grants

295,046,000

317,272,000

303.29This appropriation is from the health care
303.30access fund.

303.31

(g) Medical Assistance Grants

4,501,582,000

4,437,282,000

303.32Managed Care Incentive Payments. The
303.33commissioner shall not make managed care
304.1incentive payments for expanding preventive
304.2services during fiscal years beginning July 1,
304.32011, and July 1, 2012.
304.4Reduction of Rates for Congregate
304.5Living for Individuals with Lower Needs.
304.6Beginning October 1, 2011, lead agencies
304.7must reduce rates in effect on January 1, 2011,
304.8by ten percent for individuals with lower
304.9needs living in foster care settings where the
304.10license holder does not share the residence
304.11with recipients on the CADI and DD waivers
304.12and customized living settings for CADI.
304.13Lead agencies shall consult with providers to
304.14review individual service plans and identify
304.15changes or modifications to reduce the
304.16utilization of services while maintaining the
304.17health and safety of the individual receiving
304.18services. Lead agencies must adjust contracts
304.19within 60 days of the effective date. If
304.20federal waiver approval is obtained under
304.21the long-term care realignment waiver
304.22application submitted on February 13,
304.232012, and federal financial participation is
304.24authorized for the alternative care program,
304.25the commissioner shall adjust this payment
304.26rate reduction from ten to five percent for
304.27services rendered on or after July 1, 2012, or
304.28the first day of the month following federal
304.29approval, whichever is later. Effective
304.30August 1, 2013, this provision does not apply
304.31to individuals whose primary diagnosis is
304.32mental illness and who are living in foster
304.33care settings where the license holder is
304.34also (1) a provider of assertive community
304.35treatment (ACT) or adult rehabilitative
304.36mental health services (ARMHS) as defined
305.1in Minnesota Statutes, section 256B.0623;
305.2(2) a mental health center or mental health
305.3clinic certified under Minnesota Rules, parts
305.49520.0750 to 9520.0870; or (3) a provider
305.5of intensive residential treatment services
305.6(IRTS) licensed under Minnesota Rules,
305.7parts 9520.0500 to 9520.0670.
305.8Reduction of Lead Agency Waiver
305.9Allocations to Implement Rate Reductions
305.10for Congregate Living for Individuals
305.11with Lower Needs. Beginning October 1,
305.122011, the commissioner shall reduce lead
305.13agency waiver allocations to implement the
305.14reduction of rates for individuals with lower
305.15needs living in foster care settings where the
305.16license holder does not share the residence
305.17with recipients on the CADI and DD waivers
305.18and customized living settings for CADI.
305.19Reduce customized living and 24-hour
305.20customized living component rates.
305.21Effective July 1, 2011, the commissioner
305.22shall reduce elderly waiver customized living
305.23and 24-hour customized living component
305.24service spending by five percent through
305.25reductions in component rates and service
305.26rate limits. The commissioner shall adjust
305.27the elderly waiver capitation payment
305.28rates for managed care organizations paid
305.29under Minnesota Statutes, section 256B.69,
305.30subdivisions 6a and 23, to reflect reductions
305.31in component spending for customized living
305.32services and 24-hour customized living
305.33services under Minnesota Statutes, section
305.34256B.0915, subdivisions 3e and 3h, for the
305.35contract period beginning January 1, 2012.
305.36To implement the reduction specified in
306.1this provision, capitation rates paid by the
306.2commissioner to managed care organizations
306.3under Minnesota Statutes, section 256B.69,
306.4shall reflect a ten percent reduction for the
306.5specified services for the period January 1,
306.62012, to June 30, 2012, and a five percent
306.7reduction for those services on or after July
306.81, 2012.
306.9Limit Growth in the Developmental
306.10Disability Waiver. The commissioner
306.11shall limit growth in the developmental
306.12disability waiver to six diversion allocations
306.13per month beginning July 1, 2011, through
306.14June 30, 2013, and 15 diversion allocations
306.15per month beginning July 1, 2013, through
306.16June 30, 2015. Waiver allocations shall
306.17be targeted to individuals who meet the
306.18priorities for accessing waiver services
306.19identified in Minnesota Statutes, 256B.092,
306.20subdivision 12 . The limits do not include
306.21conversions from intermediate care facilities
306.22for persons with developmental disabilities.
306.23Notwithstanding any contrary provisions in
306.24this article, this paragraph expires June 30,
306.252015.
306.26Limit Growth in the Community
306.27Alternatives for Disabled Individuals
306.28Waiver. The commissioner shall limit
306.29growth in the community alternatives for
306.30disabled individuals waiver to 60 allocations
306.31per month beginning July 1, 2011, through
306.32June 30, 2013, and 85 allocations per
306.33month beginning July 1, 2013, through
306.34June 30, 2015. Waiver allocations must
306.35be targeted to individuals who meet the
306.36priorities for accessing waiver services
307.1identified in Minnesota Statutes, section
307.2256B.49, subdivision 11a . The limits include
307.3conversions and diversions, unless the
307.4commissioner has approved a plan to convert
307.5funding due to the closure or downsizing
307.6of a residential facility or nursing facility
307.7to serve directly affected individuals on
307.8the community alternatives for disabled
307.9individuals waiver. Notwithstanding any
307.10contrary provisions in this article, this
307.11paragraph expires June 30, 2015.
307.12Personal Care Assistance Relative
307.13Care. The commissioner shall adjust the
307.14capitation payment rates for managed care
307.15organizations paid under Minnesota Statutes,
307.16section 256B.69, to reflect the rate reductions
307.17for personal care assistance provided by
307.18a relative pursuant to Minnesota Statutes,
307.19section 256B.0659, subdivision 11. This rate
307.20reduction is effective July 1, 2013.

307.21

(h) Alternative Care Grants

46,421,000

46,035,000

307.22Alternative Care Transfer. Any money
307.23allocated to the alternative care program that
307.24is not spent for the purposes indicated does
307.25not cancel but shall be transferred to the
307.26medical assistance account.

307.27

(i) Chemical Dependency Entitlement Grants

94,675,000

93,298,000

307.28EFFECTIVE DATE.This section is effective August 1, 2013.

307.29    Sec. 52. Laws 2012, chapter 247, article 6, section 4, is amended to read:

307.30 307.31

Sec. 4. BOARD OF NURSING HOME ADMINISTRATORS

$

-0-

$

10,000

307.32Administrative Services Unit. This
307.33appropriation is to provide a grant to the
308.1Minnesota Ambulance Association to
308.2coordinate and prepare an assessment of
308.3the extent and costs of uncompensated care
308.4as a direct result of emergency responses
308.5on interstate highways in Minnesota.
308.6The study will collect appropriate
308.7information from medical response units
308.8and ambulance services regulated under
308.9Minnesota Statutes, chapter 144E, and to
308.10the extent possible, firefighting agencies.
308.11In preparing the assessment, the Minnesota
308.12Ambulance Association shall consult with
308.13its membership, the Minnesota Fire Chiefs
308.14Association, the Office of the State Fire
308.15Marshal, and the Emergency Medical
308.16Services Regulatory Board. The findings
308.17of the assessment will be reported to the
308.18chairs and ranking minority members of the
308.19legislative committees with jurisdiction over
308.20health and public safety by January 1, 2013.
308.21 This is a onetime appropriation.

308.22    Sec. 53. RECOMMENDATIONS FOR CONCENTRATION LIMITS ON HOME
308.23AND COMMUNITY-BASED SETTINGS.
308.24The commissioner of human services shall consult with the Minnesota Olmstead
308.25subcabinet, advocates, providers, and city representatives to develop recommendations
308.26on concentration limits on home and community-based settings, as defined in
308.27Minnesota Statutes, section 256B.492, as well as any other exceptions to the definition.
308.28The recommendations must be consistent with Minnesota's Olmstead plan. The
308.29recommendations and proposed legislation must be submitted to the chairs and ranking
308.30minority members of the legislative committees with jurisdiction over health and human
308.31services policy and finance by February 1, 2014.

308.32    Sec. 54. TRAINING OF AUTISM SERVICE PROVIDERS.
308.33    The commissioners of health and human services shall ensure that the departments'
308.34autism-related service providers receive training in culturally appropriate approaches to
309.1serving the Somali, Latino, Hmong, and Indigenous American Indian communities, and
309.2other cultural groups experiencing a disproportionate incidence of autism.

309.3    Sec. 55. DIRECTION TO COMMISSIONER; SPOUSAL DISREGARD.
309.4    The commissioner of human services shall request authority, in whatever form is
309.5necessary, from the federal Centers for Medicare and Medicaid Services to allow persons
309.6under age 65 participating in the home and community-based services waivers to continue
309.7to use the disregard of the nonassisted spouse's income and assets instead of the spousal
309.8impoverishment provisions under the federal Patient Protection and Affordable Care Act,
309.9Public Law 111-148, section 2404, as amended by the federal Health Care and Education
309.10Reconciliation Act of 2010, Public Law 111-152, and any amendments to, or regulations
309.11or guidance issued under, those acts.

309.12    Sec. 56. DIRECTION TO COMMISSIONER; ABA.
309.13    By January 1, 2014, the commissioner of human services shall apply to the federal
309.14Centers for Medicare and Medicaid Services for a waiver or other authority to provide
309.15applied behavioral analysis services to children with autism spectrum disorder and related
309.16conditions under the medical assistance program.
309.17EFFECTIVE DATE.This section is effective the day following final enactment.

309.18    Sec. 57. RECOMMENDATIONS ON RAISING THE ASSET LIMITS FOR
309.19SENIORS AND PERSONS WITH DISABILITIES.
309.20    The commissioner of human services shall consult with interested stakeholders to
309.21develop recommendations and a request for a federal 1115 demonstration waiver in order
309.22to increase the asset limit for individuals eligible for medical assistance due to disability
309.23or age who are not residing in a nursing facility, intermediate care facility for persons
309.24with developmental disabilities, or other institution whose costs for room and board are
309.25covered by medical assistance or state funds. The recommendations must be provided to
309.26the legislative committees and divisions with jurisdiction over health and human services
309.27policy and finance by February 1, 2014.

309.28    Sec. 58. NURSING HOME LEVEL OF CARE REPORT.
309.29    (a) The commissioner of human services shall report on the impact of the
309.30modification to the nursing facility level of care to be implemented January 1, 2014,
309.31including the following:
310.1    (1) the number of individuals who lose eligibility for home and community-based
310.2services waivers under Minnesota Statutes, sections 256B.0915 and 256B.49, and
310.3alternative care under Minnesota Statutes, section 256B.0913;
310.4    (2) the number of individuals who lose eligibility for medical assistance; and
310.5    (3) for individuals reported under clauses (1) and (2), and to the extent possible:
310.6    (i) their living situation before and after nursing facility level of care implementation;
310.7and
310.8    (ii) the programs or services they received before and after nursing facility level of
310.9care implementation, including, but not limited to, personal care assistant services and
310.10essential community supports.
310.11    (b) The commissioner of human services shall report to the chairs and ranking
310.12minority members of the legislative committees and divisions with jurisdiction over health
310.13and human services policy and finance with the information required under paragraph
310.14(a). A preliminary report shall be submitted on October 1, 2014, and a final report shall
310.15be submitted February 15, 2015.

310.16    Sec. 59. ASSISTIVE TECHNOLOGY EQUIPMENT FOR HOME AND
310.17COMMUNITY-BASED SERVICES WAIVERS FUNDING DEVELOPMENT.
310.18(a) For the purposes of this section, "assistive technology equipment" includes
310.19computer tablets, passive sensors, and other forms of technology allowing increased
310.20safety and independence, and used by those receiving services through a home and
310.21community-based services waiver under Minnesota Statutes, sections 256B.0915,
310.22256B.092, and 256B.49.
310.23(b) The commissioner of human services shall develop recommendations for
310.24assistive technology equipment funding to enable individuals receiving services identified
310.25in paragraph (a) to live in the least restrictive setting possible. In developing the funding,
310.26the commissioner shall examine funding for the following:
310.27(1) an assessment process to match the appropriate assistive technology equipment
310.28with the waiver recipient, including when the recipient's condition changes or progresses;
310.29(2) the use of monitoring services, if applicable, to the assistive technology
310.30equipment identified in clause (1);
310.31(3) the leasing of assistive technology equipment as a possible alternative to
310.32purchasing the equipment; and
310.33(4) ongoing support services, such as technological support.
310.34(c) The commissioner shall provide the chairs and ranking minority members of the
310.35legislative committees and divisions with jurisdiction over health and human services
311.1policy and finance a recommendation for implementing an assistive technology equipment
311.2program as developed in paragraph (b) by February 1, 2014.

311.3    Sec. 60. PROVIDER RATE AND GRANT INCREASE EFFECTIVE APRIL
311.41, 2014.
311.5(a) The commissioner of human services shall increase reimbursement rates, grants,
311.6allocations, individual limits, and rate limits, as applicable, by one percent for the rate
311.7period beginning April 1, 2014, for services rendered on or after those dates. County or
311.8tribal contracts for services specified in this section must be amended to pass through
311.9these rate increases within 60 days of the effective date.
311.10(b) The rate changes described in this section must be provided to:
311.11(1) home and community-based waivered services for persons with developmental
311.12disabilities or related conditions, including consumer-directed community supports, under
311.13Minnesota Statutes, section 256B.501;
311.14(2) waivered services under community alternatives for disabled individuals,
311.15including consumer-directed community supports, under Minnesota Statutes, section
311.16256B.49;
311.17(3) community alternative care waivered services, including consumer-directed
311.18community supports, under Minnesota Statutes, section 256B.49;
311.19(4) brain injury waivered services, including consumer-directed community
311.20supports, under Minnesota Statutes, section 256B.49;
311.21(5) home and community-based waivered services for the elderly under Minnesota
311.22Statutes, section 256B.0915;
311.23(6) nursing services and home health services under Minnesota Statutes, section
311.24256B.0625, subdivision 6a;
311.25(7) personal care services and qualified professional supervision of personal care
311.26services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
311.27(8) private duty nursing services under Minnesota Statutes, section 256B.0625,
311.28subdivision 7;
311.29(9) day training and habilitation services for adults with developmental disabilities
311.30or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
311.31additional cost of rate adjustments on day training and habilitation services, provided as a
311.32social service, formerly funded under Minnesota Statutes 2010, chapter 256M;
311.33(10) alternative care services under Minnesota Statutes, section 256B.0913;
311.34(11) living skills training programs for persons with intractable epilepsy who need
311.35assistance in the transition to independent living under Laws 1988, chapter 689;
312.1(12) semi-independent living services (SILS) under Minnesota Statutes, section
312.2252.275, including SILS funding under county social services grants formerly funded
312.3under Minnesota Statutes, chapter 256M;
312.4(13) consumer support grants under Minnesota Statutes, section 256.476;
312.5(14) family support grants under Minnesota Statutes, section 252.32;
312.6(15) housing access grants under Minnesota Statutes, sections 256B.0658 and
312.7256B.0917, subdivision 14;
312.8(16) self-advocacy grants under Laws 2009, chapter 101;
312.9(17) technology grants under Laws 2009, chapter 79;
312.10(18) aging grants under Minnesota Statutes, sections 256.975 to 256.977, 256B.0917,
312.11and 256B.0928; and
312.12(19) community support services for deaf and hard-of-hearing adults with mental
312.13illness who use or wish to use sign language as their primary means of communication
312.14under Minnesota Statutes, section 256.01, subdivision 2; and deaf and hard-of-hearing
312.15grants under Minnesota Statutes, sections 256C.233 and 256C.25; Laws 1985, chapter 9;
312.16and Laws 1997, First Special Session chapter 5, section 20.
312.17(c) A managed care plan receiving state payments for the services in this section
312.18must include these increases in their payments to providers. To implement the rate increase
312.19in this section, capitation rates paid by the commissioner to managed care organizations
312.20under Minnesota Statutes, section 256B.69, shall reflect a one percent increase for the
312.21specified services for the period beginning April 1, 2014.
312.22(d) Counties shall increase the budget for each recipient of consumer-directed
312.23community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).

312.24    Sec. 61. SAFETY NET FOR HOME AND COMMUNITY-BASED SERVICES
312.25WAIVERS.
312.26The commissioner of human services shall submit a request by December 31, 2013,
312.27to the federal government to amend the home and community-based services waivers for
312.28individuals with disabilities authorized under Minnesota Statutes, section 256B.49, to
312.29modify the financial management of the home and community-based services waivers
312.30to provide a state-administered safety net when costs for an individual increase above
312.31an identified threshold. The implementation of the safety net may result in a decreased
312.32allocation for individual counties, tribes, or collaboratives of counties or tribes, but must
312.33not result in a net decreased statewide allocation.

312.34    Sec. 62. SHARED LIVING MODEL.
313.1The commissioner of human services shall develop and promote a shared living model
313.2option for individuals receiving services through the home and community-based services
313.3waivers for individuals with disabilities, authorized under Minnesota Statutes, section
313.4256B.092 or 256B.49, as an option for individuals who require 24-hour assistance. The
313.5option must be a companion model with a limit of one or two individuals receiving support
313.6in the home, planned respite for the caregiver, and the availability of intensive training
313.7and support on the needs of the individual or individuals. Any necessary amendments to
313.8implement the model must be submitted to the federal government by December 31, 2013.

313.9    Sec. 63. MONEY FOLLOWS THE PERSON GRANT.
313.10The commissioner of human services shall submit to the federal government all
313.11necessary waiver amendments to implement the Money Follows the Person federal grant
313.12by December 31, 2013.

313.13    Sec. 64. REPEALER.
313.14Minnesota Statutes 2012, sections 256B.0917, subdivision 14; 256B.096,
313.15subdivisions 1, 2, 3, and 4; 256B.14, subdivision 3a; and 256B.5012, subdivision 13, and
313.16Laws 2011, First Special Session chapter 9, article 7, section 54, as amended by Laws 2012,
313.17chapter 247, article 4, section 42, and Laws 2012, chapter 298, section 3, are repealed.


313.20    Section 1. Minnesota Statutes 2012, section 13.461, is amended by adding a
313.21subdivision to read:
313.22    Subd. 7c. Human services license holders. Section 245D.095, subdivision 3,
313.23requires certain license holders to protect service recipient records in accordance with
313.24specified provisions of this chapter.

313.25    Sec. 2. Minnesota Statutes 2012, section 145C.01, subdivision 7, is amended to read:
313.26    Subd. 7. Health care facility. "Health care facility" means a hospital or other entity
313.27licensed under sections 144.50 to 144.58, a nursing home licensed to serve adults under
313.28section 144A.02, a home care provider licensed under sections 144A.43 to 144A.47,
313.29an adult foster care provider licensed under chapter 245A and Minnesota Rules, parts
313.309555.5105 to 9555.6265, a community residential setting licensed under chapter 245D, or
313.31a hospice provider licensed under sections 144A.75 to 144A.755.

314.1    Sec. 3. Minnesota Statutes 2012, section 243.166, subdivision 4b, is amended to read:
314.2    Subd. 4b. Health care facility; notice of status. (a) For the purposes of this
314.3subdivision, "health care facility" means a facility:
314.4(1) licensed by the commissioner of health as a hospital, boarding care home or
314.5supervised living facility under sections 144.50 to 144.58, or a nursing home under
314.6chapter 144A;
314.7(2) registered by the commissioner of health as a housing with services establishment
314.8as defined in section 144D.01; or
314.9(3) licensed by the commissioner of human services as a residential facility under
314.10chapter 245A to provide adult foster care, adult mental health treatment, chemical
314.11dependency treatment to adults, or residential services to persons with developmental
314.12 disabilities.
314.13(b) Prior to admission to a health care facility, a person required to register under
314.14this section shall disclose to:
314.15(1) the health care facility employee processing the admission the person's status
314.16as a registered predatory offender under this section; and
314.17(2) the person's corrections agent, or if the person does not have an assigned
314.18corrections agent, the law enforcement authority with whom the person is currently
314.19required to register, that inpatient admission will occur.
314.20(c) A law enforcement authority or corrections agent who receives notice under
314.21paragraph (b) or who knows that a person required to register under this section is
314.22planning to be admitted and receive, or has been admitted and is receiving health care
314.23at a health care facility shall notify the administrator of the facility and deliver a fact
314.24sheet to the administrator containing the following information: (1) name and physical
314.25description of the offender; (2) the offender's conviction history, including the dates of
314.26conviction; (3) the risk level classification assigned to the offender under section 244.052,
314.27if any; and (4) the profile of likely victims.
314.28(d) Except for a hospital licensed under sections 144.50 to 144.58, if a health care
314.29facility receives a fact sheet under paragraph (c) that includes a risk level classification for
314.30the offender, and if the facility admits the offender, the facility shall distribute the fact
314.31sheet to all residents at the facility. If the facility determines that distribution to a resident
314.32is not appropriate given the resident's medical, emotional, or mental status, the facility
314.33shall distribute the fact sheet to the patient's next of kin or emergency contact.

314.34    Sec. 4. [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY
314.35MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
315.1    Subdivision 1. Rules. The commissioner of human services shall, within 24 months
315.2of enactment of this section, adopt rules governing the use of positive support strategies,
315.3safety interventions, and emergency use of manual restraint in facilities and services
315.4licensed under chapter 245D.
315.5    Subd. 2. Data collection. (a) The commissioner shall, with stakeholder input,
315.6develop data collection elements specific to incidents of emergency use of manual restraint
315.7and positive support transition plans for persons receiving services from providers
315.8governed under chapter 245D effective January 1, 2014. Providers shall report the data in
315.9a format and at a frequency determined by the commissioner of human services. Providers
315.10shall submit the data to the commissioner and the Office of the Ombudsman for Mental
315.11Health and Developmental Disabilities.
315.12(b) Beginning July 1, 2013, providers regulated under Minnesota Rules, parts
315.139525.2700 to 9525.2810, shall submit data regarding the use of all controlled procedures
315.14identified in Minnesota Rules, part 9525.2740, in a format and at a frequency determined
315.15by the commissioner. Providers shall submit the data to the commissioner and the Office
315.16of the Ombudsman for Mental Health and Developmental Disabilities.

315.17    Sec. 5. Minnesota Statutes 2012, section 245.91, is amended by adding a subdivision
315.18to read:
315.19    Subd. 3a. Emergency use of manual restraint. "Emergency use of manual
315.20restraint" has the meaning given in section 245D.02, subdivision 8a, and applies to
315.21services licensed under chapter 245D.

315.22    Sec. 6. Minnesota Statutes 2012, section 245.94, subdivision 2, is amended to read:
315.23    Subd. 2. Matters appropriate for review. (a) In selecting matters for review by the
315.24office, the ombudsman shall give particular attention to unusual deaths or injuries of a
315.25client or reports of emergency use of manual restraint as identified in section 245D.061,
315.26served by an agency, facility, or program, or actions of an agency, facility, or program that:
315.27(1) may be contrary to law or rule;
315.28(2) may be unreasonable, unfair, oppressive, or inconsistent with a policy or order of
315.29an agency, facility, or program;
315.30(3) may be mistaken in law or arbitrary in the ascertainment of facts;
315.31(4) may be unclear or inadequately explained, when reasons should have been
315.32revealed;
315.33(5) may result in abuse or neglect of a person receiving treatment;
316.1(6) may disregard the rights of a client or other individual served by an agency
316.2or facility;
316.3(7) may impede or promote independence, community integration, and productivity
316.4for clients; or
316.5(8) may impede or improve the monitoring or evaluation of services provided to
316.6clients.
316.7(b) The ombudsman shall, in selecting matters for review and in the course of the
316.8review, avoid duplicating other investigations or regulatory efforts.

316.9    Sec. 7. Minnesota Statutes 2012, section 245.94, subdivision 2a, is amended to read:
316.10    Subd. 2a. Mandatory reporting. Within 24 hours after a client suffers death or
316.11serious injury, the agency, facility, or program director shall notify the ombudsman of the
316.12death or serious injury. The emergency use of manual restraint must be reported to the
316.13ombudsman as required under section 245D.061, subdivision 10. The ombudsman is
316.14authorized to receive identifying information about a deceased client according to Code of
316.15Federal Regulations, title 42, section 2.15, paragraph (b).

316.16    Sec. 8. Minnesota Statutes 2012, section 245A.02, subdivision 10, is amended to read:
316.17    Subd. 10. Nonresidential program. "Nonresidential program" means care,
316.18supervision, rehabilitation, training or habilitation of a person provided outside the
316.19person's own home and provided for fewer than 24 hours a day, including adult day
316.20care programs; and chemical dependency or chemical abuse programs that are located
316.21in a nursing home or hospital and receive public funds for providing chemical abuse or
316.22chemical dependency treatment services under chapter 254B. Nonresidential programs
316.23include home and community-based services and semi-independent living services for
316.24persons with developmental disabilities or persons age 65 and older that are provided in
316.25or outside of a person's own home under chapter 245D.

316.26    Sec. 9. Minnesota Statutes 2012, section 245A.02, subdivision 14, is amended to read:
316.27    Subd. 14. Residential program. "Residential program" means a program
316.28that provides 24-hour-a-day care, supervision, food, lodging, rehabilitation, training,
316.29education, habilitation, or treatment outside a person's own home, including a program
316.30in an intermediate care facility for four or more persons with developmental disabilities;
316.31and chemical dependency or chemical abuse programs that are located in a hospital
316.32or nursing home and receive public funds for providing chemical abuse or chemical
316.33dependency treatment services under chapter 254B. Residential programs include home
317.1and community-based services for persons with developmental disabilities or persons age
317.265 and older that are provided in or outside of a person's own home under chapter 245D.

317.3    Sec. 10. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
317.4    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an initial
317.5license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340,
317.6or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under
317.7this chapter for a physical location that will not be the primary residence of the license
317.8holder for the entire period of licensure. If a license is issued during this moratorium, and
317.9the license holder changes the license holder's primary residence away from the physical
317.10location of the foster care license, the commissioner shall revoke the license according
317.11to section 245A.07. The commissioner shall not issue an initial license for a community
317.12residential setting licensed under chapter 245D. Exceptions to the moratorium include:
317.13(1) foster care settings that are required to be registered under chapter 144D;
317.14(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
317.15community residential setting licenses replacing adult foster care licenses in existence on
317.16December 31, 2013, and determined to be needed by the commissioner under paragraph (b);
317.17(3) new foster care licenses or community residential setting licenses determined to
317.18be needed by the commissioner under paragraph (b) for the closure of a nursing facility,
317.19ICF/MR, or regional treatment center, or restructuring of state-operated services that
317.20limits the capacity of state-operated facilities;
317.21(4) new foster care licenses or community residential setting licenses determined
317.22to be needed by the commissioner under paragraph (b) for persons requiring hospital
317.23level care; or
317.24(5) new foster care licenses or community residential setting licenses determined to
317.25be needed by the commissioner for the transition of people from personal care assistance
317.26to the home and community-based services.
317.27(b) The commissioner shall determine the need for newly licensed foster care
317.28homes or community residential settings as defined under this subdivision. As part of the
317.29determination, the commissioner shall consider the availability of foster care capacity in
317.30the area in which the licensee seeks to operate, and the recommendation of the local
317.31county board. The determination by the commissioner must be final. A determination of
317.32need is not required for a change in ownership at the same address.
317.33(c) The commissioner shall study the effects of the license moratorium under this
317.34subdivision and shall report back to the legislature by January 15, 2011. This study shall
317.35include, but is not limited to the following:
318.1(1) the overall capacity and utilization of foster care beds where the physical location
318.2is not the primary residence of the license holder prior to and after implementation
318.3of the moratorium;
318.4(2) the overall capacity and utilization of foster care beds where the physical
318.5location is the primary residence of the license holder prior to and after implementation
318.6of the moratorium; and
318.7(3) the number of licensed and occupied ICF/MR beds prior to and after
318.8implementation of the moratorium.
318.9(d) When a foster care recipient an adult resident served by the program moves out
318.10of a foster home that is not the primary residence of the license holder according to section
318.11256B.49, subdivision 15 , paragraph (f), or the adult community residential setting, the
318.12county shall immediately inform the Department of Human Services Licensing Division.
318.13The department shall decrease the statewide licensed capacity for adult foster care settings
318.14where the physical location is not the primary residence of the license holder, or for adult
318.15community residential settings, if the voluntary changes described in paragraph (f) are
318.16not sufficient to meet the savings required by reductions in licensed bed capacity under
318.17Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f),
318.18and maintain statewide long-term care residential services capacity within budgetary
318.19limits. Implementation of the statewide licensed capacity reduction shall begin on July
318.201, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the
318.21needs determination process. Under this paragraph, the commissioner has the authority
318.22to reduce unused licensed capacity of a current foster care program, or the community
318.23residential settings, to accomplish the consolidation or closure of settings. A decreased
318.24licensed capacity according to this paragraph is not subject to appeal under this chapter.
318.25(e) Residential settings that would otherwise be subject to the decreased license
318.26capacity established in paragraph (d) shall be exempt under the following circumstances:
318.27(1) until August 1, 2013, the license holder's beds occupied by residents whose
318.28primary diagnosis is mental illness and the license holder is:
318.29(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
318.30health services (ARMHS) as defined in section 256B.0623;
318.31(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
318.329520.0870;
318.33(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
318.349520.0870; or
318.35(iv) a provider of intensive residential treatment services (IRTS) licensed under
318.36Minnesota Rules, parts 9520.0500 to 9520.0670; or
319.1(2) the license holder is certified under the requirements in subdivision 6a or section
319.2245D.33.
319.3(f) A resource need determination process, managed at the state level, using the
319.4available reports required by section 144A.351, and other data and information shall
319.5be used to determine where the reduced capacity required under paragraph (d) will be
319.6implemented. The commissioner shall consult with the stakeholders described in section
319.7144A.351 , and employ a variety of methods to improve the state's capacity to meet
319.8long-term care service needs within budgetary limits, including seeking proposals from
319.9service providers or lead agencies to change service type, capacity, or location to improve
319.10services, increase the independence of residents, and better meet needs identified by the
319.11long-term care services reports and statewide data and information. By February 1 of each
319.12year, the commissioner shall provide information and data on the overall capacity of
319.13licensed long-term care services, actions taken under this subdivision to manage statewide
319.14long-term care services and supports resources, and any recommendations for change to
319.15the legislative committees with jurisdiction over health and human services budget.
319.16    (g) At the time of application and reapplication for licensure, the applicant and the
319.17license holder that are subject to the moratorium or an exclusion established in paragraph
319.18(a) are required to inform the commissioner whether the physical location where the foster
319.19care will be provided is or will be the primary residence of the license holder for the entire
319.20period of licensure. If the primary residence of the applicant or license holder changes, the
319.21applicant or license holder must notify the commissioner immediately. The commissioner
319.22shall print on the foster care license certificate whether or not the physical location is the
319.23primary residence of the license holder.
319.24    (h) License holders of foster care homes identified under paragraph (g) that are not
319.25the primary residence of the license holder and that also provide services in the foster care
319.26home that are covered by a federally approved home and community-based services
319.27waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must inform the
319.28human services licensing division that the license holder provides or intends to provide
319.29these waiver-funded services. These license holders must be considered registered under
319.30section 256B.092, subdivision 11, paragraph (c), and this registration status must be
319.31identified on their license certificates.

319.32    Sec. 11. Minnesota Statutes 2012, section 245A.03, subdivision 8, is amended to read:
319.33    Subd. 8. Excluded providers seeking licensure. Nothing in this section shall
319.34prohibit a program that is excluded from licensure under subdivision 2, paragraph
319.35(a), clause (28) (26), from seeking licensure. The commissioner shall ensure that any
320.1application received from such an excluded provider is processed in the same manner as
320.2all other applications for child care center licensure.

320.3    Sec. 12. Minnesota Statutes 2012, section 245A.03, subdivision 9, is amended to read:
320.4    Subd. 9. Permitted services by an individual who is related. Notwithstanding
320.5subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
320.6person receiving supported living services may provide licensed services to that person if:
320.7(1) the person who receives supported living services received these services in a
320.8residential site on July 1, 2005;
320.9(2) the services under clause (1) were provided in a corporate foster care setting for
320.10adults and were funded by the developmental disabilities home and community-based
320.11services waiver defined in section 256B.092;
320.12(3) the individual who is related obtains and maintains both a license under chapter
320.13245B or successor licensing requirements for the provision of supported living services
320.14and an adult foster care license under Minnesota Rules, parts 9555.5105 to 9555.6265; and
320.15(4) the individual who is related is not the guardian of the person receiving supported
320.16living services.

320.17    Sec. 13. Minnesota Statutes 2012, section 245A.042, subdivision 3, is amended to read:
320.18    Subd. 3. Implementation. (a) The commissioner shall implement the
320.19responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
320.20only within the limits of available appropriations or other administrative cost recovery
320.21methodology.
320.22(b) The licensure of home and community-based services according to this section
320.23shall be implemented January 1, 2014. License applications shall be received and
320.24processed on a phased-in schedule as determined by the commissioner beginning July
320.251, 2013. Licenses will be issued thereafter upon the commissioner's determination that
320.26the application is complete according to section 245A.04.
320.27(c) Within the limits of available appropriations or other administrative cost recovery
320.28methodology, implementation of compliance monitoring must be phased in after January
320.291, 2014.
320.30(1) Applicants who do not currently hold a license issued under this chapter 245B
320.31 must receive an initial compliance monitoring visit after 12 months of the effective date of
320.32the initial license for the purpose of providing technical assistance on how to achieve and
320.33maintain compliance with the applicable law or rules governing the provision of home and
320.34community-based services under chapter 245D. If during the review the commissioner
321.1finds that the license holder has failed to achieve compliance with an applicable law or
321.2rule and this failure does not imminently endanger the health, safety, or rights of the
321.3persons served by the program, the commissioner may issue a licensing review report with
321.4recommendations for achieving and maintaining compliance.
321.5(2) Applicants who do currently hold a license issued under this chapter must receive
321.6a compliance monitoring visit after 24 months of the effective date of the initial license.
321.7(d) Nothing in this subdivision shall be construed to limit the commissioner's
321.8authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
321.9or make issue correction orders and make a license conditional for failure to comply with
321.10applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
321.11of the violation of law or rule and the effect of the violation on the health, safety, or
321.12rights of persons served by the program.

321.13    Sec. 14. Minnesota Statutes 2012, section 245A.08, subdivision 2a, is amended to read:
321.14    Subd. 2a. Consolidated contested case hearings. (a) When a denial of a license
321.15under section 245A.05 or a licensing sanction under section 245A.07, subdivision 3, is
321.16based on a disqualification for which reconsideration was requested and which was not
321.17set aside under section 245C.22, the scope of the contested case hearing shall include the
321.18disqualification and the licensing sanction or denial of a license, unless otherwise specified
321.19in this subdivision. When the licensing sanction or denial of a license is based on a
321.20determination of maltreatment under section 626.556 or 626.557, or a disqualification for
321.21serious or recurring maltreatment which was not set aside, the scope of the contested case
321.22hearing shall include the maltreatment determination, disqualification, and the licensing
321.23sanction or denial of a license, unless otherwise specified in this subdivision. In such
321.24cases, a fair hearing under section 256.045 shall not be conducted as provided for in
321.25sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d.
321.26    (b) Except for family child care and child foster care, reconsideration of a
321.27maltreatment determination under sections 626.556, subdivision 10i, and 626.557,
321.28subdivision 9d, and reconsideration of a disqualification under section 245C.22, shall
321.29not be conducted when:
321.30    (1) a denial of a license under section 245A.05, or a licensing sanction under section
321.31245A.07 , is based on a determination that the license holder is responsible for maltreatment
321.32or the disqualification of a license holder is based on serious or recurring maltreatment;
321.33    (2) the denial of a license or licensing sanction is issued at the same time as the
321.34maltreatment determination or disqualification; and
322.1    (3) the license holder appeals the maltreatment determination or disqualification,
322.2and denial of a license or licensing sanction. In these cases, a fair hearing shall not be
322.3conducted under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision
322.49d. The scope of the contested case hearing must include the maltreatment determination,
322.5disqualification, and denial of a license or licensing sanction.
322.6    Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
322.7determination or disqualification, but does not appeal the denial of a license or a licensing
322.8sanction, reconsideration of the maltreatment determination shall be conducted under
322.9sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
322.10disqualification shall be conducted under section 245C.22. In such cases, a fair hearing
322.11shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
322.12626.557, subdivision 9d .
322.13    (c) In consolidated contested case hearings regarding sanctions issued in family child
322.14care, child foster care, family adult day services, and adult foster care, and community
322.15residential settings, the county attorney shall defend the commissioner's orders in
322.16accordance with section 245A.16, subdivision 4.
322.17    (d) The commissioner's final order under subdivision 5 is the final agency action
322.18on the issue of maltreatment and disqualification, including for purposes of subsequent
322.19background studies under chapter 245C and is the only administrative appeal of the final
322.20agency determination, specifically, including a challenge to the accuracy and completeness
322.21of data under section 13.04.
322.22    (e) When consolidated hearings under this subdivision involve a licensing sanction
322.23based on a previous maltreatment determination for which the commissioner has issued
322.24a final order in an appeal of that determination under section 256.045, or the individual
322.25failed to exercise the right to appeal the previous maltreatment determination under
322.26section 626.556, subdivision 10i, or 626.557, subdivision 9d, the commissioner's order is
322.27conclusive on the issue of maltreatment. In such cases, the scope of the administrative
322.28law judge's review shall be limited to the disqualification and the licensing sanction or
322.29denial of a license. In the case of a denial of a license or a licensing sanction issued to
322.30a facility based on a maltreatment determination regarding an individual who is not the
322.31license holder or a household member, the scope of the administrative law judge's review
322.32includes the maltreatment determination.
322.33    (f) The hearings of all parties may be consolidated into a single contested case
322.34hearing upon consent of all parties and the administrative law judge, if:
323.1    (1) a maltreatment determination or disqualification, which was not set aside under
323.2section 245C.22, is the basis for a denial of a license under section 245A.05 or a licensing
323.3sanction under section 245A.07;
323.4    (2) the disqualified subject is an individual other than the license holder and upon
323.5whom a background study must be conducted under section 245C.03; and
323.6    (3) the individual has a hearing right under section 245C.27.
323.7    (g) When a denial of a license under section 245A.05 or a licensing sanction under
323.8section 245A.07 is based on a disqualification for which reconsideration was requested
323.9and was not set aside under section 245C.22, and the individual otherwise has no hearing
323.10right under section 245C.27, the scope of the administrative law judge's review shall
323.11include the denial or sanction and a determination whether the disqualification should
323.12be set aside, unless section 245C.24 prohibits the set-aside of the disqualification. In
323.13determining whether the disqualification should be set aside, the administrative law judge
323.14shall consider the factors under section 245C.22, subdivision 4, to determine whether the
323.15individual poses a risk of harm to any person receiving services from the license holder.
323.16    (h) Notwithstanding section 245C.30, subdivision 5, when a licensing sanction
323.17under section 245A.07 is based on the termination of a variance under section 245C.30,
323.18subdivision 4 , the scope of the administrative law judge's review shall include the sanction
323.19and a determination whether the disqualification should be set aside, unless section
323.20245C.24 prohibits the set-aside of the disqualification. In determining whether the
323.21disqualification should be set aside, the administrative law judge shall consider the factors
323.22under section 245C.22, subdivision 4, to determine whether the individual poses a risk of
323.23harm to any person receiving services from the license holder.

323.24    Sec. 15. Minnesota Statutes 2012, section 245A.10, is amended to read:
323.25245A.10 FEES.
323.26    Subdivision 1. Application or license fee required, programs exempt from fee.
323.27(a) Unless exempt under paragraph (b), the commissioner shall charge a fee for evaluation
323.28of applications and inspection of programs which are licensed under this chapter.
323.29(b) Except as provided under subdivision 2, no application or license fee shall be
323.30charged for child foster care, adult foster care, or family and group family child care, or
323.31a community residential setting.
323.32    Subd. 2. County fees for background studies and licensing inspections. (a) For
323.33purposes of family and group family child care licensing under this chapter, a county
323.34agency may charge a fee to an applicant or license holder to recover the actual cost of
323.35background studies, but in any case not to exceed $100 annually. A county agency may
324.1also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
324.2license or $100 for a two-year license.
324.3    (b) A county agency may charge a fee to a legal nonlicensed child care provider or
324.4applicant for authorization to recover the actual cost of background studies completed
324.5under section 119B.125, but in any case not to exceed $100 annually.
324.6    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
324.7    (1) in cases of financial hardship;
324.8    (2) if the county has a shortage of providers in the county's area;
324.9    (3) for new providers; or
324.10    (4) for providers who have attained at least 16 hours of training before seeking
324.11initial licensure.
324.12    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
324.13an installment basis for up to one year. If the provider is receiving child care assistance
324.14payments from the state, the provider may have the fees under paragraph (a) or (b)
324.15deducted from the child care assistance payments for up to one year and the state shall
324.16reimburse the county for the county fees collected in this manner.
324.17    (e) For purposes of adult foster care and child foster care licensing, and licensing
324.18the physical plant of a community residential setting, under this chapter, a county agency
324.19may charge a fee to a corporate applicant or corporate license holder to recover the actual
324.20cost of licensing inspections, not to exceed $500 annually.
324.21    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the
324.22following circumstances:
324.23(1) in cases of financial hardship;
324.24(2) if the county has a shortage of providers in the county's area; or
324.25(3) for new providers.
324.26    Subd. 3. Application fee for initial license or certification. (a) For fees required
324.27under subdivision 1, an applicant for an initial license or certification issued by the
324.28commissioner shall submit a $500 application fee with each new application required
324.29under this subdivision. An applicant for an initial day services facility license under
324.30chapter 245D shall submit a $250 application fee with each new application. The
324.31application fee shall not be prorated, is nonrefundable, and is in lieu of the annual license
324.32or certification fee that expires on December 31. The commissioner shall not process an
324.33application until the application fee is paid.
324.34(b) Except as provided in clauses (1) to (4) (3), an applicant shall apply for a license
324.35to provide services at a specific location.
325.1(1) For a license to provide residential-based habilitation services to persons with
325.2developmental disabilities under chapter 245B, an applicant shall submit an application
325.3for each county in which the services will be provided. Upon licensure, the license
325.4holder may provide services to persons in that county plus no more than three persons
325.5at any one time in each of up to ten additional counties. A license holder in one county
325.6may not provide services under the home and community-based waiver for persons with
325.7developmental disabilities to more than three people in a second county without holding
325.8a separate license for that second county. Applicants or licensees providing services
325.9under this clause to not more than three persons remain subject to the inspection fees
325.10established in section 245A.10, subdivision 2, for each location. The license issued by
325.11the commissioner must state the name of each additional county where services are being
325.12provided to persons with developmental disabilities. A license holder must notify the
325.13commissioner before making any changes that would alter the license information listed
325.14under section 245A.04, subdivision 7, paragraph (a), including any additional counties
325.15where persons with developmental disabilities are being served. For a license to provide
325.16home and community-based services to persons with disabilities or age 65 and older under
325.17chapter 245D, an applicant shall submit an application to provide services statewide.
325.18Notwithstanding paragraph (a), applications received by the commissioner between July 1,
325.192013, and December 31, 2013, for licensure of services provided under chapter 245D must
325.20include an application fee that is equal to the annual license renewal fee under subdivision
325.214, paragraph (b), or $500, whichever is less. Applications received by the commissioner
325.22after January 1, 2014, must include the application fee required under paragraph (a).
325.23Applicants who meet the modified application criteria identified in section 245A.042,
325.24subdivision 2, are exempt from paying an application fee.
325.25(2) For a license to provide supported employment, crisis respite, or
325.26semi-independent living services to persons with developmental disabilities under chapter
325.27245B, an applicant shall submit a single application to provide services statewide.
325.28(3) For a license to provide independent living assistance for youth under section
325.29245A.22 , an applicant shall submit a single application to provide services statewide.
325.30(4) (3) For a license for a private agency to provide foster care or adoption services
325.31under Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single
325.32application to provide services statewide.
325.33(c) The initial application fee charged under this subdivision does not include the
325.34temporary license surcharge under section 16E.22.
325.35    Subd. 4. License or certification fee for certain programs. (a) Child care centers
325.36shall pay an annual nonrefundable license fee based on the following schedule:

326.1 326.2		Licensed Capacity	Child Care Center License Fee
326.3		1 to 24 persons	$200
326.4		25 to 49 persons	$300
326.5		50 to 74 persons	$400
326.6		75 to 99 persons	$500
326.7		100 to 124 persons	$600
326.8		125 to 149 persons	$700
326.9		150 to 174 persons	$800
326.10		175 to 199 persons	$900
326.11		200 to 224 persons	$1,000
326.12		225 or more persons	$1,100

326.13    (b) A day training and habilitation program serving persons with developmental
326.14disabilities or related conditions shall pay an annual nonrefundable license fee based on
326.15the following schedule:

326.16		Licensed Capacity	License Fee
326.17		1 to 24 persons	$800
326.18		25 to 49 persons	$1,000
326.19		50 to 74 persons	$1,200
326.20		75 to 99 persons	$1,400
326.21		100 to 124 persons	$1,600
326.22		125 to 149 persons	$1,800
326.23		150 or more persons	$2,000

326.24Except as provided in paragraph (c), when a day training and habilitation program
326.25serves more than 50 percent of the same persons in two or more locations in a community,
326.26the day training and habilitation program shall pay a license fee based on the licensed
326.27capacity of the largest facility and the other facility or facilities shall be charged a license
326.28fee based on a licensed capacity of a residential program serving one to 24 persons.
326.29    (c) When a day training and habilitation program serving persons with developmental
326.30disabilities or related conditions seeks a single license allowed under section 245B.07,
326.31subdivision 12, clause (2) or (3), the licensing fee must be based on the combined licensed
326.32capacity for each location.
326.33(d) A program licensed to provide supported employment services to persons
326.34with developmental disabilities under chapter 245B shall pay an annual nonrefundable
326.35license fee of $650.
326.36(e) A program licensed to provide crisis respite services to persons with
326.37developmental disabilities under chapter 245B shall pay an annual nonrefundable license
326.38fee of $700.
327.1(f) A program licensed to provide semi-independent living services to persons
327.2with developmental disabilities under chapter 245B shall pay an annual nonrefundable
327.3license fee of $700.
327.4(g) A program licensed to provide residential-based habilitation services under the
327.5home and community-based waiver for persons with developmental disabilities shall pay
327.6an annual license fee that includes a base rate of $690 plus $60 times the number of clients
327.7served on the first day of July of the current license year.
327.8(h) A residential program certified by the Department of Health as an intermediate
327.9care facility for persons with developmental disabilities (ICF/MR) and a noncertified
327.10residential program licensed to provide health or rehabilitative services for persons
327.11with developmental disabilities shall pay an annual nonrefundable license fee based on
327.12the following schedule:

327.13		Licensed Capacity	License Fee
327.14		1 to 24 persons	$535
327.15		25 to 49 persons	$735
327.16		50 or more persons	$935

327.17(b)(1) A program licensed to provide one or more of the home and community-based
327.18services and supports identified under chapter 245D to persons with disabilities or age
327.1965 and older, shall pay an annual nonrefundable license fee based on revenues derived
327.20from the provision of services that would require licensure under chapter 245D during the
327.21calendar year immediately preceding the year in which the license fee is paid, according to
327.22the following schedule:

327.23	License Holder Annual Revenue	License Fee
327.24	less than or equal to $10,000	$200
327.25 327.26	greater than $10,000 but less than or equal to $25,000	$300
327.27 327.28	greater than $25,000 but less than or equal to $50,000	$400
327.29 327.30	greater than $50,000 but less than or equal to $100,000	$500
327.31 327.32	greater than $100,000 but less than or equal to $150,000	$600
327.33 327.34	greater than $150,000 but less than or equal to $200,000	$800
327.35 327.36	greater than $200,000 but less than or equal to $250,000	$1,000
327.37 327.38	greater than $250,000 but less than or equal to $300,000	$1,200
327.39 327.40	greater than $300,000 but less than or equal to $350,000	$1,400
328.1 328.2	greater than $350,000 but less than or equal to $400,000	$1,600
328.3 328.4	greater than $400,000 but less than or equal to $450,000	$1,800
328.5 328.6	greater than $450,000 but less than or equal to $500,000	$2,000
328.7 328.8	greater than $500,000 but less than or equal to $600,000	$2,250
328.9 328.10	greater than $600,000 but less than or equal to $700,000	$2,500
328.11 328.12	greater than $700,000 but less than or equal to $800,000	$2,750
328.13 328.14	greater than $800,000 but less than or equal to $900,000	$3,000
328.15 328.16	greater than $900,000 but less than or equal to $1,000,000	$3,250
328.17 328.18	greater than $1,000,000 but less than or equal to $1,250,000	$3,500
328.19 328.20	greater than $1,250,000 but less than or equal to $1,500,000	$3,750
328.21 328.22	greater than $1,500,000 but less than or equal to $1,750,000	$4,000
328.23 328.24	greater than $1,750,000 but less than or equal to $2,000,000	$4,250
328.25 328.26	greater than $2,000,000 but less than or equal to $2,500,000	$4,500
328.27 328.28	greater than $2,500,000 but less than or equal to $3,000,000	$4,750
328.29 328.30	greater than $3,000,000 but less than or equal to $3,500,000	$5,000
328.31 328.32	greater than $3,500,000 but less than or equal to $4,000,000	$5,500
328.33 328.34	greater than $4,000,000 but less than or equal to $4,500,000	$6,000
328.35 328.36	greater than $4,500,000 but less than or equal to $5,000,000	$6,500
328.37 328.38	greater than $5,000,000 but less than or equal to $7,500,000	$7,000
328.39 328.40	greater than $7,500,000 but less than or equal to $10,000,000	$8,500
328.41 328.42	greater than $10,000,000 but less than or equal to $12,500,000	$10,000
328.43 328.44	greater than $12,500,000 but less than or equal to $15,000,000	$14,000
328.45	greater than $15,000,000	$18,000

328.46(2) If requested, the license holder shall provide the commissioner information to
328.47verify the license holder's annual revenues or other information as needed, including
328.48copies of documents submitted to the Department of Revenue.
329.1(3) At each annual renewal, a license holder may elect to pay the highest renewal
329.2fee, and not provide annual revenue information to the commissioner.
329.3(4) A license holder that knowingly provides the commissioner incorrect revenue
329.4amounts for the purpose of paying a lower license fee shall be subject to a civil penalty in
329.5the amount of double the fee the provider should have paid.
329.6(5) Notwithstanding clause (1), a license holder providing services under one or
329.7more licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual
329.8license fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid
329.9by the license holder for all licenses held under chapter 245B for calendar year 2013.
329.10For calendar year 2017 and thereafter, the license holder shall pay an annual license fee
329.11according to clause (1).
329.12(i) (c) A chemical dependency treatment program licensed under Minnesota Rules,
329.13parts 9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an
329.14annual nonrefundable license fee based on the following schedule:

329.15		Licensed Capacity	License Fee
329.16		1 to 24 persons	$600
329.17		25 to 49 persons	$800
329.18		50 to 74 persons	$1,000
329.19		75 to 99 persons	$1,200
329.20		100 or more persons	$1,400

329.21(j) (d) A chemical dependency program licensed under Minnesota Rules, parts
329.229530.6510 to 9530.6590, to provide detoxification services shall pay an annual
329.23nonrefundable license fee based on the following schedule:

329.24		Licensed Capacity	License Fee
329.25		1 to 24 persons	$760
329.26		25 to 49 persons	$960
329.27		50 or more persons	$1,160

329.28(k) (e) Except for child foster care, a residential facility licensed under Minnesota
329.29Rules, chapter 2960, to serve children shall pay an annual nonrefundable license fee
329.30based on the following schedule:

329.31		Licensed Capacity	License Fee
329.32		1 to 24 persons	$1,000
329.33		25 to 49 persons	$1,100
329.34		50 to 74 persons	$1,200
329.35		75 to 99 persons	$1,300
329.36		100 or more persons	$1,400

330.1(l) (f) A residential facility licensed under Minnesota Rules, parts 9520.0500 to
330.29520.0670, to serve persons with mental illness shall pay an annual nonrefundable license
330.3fee based on the following schedule:

330.4		Licensed Capacity	License Fee
330.5		1 to 24 persons	$2,525
330.6		25 or more persons	$2,725

330.7(m) (g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to
330.89570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable
330.9license fee based on the following schedule:

330.10		Licensed Capacity	License Fee
330.11		1 to 24 persons	$450
330.12		25 to 49 persons	$650
330.13		50 to 74 persons	$850
330.14		75 to 99 persons	$1,050
330.15		100 or more persons	$1,250

330.16(n) (h) A program licensed to provide independent living assistance for youth under
330.17section 245A.22 shall pay an annual nonrefundable license fee of $1,500.
330.18(o) (i) A private agency licensed to provide foster care and adoption services under
330.19Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable
330.20license fee of $875.
330.21(p) (j) A program licensed as an adult day care center licensed under Minnesota
330.22Rules, parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based
330.23on the following schedule:

330.24		Licensed Capacity	License Fee
330.25		1 to 24 persons	$500
330.26		25 to 49 persons	$700
330.27		50 to 74 persons	$900
330.28		75 to 99 persons	$1,100
330.29		100 or more persons	$1,300

330.30(q) (k) A program licensed to provide treatment services to persons with sexual
330.31psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts
330.329515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.
330.33(r) (l) A mental health center or mental health clinic requesting certification for
330.34purposes of insurance and subscriber contract reimbursement under Minnesota Rules,
330.35parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,550 per year. If the
330.36mental health center or mental health clinic provides services at a primary location with
331.1satellite facilities, the satellite facilities shall be certified with the primary location without
331.2an additional charge.
331.3    Subd. 6. License not issued until license or certification fee is paid. The
331.4commissioner shall not issue a license or certification until the license or certification fee
331.5is paid. The commissioner shall send a bill for the license or certification fee to the billing
331.6address identified by the license holder. If the license holder does not submit the license or
331.7certification fee payment by the due date, the commissioner shall send the license holder
331.8a past due notice. If the license holder fails to pay the license or certification fee by the
331.9due date on the past due notice, the commissioner shall send a final notice to the license
331.10holder informing the license holder that the program license will expire on December 31
331.11unless the license fee is paid before December 31. If a license expires, the program is no
331.12longer licensed and, unless exempt from licensure under section 245A.03, subdivision 2,
331.13must not operate after the expiration date. After a license expires, if the former license
331.14holder wishes to provide licensed services, the former license holder must submit a new
331.15license application and application fee under subdivision 3.
331.16    Subd. 7. Human services licensing fees to recover expenditures. Notwithstanding
331.17section 16A.1285, subdivision 2, related to activities for which the commissioner charges
331.18a fee, the commissioner must plan to fully recover direct expenditures for licensing
331.19activities under this chapter over a five-year period. The commissioner may have
331.20anticipated expenditures in excess of anticipated revenues in a biennium by using surplus
331.21revenues accumulated in previous bienniums.
331.22    Subd. 8. Deposit of license fees. A human services licensing account is created in
331.23the state government special revenue fund. Fees collected under subdivisions 3 and 4 must
331.24be deposited in the human services licensing account and are annually appropriated to the
331.25commissioner for licensing activities authorized under this chapter.
331.26EFFECTIVE DATE.This section is effective July 1, 2013.

331.27    Sec. 16. Minnesota Statutes 2012, section 245A.11, subdivision 2a, is amended to read:
331.28    Subd. 2a. Adult foster care and community residential setting license capacity.
331.29(a) The commissioner shall issue adult foster care and community residential setting
331.30 licenses with a maximum licensed capacity of four beds, including nonstaff roomers and
331.31boarders, except that the commissioner may issue a license with a capacity of five beds,
331.32including roomers and boarders, according to paragraphs (b) to (f).
331.33(b) An adult foster care The license holder may have a maximum license capacity
331.34of five if all persons in care are age 55 or over and do not have a serious and persistent
331.35mental illness or a developmental disability.
332.1(c) The commissioner may grant variances to paragraph (b) to allow a foster care
332.2provider facility with a licensed capacity of five persons to admit an individual under the
332.3age of 55 if the variance complies with section 245A.04, subdivision 9, and approval of
332.4the variance is recommended by the county in which the licensed foster care provider
332.5 facility is located.
332.6(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
332.7bed for emergency crisis services for a person with serious and persistent mental illness
332.8or a developmental disability, regardless of age, if the variance complies with section
332.9245A.04, subdivision 9 , and approval of the variance is recommended by the county in
332.10which the licensed foster care provider facility is located.
332.11(e) The commissioner may grant a variance to paragraph (b) to allow for the use of a
332.12fifth bed for respite services, as defined in section 245A.02, for persons with disabilities,
332.13regardless of age, if the variance complies with sections 245A.03, subdivision 7, and
332.14245A.04, subdivision 9 , and approval of the variance is recommended by the county in
332.15which the licensed foster care provider facility is licensed located. Respite care may be
332.16provided under the following conditions:
332.17(1) staffing ratios cannot be reduced below the approved level for the individuals
332.18being served in the home on a permanent basis;
332.19(2) no more than two different individuals can be accepted for respite services in
332.20any calendar month and the total respite days may not exceed 120 days per program in
332.21any calendar year;
332.22(3) the person receiving respite services must have his or her own bedroom, which
332.23could be used for alternative purposes when not used as a respite bedroom, and cannot be
332.24the room of another person who lives in the foster care home facility; and
332.25(4) individuals living in the foster care home facility must be notified when the
332.26variance is approved. The provider must give 60 days' notice in writing to the residents
332.27and their legal representatives prior to accepting the first respite placement. Notice must
332.28be given to residents at least two days prior to service initiation, or as soon as the license
332.29holder is able if they receive notice of the need for respite less than two days prior to
332.30initiation, each time a respite client will be served, unless the requirement for this notice is
332.31waived by the resident or legal guardian.
332.32(f) The commissioner may issue an adult foster care or community residential setting
332.33 license with a capacity of five adults if the fifth bed does not increase the overall statewide
332.34capacity of licensed adult foster care or community residential setting beds in homes that
332.35are not the primary residence of the license holder, as identified in a plan submitted to the
333.1commissioner by the county, when the capacity is recommended by the county licensing
333.2agency of the county in which the facility is located and if the recommendation verifies that:
333.3(1) the facility meets the physical environment requirements in the adult foster
333.4care licensing rule;
333.5(2) the five-bed living arrangement is specified for each resident in the resident's:
333.6(i) individualized plan of care;
333.7(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
333.8(iii) individual resident placement agreement under Minnesota Rules, part
333.99555.5105, subpart 19, if required;
333.10(3) the license holder obtains written and signed informed consent from each
333.11resident or resident's legal representative documenting the resident's informed choice
333.12to remain living in the home and that the resident's refusal to consent would not have
333.13resulted in service termination; and
333.14(4) the facility was licensed for adult foster care before March 1, 2011.
333.15(g) The commissioner shall not issue a new adult foster care license under paragraph
333.16(f) after June 30, 2016. The commissioner shall allow a facility with an adult foster care
333.17license issued under paragraph (f) before June 30, 2016, to continue with a capacity of five
333.18adults if the license holder continues to comply with the requirements in paragraph (f).

333.19    Sec. 17. Minnesota Statutes 2012, section 245A.11, subdivision 7, is amended to read:
333.20    Subd. 7. Adult foster care; variance for alternate overnight supervision. (a) The
333.21commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts
333.22requiring a caregiver to be present in an adult foster care home during normal sleeping
333.23hours to allow for alternative methods of overnight supervision. The commissioner may
333.24grant the variance if the local county licensing agency recommends the variance and the
333.25county recommendation includes documentation verifying that:
333.26    (1) the county has approved the license holder's plan for alternative methods of
333.27providing overnight supervision and determined the plan protects the residents' health,
333.28safety, and rights;
333.29    (2) the license holder has obtained written and signed informed consent from
333.30each resident or each resident's legal representative documenting the resident's or legal
333.31representative's agreement with the alternative method of overnight supervision; and
333.32    (3) the alternative method of providing overnight supervision, which may include
333.33the use of technology, is specified for each resident in the resident's: (i) individualized
333.34plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if
334.1required; or (iii) individual resident placement agreement under Minnesota Rules, part
334.29555.5105, subpart 19, if required.
334.3    (b) To be eligible for a variance under paragraph (a), the adult foster care license
334.4holder must not have had a conditional license issued under section 245A.06, or any
334.5other licensing sanction issued under section 245A.07 during the prior 24 months based
334.6on failure to provide adequate supervision, health care services, or resident safety in
334.7the adult foster care home.
334.8    (c) A license holder requesting a variance under this subdivision to utilize
334.9technology as a component of a plan for alternative overnight supervision may request
334.10the commissioner's review in the absence of a county recommendation. Upon receipt of
334.11such a request from a license holder, the commissioner shall review the variance request
334.12with the county.
334.13(d) A variance granted by the commissioner according to this subdivision before
334.14January 1, 2014, to a license holder for an adult foster care home must transfer with the
334.15license when the license converts to a community residential setting license under chapter
334.16245D. The terms and conditions of the variance remain in effect as approved at the time
334.17the variance was granted.

334.18    Sec. 18. Minnesota Statutes 2012, section 245A.11, subdivision 7a, is amended to read:
334.19    Subd. 7a. Alternate overnight supervision technology; adult foster care license
334.20 and community residential setting licenses. (a) The commissioner may grant an
334.21applicant or license holder an adult foster care or community residential setting license
334.22for a residence that does not have a caregiver in the residence during normal sleeping
334.23hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, or section
334.24245D.02, subdivision 33b, but uses monitoring technology to alert the license holder
334.25when an incident occurs that may jeopardize the health, safety, or rights of a foster
334.26care recipient. The applicant or license holder must comply with all other requirements
334.27under Minnesota Rules, parts 9555.5105 to 9555.6265, or applicable requirements under
334.28chapter 245D, and the requirements under this subdivision. The license printed by the
334.29commissioner must state in bold and large font:
334.30    (1) that the facility is under electronic monitoring; and
334.31    (2) the telephone number of the county's common entry point for making reports of
334.32suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
334.33(b) Applications for a license under this section must be submitted directly to
334.34the Department of Human Services licensing division. The licensing division must
334.35immediately notify the host county and lead county contract agency and the host county
335.1licensing agency. The licensing division must collaborate with the county licensing
335.2agency in the review of the application and the licensing of the program.
335.3    (c) Before a license is issued by the commissioner, and for the duration of the
335.4license, the applicant or license holder must establish, maintain, and document the
335.5implementation of written policies and procedures addressing the requirements in
335.6paragraphs (d) through (f).
335.7    (d) The applicant or license holder must have policies and procedures that:
335.8    (1) establish characteristics of target populations that will be admitted into the home,
335.9and characteristics of populations that will not be accepted into the home;
335.10    (2) explain the discharge process when a foster care recipient resident served by the
335.11program requires overnight supervision or other services that cannot be provided by the
335.12license holder due to the limited hours that the license holder is on site;
335.13    (3) describe the types of events to which the program will respond with a physical
335.14presence when those events occur in the home during time when staff are not on site, and
335.15how the license holder's response plan meets the requirements in paragraph (e), clause
335.16(1) or (2);
335.17    (4) establish a process for documenting a review of the implementation and
335.18effectiveness of the response protocol for the response required under paragraph (e),
335.19clause (1) or (2). The documentation must include:
335.20    (i) a description of the triggering incident;
335.21    (ii) the date and time of the triggering incident;
335.22    (iii) the time of the response or responses under paragraph (e), clause (1) or (2);
335.23    (iv) whether the response met the resident's needs;
335.24    (v) whether the existing policies and response protocols were followed; and
335.25    (vi) whether the existing policies and protocols are adequate or need modification.
335.26    When no physical presence response is completed for a three-month period, the
335.27license holder's written policies and procedures must require a physical presence response
335.28drill to be conducted for which the effectiveness of the response protocol under paragraph
335.29(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
335.30    (5) establish that emergency and nonemergency phone numbers are posted in a
335.31prominent location in a common area of the home where they can be easily observed by a
335.32person responding to an incident who is not otherwise affiliated with the home.
335.33    (e) The license holder must document and include in the license application which
335.34response alternative under clause (1) or (2) is in place for responding to situations that
335.35present a serious risk to the health, safety, or rights of people receiving foster care services
335.36in the home residents served by the program:
336.1    (1) response alternative (1) requires only the technology to provide an electronic
336.2notification or alert to the license holder that an event is underway that requires a response.
336.3Under this alternative, no more than ten minutes will pass before the license holder will be
336.4physically present on site to respond to the situation; or
336.5    (2) response alternative (2) requires the electronic notification and alert system under
336.6alternative (1), but more than ten minutes may pass before the license holder is present on
336.7site to respond to the situation. Under alternative (2), all of the following conditions are met:
336.8    (i) the license holder has a written description of the interactive technological
336.9applications that will assist the license holder in communicating with and assessing the
336.10needs related to the care, health, and safety of the foster care recipients. This interactive
336.11technology must permit the license holder to remotely assess the well being of the foster
336.12care recipient resident served by the program without requiring the initiation of the
336.13foster care recipient. Requiring the foster care recipient to initiate a telephone call does
336.14not meet this requirement;
336.15(ii) the license holder documents how the remote license holder is qualified and
336.16capable of meeting the needs of the foster care recipients and assessing foster care
336.17recipients' needs under item (i) during the absence of the license holder on site;
336.18(iii) the license holder maintains written procedures to dispatch emergency response
336.19personnel to the site in the event of an identified emergency; and
336.20    (iv) each foster care recipient's resident's individualized plan of care, individual
336.21service plan coordinated service and support plan under section sections 256B.0913,
336.22subdivision 8; 256B.0915, subdivision 6; 256B.092, subdivision 1b; and 256B.49,
336.23subdivision 15, if required, or individual resident placement agreement under Minnesota
336.24Rules, part 9555.5105, subpart 19, if required, identifies the maximum response time,
336.25which may be greater than ten minutes, for the license holder to be on site for that foster
336.26care recipient resident.
336.27    (f) Each foster care recipient's resident's placement agreement, individual service
336.28agreement, and plan must clearly state that the adult foster care or community residential
336.29setting license category is a program without the presence of a caregiver in the residence
336.30during normal sleeping hours; the protocols in place for responding to situations that
336.31present a serious risk to the health, safety, or rights of foster care recipients residents
336.32served by the program under paragraph (e), clause (1) or (2); and a signed informed
336.33consent from each foster care recipient resident served by the program or the person's
336.34legal representative documenting the person's or legal representative's agreement with
336.35placement in the program. If electronic monitoring technology is used in the home, the
336.36informed consent form must also explain the following:
337.1    (1) how any electronic monitoring is incorporated into the alternative supervision
337.2system;
337.3    (2) the backup system for any electronic monitoring in times of electrical outages or
337.4other equipment malfunctions;
337.5    (3) how the caregivers or direct support staff are trained on the use of the technology;
337.6    (4) the event types and license holder response times established under paragraph (e);
337.7    (5) how the license holder protects the foster care recipient's each resident's privacy
337.8related to electronic monitoring and related to any electronically recorded data generated
337.9by the monitoring system. A foster care recipient resident served by the program may
337.10not be removed from a program under this subdivision for failure to consent to electronic
337.11monitoring. The consent form must explain where and how the electronically recorded
337.12data is stored, with whom it will be shared, and how long it is retained; and
337.13    (6) the risks and benefits of the alternative overnight supervision system.
337.14    The written explanations under clauses (1) to (6) may be accomplished through
337.15cross-references to other policies and procedures as long as they are explained to the
337.16person giving consent, and the person giving consent is offered a copy.
337.17(g) Nothing in this section requires the applicant or license holder to develop or
337.18maintain separate or duplicative policies, procedures, documentation, consent forms, or
337.19individual plans that may be required for other licensing standards, if the requirements of
337.20this section are incorporated into those documents.
337.21(h) The commissioner may grant variances to the requirements of this section
337.22according to section 245A.04, subdivision 9.
337.23(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
337.24under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
337.25contractors affiliated with the license holder.
337.26(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to
337.27remotely determine what action the license holder needs to take to protect the well-being
337.28of the foster care recipient.
337.29(k) The commissioner shall evaluate license applications using the requirements
337.30in paragraphs (d) to (f). The commissioner shall provide detailed application forms,
337.31including a checklist of criteria needed for approval.
337.32(l) To be eligible for a license under paragraph (a), the adult foster care or community
337.33residential setting license holder must not have had a conditional license issued under
337.34section 245A.06 or any licensing sanction under section 245A.07 during the prior 24
337.35months based on failure to provide adequate supervision, health care services, or resident
337.36safety in the adult foster care home or community residential setting.
338.1(m) The commissioner shall review an application for an alternative overnight
338.2supervision license within 60 days of receipt of the application. When the commissioner
338.3receives an application that is incomplete because the applicant failed to submit required
338.4documents or that is substantially deficient because the documents submitted do not meet
338.5licensing requirements, the commissioner shall provide the applicant written notice
338.6that the application is incomplete or substantially deficient. In the written notice to the
338.7applicant, the commissioner shall identify documents that are missing or deficient and
338.8give the applicant 45 days to resubmit a second application that is substantially complete.
338.9An applicant's failure to submit a substantially complete application after receiving
338.10notice from the commissioner is a basis for license denial under section 245A.05. The
338.11commissioner shall complete subsequent review within 30 days.
338.12(n) Once the application is considered complete under paragraph (m), the
338.13commissioner will approve or deny an application for an alternative overnight supervision
338.14license within 60 days.
338.15(o) For the purposes of this subdivision, "supervision" means:
338.16(1) oversight by a caregiver or direct support staff as specified in the individual
338.17resident's place agreement or coordinated service and support plan and awareness of the
338.18resident's needs and activities; and
338.19(2) the presence of a caregiver or direct support staff in a residence during normal
338.20sleeping hours, unless a determination has been made and documented in the individual's
338.21 coordinated service and support plan that the individual does not require the presence of a
338.22caregiver or direct support staff during normal sleeping hours.

338.23    Sec. 19. Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to read:
338.24    Subd. 7b. Adult foster care data privacy and security. (a) An adult foster care
338.25 or community residential setting license holder who creates, collects, records, maintains,
338.26stores, or discloses any individually identifiable recipient data, whether in an electronic
338.27or any other format, must comply with the privacy and security provisions of applicable
338.28privacy laws and regulations, including:
338.29(1) the federal Health Insurance Portability and Accountability Act of 1996
338.30(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
338.31title 45, part 160, and subparts A and E of part 164; and
338.32(2) the Minnesota Government Data Practices Act as codified in chapter 13.
338.33(b) For purposes of licensure, the license holder shall be monitored for compliance
338.34with the following data privacy and security provisions:
339.1(1) the license holder must control access to data on foster care recipients residents
339.2served by the program according to the definitions of public and private data on individuals
339.3under section 13.02; classification of the data on individuals as private under section
339.413.46, subdivision 2 ; and control over the collection, storage, use, access, protection,
339.5and contracting related to data according to section 13.05, in which the license holder is
339.6assigned the duties of a government entity;
339.7(2) the license holder must provide each foster care recipient resident served by
339.8the program with a notice that meets the requirements under section 13.04, in which
339.9the license holder is assigned the duties of the government entity, and that meets the
339.10requirements of Code of Federal Regulations, title 45, part 164.52. The notice shall
339.11describe the purpose for collection of the data, and to whom and why it may be disclosed
339.12pursuant to law. The notice must inform the recipient individual that the license holder
339.13uses electronic monitoring and, if applicable, that recording technology is used;
339.14(3) the license holder must not install monitoring cameras in bathrooms;
339.15(4) electronic monitoring cameras must not be concealed from the foster care
339.16recipients residents served by the program; and
339.17(5) electronic video and audio recordings of foster care recipients residents served
339.18by the program shall be stored by the license holder for five days unless: (i) a foster care
339.19recipient resident served by the program or legal representative requests that the recording
339.20be held longer based on a specific report of alleged maltreatment; or (ii) the recording
339.21captures an incident or event of alleged maltreatment under section 626.556 or 626.557 or
339.22a crime under chapter 609. When requested by a recipient resident served by the program
339.23 or when a recording captures an incident or event of alleged maltreatment or a crime, the
339.24license holder must maintain the recording in a secured area for no longer than 30 days
339.25to give the investigating agency an opportunity to make a copy of the recording. The
339.26investigating agency will maintain the electronic video or audio recordings as required in
339.27section 626.557, subdivision 12b.
339.28(c) The commissioner shall develop, and make available to license holders and
339.29county licensing workers, a checklist of the data privacy provisions to be monitored
339.30for purposes of licensure.

339.31    Sec. 20. Minnesota Statutes 2012, section 245A.11, subdivision 8, is amended to read:
339.32    Subd. 8. Community residential setting license. (a) The commissioner shall
339.33establish provider standards for residential support services that integrate service standards
339.34and the residential setting under one license. The commissioner shall propose statutory
339.35language and an implementation plan for licensing requirements for residential support
340.1services to the legislature by January 15, 2012, as a component of the quality outcome
340.2standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
340.3(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
340.4for services in settings licensed as adult foster care under Minnesota Rules, parts 9555.5105
340.5to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to 2960.3340;
340.6and meeting the provisions of section 256B.092, subdivision 11, paragraph (b) section
340.7245D.02, subdivision 4a, must be required to obtain a community residential setting license.

340.8    Sec. 21. Minnesota Statutes 2012, section 245A.16, subdivision 1, is amended to read:
340.9    Subdivision 1. Delegation of authority to agencies. (a) County agencies and
340.10private agencies that have been designated or licensed by the commissioner to perform
340.11licensing functions and activities under section 245A.04 and background studies for family
340.12child care under chapter 245C; to recommend denial of applicants under section 245A.05;
340.13to issue correction orders, to issue variances, and recommend a conditional license under
340.14section 245A.06, or to recommend suspending or revoking a license or issuing a fine under
340.15section 245A.07, shall comply with rules and directives of the commissioner governing
340.16those functions and with this section. The following variances are excluded from the
340.17delegation of variance authority and may be issued only by the commissioner:
340.18    (1) dual licensure of family child care and child foster care, dual licensure of child
340.19and adult foster care, and adult foster care and family child care;
340.20    (2) adult foster care maximum capacity;
340.21    (3) adult foster care minimum age requirement;
340.22    (4) child foster care maximum age requirement;
340.23    (5) variances regarding disqualified individuals except that county agencies may
340.24issue variances under section 245C.30 regarding disqualified individuals when the county
340.25is responsible for conducting a consolidated reconsideration according to sections 245C.25
340.26and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
340.27and a disqualification based on serious or recurring maltreatment; and
340.28    (6) the required presence of a caregiver in the adult foster care residence during
340.29normal sleeping hours; and
340.30    (7) variances for community residential setting licenses under chapter 245D.
340.31Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency
340.32must not grant a license holder a variance to exceed the maximum allowable family child
340.33care license capacity of 14 children.
340.34    (b) County agencies must report information about disqualification reconsiderations
340.35under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
341.1granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
341.2prescribed by the commissioner.
341.3    (c) For family day care programs, the commissioner may authorize licensing reviews
341.4every two years after a licensee has had at least one annual review.
341.5    (d) For family adult day services programs, the commissioner may authorize
341.6licensing reviews every two years after a licensee has had at least one annual review.
341.7    (e) A license issued under this section may be issued for up to two years.
341.8(f) During implementation of chapter 245D, the commissioner shall consider:
341.9(1) the role of counties in quality assurance;
341.10(2) the duties of county licensing staff; and
341.11(3) the possible use of joint powers agreements, according to section 471.59, with
341.12counties through which some licensing duties under chapter 245D may be delegated by
341.13the commissioner to the counties.
341.14Any consideration related to this paragraph must meet all of the requirements of the
341.15corrective action plan ordered by the federal Centers for Medicare and Medicaid Services.

341.16    Sec. 22. Minnesota Statutes 2012, section 245D.02, is amended to read:
341.17245D.02 DEFINITIONS.
341.18    Subdivision 1. Scope. The terms used in this chapter have the meanings given
341.19them in this section.
341.20    Subd. 2. Annual and annually. "Annual" and "annually" have the meaning given
341.21in section 245A.02, subdivision 2b.
341.22    Subd. 2a. Authorized representative. "Authorized representative" means a parent,
341.23family member, advocate, or other adult authorized by the person or the person's legal
341.24representative, to serve as a representative in connection with the provision of services
341.25licensed under this chapter. This authorization must be in writing or by another method
341.26that clearly indicates the person's free choice. The authorized representative must have no
341.27financial interest in the provision of any services included in the person's service delivery
341.28plan and must be capable of providing the support necessary to assist the person in the use
341.29of home and community-based services licensed under this chapter.
341.30    Subd. 2b. Aversive procedure. "Aversive procedure" means the application of
341.31an aversive stimulus contingent upon the occurrence of a behavior for the purposes of
341.32reducing or eliminating the behavior.
341.33    Subd. 2c. Aversive stimulus. "Aversive stimulus" means an object, event, or
341.34situation that is presented immediately following a behavior in an attempt to suppress the
341.35behavior. Typically, an aversive stimulus is unpleasant and penalizes or confines.
342.1    Subd. 3. Case manager. "Case manager" means the individual designated
342.2to provide waiver case management services, care coordination, or long-term care
342.3consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
342.4or successor provisions.
342.5    Subd. 3a. Certification. "Certification" means the commissioner's written
342.6authorization for a license holder to provide specialized services based on certification
342.7standards in section 245D.33. The term certification and its derivatives have the same
342.8meaning and may be substituted for the term licensure and its derivatives in this chapter
342.9and chapter 245A.
342.10    Subd. 3b. Chemical restraint. "Chemical restraint" means the administration of
342.11a drug or medication to control the person's behavior or restrict the person's freedom
342.12of movement and is not a standard treatment or dosage for the person's medical or
342.13psychological condition.
342.14    Subd. 4. Commissioner. "Commissioner" means the commissioner of the
342.15Department of Human Services or the commissioner's designated representative.
342.16    Subd. 4a. Community residential setting. "Community residential setting" means
342.17a residential program as identified in section 245A.11, subdivision 8, where residential
342.18supports and services identified in section 245D.03, subdivision 1, paragraph (c), clause
342.19(3), items (i) and (ii), are provided and the license holder is the owner, lessor, or tenant
342.20of the facility licensed according to this chapter, and the license holder does not reside
342.21in the facility.
342.22    Subd. 4b. Coordinated service and support plan. "Coordinated service and support
342.23plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915, subdivision
342.246; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor provisions.
342.25    Subd. 4c. Coordinated service and support plan addendum. "Coordinated
342.26service and support plan addendum" means the documentation that this chapter requires
342.27of the license holder for each person receiving services.
342.28    Subd. 4d. Corporate foster care. "Corporate foster care" means a child foster
342.29residence setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340,
342.30or an adult foster care home licensed according to Minnesota Rules, parts 9555.5105 to
342.319555.6265, where the license holder does not live in the home.
342.32    Subd. 4e. Cultural competence or culturally competent. "Cultural competence"
342.33or "culturally competent" means the ability and the will to respond to the unique needs of
342.34a person that arise from the person's culture and the ability to use the person's culture as a
342.35resource or tool to assist with the intervention and help meet the person's needs.
343.1    Subd. 4f. Day services facility. "Day services facility" means a facility licensed
343.2according to this chapter at which persons receive day services licensed under this chapter
343.3from the license holder's direct support staff for a cumulative total of more than 30 days
343.4within any 12-month period and the license holder is the owner, lessor, or tenant of the
343.5facility.
343.6    Subd. 5. Department. "Department" means the Department of Human Services.
343.7    Subd. 5a. Deprivation procedure. "Deprivation procedure" means the removal of a
343.8positive reinforcer following a response resulting in, or intended to result in, a decrease in
343.9the frequency, duration, or intensity of that response. Oftentimes the positive reinforcer
343.10available is goods, services, or activities to which the person is normally entitled. The
343.11removal is often in the form of a delay or postponement of the positive reinforcer.
343.12    Subd. 6. Direct contact. "Direct contact" has the meaning given in section 245C.02,
343.13subdivision 11 , and is used interchangeably with the term "direct support service."
343.14    Subd. 6a. Direct support staff or staff. "Direct support staff" or "staff" means
343.15employees of the license holder who have direct contact with persons served by the
343.16program and includes temporary staff or subcontractors, regardless of employer, providing
343.17program services for hire under the control of the license holder who have direct contact
343.18with persons served by the program.
343.19    Subd. 7. Drug. "Drug" has the meaning given in section 151.01, subdivision 5.
343.20    Subd. 8. Emergency. "Emergency" means any event that affects the ordinary
343.21daily operation of the program including, but not limited to, fires, severe weather, natural
343.22disasters, power failures, or other events that threaten the immediate health and safety of
343.23a person receiving services and that require calling 911, emergency evacuation, moving
343.24to an emergency shelter, or temporary closure or relocation of the program to another
343.25facility or service site for more than 24 hours.
343.26    Subd. 8a. Emergency use of manual restraint. "Emergency use of manual
343.27restraint" means using a manual restraint when a person poses an imminent risk of
343.28physical harm to self or others and is the least restrictive intervention that would achieve
343.29safety. Property damage, verbal aggression, or a person's refusal to receive or participate
343.30in treatment or programming on their own, do not constitute an emergency.
343.31    Subd. 8b. Expanded support team. "Expanded support team" means the members
343.32of the support team defined in subdivision 46, and a licensed health or mental health
343.33professional or other licensed, certified, or qualified professionals or consultants working
343.34with the person and included in the team at the request of the person or the person's legal
343.35representative.
344.1    Subd. 8c. Family foster care. "Family foster care" means a child foster family
344.2setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340, or an adult
344.3foster care home licensed according to Minnesota Rules, parts 9555.5105 to 9555.6265,
344.4where the license holder lives in the home.
344.5    Subd. 9. Health services. "Health services" means any service or treatment
344.6consistent with the physical and mental health needs of the person, such as medication
344.7administration and monitoring, medical, dental, nutritional, health monitoring, wellness
344.8education, and exercise.
344.9    Subd. 10. Home and community-based services. "Home and community-based
344.10services" means the services subject to the provisions of this chapter identified in section
344.11245D.03, subdivision 1, and as defined in:
344.12(1) the federal federally approved waiver plans governed by United States Code,
344.13title 42, sections 1396 et seq., or the state's alternative care program according to section
344.14256B.0913, including the waivers for persons with disabilities under section 256B.49,
344.15subdivision 11, including the brain injury (BI) waiver, plan; the community alternative
344.16care (CAC) waiver, plan; the community alternatives for disabled individuals (CADI)
344.17waiver, plan; the developmental disability (DD) waiver, plan under section 256B.092,
344.18subdivision 5; the elderly waiver (EW), and plan under section 256B.0915, subdivision 1;
344.19or successor plans respective to each waiver; or
344.20(2) the alternative care (AC) program under section 256B.0913.
344.21    Subd. 11. Incident. "Incident" means an occurrence that affects the which involves
344.22a person and requires the program to make a response that is not a part of the program's
344.23 ordinary provision of services to a that person, and includes any of the following:
344.24(1) serious injury of a person as determined by section 245.91, subdivision 6;
344.25(2) a person's death;
344.26(3) any medical emergency, unexpected serious illness, or significant unexpected
344.27change in an illness or medical condition, or the mental health status of a person that
344.28requires calling the program to call 911 or a mental health crisis intervention team,
344.29physician treatment, or hospitalization;
344.30(4) any mental health crisis that requires the program to call 911 or a mental health
344.31crisis intervention team;
344.32(5) an act or situation involving a person that requires the program to call 911,
344.33law enforcement, or the fire department;
344.34(4) (6) a person's unauthorized or unexplained absence from a program;
344.35(5) (7) physical aggression conduct by a person receiving services against another
344.36person receiving services that causes physical pain, injury, or persistent emotional distress,
345.1including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting,
345.2pushing, and spitting;:
345.3(i) is so severe, pervasive, or objectively offensive that it substantially interferes with
345.4a person's opportunities to participate in or receive service or support;
345.5(ii) places the person in actual and reasonable fear of harm;
345.6(iii) places the person in actual and reasonable fear of damage to property of the
345.7person; or
345.8(iv) substantially disrupts the orderly operation of the program;
345.9(6) (8) any sexual activity between persons receiving services involving force or
345.10coercion as defined under section 609.341, subdivisions 3 and 14; or
345.11(9) any emergency use of manual restraint as identified in section 245D.061; or
345.12(7) (10) a report of alleged or suspected child or vulnerable adult maltreatment
345.13under section 626.556 or 626.557.
345.14    Subd. 11a. Intermediate care facility for persons with developmental disabilities
345.15or ICF/DD. "Intermediate care facility for persons with developmental disabilities" or
345.16"ICF/DD" means a residential program licensed to serve four or more persons with
345.17developmental disabilities under section 252.28 and chapter 245A and licensed as a
345.18supervised living facility under chapter 144, which together are certified by the Department
345.19of Health as an intermediate care facility for persons with developmental disabilities.
345.20    Subd. 11b. Least restrictive alternative. "Least restrictive alternative" means
345.21the alternative method for providing supports and services that is the least intrusive and
345.22most normalized given the level of supervision and protection required for the person.
345.23This level of supervision and protection allows risk taking to the extent that there is no
345.24reasonable likelihood that serious harm will happen to the person or others.
345.25    Subd. 12. Legal representative. "Legal representative" means the parent of a
345.26person who is under 18 years of age, a court-appointed guardian, or other representative
345.27with legal authority to make decisions about services for a person. Other representatives
345.28with legal authority to make decisions include but are not limited to a health care agent or
345.29an attorney-in-fact authorized through a health care directive or power of attorney.
345.30    Subd. 13. License. "License" has the meaning given in section 245A.02,
345.31subdivision 8 .
345.32    Subd. 14. Licensed health professional. "Licensed health professional" means a
345.33person licensed in Minnesota to practice those professions described in section 214.01,
345.34subdivision 2 .
345.35    Subd. 15. License holder. "License holder" has the meaning given in section
345.36245A.02, subdivision 9 .
346.1    Subd. 15a. Manual restraint. "Manual restraint" means physical intervention
346.2intended to hold a person immobile or limit a person's voluntary movement by using body
346.3contact as the only source of physical restraint.
346.4    Subd. 15b. Mechanical restraint. Except for devices worn by the person that
346.5trigger electronic alarms to warn staff that a person is leaving a room or area, which
346.6do not, in and of themselves, restrict freedom of movement, or the use of adaptive aids
346.7or equipment or orthotic devices ordered by a health care professional used to treat or
346.8manage a medical condition, "mechanical restraint" means the use of devices, materials,
346.9or equipment attached or adjacent to the person's body, or the use of practices that are
346.10intended to restrict freedom of movement or normal access to one's body or body parts,
346.11or limits a person's voluntary movement or holds a person immobile as an intervention
346.12precipitated by a person's behavior. The term applies to the use of mechanical restraint
346.13used to prevent injury with persons who engage in self-injurious behaviors, such as
346.14head-banging, gouging, or other actions resulting in tissue damage that have caused or
346.15could cause medical problems resulting from the self-injury.
346.16    Subd. 16. Medication. "Medication" means a prescription drug or over-the-counter
346.17drug. For purposes of this chapter, "medication" includes dietary supplements.
346.18    Subd. 17. Medication administration. "Medication administration" means
346.19performing the following set of tasks to ensure a person takes both prescription and
346.20over-the-counter medications and treatments according to orders issued by appropriately
346.21licensed professionals, and includes the following:
346.22(1) checking the person's medication record;
346.23(2) preparing the medication for administration;
346.24(3) administering the medication to the person;
346.25(4) documenting the administration of the medication or the reason for not
346.26administering the medication; and
346.27(5) reporting to the prescriber or a nurse any concerns about the medication,
346.28including side effects, adverse reactions, effectiveness, or the person's refusal to take the
346.29medication or the person's self-administration of the medication.
346.30    Subd. 18. Medication assistance. "Medication assistance" means providing verbal
346.31or visual reminders to take regularly scheduled medication, which includes either of
346.32the following:
346.33(1) bringing to the person and opening a container of previously set up medications
346.34and emptying the container into the person's hand or opening and giving the medications
346.35in the original container to the person, or bringing to the person liquids or food to
346.36accompany the medication; or
347.1(2) providing verbal or visual reminders to perform regularly scheduled treatments
347.2and exercises.
347.3    Subd. 19. Medication management. "Medication management" means the
347.4provision of any of the following:
347.5(1) medication-related services to a person;
347.6(2) medication setup;
347.7(3) medication administration;
347.8(4) medication storage and security;
347.9(5) medication documentation and charting;
347.10(6) verification and monitoring of effectiveness of systems to ensure safe medication
347.11handling and administration;
347.12(7) coordination of medication refills;
347.13(8) handling changes to prescriptions and implementation of those changes;
347.14(9) communicating with the pharmacy; or
347.15(10) coordination and communication with prescriber.
347.16For the purposes of this chapter, medication management does not mean "medication
347.17therapy management services" as identified in section 256B.0625, subdivision 13h.
347.18    Subd. 20. Mental health crisis intervention team. "Mental health crisis
347.19intervention team" means a mental health crisis response providers provider as identified
347.20in section 256B.0624, subdivision 2, paragraph (d), for adults, and in section 256B.0944,
347.21subdivision 1 , paragraph (d), for children.
347.22    Subd. 20a. Most integrated setting. "Most integrated setting" means a setting that
347.23enables individuals with disabilities to interact with nondisabled persons to the fullest
347.24extent possible.
347.25    Subd. 21. Over-the-counter drug. "Over-the-counter drug" means a drug that
347.26is not required by federal law to bear the statement "Caution: Federal law prohibits
347.27dispensing without prescription."
347.28    Subd. 21a. Outcome. "Outcome" means the behavior, action, or status attained by
347.29the person that can be observed, measured, and determined reliable and valid.
347.30    Subd. 22. Person. "Person" has the meaning given in section 245A.02, subdivision
347.3111 .
347.32    Subd. 23. Person with a disability. "Person with a disability" means a person
347.33determined to have a disability by the commissioner's state medical review team as
347.34identified in section 256B.055, subdivision 7, the Social Security Administration, or
347.35the person is determined to have a developmental disability as defined in Minnesota
348.1Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section
348.2252.27, subdivision 1a .
348.3    Subd. 23a. Physician. "Physician" means a person who is licensed under chapter
348.4147.
348.5    Subd. 23b. Positive support transition plan. "Positive support transition plan"
348.6means the plan required in section 245D.06, subdivision 5, paragraph (b), to be developed
348.7by the expanded support team to implement positive support strategies to:
348.8(1) eliminate the use of prohibited procedures as identified in section 245D.06,
348.9subdivision 5, paragraph (a);
348.10(2) avoid the emergency use of manual restraint as identified in section 245D.061; and
348.11(3) prevent the person from physically harming self or others.
348.12    Subd. 24. Prescriber. "Prescriber" means a licensed practitioner as defined in
348.13section 151.01, subdivision 23, person who is authorized under section 148.235; 151.01,
348.14subdivision 23; or 151.37 to prescribe drugs. For the purposes of this chapter, the term
348.15"prescriber" is used interchangeably with "physician."
348.16    Subd. 25. Prescription drug. "Prescription drug" has the meaning given in section
348.17151.01, subdivision 17 16 .
348.18    Subd. 26. Program. "Program" means either the nonresidential or residential
348.19program as defined in section 245A.02, subdivisions 10 and 14.
348.20    Subd. 27. Psychotropic medication. "Psychotropic medication" means any
348.21medication prescribed to treat the symptoms of mental illness that affect thought processes,
348.22mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic
348.23(neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and
348.24stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder.
348.25Other miscellaneous medications are considered to be a psychotropic medication when
348.26they are specifically prescribed to treat a mental illness or to control or alter behavior.
348.27    Subd. 28. Restraint. "Restraint" means physical or mechanical manual restraint
348.28as defined in subdivision 15a or mechanical restraint as defined in subdivision 15b, or
348.29any other form of restraint that results in limiting of the free and normal movement of
348.30body or limbs.
348.31    Subd. 29. Seclusion. "Seclusion" means separating a person from others in a way
348.32that prevents social contact and prevents the person from leaving the situation if he or she
348.33chooses the placement of a person alone in a room from which exit is prohibited by a staff
348.34person or a mechanism such as a lock, a device, or an object positioned to hold the door
348.35closed or otherwise prevent the person from leaving the room.
349.1    Subd. 29a. Self-determination. "Self-determination" means the person makes
349.2decisions independently, plans for the person's own future, determines how money is spent
349.3for the person's supports, and takes responsibility for making these decisions. If a person
349.4has a legal representative, the legal representative's decision-making authority is limited to
349.5the scope of authority granted by the court or allowed in the document authorizing the
349.6legal representative to act.
349.7    Subd. 29b. Semi-independent living services. "Semi-independent living services"
349.8has the meaning given in section 252.275.
349.9    Subd. 30. Service. "Service" means care, training, supervision, counseling,
349.10consultation, or medication assistance assigned to the license holder in the coordinated
349.11service and support plan.
349.12    Subd. 31. Service plan. "Service plan" means the individual service plan or
349.13individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
349.14or successor provisions, and includes any support plans or service needs identified as
349.15a result of long-term care consultation, or a support team meeting that includes the
349.16participation of the person, the person's legal representative, and case manager, or assigned
349.17to a license holder through an authorized service agreement.
349.18    Subd. 32. Service site. "Service site" means the location where the service is
349.19provided to the person, including, but not limited to, a facility licensed according to
349.20chapter 245A; a location where the license holder is the owner, lessor, or tenant; a person's
349.21own home; or a community-based location.
349.22    Subd. 33. Staff. "Staff" means an employee who will have direct contact with a
349.23person served by the facility, agency, or program.
349.24    Subd. 33a. Supervised living facility. "Supervised living facility" has the meaning
349.25given in Minnesota Rules, part 4665.0100, subpart 10.
349.26    Subd. 33b. Supervision. (a) "Supervision" means:
349.27(1) oversight by direct support staff as specified in the person's coordinated service
349.28and support plan or coordinated service and support plan addendum and awareness of
349.29the person's needs and activities;
349.30(2) responding to situations that present a serious risk to the health, safety, or rights
349.31of the person while services are being provided; and
349.32(3) the presence of direct support staff at a service site while services are being
349.33provided, unless a determination has been made and documented in the person's coordinated
349.34service and support plan or coordinated service and support plan addendum that the person
349.35does not require the presence of direct support staff while services are being provided.
350.1(b) For the purposes of this definition, "while services are being provided," means
350.2any period of time during which the license holder will seek reimbursement for services.
350.3    Subd. 34. Support team. "Support team" means the service planning team
350.4identified in section 256B.49, subdivision 15, or the interdisciplinary team identified in
350.5Minnesota Rules, part 9525.0004, subpart 14.
350.6    Subd. 34a. Time out. "Time out" means removing a person involuntarily from an
350.7ongoing activity to a room, either locked or unlocked, or otherwise separating a person
350.8from others in a way that prevents social contact and prevents the person from leaving
350.9the situation if the person chooses. For the purpose of chapter 245D, "time out" does
350.10not mean voluntary removal or self-removal for the purpose of calming, prevention of
350.11escalation, or de-escalation of behavior for a period of up to 15 minutes. "Time out"
350.12does not include a person voluntarily moving from an ongoing activity to an unlocked
350.13room or otherwise separating from a situation or social contact with others if the person
350.14chooses. For the purposes of this definition, "voluntarily" means without being forced,
350.15compelled, or coerced.
350.16    Subd. 35. Unit of government. "Unit of government" means every city, county,
350.17town, school district, other political subdivisions of the state, and any agency of the state
350.18or the United States, and includes any instrumentality of a unit of government.
350.19    Subd. 35a. Treatment. "Treatment" means the provision of care, other than
350.20medications, ordered or prescribed by a licensed health or mental health professional,
350.21provided to a person to cure, rehabilitate, or ease symptoms.
350.22    Subd. 36. Volunteer. "Volunteer" means an individual who, under the direction of the
350.23license holder, provides direct services without pay to a person served by the license holder.
350.24EFFECTIVE DATE.This section is effective January 1, 2014.

350.25    Sec. 23. Minnesota Statutes 2012, section 245D.03, is amended to read:
350.26245D.03 APPLICABILITY AND EFFECT.
350.27    Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of
350.28home and community-based services to persons with disabilities and persons age 65 and
350.29older pursuant to this chapter. The licensing standards in this chapter govern the provision
350.30of the following basic support services: and intensive support services.
350.31(1) housing access coordination as defined under the current BI, CADI, and DD
350.32waiver plans or successor plans;
350.33(2) respite services as defined under the current CADI, BI, CAC, DD, and EW
350.34waiver plans or successor plans when the provider is an individual who is not an employee
351.1of a residential or nonresidential program licensed by the Department of Human Services
351.2or the Department of Health that is otherwise providing the respite service;
351.3(3) behavioral programming as defined under the current BI and CADI waiver
351.4plans or successor plans;
351.5(4) specialist services as defined under the current DD waiver plan or successor plans;
351.6(5) companion services as defined under the current BI, CADI, and EW waiver
351.7plans or successor plans, excluding companion services provided under the Corporation
351.8for National and Community Services Senior Companion Program established under the
351.9Domestic Volunteer Service Act of 1973, Public Law 98-288;
351.10(6) personal support as defined under the current DD waiver plan or successor plans;
351.11(7) 24-hour emergency assistance, on-call and personal emergency response as
351.12defined under the current CADI and DD waiver plans or successor plans;
351.13(8) night supervision services as defined under the current BI waiver plan or
351.14successor plans;
351.15(9) homemaker services as defined under the current CADI, BI, CAC, DD, and EW
351.16waiver plans or successor plans, excluding providers licensed by the Department of Health
351.17under chapter 144A and those providers providing cleaning services only;
351.18(10) independent living skills training as defined under the current BI and CADI
351.19waiver plans or successor plans;
351.20(11) prevocational services as defined under the current BI and CADI waiver plans
351.21or successor plans;
351.22(12) structured day services as defined under the current BI waiver plan or successor
351.23plans; or
351.24(13) supported employment as defined under the current BI and CADI waiver plans
351.25or successor plans.
351.26(b) Basic support services provide the level of assistance, supervision, and care that
351.27is necessary to ensure the health and safety of the person and do not include services that
351.28are specifically directed toward the training, treatment, habilitation, or rehabilitation of
351.29the person. Basic support services include:
351.30(1) in-home and out-of-home respite care services as defined in section 245A.02,
351.31subdivision 15, and under the brain injury, community alternative care, community
351.32alternatives for disabled individuals, developmental disability, and elderly waiver plans;
351.33(2) companion services as defined under the brain injury, community alternatives for
351.34disabled individuals, and elderly waiver plans, excluding companion services provided
351.35under the Corporation for National and Community Services Senior Companion Program
351.36established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
352.1(3) personal support as defined under the developmental disability waiver plan;
352.2(4) 24-hour emergency assistance, personal emergency response as defined under the
352.3community alternatives for disabled individuals and developmental disability waiver plans;
352.4(5) night supervision services as defined under the brain injury waiver plan; and
352.5(6) homemaker services as defined under the community alternatives for disabled
352.6individuals, brain injury, community alternative care, developmental disability, and elderly
352.7waiver plans, excluding providers licensed by the Department of Health under chapter
352.8144A and those providers providing cleaning services only.
352.9(c) Intensive support services provide assistance, supervision, and care that is
352.10necessary to ensure the health and safety of the person and services specifically directed
352.11toward the training, habilitation, or rehabilitation of the person. Intensive support services
352.12include:
352.13(1) intervention services, including:
352.14(i) behavioral support services as defined under the brain injury and community
352.15alternatives for disabled individuals waiver plans;
352.16(ii) in-home or out-of-home crisis respite services as defined under the developmental
352.17disability waiver plan; and
352.18(iii) specialist services as defined under the current developmental disability waiver
352.19plan;
352.20(2) in-home support services, including:
352.21(i) in-home family support and supported living services as defined under the
352.22developmental disability waiver plan;
352.23(ii) independent living services training as defined under the brain injury and
352.24community alternatives for disabled individuals waiver plans; and
352.25(iii) semi-independent living services;
352.26(3) residential supports and services, including:
352.27(i) supported living services as defined under the developmental disability waiver
352.28plan provided in a family or corporate child foster care residence, a family adult foster
352.29care residence, a community residential setting, or a supervised living facility;
352.30(ii) foster care services as defined in the brain injury, community alternative care,
352.31and community alternatives for disabled individuals waiver plans provided in a family or
352.32corporate child foster care residence, a family adult foster care residence, or a community
352.33residential setting; and
352.34(iii) residential services provided in a supervised living facility that is certified by
352.35the Department of Health as an ICF/DD;
352.36(4) day services, including:
353.1(i) structured day services as defined under the brain injury waiver plan;
353.2(ii) day training and habilitation services under sections 252.40 to 252.46, and as
353.3defined under the developmental disability waiver plan; and
353.4(iii) prevocational services as defined under the brain injury and community
353.5alternatives for disabled individuals waiver plans; and
353.6(5) supported employment as defined under the brain injury, developmental
353.7disability, and community alternatives for disabled individuals waiver plans.
353.8    Subd. 2. Relationship to other standards governing home and community-based
353.9services. (a) A license holder governed by this chapter is also subject to the licensure
353.10requirements under chapter 245A.
353.11(b) A license holder concurrently providing child foster care services licensed
353.12according to Minnesota Rules, chapter 2960, to the same person receiving a service licensed
353.13under this chapter is exempt from section 245D.04 as it applies to the person. A corporate
353.14or family child foster care site controlled by a license holder and providing services
353.15governed by this chapter is exempt from compliance with section 245D.04. This exemption
353.16applies to foster care homes where at least one resident is receiving residential supports
353.17and services licensed according to this chapter. This chapter does not apply to corporate or
353.18family child foster care homes that do not provide services licensed under this chapter.
353.19(c) A family adult foster care site controlled by a license holder and providing
353.20services governed by this chapter is exempt from compliance with Minnesota Rules,
353.21parts 9555.6185; 9555.6225; 9555.6245; 9555.6255; and 9555.6265. These exemptions
353.22apply to family adult foster care homes where at least one resident is receiving residential
353.23supports and services licensed according to this chapter. This chapter does not apply to
353.24family adult foster care homes that do not provide services licensed under this chapter.
353.25(d) A license holder providing services licensed according to this chapter in a
353.26supervised living facility is exempt from compliance with sections 245D.04; 245D.05,
353.27subdivision 2; and 245D.06, subdivision 2, clauses (1), (4), and (5).
353.28(e) A license holder providing residential services to persons in an ICF/DD is exempt
353.29from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision
353.302, clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09,
353.31subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.
353.32(c) (f) A license holder concurrently providing home care homemaker services
353.33registered licensed according to sections 144A.43 to 144A.49 to the same person receiving
353.34home management services licensed under this chapter and registered according to chapter
353.35144A is exempt from compliance with section 245D.04 as it applies to the person.
354.1(d) A license holder identified in subdivision 1, clauses (1), (5), and (9), is exempt
354.2from compliance with sections 245A.65, subdivision 2, paragraph (a), and 626.557,
354.3subdivision 14 , paragraph (b).
354.4(e) Notwithstanding section 245D.06, subdivision 5, a license holder providing
354.5structured day, prevocational, or supported employment services under this chapter
354.6and day training and habilitation or supported employment services licensed under
354.7chapter 245B within the same program is exempt from compliance with this chapter
354.8when the license holder notifies the commissioner in writing that the requirements under
354.9chapter 245B will be met for all persons receiving these services from the program. For
354.10the purposes of this paragraph, if the license holder has obtained approval from the
354.11commissioner for an alternative inspection status according to section 245B.031, that
354.12approval will apply to all persons receiving services in the program.
354.13(g) Nothing in this chapter prohibits a license holder from concurrently serving
354.14persons without disabilities or people who are or are not age 65 and older, provided this
354.15chapter's standards are met as well as other relevant standards.
354.16(h) The documentation required under sections 245D.07 and 245D.071 must meet
354.17the individual program plan requirements identified in section 256B.092 or successor
354.18provisions.
354.19    Subd. 3. Variance. If the conditions in section 245A.04, subdivision 9, are met,
354.20the commissioner may grant a variance to any of the requirements in this chapter, except
354.21sections 245D.04, and 245D.10, subdivision 4, paragraph (b) 245D.06, subdivision 4,
354.22paragraph (b), and 245D.061, subdivision 3, or provisions governing data practices and
354.23information rights of persons.
354.24    Subd. 4. License holders with multiple 245D licenses. (a) When a person changes
354.25service from one license to a different license held by the same license holder, the license
354.26holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).
354.27(b) When a staff person begins providing direct service under one or more licenses
354.28held by the same license holder, other than the license for which staff orientation was
354.29initially provided according to section 245D.09, subdivision 4, the license holder is
354.30exempt from those staff orientation requirements, except the staff person must review each
354.31person's service plan and medication administration procedures in accordance with section
354.32245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.
354.33    Subd. 5. Program certification. An applicant or a license holder may apply for
354.34program certification as identified in section 245D.33.
354.35EFFECTIVE DATE.This section is effective January 1, 2014.

355.1    Sec. 24. Minnesota Statutes 2012, section 245D.04, is amended to read:
355.2245D.04 SERVICE RECIPIENT RIGHTS.
355.3    Subdivision 1. License holder responsibility for individual rights of persons
355.4served by the program. The license holder must:
355.5(1) provide each person or each person's legal representative with a written notice
355.6that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of
355.7those rights within five working days of service initiation and annually thereafter;
355.8(2) make reasonable accommodations to provide this information in other formats
355.9or languages as needed to facilitate understanding of the rights by the person and the
355.10person's legal representative, if any;
355.11(3) maintain documentation of the person's or the person's legal representative's
355.12receipt of a copy and an explanation of the rights; and
355.13(4) ensure the exercise and protection of the person's rights in the services provided
355.14by the license holder and as authorized in the coordinated service and support plan.
355.15    Subd. 2. Service-related rights. A person's service-related rights include the right to:
355.16(1) participate in the development and evaluation of the services provided to the
355.17person;
355.18(2) have services and supports identified in the coordinated service and support plan
355.19and the coordinated service and support plan addendum provided in a manner that respects
355.20and takes into consideration the person's preferences according to the requirements in
355.21sections 245D.07 and 245D.071;
355.22(3) refuse or terminate services and be informed of the consequences of refusing
355.23or terminating services;
355.24(4) know, in advance, limits to the services available from the license holder,
355.25including the license holder's knowledge, skill, and ability to meet the person's service
355.26and support needs;
355.27(5) know conditions and terms governing the provision of services, including the
355.28license holder's admission criteria and policies and procedures related to temporary
355.29service suspension and service termination;
355.30(6) a coordinated transfer to ensure continuity of care when there will be a change
355.31in the provider;
355.32(7) know what the charges are for services, regardless of who will be paying for the
355.33services, and be notified of changes in those charges;
355.34(7) (8) know, in advance, whether services are covered by insurance, government
355.35funding, or other sources, and be told of any charges the person or other private party
355.36may have to pay; and
356.1(8) (9) receive services from an individual who is competent and trained, who has
356.2professional certification or licensure, as required, and who meets additional qualifications
356.3identified in the person's coordinated service and support plan. or coordinated service and
356.4support plan addendum.
356.5    Subd. 3. Protection-related rights. (a) A person's protection-related rights include
356.6the right to:
356.7(1) have personal, financial, service, health, and medical information kept private,
356.8and be advised of disclosure of this information by the license holder;
356.9(2) access records and recorded information about the person in accordance with
356.10applicable state and federal law, regulation, or rule;
356.11(3) be free from maltreatment;
356.12(4) be free from restraint, time out, or seclusion used for a purpose other than except
356.13for emergency use of manual restraint to protect the person from imminent danger to self
356.14or others according to the requirements in section 245D.06;
356.15(5) receive services in a clean and safe environment when the license holder is the
356.16owner, lessor, or tenant of the service site;
356.17(6) be treated with courtesy and respect and receive respectful treatment of the
356.18person's property;
356.19(7) reasonable observance of cultural and ethnic practice and religion;
356.20(8) be free from bias and harassment regarding race, gender, age, disability,
356.21spirituality, and sexual orientation;
356.22(9) be informed of and use the license holder's grievance policy and procedures,
356.23including knowing how to contact persons responsible for addressing problems and to
356.24appeal under section 256.045;
356.25(10) know the name, telephone number, and the Web site, e-mail, and street
356.26addresses of protection and advocacy services, including the appropriate state-appointed
356.27ombudsman, and a brief description of how to file a complaint with these offices;
356.28(11) assert these rights personally, or have them asserted by the person's family,
356.29authorized representative, or legal representative, without retaliation;
356.30(12) give or withhold written informed consent to participate in any research or
356.31experimental treatment;
356.32(13) associate with other persons of the person's choice;
356.33(14) personal privacy; and
356.34(15) engage in chosen activities.
357.1(b) For a person residing in a residential site licensed according to chapter 245A,
357.2or where the license holder is the owner, lessor, or tenant of the residential service site,
357.3protection-related rights also include the right to:
357.4(1) have daily, private access to and use of a non-coin-operated telephone for local
357.5calls and long-distance calls made collect or paid for by the person;
357.6(2) receive and send, without interference, uncensored, unopened mail or electronic
357.7correspondence or communication; and
357.8(3) have use of and free access to common areas in the residence; and
357.9(4) privacy for visits with the person's spouse, next of kin, legal counsel, religious
357.10advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
357.11privacy in the person's bedroom.
357.12(c) Restriction of a person's rights under subdivision 2, clause (10), or paragraph (a),
357.13clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure
357.14the health, safety, and well-being of the person. Any restriction of those rights must be
357.15documented in the person's coordinated service and support plan for the person and or
357.16coordinated service and support plan addendum. The restriction must be implemented
357.17in the least restrictive alternative manner necessary to protect the person and provide
357.18support to reduce or eliminate the need for the restriction in the most integrated setting
357.19and inclusive manner. The documentation must include the following information:
357.20(1) the justification for the restriction based on an assessment of the person's
357.21vulnerability related to exercising the right without restriction;
357.22(2) the objective measures set as conditions for ending the restriction;
357.23(3) a schedule for reviewing the need for the restriction based on the conditions for
357.24ending the restriction to occur, at a minimum, every three months for persons who do not
357.25have a legal representative and annually for persons who do have a legal representative
357.26 semiannually from the date of initial approval, at a minimum, or more frequently if
357.27requested by the person, the person's legal representative, if any, and case manager; and
357.28(4) signed and dated approval for the restriction from the person, or the person's
357.29legal representative, if any. A restriction may be implemented only when the required
357.30approval has been obtained. Approval may be withdrawn at any time. If approval is
357.31withdrawn, the right must be immediately and fully restored.
357.32EFFECTIVE DATE.This section is effective January 1, 2014.

357.33    Sec. 25. Minnesota Statutes 2012, section 245D.05, is amended to read:
357.34245D.05 HEALTH SERVICES.
358.1    Subdivision 1. Health needs. (a) The license holder is responsible for providing
358.2 meeting health services service needs assigned in the coordinated service and support plan
358.3and or the coordinated service and support plan addendum, consistent with the person's
358.4health needs. The license holder is responsible for promptly notifying the person or
358.5 the person's legal representative, if any, and the case manager of changes in a person's
358.6physical and mental health needs affecting assigned health services service needs assigned
358.7to the license holder in the coordinated service and support plan or the coordinated service
358.8and support plan addendum, when discovered by the license holder, unless the license
358.9holder has reason to know the change has already been reported. The license holder
358.10must document when the notice is provided.
358.11(b) When assigned in the service plan, If responsibility for meeting the person's
358.12health service needs has been assigned to the license holder in the coordinated service and
358.13support plan or the coordinated service and support plan addendum, the license holder is
358.14required to must maintain documentation on how the person's health needs will be met,
358.15including a description of the procedures the license holder will follow in order to:
358.16(1) provide medication administration, assistance or medication assistance, or
358.17medication management administration according to this chapter;
358.18(2) monitor health conditions according to written instructions from the person's
358.19physician or a licensed health professional;
358.20(3) assist with or coordinate medical, dental, and other health service appointments; or
358.21(4) use medical equipment, devices, or adaptive aides or technology safely and
358.22correctly according to written instructions from the person's physician or a licensed
358.23health professional.
358.24    Subd. 1a. Medication setup. For the purposes of this subdivision, "medication
358.25setup" means the arranging of medications according to instructions from the pharmacy,
358.26the prescriber, or a licensed nurse, for later administration when the license holder
358.27is assigned responsibility for medication assistance or medication administration in
358.28the coordinated service and support plan or the coordinated service and support plan
358.29addendum. A prescription label or the prescriber's written or electronically recorded order
358.30for the prescription is sufficient to constitute written instructions from the prescriber. The
358.31license holder must document in the person's medication administration record: dates
358.32of setup, name of medication, quantity of dose, times to be administered, and route of
358.33administration at time of setup; and, when the person will be away from home, to whom
358.34the medications were given.
358.35    Subd. 1b. Medication assistance. If responsibility for medication assistance
358.36is assigned to the license holder in the coordinated service and support plan or the
359.1coordinated service and support plan addendum, the license holder must ensure that
359.2the requirements of subdivision 2, paragraph (b), have been met when staff provides
359.3medication assistance to enable a person to self-administer medication or treatment when
359.4the person is capable of directing the person's own care, or when the person's legal
359.5representative is present and able to direct care for the person. For the purposes of this
359.6subdivision, "medication assistance" means any of the following:
359.7(1) bringing to the person and opening a container of previously set up medications,
359.8emptying the container into the person's hand, or opening and giving the medications in
359.9the original container to the person;
359.10(2) bringing to the person liquids or food to accompany the medication; or
359.11(3) providing reminders to take regularly scheduled medication or perform regularly
359.12scheduled treatments and exercises.
359.13    Subd. 2. Medication administration. (a) If responsibility for medication
359.14administration is assigned to the license holder in the coordinated service and support plan
359.15or the coordinated service and support plan addendum, the license holder must implement
359.16the following medication administration procedures to ensure a person takes medications
359.17and treatments as prescribed:
359.18(1) checking the person's medication record;
359.19(2) preparing the medication as necessary;
359.20(3) administering the medication or treatment to the person;
359.21(4) documenting the administration of the medication or treatment or the reason for
359.22not administering the medication or treatment; and
359.23(5) reporting to the prescriber or a nurse any concerns about the medication or
359.24treatment, including side effects, effectiveness, or a pattern of the person refusing to
359.25take the medication or treatment as prescribed. Adverse reactions must be immediately
359.26reported to the prescriber or a nurse.
359.27(b)(1) The license holder must ensure that the following criteria requirements in
359.28clauses (2) to (4) have been met before staff that is not a licensed health professional
359.29administers administering medication or treatment:.
359.30(1) (2) The license holder must obtain written authorization has been obtained from
359.31the person or the person's legal representative to administer medication or treatment
359.32orders; and must obtain reauthorization annually as needed. If the person or the person's
359.33legal representative refuses to authorize the license holder to administer medication, the
359.34medication must not be administered. The refusal to authorize medication administration
359.35must be reported to the prescriber as expediently as possible.
360.1(2) (3) The staff person has completed responsible for administering the medication
360.2or treatment must complete medication administration training according to section
360.3245D.09, subdivision 4 , paragraph 4a, paragraphs (a) and (c), clause (2); and, as applicable
360.4to the person, paragraph (d).
360.5(3) The medication or treatment will be administered under administration
360.6procedures established for the person in consultation with a licensed health professional.
360.7written instruction from the person's physician may constitute the medication
360.8administration procedures. A prescription label or the prescriber's order for the
360.9prescription is sufficient to constitute written instructions from the prescriber. A licensed
360.10health professional may delegate medication administration procedures.
360.11(4) For a license holder providing intensive support services, the medication or
360.12treatment must be administered according to the license holder's medication administration
360.13policy and procedures as required under section 245D.11, subdivision 2, clause (3).
360.14(b) (c) The license holder must ensure the following information is documented in
360.15the person's medication administration record:
360.16(1) the information on the current prescription label or the prescriber's current written
360.17or electronically recorded order or prescription that includes directions for the person's
360.18name, description of the medication or treatment to be provided, and the frequency and
360.19other information needed to safely and correctly administering administer the medication
360.20or treatment to ensure effectiveness;
360.21(2) information on any discomforts, risks, or other side effects that are reasonable to
360.22expect, and any contraindications to its use. This information must be readily available
360.23to all staff administering the medication;
360.24(3) the possible consequences if the medication or treatment is not taken or
360.25administered as directed;
360.26(4) instruction from the prescriber on when and to whom to report the following:
360.27(i) if the a dose of medication or treatment is not administered or treatment is not
360.28performed as prescribed, whether by error by the staff or the person or by refusal by
360.29the person; and
360.30(ii) the occurrence of possible adverse reactions to the medication or treatment;
360.31(5) notation of any occurrence of a dose of medication not being administered or
360.32treatment not performed as prescribed, whether by error by the staff or the person or by
360.33refusal by the person, or of adverse reactions, and when and to whom the report was
360.34made; and
360.35(6) notation of when a medication or treatment is started, administered, changed, or
360.36discontinued.
361.1(c) The license holder must ensure that the information maintained in the medication
361.2administration record is current and is regularly reviewed with the person or the person's
361.3legal representative and the staff administering the medication to identify medication
361.4administration issues or errors. At a minimum, the review must be conducted every three
361.5months or more often if requested by the person or the person's legal representative.
361.6Based on the review, the license holder must develop and implement a plan to correct
361.7medication administration issues or errors. If issues or concerns are identified related to
361.8the medication itself, the license holder must report those as required under subdivision 4.
361.9    Subd. 3. Medication assistance. The license holder must ensure that the
361.10requirements of subdivision 2, paragraph (a), have been met when staff provides assistance
361.11to enable a person to self-administer medication when the person is capable of directing
361.12the person's own care, or when the person's legal representative is present and able to
361.13direct care for the person.
361.14    Subd. 4. Reviewing and reporting medication and treatment issues. The
361.15following medication administration issues must be reported to the person or the person's
361.16legal representative and case manager as they occur or following timelines established
361.17in the person's service plan or as requested in writing by the person or the person's legal
361.18representative, or the case manager: (a) When assigned responsibility for medication
361.19administration, the license holder must ensure that the information maintained in
361.20the medication administration record is current and is regularly reviewed to identify
361.21medication administration errors. At a minimum, the review must be conducted every
361.22three months, or more frequently as directed in the coordinated service and support plan
361.23or coordinated service and support plan addendum or as requested by the person or the
361.24person's legal representative. Based on the review, the license holder must develop and
361.25implement a plan to correct patterns of medication administration errors when identified.
361.26(b) If assigned responsibility for medication assistance or medication administration,
361.27the license holder must report the following to the person's legal representative and case
361.28manager as they occur or as otherwise directed in the coordinated service and support plan
361.29or the coordinated service and support plan addendum:
361.30(1) any reports made to the person's physician or prescriber required under
361.31subdivision 2, paragraph (b) (c), clause (4);
361.32(2) a person's refusal or failure to take or receive medication or treatment as
361.33prescribed; or
361.34(3) concerns about a person's self-administration of medication or treatment.
362.1    Subd. 5. Injectable medications. Injectable medications may be administered
362.2according to a prescriber's order and written instructions when one of the following
362.3conditions has been met:
362.4(1) a registered nurse or licensed practical nurse will administer the subcutaneous or
362.5intramuscular injection;
362.6(2) a supervising registered nurse with a physician's order has delegated the
362.7administration of subcutaneous injectable medication to an unlicensed staff member
362.8and has provided the necessary training; or
362.9(3) there is an agreement signed by the license holder, the prescriber, and the
362.10person or the person's legal representative specifying what subcutaneous injections may
362.11be given, when, how, and that the prescriber must retain responsibility for the license
362.12holder's giving the injections. A copy of the agreement must be placed in the person's
362.13service recipient record.
362.14Only licensed health professionals are allowed to administer psychotropic
362.15medications by injection.
362.16EFFECTIVE DATE.This section is effective January 1, 2014.

362.17    Sec. 26. [245D.051] PSYCHOTROPIC MEDICATION USE AND
362.18MONITORING.
362.19    Subdivision 1. Conditions for psychotropic medication administration. (a)
362.20When a person is prescribed a psychotropic medication and the license holder is assigned
362.21responsibility for administration of the medication in the person's coordinated service
362.22and support plan or the coordinated service and support plan addendum, the license
362.23holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05,
362.24subdivision 2, are met.
362.25(b) Use of the medication must be included in the person's coordinated service and
362.26support plan or in the coordinated service and support plan addendum and based on a
362.27prescriber's current written or electronically recorded prescription.
362.28(c) The license holder must develop, implement, and maintain the following
362.29documentation in the person's coordinated service and support plan addendum according
362.30to the requirements in sections 245D.07 and 245D.071:
362.31(1) a description of the target symptoms that the psychotropic medication is to
362.32alleviate; and
362.33(2) documentation methods the license holder will use to monitor and measure
362.34changes in the target symptoms that are to be alleviated by the psychotropic medication if
362.35required by the prescriber. The license holder must collect and report on medication and
363.1symptom-related data as instructed by the prescriber. The license holder must provide
363.2the monitoring data to the expanded support team for review every three months, or as
363.3otherwise requested by the person or the person's legal representative.
363.4For the purposes of this section, "target symptom" refers to any perceptible
363.5diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic
363.6and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
363.7successive editions that has been identified for alleviation.
363.8    Subd. 2. Refusal to authorize psychotropic medication. If the person or the
363.9person's legal representative refuses to authorize the administration of a psychotropic
363.10medication as ordered by the prescriber, the license holder must follow the requirement
363.11in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal
363.12to the prescriber, the license holder must follow any directives or orders given by the
363.13prescriber. A court order must be obtained to override the refusal. Refusal to authorize
363.14administration of a specific psychotropic medication is not grounds for service termination
363.15and does not constitute an emergency. A decision to terminate services must be reached in
363.16compliance with section 245D.10, subdivision 3.
363.17EFFECTIVE DATE.This section is effective January 1, 2014.

363.18    Sec. 27. Minnesota Statutes 2012, section 245D.06, is amended to read:
363.19245D.06 PROTECTION STANDARDS.
363.20    Subdivision 1. Incident response and reporting. (a) The license holder must
363.21respond to all incidents under section 245D.02, subdivision 11, that occur while providing
363.22services to protect the health and safety of and minimize risk of harm to the person.
363.23(b) The license holder must maintain information about and report incidents to the
363.24person's legal representative or designated emergency contact and case manager within 24
363.25hours of an incident occurring while services are being provided, or within 24 hours of
363.26discovery or receipt of information that an incident occurred, unless the license holder
363.27has reason to know that the incident has already been reported, or as otherwise directed
363.28in a person's coordinated service and support plan or coordinated service and support
363.29plan addendum. An incident of suspected or alleged maltreatment must be reported as
363.30required under paragraph (d), and an incident of serious injury or death must be reported
363.31as required under paragraph (e).
363.32(c) When the incident involves more than one person, the license holder must not
363.33disclose personally identifiable information about any other person when making the report
363.34to each person and case manager unless the license holder has the consent of the person.
364.1(d) Within 24 hours of reporting maltreatment as required under section 626.556
364.2or 626.557, the license holder must inform the case manager of the report unless there is
364.3reason to believe that the case manager is involved in the suspected maltreatment. The
364.4license holder must disclose the nature of the activity or occurrence reported and the
364.5agency that received the report.
364.6(e) The license holder must report the death or serious injury of the person to the legal
364.7representative, if any, and case manager, as required in paragraph (b) and to the Department
364.8of Human Services Licensing Division, and the Office of Ombudsman for Mental Health
364.9and Developmental Disabilities as required under section 245.94, subdivision 2a, within
364.1024 hours of the death, or receipt of information that the death occurred, unless the license
364.11holder has reason to know that the death has already been reported.
364.12(f) When a death or serious injury occurs in a facility certified as an intermediate
364.13care facility for persons with developmental disabilities, the death or serious injury must
364.14be reported to the Department of Health, Office of Health Facility Complaints, and the
364.15Office of Ombudsman for Mental Health and Developmental Disabilities, as required
364.16under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
364.17know that the death has already been reported.
364.18(f) (g) The license holder must conduct a an internal review of incident reports of
364.19deaths and serious injuries that occurred while services were being provided and that
364.20were not reported by the program as alleged or suspected maltreatment, for identification
364.21of incident patterns, and implementation of corrective action as necessary to reduce
364.22occurrences. The review must include an evaluation of whether related policies and
364.23procedures were followed, whether the policies and procedures were adequate, whether
364.24there is a need for additional staff training, whether the reported event is similar to past
364.25events with the persons or the services involved, and whether there is a need for corrective
364.26action by the license holder to protect the health and safety of persons receiving services.
364.27Based on the results of this review, the license holder must develop, document, and
364.28implement a corrective action plan designed to correct current lapses and prevent future
364.29lapses in performance by staff or the license holder, if any.
364.30(h) The license holder must verbally report the emergency use of manual restraint of
364.31a person as required in paragraph (b), within 24 hours of the occurrence. The license holder
364.32must ensure the written report and internal review of all incident reports of the emergency
364.33use of manual restraints are completed according to the requirements in section 245D.061.
364.34    Subd. 2. Environment and safety. The license holder must:
364.35(1) ensure the following when the license holder is the owner, lessor, or tenant
364.36of the service site:
365.1(i) the service site is a safe and hazard-free environment;
365.2(ii) doors are locked or that toxic substances or dangerous items normally accessible
365.3 are inaccessible to persons served by the program are stored in locked cabinets, drawers, or
365.4containers only to protect the safety of a person receiving services and not as a substitute
365.5for staff supervision or interactions with a person who is receiving services. If doors are
365.6locked or toxic substances or dangerous items normally accessible to persons served by the
365.7program are stored in locked cabinets, drawers, or containers are made inaccessible, the
365.8license holder must justify and document how this determination was made in consultation
365.9with the person or person's legal representative, and how access will otherwise be provided
365.10to the person and all other affected persons receiving services; and document an assessment
365.11of the physical plant, its environment, and its population identifying the risk factors which
365.12require toxic substances or dangerous items to be inaccessible and a statement of specific
365.13measures to be taken to minimize the safety risk to persons receiving services;
365.14(iii) doors are locked from the inside to prevent a person from exiting only when
365.15necessary to protect the safety of a person receiving services and not as a substitute for
365.16staff supervision or interactions with the person. If doors are locked from the inside, the
365.17license holder must document an assessment of the physical plant, the environment and
365.18the population served, identifying the risk factors which require the use of locked doors,
365.19and a statement of specific measures to be taken to minimize the safety risk to persons
365.20receiving services at the service site; and
365.21(iii) (iv) a staff person is available on at the service site who is trained in basic first
365.22aid and, when required in a person's coordinated service and support plan or coordinated
365.23service and support plan addendum, cardiopulmonary resuscitation, "CPR," whenever
365.24persons are present and staff are required to be at the site to provide direct service. The
365.25CPR training must include in-person instruction, hands-on practice, and an observed skills
365.26assessment under the direct supervision of a CPR instructor;
365.27(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
365.28license holder in good condition when used to provide services;
365.29(3) follow procedures to ensure safe transportation, handling, and transfers of the
365.30person and any equipment used by the person, when the license holder is responsible for
365.31transportation of a person or a person's equipment;
365.32(4) be prepared for emergencies and follow emergency response procedures to
365.33ensure the person's safety in an emergency; and
365.34(5) follow universal precautions and sanitary practices, including hand washing, for
365.35infection prevention and control, and to prevent communicable diseases.
366.1    Subd. 3. Compliance with fire and safety codes. When services are provided at a
366.2 service site licensed according to chapter 245A or where the license holder is the owner,
366.3lessor, or tenant of the service site, the license holder must document compliance with
366.4applicable building codes, fire and safety codes, health rules, and zoning ordinances, or
366.5document that an appropriate waiver has been granted.
366.6    Subd. 4. Funds and property. (a) Whenever the license holder assists a person
366.7with the safekeeping of funds or other property according to section 245A.04, subdivision
366.813 , the license holder must have obtain written authorization to do so from the person or
366.9the person's legal representative and the case manager. Authorization must be obtained
366.10within five working days of service initiation and renewed annually thereafter. At the time
366.11initial authorization is obtained, the license holder must survey, document, and implement
366.12the preferences of the person or the person's legal representative and the case manager
366.13for frequency of receiving a statement that itemizes receipts and disbursements of funds
366.14or other property. The license holder must document changes to these preferences when
366.15they are requested.
366.16(b) A license holder or staff person may not accept powers-of-attorney from a
366.17person receiving services from the license holder for any purpose, and may not accept an
366.18appointment as guardian or conservator of a person receiving services from the license
366.19holder. This does not apply to license holders that are Minnesota counties or other
366.20units of government or to staff persons employed by license holders who were acting
366.21as power-of-attorney, guardian, or conservator attorney-in-fact for specific individuals
366.22prior to April 23, 2012 implementation of this chapter. The license holder must maintain
366.23documentation of the power-of-attorney, guardianship, or conservatorship in the service
366.24recipient record.
366.25(c) Upon the transfer or death of a person, any funds or other property of the person
366.26must be surrendered to the person or the person's legal representative, or given to the
366.27executor or administrator of the estate in exchange for an itemized receipt.
366.28    Subd. 5. Prohibitions Prohibited procedures. (a) The license holder is prohibited
366.29from using psychotropic medication chemical restraints, mechanical restraints, manual
366.30restraints, time out, seclusion, or any other aversive or deprivation procedure, as a
366.31substitute for adequate staffing, for a behavioral or therapeutic program to reduce or
366.32eliminate behavior, as punishment, or for staff convenience, or for any reason other than
366.33as prescribed.
366.34(b) The license holder is prohibited from using restraints or seclusion under any
366.35circumstance, unless the commissioner has approved a variance request from the license
366.36holder that allows for the emergency use of restraints and seclusion according to terms
367.1and conditions approved in the variance. Applicants and license holders who have
367.2reason to believe they may be serving an individual who will need emergency use of
367.3restraints or seclusion may request a variance on the application or reapplication, and
367.4the commissioner shall automatically review the request for a variance as part of the
367.5application or reapplication process. License holders may also request the variance any
367.6time after issuance of a license. In the event a license holder uses restraint or seclusion for
367.7any reason without first obtaining a variance as required, the license holder must report
367.8the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the
367.9occurrence and request the required variance.
367.10    Subd. 6. Restricted procedures. The following procedures are allowed when the
367.11procedures are implemented in compliance with the standards governing their use as
367.12identified in clauses (1) to (3). Allowed but restricted procedures include:
367.13(1) permitted actions and procedures subject to the requirements in subdivision 7;
367.14(2) procedures identified in a positive support transition plan subject to the
367.15requirements in subdivision 8; or
367.16(3) emergency use of manual restraint subject to the requirements in section
367.17245D.061.
367.18For purposes of this chapter, this section supersedes the requirements identified in
367.19Minnesota Rules, part 9525.2740.
367.20    Subd. 7. Permitted actions and procedures. (a) Use of the instructional techniques
367.21and intervention procedures as identified in paragraphs (b) and (c), is permitted when used
367.22on an intermittent or continuous basis. When used on a continuous basis, it must be
367.23addressed in a person's coordinated service and support plan addendum as identified in
367.24sections 245D.07 and 245D.071. For purposes of this chapter, the requirements of this
367.25subdivision supersede the requirements identified in Minnesota Rules, part 9525.2720.
367.26(b) Physical contact or instructional techniques must use the least restrictive
367.27alternative possible to meet the needs of the person and may be used:
367.28(1) to calm or comfort a person by holding that person with no resistance from
367.29that person;
367.30(2) to protect a person known to be at risk or injury due to frequent falls as a result
367.31of a medical condition;
367.32(3) to facilitate the person's completion of a task or response when the person does
367.33not resist or the person's resistance is minimal in intensity and duration; or
367.34(4) to briefly block or redirect a person's limbs or body without holding the person
367.35or limiting the person's movement to interrupt the person's behavior that may result in
367.36injury to self or others.
368.1(c) Restraint may be used as an intervention procedure to:
368.2(1) allow a licensed health care professional to safely conduct a medical examination
368.3or to provide medical treatment ordered by a licensed health care professional to a person
368.4necessary to promote healing or recovery from an acute, meaning short-term, medical
368.5condition;
368.6(2) assist in the safe evacuation or redirection of a person in the event of an
368.7emergency and the person is at imminent risk of harm.
368.8Any use of manual restraint as allowed in this paragraph must comply with the restrictions
368.9identified in section 245D.061, subdivision 3; or
368.10(3) to position a person with physical disabilities in a manner specified in the
368.11person's coordinated service and support plan addendum.
368.12(d) Use of adaptive aids or equipment, orthotic devices, or other medical equipment
368.13ordered by a licensed health professional to treat a diagnosed medical condition do not in
368.14and of themselves constitute the use of mechanical restraint.
368.15    Subd. 8. Positive support transition plan. License holders must develop a positive
368.16support transition plan on the forms and in the manner prescribed by the commissioner for
368.17a person who requires intervention in order to maintain safety when it is known that the
368.18person's behavior poses an immediate risk of physical harm to self or others. The positive
368.19support transition plan forms and instructions will supersede the requirements in Minnesota
368.20Rules, parts 9525.2750; 9525.2760; and 9525.2780. The positive support transition plan
368.21must phase out any existing plans for the emergency or programmatic use of aversive or
368.22deprivation procedures prohibited under this chapter within the following timelines:
368.23(1) for persons receiving services from the license holder before January 1, 2014,
368.24the plan must be developed and implemented by February 1, 2014, and phased out no
368.25later than December 31, 2014; and
368.26(2) for persons admitted to the program on or after January 1, 2014, the plan must be
368.27developed and implemented within 30 calendar days of service initiation and phased out
368.28no later than 11 months from the date of plan implementation.
368.29EFFECTIVE DATE.This section is effective January 1, 2014.

368.30    Sec. 28. [245D.061] EMERGENCY USE OF MANUAL RESTRAINTS.
368.31    Subdivision 1. Standards for emergency use of manual restraints. The license
368.32holder must ensure that emergency use of manual restraints complies with the requirements
368.33of this chapter and the license holder's policy and procedures as required under subdivision
369.110. For the purposes of persons receiving services governed by this chapter, this section
369.2supersedes the requirements identified in Minnesota Rules, part 9525.2770.
369.3    Subd. 2. Conditions for emergency use of manual restraint. Emergency use of
369.4manual restraint must meet the following conditions:
369.5(1) immediate intervention must be needed to protect the person or others from
369.6imminent risk of physical harm; and
369.7(2) the type of manual restraint used must be the least restrictive intervention to
369.8eliminate the immediate risk of harm and effectively achieve safety. The manual restraint
369.9must end when the threat of harm ends.
369.10    Subd. 3. Restrictions when implementing emergency use of manual restraint.
369.11(a) Emergency use of manual restraint procedures must not:
369.12(1) be implemented with a child in a manner that constitutes sexual abuse, neglect,
369.13physical abuse, or mental injury, as defined in section 626.556, subdivision 2;
369.14(2) be implemented with an adult in a manner that constitutes abuse or neglect as
369.15defined in section 626.5572, subdivisions 2 and 17;
369.16(3) be implemented in a manner that violates a person's rights and protections
369.17identified in section 245D.04;
369.18(4) restrict a person's normal access to a nutritious diet, drinking water, adequate
369.19ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping
369.20conditions, or necessary clothing, or to any protection required by state licensing standards
369.21and federal regulations governing the program;
369.22(5) deny the person visitation or ordinary contact with legal counsel, a legal
369.23representative, or next of kin;
369.24(6) be used as a substitute for adequate staffing, for the convenience of staff, as
369.25punishment, or as a consequence if the person refuses to participate in the treatment
369.26or services provided by the program; or
369.27(7) use prone restraint. For the purposes of this section, "prone restraint" means use
369.28of manual restraint that places a person in a face-down position. This does not include
369.29brief physical holding of a person who, during an emergency use of manual restraint, rolls
369.30into a prone position, and the person is restored to a standing, sitting, or side-lying position
369.31as quickly as possible. Applying back or chest pressure while a person is in the prone or
369.32supine position or face-up is prohibited.
369.33    Subd. 4. Monitoring emergency use of manual restraint. The license holder shall
369.34monitor a person's health and safety during an emergency use of a manual restraint. Staff
369.35monitoring the procedure must not be the staff implementing the procedure when possible.
370.1The license holder shall complete a monitoring form, approved by the commissioner, for
370.2each incident involving the emergency use of a manual restraint.
370.3    Subd. 5. Reporting emergency use of manual restraint incident. (a) Within
370.4three calendar days after an emergency use of a manual restraint, the staff person who
370.5implemented the emergency use must report in writing to the designated coordinator the
370.6following information about the emergency use:
370.7(1) the staff and persons receiving services who were involved in the incident
370.8leading up to the emergency use of manual restraint;
370.9(2) a description of the physical and social environment, including who was present
370.10before and during the incident leading up to the emergency use of manual restraint;
370.11(3) a description of what less restrictive alternative measures were attempted to
370.12de-escalate the incident and maintain safety before the manual restraint was implemented
370.13that identifies when, how, and how long the alternative measures were attempted before
370.14manual restraint was implemented;
370.15(4) a description of the mental, physical, and emotional condition of the person who
370.16was restrained, and other persons involved in the incident leading up to, during, and
370.17following the manual restraint;
370.18(5) whether there was any injury to the person who was restrained or other persons
370.19involved in the incident, including staff, before or as a result of the use of manual restraint;
370.20(6) whether there was a debriefing with the staff, and, if not contraindicated, with
370.21the person who was restrained and other persons who were involved in or who witnessed
370.22the restraint, following the incident and the outcome of the debriefing. If the debriefing
370.23was not conducted at the time the incident report was made, the report should identify
370.24whether a debriefing is planned; and
370.25(7) a copy of the report must be maintained in the person's service recipient record.
370.26(b) Each single incident of emergency use of manual restraint must be reported
370.27separately. For the purposes of this subdivision, an incident of emergency use of manual
370.28restraint is a single incident when the following conditions have been met:
370.29(1) after implementing the manual restraint, staff attempt to release the person at the
370.30moment staff believe the person's conduct no longer poses an imminent risk of physical
370.31harm to self or others and less restrictive strategies can be implemented to maintain safety;
370.32(2) upon the attempt to release the restraint, the person's behavior immediately
370.33re-escalates; and
370.34(3) staff must immediately reimplement the restraint in order to maintain safety.
370.35    Subd. 6. Internal review of emergency use of manual restraint. (a) Within five
370.36working days of the emergency use of manual restraint, the license holder must complete
371.1and document an internal review of each report of emergency use of manual restraint. The
371.2review must include an evaluation of whether:
371.3(1) the person's service and support strategies developed according to sections
371.4245D.07 and 245D.071 need to be revised;
371.5(2) related policies and procedures were followed;
371.6(3) the policies and procedures were adequate;
371.7(4) there is a need for additional staff training;
371.8(5) the reported event is similar to past events with the persons, staff, or the services
371.9involved; and
371.10(6) there is a need for corrective action by the license holder to protect the health
371.11and safety of persons.
371.12(b) Based on the results of the internal review, the license holder must develop,
371.13document, and implement a corrective action plan for the program designed to correct
371.14current lapses and prevent future lapses in performance by individuals or the license
371.15holder, if any. The corrective action plan, if any, must be implemented within 30 days of
371.16the internal review being completed.
371.17(c) The license holder must maintain a copy of the internal review and the corrective
371.18action plan, if any, in the person's service recipient record.
371.19    Subd. 7. Expanded support team review. (a) Within five working days after the
371.20completion of the internal review required in subdivision 8, the license holder must consult
371.21with the expanded support team following the emergency use of manual restraint to:
371.22(1) discuss the incident reported in subdivision 7, to define the antecedent or event
371.23that gave rise to the behavior resulting in the manual restraint and identify the perceived
371.24function the behavior served; and
371.25(2) determine whether the person's coordinated service and support plan addendum
371.26needs to be revised according to sections 245D.07 and 245D.071 to positively and
371.27effectively help the person maintain stability and to reduce or eliminate future occurrences
371.28requiring emergency use of manual restraint.
371.29(b) The license holder must maintain a written summary of the expanded support
371.30team's discussion and decisions required in paragraph (a) in the person's service recipient
371.31record.
371.32    Subd. 8. External review and reporting. Within five working days of the expanded
371.33support team review, the license holder must submit the following to the Department of
371.34Human Services, and the Office of the Ombudsman for Mental Health and Developmental
371.35Disabilities, as required under section 245.94, subdivision 2a:
371.36(1) the report required under subdivision 7;
372.1(2) the internal review and the corrective action plan required under subdivision 8; and
372.2(3) the summary of the expanded support team review required under subdivision 9.
372.3    Subd. 9. Emergency use of manual restraints policy and procedures. The license
372.4holder must develop, document, and implement a policy and procedures that promote
372.5service recipient rights and protect health and safety during the emergency use of manual
372.6restraints. The policy and procedures must comply with the requirements of this section
372.7and must specify the following:
372.8(1) a description of the positive support strategies and techniques staff must use to
372.9attempt to de-escalate a person's behavior before it poses an imminent risk of physical
372.10harm to self or others;
372.11(2) a description of the types of manual restraints the license holder allows staff to
372.12use on an emergency basis, if any. If the license holder will not allow the emergency use
372.13of manual restraint, the policy and procedure must identify the alternative measures the
372.14license holder will require staff to use when a person's conduct poses an imminent risk of
372.15physical harm to self or others and less restrictive strategies would not achieve safety;
372.16(3) instructions for safe and correct implementation of the allowed manual restraint
372.17procedures;
372.18(4) the training that staff must complete and the timelines for completion, before they
372.19may implement an emergency use of manual restraint. In addition to the training on this
372.20policy and procedure and the orientation and annual training required in section 245D.09,
372.21subdivision 4, the training for emergency use of manual restraint must incorporate the
372.22following subjects:
372.23(i) alternatives to manual restraint procedures, including techniques to identify
372.24events and environmental factors that may escalate conduct that poses an imminent risk of
372.25physical harm to self or others;
372.26(ii) de-escalation methods, positive support strategies, and how to avoid power
372.27struggles;
372.28(iii) simulated experiences of administering and receiving manual restraint
372.29procedures allowed by the license holder on an emergency basis;
372.30(iv) how to properly identify thresholds for implementing and ceasing restrictive
372.31procedures;
372.32(v) how to recognize, monitor, and respond to the person's physical signs of distress,
372.33including positional asphyxia;
372.34(vi) the physiological and psychological impact on the person and the staff when
372.35restrictive procedures are used;
372.36(vii) the communicative intent of behaviors; and
373.1(viii) relationship building;
373.2(5) the procedures and forms to be used to monitor the emergency use of manual
373.3restraints, including what must be monitored and the frequency of monitoring per
373.4each incident of emergency use of manual restraint, and the person or position who is
373.5responsible for monitoring the use;
373.6(6) the instructions, forms, and timelines required for completing and submitting an
373.7incident report by the person or persons who implemented the manual restraint; and
373.8(7) the procedures and timelines for conducting the internal review and the expanded
373.9support team review, and the person or position responsible for completing the reviews
373.10and for ensuring that corrective action is taken or the person's coordinated service and
373.11support plan addendum is revised, when determined necessary.
373.12EFFECTIVE DATE.This section is effective January 1, 2014.

373.13    Sec. 29. Minnesota Statutes 2012, section 245D.07, is amended to read:
373.14245D.07 SERVICE NEEDS PLANNING AND DELIVERY.
373.15    Subdivision 1. Provision of services. The license holder must provide services as
373.16specified assigned in the coordinated service and support plan and assigned to the license
373.17holder. The provision of services must comply with the requirements of this chapter and
373.18the federal waiver plans.
373.19    Subd. 1a. Person-centered planning and service delivery. (a) The license holder
373.20must provide services in response to the person's identified needs, interests, preferences,
373.21and desired outcomes as specified in the coordinated service and support plan and the
373.22coordinated service and support plan addendum, and in compliance with the requirements
373.23of this chapter. License holders providing intensive support services must also provide
373.24outcome-based services according to the requirements in section 245D.071.
373.25(b) Services must be provided in a manner that supports the person's preferences,
373.26daily needs, and activities and accomplishment of the person's personal goals and service
373.27outcomes, consistent with the principles of:
373.28(1) person-centered service planning and delivery that:
373.29(i) identifies and supports what is important to the person as well as what is
373.30important for the person, including preferences for when, how, and by whom direct
373.31support service is provided;
373.32(ii) uses that information to identify outcomes the person desires; and
373.33(iii) respects each person's history, dignity, and cultural background;
373.34(2) self-determination that supports and provides:
374.1(i) opportunities for the development and exercise of functional and age-appropriate
374.2skills, decision making and choice, personal advocacy, and communication; and
374.3(ii) the affirmation and protection of each person's civil and legal rights; and
374.4(3) providing the most integrated setting and inclusive service delivery that supports,
374.5promotes, and allows:
374.6(i) inclusion and participation in the person's community as desired by the person
374.7in a manner that enables the person to interact with nondisabled persons to the fullest
374.8extent possible and supports the person in developing and maintaining a role as a valued
374.9community member;
374.10(ii) opportunities for self-sufficiency as well as developing and maintaining social
374.11relationships and natural supports; and
374.12(iii) a balance between risk and opportunity, meaning the least restrictive supports or
374.13interventions necessary are provided in the most integrated settings in the most inclusive
374.14manner possible to support the person to engage in activities of the person's own choosing
374.15that may otherwise present a risk to the person's health, safety, or rights.
374.16    Subd. 2. Service planning requirements for basic support services. (a) License
374.17holders providing basic support services must meet the requirements of this subdivision.
374.18(b) Within 15 days of service initiation the license holder must complete a
374.19preliminary coordinated service and support plan addendum based on the coordinated
374.20service and support plan.
374.21(c) Within 60 days of service initiation the license holder must review and revise as
374.22needed the preliminary coordinated service and support plan addendum to document the
374.23services that will be provided including how, when, and by whom services will be provided,
374.24and the person responsible for overseeing the delivery and coordination of services.
374.25(d) The license holder must participate in service planning and support team
374.26meetings related to for the person following stated timelines established in the person's
374.27 coordinated service and support plan or as requested by the support team, the person, or
374.28the person's legal representative, the support team or the expanded support team.
374.29    Subd. 3. Reports. The license holder must provide written reports regarding the
374.30person's progress or status as requested by the person, the person's legal representative, the
374.31case manager, or the team.
374.32EFFECTIVE DATE.This section is effective January 1, 2014.

374.33    Sec. 30. [245D.071] SERVICE PLANNING AND DELIVERY; INTENSIVE
374.34SUPPORT SERVICES.
375.1    Subdivision 1. Requirements for intensive support services. A license holder
375.2providing intensive support services identified in section 245D.03, subdivision 1,
375.3paragraph (c), must comply with the requirements in section 245D.07, subdivisions 1
375.4and 3, and this section.
375.5    Subd. 2. Abuse prevention. Prior to or upon initiating services, the license holder
375.6must develop, document, and implement an abuse prevention plan according to section
375.7245A.65, subdivision 2.
375.8    Subd. 3. Assessment and initial service planning. (a) Within 15 days of service
375.9initiation the license holder must complete a preliminary coordinated service and support
375.10plan addendum based on the coordinated service and support plan.
375.11(b) Within 45 days of service initiation the license holder must meet with the person,
375.12the person's legal representative, the case manager, and other members of the support team
375.13or expanded support team to assess and determine the following based on the person's
375.14coordinated service and support plan and the requirements in subdivision 4 and section
375.15245D.07, subdivision 1a:
375.16(1) the scope of the services to be provided to support the person's daily needs
375.17and activities;
375.18(2) the person's desired outcomes and the supports necessary to accomplish the
375.19person's desired outcomes;
375.20(3) the person's preferences for how services and supports are provided;
375.21(4) whether the current service setting is the most integrated setting available and
375.22appropriate for the person; and
375.23(5) how services must be coordinated across other providers licensed under this
375.24chapter serving the same person to ensure continuity of care for the person.
375.25(c) Within the scope of services, the license holder must, at a minimum, assess
375.26the following areas:
375.27(1) the person's ability to self-manage health and medical needs to maintain or
375.28improve physical, mental, and emotional well-being, including, when applicable, allergies,
375.29seizures, choking, special dietary needs, chronic medical conditions, self-administration
375.30of medication or treatment orders, preventative screening, and medical and dental
375.31appointments;
375.32(2) the person's ability to self-manage personal safety to avoid injury or accident in
375.33the service setting, including, when applicable, risk of falling, mobility, regulating water
375.34temperature, community survival skills, water safety skills, and sensory disabilities; and
375.35(3) the person's ability to self-manage symptoms or behavior that may otherwise
375.36result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to
376.1(7), suspension or termination of services by the license holder, or other symptoms
376.2or behaviors that may jeopardize the health and safety of the person or others. The
376.3assessments must produce information about the person that is descriptive of the person's
376.4overall strengths, functional skills and abilities, and behaviors or symptoms.
376.5    Subd. 4. Service outcomes and supports. (a) Within ten working days of the
376.645-day meeting, the license holder must develop and document the service outcomes and
376.7supports based on the assessments completed under subdivision 3 and the requirements
376.8in section 245D.07, subdivision 1a. The outcomes and supports must be included in the
376.9coordinated service and support plan addendum.
376.10(b) The license holder must document the supports and methods to be implemented
376.11to support the accomplishment of outcomes related to acquiring, retaining, or improving
376.12skills. The documentation must include:
376.13(1) the methods or actions that will be used to support the person and to accomplish
376.14the service outcomes, including information about:
376.15(i) any changes or modifications to the physical and social environments necessary
376.16when the service supports are provided;
376.17(ii) any equipment and materials required; and
376.18(iii) techniques that are consistent with the person's communication mode and
376.19learning style;
376.20(2) the measurable and observable criteria for identifying when the desired outcome
376.21has been achieved and how data will be collected;
376.22(3) the projected starting date for implementing the supports and methods and
376.23the date by which progress towards accomplishing the outcomes will be reviewed and
376.24evaluated; and
376.25(4) the names of the staff or position responsible for implementing the supports
376.26and methods.
376.27(c) Within 20 working days of the 45-day meeting, the license holder must obtain
376.28dated signatures from the person or the person's legal representative and case manager
376.29to document completion and approval of the assessment and coordinated service and
376.30support plan addendum.
376.31    Subd. 5. Progress reviews. (a) The license holder must give the person or the
376.32person's legal representative and case manager an opportunity to participate in the ongoing
376.33review and development of the methods used to support the person and accomplish
376.34outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
376.35the person's support team or expanded support team, must meet with the person, the
376.36person's legal representative, and the case manager, and participate in progress review
377.1meetings following stated timelines established in the person's coordinated service and
377.2support plan or coordinated service and support plan addendum or within 30 days of a
377.3written request by the person, the person's legal representative, or the case manager,
377.4at a minimum of once per year.
377.5(b) The license holder must summarize the person's progress toward achieving the
377.6identified outcomes and make recommendations and identify the rationale for changing,
377.7continuing, or discontinuing implementation of supports and methods identified in
377.8subdivision 4 in a written report sent to the person or the person's legal representative
377.9and case manager five working days prior to the review meeting, unless the person, the
377.10person's legal representative, or the case manager requests to receive the report at the
377.11time of the meeting.
377.12(c) Within ten working days of the progress review meeting, the license holder
377.13must obtain dated signatures from the person or the person's legal representative and
377.14the case manager to document approval of any changes to the coordinated service and
377.15support plan addendum.
377.16EFFECTIVE DATE.This section is effective January 1, 2014.

377.17    Sec. 31. [245D.081] PROGRAM COORDINATION, EVALUATION, AND
377.18OVERSIGHT.
377.19    Subdivision 1. Program coordination and evaluation. (a) The license holder
377.20is responsible for:
377.21(1) coordination of service delivery and evaluation for each person served by the
377.22program as identified in subdivision 2; and
377.23(2) program management and oversight that includes evaluation of the program
377.24quality and program improvement for services provided by the license holder as identified
377.25in subdivision 3.
377.26(b) The same person may perform the functions in paragraph (a) if the work and
377.27education qualifications are met in subdivisions 2 and 3.
377.28    Subd. 2. Coordination and evaluation of individual service delivery. (a) Delivery
377.29and evaluation of services provided by the license holder must be coordinated by a
377.30designated staff person. The designated coordinator must provide supervision, support,
377.31and evaluation of activities that include:
377.32(1) oversight of the license holder's responsibilities assigned in the person's
377.33coordinated service and support plan and the coordinated service and support plan
377.34addendum;
378.1(2) taking the action necessary to facilitate the accomplishment of the outcomes
378.2according to the requirements in section 245D.07;
378.3(3) instruction and assistance to direct support staff implementing the coordinated
378.4service and support plan and the service outcomes, including direct observation of service
378.5delivery sufficient to assess staff competency; and
378.6(4) evaluation of the effectiveness of service delivery, methodologies, and progress on
378.7the person's outcomes based on the measurable and observable criteria for identifying when
378.8the desired outcome has been achieved according to the requirements in section 245D.07.
378.9(b) The license holder must ensure that the designated coordinator is competent to
378.10perform the required duties identified in paragraph (a) through education and training in
378.11human services and disability-related fields, and work experience in providing direct care
378.12services and supports to persons with disabilities. The designated coordinator must have
378.13the skills and ability necessary to develop effective plans and to design and use data
378.14systems to measure effectiveness of services and supports. The license holder must verify
378.15and document competence according to the requirements in section 245D.09, subdivision
378.163. The designated coordinator must minimally have:
378.17(1) a baccalaureate degree in a field related to human services, and one year of
378.18full-time work experience providing direct care services to persons with disabilities or
378.19persons age 65 and older;
378.20(2) an associate degree in a field related to human services, and two years of
378.21full-time work experience providing direct care services to persons with disabilities or
378.22persons age 65 and older;
378.23(3) a diploma in a field related to human services from an accredited postsecondary
378.24institution and three years of full-time work experience providing direct care services to
378.25persons with disabilities or persons age 65 and older; or
378.26(4) a minimum of 50 hours of education and training related to human services
378.27and disabilities; and
378.28(5) four years of full-time work experience providing direct care services to persons
378.29with disabilities or persons age 65 and older under the supervision of a staff person who
378.30meets the qualifications identified in clauses (1) to (3).
378.31    Subd. 3. Program management and oversight. (a) The license holder must
378.32designate a managerial staff person or persons to provide program management and
378.33oversight of the services provided by the license holder. The designated manager is
378.34responsible for the following:
378.35(1) maintaining a current understanding of the licensing requirements sufficient to
378.36ensure compliance throughout the program as identified in section 245A.04, subdivision
379.11, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21,
379.2paragraph (b);
379.3(2) ensuring the duties of the designated coordinator are fulfilled according to the
379.4requirements in subdivision 2;
379.5(3) ensuring the program implements corrective action identified as necessary
379.6by the program following review of incident and emergency reports according to the
379.7requirements in section 245D.11, subdivision 2, clause (7). An internal review of
379.8incident reports of alleged or suspected maltreatment must be conducted according to the
379.9requirements in section 245A.65, subdivision 1, paragraph (b);
379.10(4) evaluation of satisfaction of persons served by the program, the person's legal
379.11representative, if any, and the case manager, with the service delivery and progress
379.12towards accomplishing outcomes identified in sections 245D.07 and 245D.071, and
379.13ensuring and protecting each person's rights as identified in section 245D.04;
379.14(5) ensuring staff competency requirements are met according to the requirements in
379.15section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
379.16according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
379.17(6) ensuring corrective action is taken when ordered by the commissioner and that
379.18the terms and condition of the license and any variances are met; and
379.19(7) evaluating the information identified in clauses (1) to (6) to develop, document,
379.20and implement ongoing program improvements.
379.21(b) The designated manager must be competent to perform the duties as required and
379.22must minimally meet the education and training requirements identified in subdivision
379.232, paragraph (b), and have a minimum of three years of supervisory level experience in
379.24a program providing direct support services to persons with disabilities or persons age
379.2565 and older.
379.26EFFECTIVE DATE.This section is effective January 1, 2014.

379.27    Sec. 32. Minnesota Statutes 2012, section 245D.09, is amended to read:
379.28245D.09 STAFFING STANDARDS.
379.29    Subdivision 1. Staffing requirements. The license holder must provide the level of
379.30 direct service support staff sufficient supervision, assistance, and training necessary:
379.31(1) to ensure the health, safety, and protection of rights of each person; and
379.32(2) to be able to implement the responsibilities assigned to the license holder in each
379.33person's coordinated service and support plan or identified in the coordinated service and
379.34support plan addendum, according to the requirements of this chapter.
380.1    Subd. 2. Supervision of staff having direct contact. Except for a license holder
380.2who is the sole direct service support staff, the license holder must provide adequate
380.3supervision of staff providing direct service support to ensure the health, safety, and
380.4protection of rights of each person and implementation of the responsibilities assigned to
380.5the license holder in each person's service plan coordinated service and support plan or
380.6coordinated service and support plan addendum.
380.7    Subd. 3. Staff qualifications. (a) The license holder must ensure that staff is
380.8 providing direct support, or staff who have responsibilities related to supervising or
380.9managing the provision of direct support service, are competent as demonstrated through
380.10 skills and knowledge training, experience, and education to meet the person's needs
380.11and additional requirements as written in the coordinated service and support plan or
380.12coordinated service and support plan addendum, or when otherwise required by the case
380.13manager or the federal waiver plan. The license holder must verify and maintain evidence
380.14of staff competency, including documentation of:
380.15(1) education and experience qualifications relevant to the job responsibilities
380.16assigned to the staff and the needs of the general population of persons served by the
380.17program, including a valid degree and transcript, or a current license, registration, or
380.18certification, when a degree or licensure, registration, or certification is required by this
380.19chapter or in the coordinated service and support plan or coordinated service and support
380.20plan addendum;
380.21(2) completion of required demonstrated competency in the orientation and training
380.22 areas required under this chapter, including and when applicable, completion of continuing
380.23education required to maintain professional licensure, registration, or certification
380.24requirements. Competency in these areas is determined by the license holder through
380.25knowledge testing and observed skill assessment conducted by the trainer or instructor; and
380.26(3) except for a license holder who is the sole direct service support staff, periodic
380.27 performance evaluations completed by the license holder of the direct service support staff
380.28person's ability to perform the job functions based on direct observation.
380.29(b) Staff under 18 years of age may not perform overnight duties or administer
380.30medication.
380.31    Subd. 4. Orientation to program requirements. (a) Except for a license holder
380.32who does not supervise any direct service support staff, within 90 days of hiring direct
380.33service staff 60 days of hire, unless stated otherwise, the license holder must provide
380.34and ensure completion of 30 hours of orientation for direct support staff that combines
380.35supervised on-the-job training with review of and instruction on in the following areas:
380.36(1) the job description and how to complete specific job functions, including:
381.1(i) responding to and reporting incidents as required under section 245D.06,
381.2subdivision 1; and
381.3(ii) following safety practices established by the license holder and as required in
381.4section 245D.06, subdivision 2;
381.5(2) the license holder's current policies and procedures required under this chapter,
381.6including their location and access, and staff responsibilities related to implementation
381.7of those policies and procedures;
381.8(3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the
381.9federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
381.10responsibilities related to complying with data privacy practices;
381.11(4) the service recipient rights under section 245D.04, and staff responsibilities
381.12related to ensuring the exercise and protection of those rights according to the requirements
381.13in section 245D.04;
381.14(5) sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment
381.15reporting and service planning for children and vulnerable adults, and staff responsibilities
381.16related to protecting persons from maltreatment and reporting maltreatment. This
381.17orientation must be provided within 72 hours of first providing direct contact services and
381.18annually thereafter according to section 245A.65, subdivision 3;
381.19(6) what constitutes use of restraints, seclusion, and psychotropic medications,
381.20and staff responsibilities related to the prohibitions of their use the principles of
381.21person-centered service planning and delivery as identified in section 245D.07, subdivision
381.221a, and how they apply to direct support service provided by the staff person; and
381.23(7) other topics as determined necessary in the person's coordinated service and
381.24support plan by the case manager or other areas identified by the license holder.
381.25(b) License holders who provide direct service themselves must complete the
381.26orientation required in paragraph (a), clauses (3) to (7).
381.27    Subd. 4a. Orientation to individual service recipient needs. (c) (a) Before
381.28providing having unsupervised direct service to contact with a person served by the
381.29program, or for whom the staff person has not previously provided direct service support,
381.30or any time the plans or procedures identified in clauses (1) and (2) paragraphs (b) to
381.31(f) are revised, the staff person must review and receive instruction on the following
381.32as it relates requirements in paragraphs (b) to (f) as they relate to the staff person's job
381.33functions for that person:.
381.34(b) Training and competency evaluations must include the following:
382.1(1) appropriate and safe techniques in personal hygiene and grooming, including
382.2hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of
382.3daily living (ADLs) as defined under section 256B.0659, subdivision 1;
382.4(2) an understanding of what constitutes a healthy diet according to data from the
382.5Centers for Disease Control and Prevention and the skills necessary to prepare that diet;
382.6(3) skills necessary to provide appropriate support in instrumental activities of daily
382.7living (IADLs) as defined under section 256B.0659, subdivision 1; and
382.8(4) demonstrated competence in providing first aid.
382.9(1) (c) The staff person must review and receive instruction on the person's
382.10 coordinated service and support plan or coordinated service and support plan addendum as
382.11it relates to the responsibilities assigned to the license holder, and when applicable, the
382.12person's individual abuse prevention plan according to section 245A.65, to achieve and
382.13demonstrate an understanding of the person as a unique individual, and how to implement
382.14those plans; and.
382.15(2) (d) The staff person must review and receive instruction on medication
382.16administration procedures established for the person when medication administration is
382.17 assigned to the license holder according to section 245D.05, subdivision 1, paragraph
382.18(b). Unlicensed staff may administer medications only after successful completion of a
382.19medication administration training, from a training curriculum developed by a registered
382.20nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
382.21practitioner, physician's assistant, or physician incorporating. The training curriculum
382.22must incorporate an observed skill assessment conducted by the trainer to ensure staff
382.23demonstrate the ability to safely and correctly follow medication procedures.
382.24Medication administration must be taught by a registered nurse, clinical nurse
382.25specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
382.26service initiation or any time thereafter, the person has or develops a health care condition
382.27that affects the service options available to the person because the condition requires:
382.28(i) (1) specialized or intensive medical or nursing supervision; and
382.29(ii) (2) nonmedical service providers to adapt their services to accommodate the
382.30health and safety needs of the person; and.
382.31(iii) necessary training in order to meet the health service needs of the person as
382.32determined by the person's physician.
382.33(e) The staff person must review and receive instruction on the safe and correct
382.34operation of medical equipment used by the person to sustain life, including but not
382.35limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
382.36by a licensed health care professional or a manufacturer's representative and incorporate
383.1an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
383.2operate the equipment according to the treatment orders and the manufacturer's instructions.
383.3(f) The staff person must review and receive instruction on what constitutes use of
383.4restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
383.5related to the prohibitions of their use according to the requirements in section 245D.06,
383.6subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
383.7or undesired behavior and why they are not safe, and the safe and correct use of manual
383.8restraint on an emergency basis according to the requirements in section 245D.061.
383.9(g) In the event of an emergency service initiation, the license holder must ensure
383.10the training required in this subdivision occurs within 72 hours of the direct support staff
383.11person first having unsupervised contact with the person receiving services. The license
383.12holder must document the reason for the unplanned or emergency service initiation and
383.13maintain the documentation in the person's service recipient record.
383.14(h) License holders who provide direct support services themselves must complete
383.15the orientation required in subdivision 4, clauses (3) to (7).
383.16    Subd. 5. Annual training. (a) A license holder must provide annual training
383.17to direct service support staff on the topics identified in subdivision 4, paragraph (a),
383.18 clauses (3) to (6) (7), and subdivision 4a. A license holder must provide a minimum of 24
383.19hours of annual training to direct service staff with fewer than five years of documented
383.20experience and 12 hours of annual training to direct service staff with five or more years
383.21of documented experience in topics described in subdivisions 4 and 4a, paragraphs (a)
383.22to (h). Training on relevant topics received from sources other than the license holder
383.23may count toward training requirements.
383.24(b) A license holder providing behavioral programming, specialist services, personal
383.25support, 24-hour emergency assistance, night supervision, independent living skills,
383.26structured day, prevocational, or supported employment services must provide a minimum
383.27of eight hours of annual training to direct service staff that addresses:
383.28(1) topics related to the general health, safety, and service needs of the population
383.29served by the license holder; and
383.30(2) other areas identified by the license holder or in the person's current service plan.
383.31Training on relevant topics received from sources other than the license holder
383.32may count toward training requirements.
383.33(c) When the license holder is the owner, lessor, or tenant of the service site and
383.34whenever a person receiving services is present at the site, the license holder must have
383.35a staff person available on site who is trained in basic first aid and, when required in a
383.36person's service plan, cardiopulmonary resuscitation.
384.1    Subd. 5a. Alternative sources of training. Orientation or training received by the
384.2staff person from sources other than the license holder in the same subjects as identified
384.3in subdivision 4 may count toward the orientation and annual training requirements if
384.4received in the 12-month period before the staff person's date of hire. The license holder
384.5must maintain documentation of the training received from other sources and of each staff
384.6person's competency in the required area according to the requirements in subdivision 3.
384.7    Subd. 6. Subcontractors and temporary staff. If the license holder uses a
384.8subcontractor or temporary staff to perform services licensed under this chapter on the
384.9license holder's behalf, the license holder must ensure that the subcontractor or temporary
384.10staff meets and maintains compliance with all requirements under this chapter that apply
384.11to the services to be provided, including training, orientation, and supervision necessary
384.12to fulfill their responsibilities. The license holder must ensure that a background study
384.13has been completed according to the requirements in sections 245C.03, subdivision 1,
384.14and 245C.04. Subcontractors and temporary staff hired by the license holder must meet
384.15the Minnesota licensing requirements applicable to the disciplines in which they are
384.16providing services. The license holder must maintain documentation that the applicable
384.17requirements have been met.
384.18    Subd. 7. Volunteers. The license holder must ensure that volunteers who provide
384.19direct support services to persons served by the program receive the training, orientation,
384.20and supervision necessary to fulfill their responsibilities. The license holder must ensure
384.21that a background study has been completed according to the requirements in sections
384.22245C.03, subdivision 1, and 245C.04. The license holder must maintain documentation
384.23that the applicable requirements have been met.
384.24    Subd. 8. Staff orientation and training plan. The license holder must develop
384.25a staff orientation and training plan documenting when and how compliance with
384.26subdivisions 4, 4a, and 5 will be met.
384.27EFFECTIVE DATE.This section is effective January 1, 2014.

384.28    Sec. 33. [245D.091] INTERVENTION SERVICES.
384.29    Subdivision 1. Licensure requirements. An individual meeting the staff
384.30qualification requirements of this section who is an employee of a program licensed
384.31according to this chapter and providing behavioral support services, specialist services,
384.32or crisis respite services is not required to hold a separate license under this chapter.
384.33An individual meeting the staff qualifications of this section who is not providing these
384.34services as an employee of a program licensed according to this chapter must obtain a
384.35license according to this chapter.
385.1    Subd. 2. Behavior professional qualifications. A behavior professional, as defined
385.2in the brain injury and community alternatives for disabled individuals waiver plans or
385.3successor plans, must have competencies in areas related to:
385.4(1) ethical considerations;
385.5(2) functional assessment;
385.6(3) functional analysis;
385.7(4) measurement of behavior and interpretation of data;
385.8(5) selecting intervention outcomes and strategies;
385.9(6) behavior reduction and elimination strategies that promote least restrictive
385.10approved alternatives;
385.11(7) data collection;
385.12(8) staff and caregiver training;
385.13(9) support plan monitoring;
385.14(10) co-occurring mental disorders or neuro-cognitive disorder;
385.15(11) demonstrated expertise with populations being served; and
385.16(12) must be a:
385.17(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the
385.18Board of Psychology competencies in the above identified areas;
385.19(ii) clinical social worker licensed as an independent clinical social worker under
385.20chapter 148D, or a person with a master's degree in social work from an accredited college
385.21or university, with at least 4,000 hours of post-master's supervised experience in the
385.22delivery of clinical services in the areas identified in clauses (1) to (11);
385.23(iii) physician licensed under chapter 147 and certified by the American Board
385.24of Psychiatry and Neurology or eligible for board certification in psychiatry with
385.25competencies in the areas identified in clauses (1) to (11);
385.26(iv) licensed professional clinical counselor licensed under sections 148B.29 to
385.27148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery
385.28of clinical services who has demonstrated competencies in the areas identified in clauses
385.29(1) to (11);
385.30(v) person with a master's degree from an accredited college or university in one
385.31of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
385.32supervised experience in the delivery of clinical services with demonstrated competencies
385.33in the areas identified in clauses (1) to (11); or
385.34(vi) registered nurse who is licensed under sections 148.171 to 148.285, and who is
385.35certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and
385.36mental health nursing by a national nurse certification organization, or who has a master's
386.1degree in nursing or one of the behavioral sciences or related fields from an accredited
386.2college or university or its equivalent, with at least 4,000 hours of post-master's supervised
386.3experience in the delivery of clinical services.
386.4    Subd. 3. Behavior analyst qualifications. (a) A behavior analyst, as defined in
386.5the brain injury and community alternatives for disabled individuals waiver plans or
386.6successor plans, must:
386.7(1) have obtained a baccalaureate degree, master's degree, or PhD in a social services
386.8discipline; or
386.9(2) meet the qualifications of a mental health practitioner as defined in section
386.10245.462, subdivision 17.
386.11(b) In addition, a behavior analyst must:
386.12(1) have four years of supervised experience working with individuals who exhibit
386.13challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder;
386.14(2) have received ten hours of instruction in functional assessment and functional
386.15analysis;
386.16(3) have received 20 hours of instruction in the understanding of the function of
386.17behavior;
386.18(4) have received ten hours of instruction on design of positive practices behavior
386.19support strategies;
386.20(5) have received 20 hours of instruction on the use of behavior reduction approved
386.21strategies used only in combination with behavior positive practices strategies;
386.22(6) be determined by a behavior professional to have the training and prerequisite
386.23skills required to provide positive practice strategies as well as behavior reduction
386.24approved and permitted intervention to the person who receives behavioral support; and
386.25(7) be under the direct supervision of a behavior professional.
386.26    Subd. 4. Behavior specialist qualifications. (a) A behavior specialist, as defined
386.27in the brain injury and community alternatives for disabled individuals waiver plans or
386.28successor plans, must meet the following qualifications:
386.29(1) have an associate's degree in a social services discipline; or
386.30(2) have two years of supervised experience working with individuals who exhibit
386.31challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder.
386.32(b) In addition, a behavior specialist must:
386.33(1) have received a minimum of four hours of training in functional assessment;
386.34(2) have received 20 hours of instruction in the understanding of the function of
386.35behavior;
387.1(3) have received ten hours of instruction on design of positive practices behavioral
387.2support strategies;
387.3(4) be determined by a behavior professional to have the training and prerequisite
387.4skills required to provide positive practices strategies as well as behavior reduction
387.5approved intervention to the person who receives behavioral support; and
387.6(5) be under the direct supervision of a behavior professional.
387.7    Subd. 5. Specialist services qualifications. An individual providing specialist
387.8services, as defined in the developmental disabilities waiver plan or successor plan, must
387.9have:
387.10(1) the specific experience and skills required of the specialist to meet the needs of
387.11the person identified by the person's service planning team; and
387.12(2) the qualifications of the specialist identified in the person's coordinated service
387.13and support plan.
387.14EFFECTIVE DATE.This section is effective January 1, 2014.

387.15    Sec. 34. [245D.095] RECORD REQUIREMENTS.
387.16    Subdivision 1. Record-keeping systems. The license holder must ensure that the
387.17content and format of service recipient, personnel, and program records are uniform and
387.18legible according to the requirements of this chapter.
387.19    Subd. 2. Admission and discharge register. The license holder must keep a written
387.20or electronic register, listing in chronological order the dates and names of all persons
387.21served by the program who have been admitted, discharged, or transferred, including
387.22service terminations initiated by the license holder and deaths.
387.23    Subd. 3. Service recipient record. (a) The license holder must maintain a record of
387.24current services provided to each person on the premises where the services are provided
387.25or coordinated. When the services are provided in a licensed facility, the records must
387.26be maintained at the facility, otherwise the records must be maintained at the license
387.27holder's program office. The license holder must protect service recipient records against
387.28loss, tampering, or unauthorized disclosure according to the requirements in sections
387.2913.01 to 13.10 and 13.46.
387.30(b) The license holder must maintain the following information for each person:
387.31(1) an admission form signed by the person or the person's legal representative
387.32that includes:
387.33(i) identifying information, including the person's name, date of birth, address,
387.34and telephone number; and
388.1(ii) the name, address, and telephone number of the person's legal representative, if
388.2any, and a primary emergency contact, the case manager, and family members or others as
388.3identified by the person or case manager;
388.4(2) service information, including service initiation information, verification of the
388.5person's eligibility for services, documentation verifying that services have been provided
388.6as identified in the coordinated service and support plan or coordinated service and support
388.7plan addendum according to paragraph (a), and date of admission or readmission;
388.8(3) health information, including medical history, special dietary needs, and
388.9allergies, and when the license holder is assigned responsibility for meeting the person's
388.10health service needs according to section 245D.05:
388.11(i) current orders for medication, treatments, or medical equipment and a signed
388.12authorization from the person or the person's legal representative to administer or assist in
388.13administering the medication or treatments, if applicable;
388.14(ii) a signed statement authorizing the license holder to act in a medical emergency
388.15when the person's legal representative, if any, cannot be reached or is delayed in arriving;
388.16(iii) medication administration procedures;
388.17(iv) a medication administration record documenting the implementation of the
388.18medication administration procedures, and the medication administration record reviews,
388.19including any agreements for administration of injectable medications by the license
388.20holder according to the requirements in section 245D.05; and
388.21(v) a medical appointment schedule when the license holder is assigned
388.22responsibility for assisting with medical appointments;
388.23(4) the person's current coordinated service and support plan or that portion of the
388.24plan assigned to the license holder;
388.25(5) copies of the individual abuse prevention plan and assessments as required under
388.26section 245D.071, subdivisions 2 and 3;
388.27(6) a record of other service providers serving the person when the person's
388.28coordinated service and support plan or coordinated service and support plan addendum
388.29identifies the need for coordination between the service providers, that includes a contact
388.30person and telephone numbers, services being provided, and names of staff responsible for
388.31coordination;
388.32(7) documentation of orientation to service recipient rights according to section
388.33245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
388.34section 245A.65, subdivision 1, paragraph (c);
388.35(8) copies of authorizations to handle a person's funds, according to section 245D.06,
388.36subdivision 4, paragraph (a);
389.1(9) documentation of complaints received and grievance resolution;
389.2(10) incident reports involving the person, required under section 245D.06,
389.3subdivision 1;
389.4(11) copies of written reports regarding the person's status when requested according
389.5to section 245D.07, subdivision 3, progress review reports as required under section
389.6245D.071, subdivision 5, progress or daily log notes that are recorded by the program,
389.7and reports received from other agencies involved in providing services or care to the
389.8person; and
389.9(12) discharge summary, including service termination notice and related
389.10documentation, when applicable.
389.11    Subd. 4. Access to service recipient records. The license holder must ensure that
389.12the following people have access to the information in subdivision 1 in accordance with
389.13applicable state and federal laws, regulations, or rules:
389.14(1) the person, the person's legal representative, and anyone properly authorized
389.15by the person;
389.16(2) the person's case manager;
389.17(3) staff providing services to the person unless the information is not relevant to
389.18carrying out the coordinated service and support plan or coordinated service and support
389.19plan addendum; and
389.20(4) the county child or adult foster care licensor, when services are also licensed as
389.21child or adult foster care.
389.22    Subd. 5. Personnel records. (a) The license holder must maintain a personnel
389.23record of each employee to document and verify staff qualifications, orientation, and
389.24training. The personnel record must include:
389.25(1) the employee's date of hire, completed application, an acknowledgement signed
389.26by the employee that job duties were reviewed with the employee and the employee
389.27understands those duties, and documentation that the employee meets the position
389.28requirements as determined by the license holder;
389.29 (2) documentation of staff qualifications, orientation, training, and performance
389.30evaluations as required under section 245D.09, subdivisions 3 to 5, including the date
389.31the training was completed, the number of hours per subject area, and the name of the
389.32trainer or instructor; and
389.33(3) a completed background study as required under chapter 245C.
389.34(b) For employees hired after January 1, 2014, the license holder must maintain
389.35documentation in the personnel record or elsewhere, sufficient to determine the date of the
390.1employee's first supervised direct contact with a person served by the program, and the
390.2date of first unsupervised direct contact with a person served by the program.
390.3EFFECTIVE DATE.This section is effective January 1, 2014.

390.4    Sec. 35. Minnesota Statutes 2012, section 245D.10, is amended to read:
390.5245D.10 POLICIES AND PROCEDURES.
390.6    Subdivision 1. Policy and procedure requirements. The A license holder
390.7 providing either basic or intensive supports and services must establish, enforce, and
390.8maintain policies and procedures as required in this chapter, chapter 245A, and other
390.9applicable state and federal laws and regulations governing the provision of home and
390.10community-based services licensed according to this chapter.
390.11    Subd. 2. Grievances. The license holder must establish policies and procedures
390.12that provide promote service recipient rights by providing a simple complaint process for
390.13persons served by the program and their authorized representatives to bring a grievance that:
390.14(1) provides staff assistance with the complaint process when requested, and the
390.15addresses and telephone numbers of outside agencies to assist the person;
390.16(2) allows the person to bring the complaint to the highest level of authority in the
390.17program if the grievance cannot be resolved by other staff members, and that provides
390.18the name, address, and telephone number of that person;
390.19(3) requires the license holder to promptly respond to all complaints affecting a
390.20person's health and safety. For all other complaints, the license holder must provide an
390.21initial response within 14 calendar days of receipt of the complaint. All complaints must
390.22be resolved within 30 calendar days of receipt or the license holder must document the
390.23reason for the delay and a plan for resolution;
390.24(4) requires a complaint review that includes an evaluation of whether:
390.25(i) related policies and procedures were followed and adequate;
390.26(ii) there is a need for additional staff training;
390.27(iii) the complaint is similar to past complaints with the persons, staff, or services
390.28involved; and
390.29(iv) there is a need for corrective action by the license holder to protect the health
390.30and safety of persons receiving services;
390.31(5) based on the review in clause (4), requires the license holder to develop,
390.32document, and implement a corrective action plan designed to correct current lapses and
390.33prevent future lapses in performance by staff or the license holder, if any;
391.1(6) provides a written summary of the complaint and a notice of the complaint
391.2resolution to the person and case manager that:
391.3(i) identifies the nature of the complaint and the date it was received;
391.4(ii) includes the results of the complaint review;
391.5(iii) identifies the complaint resolution, including any corrective action; and
391.6(7) requires that the complaint summary and resolution notice be maintained in the
391.7service recipient record.
391.8    Subd. 3. Service suspension and service termination. (a) The license holder must
391.9establish policies and procedures for temporary service suspension and service termination
391.10that promote continuity of care and service coordination with the person and the case
391.11manager and with other licensed caregivers, if any, who also provide support to the person.
391.12(b) The policy must include the following requirements:
391.13(1) the license holder must notify the person or the person's legal representative and
391.14case manager in writing of the intended termination or temporary service suspension, and
391.15the person's right to seek a temporary order staying the termination of service according to
391.16the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);
391.17(2) notice of the proposed termination of services, including those situations
391.18that began with a temporary service suspension, must be given at least 60 days before
391.19the proposed termination is to become effective when a license holder is providing
391.20independent living skills training, structured day, prevocational or supported employment
391.21services to the person intensive supports and services identified in section 245D.03,
391.22subdivision 1, paragraph (c), and 30 days prior to termination for all other services
391.23licensed under this chapter;
391.24(3) the license holder must provide information requested by the person or case
391.25manager when services are temporarily suspended or upon notice of termination;
391.26(4) prior to giving notice of service termination or temporary service suspension,
391.27the license holder must document actions taken to minimize or eliminate the need for
391.28service suspension or termination;
391.29(5) during the temporary service suspension or service termination notice period,
391.30the license holder will work with the appropriate county agency to develop reasonable
391.31alternatives to protect the person and others;
391.32(6) the license holder must maintain information about the service suspension or
391.33termination, including the written termination notice, in the service recipient record; and
391.34(7) the license holder must restrict temporary service suspension to situations in
391.35which the person's behavior causes immediate and serious danger to the health and safety
392.1of the person or others conduct poses an imminent risk of physical harm to self or others
392.2and less restrictive or positive support strategies would not achieve safety.
392.3    Subd. 4. Availability of current written policies and procedures. (a) The license
392.4holder must review and update, as needed, the written policies and procedures required
392.5under this chapter.
392.6(b)(1) The license holder must inform the person and case manager of the policies
392.7and procedures affecting a person's rights under section 245D.04, and provide copies of
392.8those policies and procedures, within five working days of service initiation.
392.9(2) If a license holder only provides basic services and supports, this includes the:
392.10(i) grievance policy and procedure required under subdivision 2; and
392.11(ii) service suspension and termination policy and procedure required under
392.12subdivision 3.
392.13(3) For all other license holders this includes the:
392.14(i) policies and procedures in clause (2);
392.15(ii) emergency use of manual restraints policy and procedure required under section
392.16245D.061, subdivision 10; and
392.17(iii) data privacy requirements under section 245D.11, subdivision 3.
392.18(c) The license holder must provide a written notice to all persons or their legal
392.19representatives and case managers at least 30 days before implementing any revised
392.20policies and procedures procedural revisions to policies affecting a person's service-related
392.21or protection-related rights under section 245D.04 and maltreatment reporting policies and
392.22procedures. The notice must explain the revision that was made and include a copy of the
392.23revised policy and procedure. The license holder must document the reason reasonable
392.24cause for not providing the notice at least 30 days before implementing the revisions.
392.25(d) Before implementing revisions to required policies and procedures, the license
392.26holder must inform all employees of the revisions and provide training on implementation
392.27of the revised policies and procedures.
392.28(e) The license holder must annually notify all persons, or their legal representatives,
392.29and case managers of any procedural revisions to policies required under this chapter,
392.30other than those in paragraph (c). Upon request, the license holder must provide the
392.31person, or the person's legal representative, and case manager with copies of the revised
392.32policies and procedures.
392.33EFFECTIVE DATE.This section is effective January 1, 2014.

392.34    Sec. 36. [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT
392.35SERVICES.
393.1    Subdivision 1. Policy and procedure requirements. A license holder providing
393.2intensive support services as identified in section 245D.03, subdivision 1, paragraph (c),
393.3must establish, enforce, and maintain policies and procedures as required in this section.
393.4    Subd. 2. Health and safety. The license holder must establish policies and
393.5procedures that promote health and safety by ensuring:
393.6(1) use of universal precautions and sanitary practices in compliance with section
393.7245D.06, subdivision 2, clause (5);
393.8(2) if the license holder operates a residential program, health service coordination
393.9and care according to the requirements in section 245D.05, subdivision 1;
393.10(3) safe medication assistance and administration according to the requirements
393.11in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
393.12consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
393.13doctor and require completion of medication administration training according to the
393.14requirements in section 245D.09, subdivision 4a, paragraph (d). Medication assistance
393.15and administration includes, but is not limited to:
393.16(i) providing medication-related services for a person;
393.17(ii) medication setup;
393.18(iii) medication administration;
393.19(iv) medication storage and security;
393.20(v) medication documentation and charting;
393.21(vi) verification and monitoring of effectiveness of systems to ensure safe medication
393.22handling and administration;
393.23(vii) coordination of medication refills;
393.24(viii) handling changes to prescriptions and implementation of those changes;
393.25(ix) communicating with the pharmacy; and
393.26(x) coordination and communication with prescriber;
393.27(4) safe transportation, when the license holder is responsible for transportation of
393.28persons, with provisions for handling emergency situations according to the requirements
393.29in section 245D.06, subdivision 2, clauses (2) to (4);
393.30(5) a plan for ensuring the safety of persons served by the program in emergencies as
393.31defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
393.32to the license holder. A license holder with a community residential setting or a day service
393.33facility license must ensure the policy and procedures comply with the requirements in
393.34section 245D.22, subdivision 4;
394.1(6) a plan for responding to all incidents as defined in section 245D.02, subdivision
394.211; and reporting all incidents required to be reported according to section 245D.06,
394.3subdivision 1. The plan must:
394.4(i) provide the contact information of a source of emergency medical care and
394.5transportation; and
394.6(ii) require staff to first call 911 when the staff believes a medical emergency may be
394.7life threatening, or to call the mental health crisis intervention team when the person is
394.8experiencing a mental health crisis; and
394.9(7) a procedure for the review of incidents and emergencies to identify trends or
394.10patterns, and corrective action if needed. The license holder must establish and maintain
394.11a record-keeping system for the incident and emergency reports. Each incident and
394.12emergency report file must contain a written summary of the incident. The license holder
394.13must conduct a review of incident reports for identification of incident patterns, and
394.14implementation of corrective action as necessary to reduce occurrences. Each incident
394.15report must include:
394.16(i) the name of the person or persons involved in the incident. It is not necessary
394.17to identify all persons affected by or involved in an emergency unless the emergency
394.18resulted in an incident;
394.19(ii) the date, time, and location of the incident or emergency;
394.20(iii) a description of the incident or emergency;
394.21(iv) a description of the response to the incident or emergency and whether a person's
394.22coordinated service and support plan addendum or program policies and procedures were
394.23implemented as applicable;
394.24(v) the name of the staff person or persons who responded to the incident or
394.25emergency; and
394.26(vi) the determination of whether corrective action is necessary based on the results
394.27of the review.
394.28    Subd. 3. Data privacy. The license holder must establish policies and procedures that
394.29promote service recipient rights by ensuring data privacy according to the requirements in:
394.30(1) the Minnesota Government Data Practices Act, section 13.46, and all other
394.31applicable Minnesota laws and rules in handling all data related to the services provided;
394.32and
394.33(2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the
394.34extent that the license holder performs a function or activity involving the use of protected
394.35health information as defined under Code of Federal Regulations, title 45, section 164.501,
394.36including, but not limited to, providing health care services; health care claims processing
395.1or administration; data analysis, processing, or administration; utilization review; quality
395.2assurance; billing; benefit management; practice management; repricing; or as otherwise
395.3provided by Code of Federal Regulations, title 45, section 160.103. The license holder
395.4must comply with the Health Insurance Portability and Accountability Act of 1996 and
395.5its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164,
395.6and all applicable requirements.
395.7    Subd. 4. Admission criteria. The license holder must establish policies and
395.8procedures that promote continuity of care by ensuring that admission or service initiation
395.9criteria:
395.10(1) is consistent with the license holder's registration information identified in the
395.11requirements in section 245D.031, subdivision 2, and with the service-related rights
395.12identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);
395.13(2) identifies the criteria to be applied in determining whether the license holder
395.14can develop services to meet the needs specified in the person's coordinated service and
395.15support plan;
395.16(3) requires a license holder providing services in a health care facility to comply
395.17with the requirements in section 243.166, subdivision 4b, to provide notification to
395.18residents when a registered predatory offender is admitted into the program or to a
395.19potential admission when the facility was already serving a registered predatory offender.
395.20For purposes of this clause, "health care facility" means a facility licensed by the
395.21commissioner as a residential facility under chapter 245A to provide adult foster care or
395.22residential services to persons with disabilities; and
395.23(4) requires that when a person or the person's legal representative requests services
395.24from the license holder, a refusal to admit the person must be based on an evaluation of
395.25the person's assessed needs and the license holder's lack of capacity to meet the needs of
395.26the person. The license holder must not refuse to admit a person based solely on the
395.27type of residential services the person is receiving, or solely on the person's severity of
395.28disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of
395.29communication skills, physical disabilities, toilet habits, behavioral disorders, or past
395.30failure to make progress. Documentation of the basis for refusal must be provided to the
395.31person or the person's legal representative and case manager upon request.
395.32EFFECTIVE DATE.This section is effective January 1, 2014.

395.33    Sec. 37. [245D.21] FACILITY LICENSURE REQUIREMENTS AND
395.34APPLICATION PROCESS.
396.1    Subdivision 1. Community residential settings and day service facilities. For
396.2purposes of this section, "facility" means both a community residential setting and day
396.3service facility and the physical plant.
396.4    Subd. 2. Inspections and code compliance. (a) Physical plants must comply with
396.5applicable state and local fire, health, building, and zoning codes.
396.6(b)(1) The facility must be inspected by a fire marshal or their delegate within
396.712 months before initial licensure to verify that it meets the applicable occupancy
396.8requirements as defined in the State Fire Code and that the facility complies with the fire
396.9safety standards for that occupancy code contained in the State Fire Code.
396.10(2) The fire marshal inspection of a community residential setting must verify the
396.11residence is a dwelling unit within a residential occupancy as defined in section 9.117 of
396.12the State Fire Code. A home safety checklist, approved by the commissioner, must be
396.13completed for a community residential setting by the license holder and the commissioner
396.14before the satellite license is reissued.
396.15(3) The facility shall be inspected according to the facility capacity specified on the
396.16initial application form.
396.17(4) If the commissioner has reasonable cause to believe that a potentially hazardous
396.18condition may be present or the licensed capacity is increased, the commissioner shall
396.19request a subsequent inspection and written report by a fire marshal to verify the absence
396.20of hazard.
396.21(5) Any condition cited by a fire marshal, building official, or health authority as
396.22hazardous or creating an immediate danger of fire or threat to health and safety must be
396.23corrected before a license is issued by the department, and for community residential
396.24settings, before a license is reissued.
396.25(c) The facility must maintain in a permanent file the reports of health, fire, and
396.26other safety inspections.
396.27(d) The facility's plumbing, ventilation, heating, cooling, lighting, and other
396.28fixtures and equipment, including elevators or food service, if provided, must conform to
396.29applicable health, sanitation, and safety codes and regulations.
396.30EFFECTIVE DATE.This section is effective January 1, 2014.

396.31    Sec. 38. [245D.22] FACILITY SANITATION AND HEALTH.
396.32    Subdivision 1. General maintenance. The license holder must maintain the interior
396.33and exterior of buildings, structures, or enclosures used by the facility, including walls,
396.34floors, ceilings, registers, fixtures, equipment, and furnishings in good repair and in a
396.35sanitary and safe condition. The facility must be clean and free from accumulations of
397.1dirt, grease, garbage, peeling paint, mold, vermin, and insects. The license holder must
397.2correct building and equipment deterioration, safety hazards, and unsanitary conditions.
397.3    Subd. 2. Hazards and toxic substances. The license holder must ensure that
397.4service sites owned or leased by the license holder are free from hazards that would
397.5threaten the health or safety of a person receiving services by ensuring the requirements
397.6in paragraphs (a) to (g) are met.
397.7(a) Chemicals, detergents, and other hazardous or toxic substances must not be
397.8stored with food products or in any way that poses a hazard to persons receiving services.
397.9(b) The license holder must install handrails and nonslip surfaces on interior and
397.10exterior runways, stairways, and ramps according to the applicable building code.
397.11(c) If there are elevators in the facility, the license holder must have elevators
397.12inspected each year. The date of the inspection, any repairs needed, and the date the
397.13necessary repairs were made must be documented.
397.14(d) The license holder must keep stairways, ramps, and corridors free of obstructions.
397.15(e) Outside property must be free from debris and safety hazards. Exterior stairs and
397.16walkways must be kept free of ice and snow.
397.17(f) Heating, ventilation, air conditioning units, and other hot surfaces and moving
397.18parts of machinery must be shielded or enclosed.
397.19(g) Use of dangerous items or equipment by persons served by the program must be
397.20allowed in accordance with the person's coordinated service and support plan addendum
397.21or the program abuse prevention plan, if not addressed in the coordinated service and
397.22support plan addendum.
397.23    Subd. 3. Storage and disposal of medication. Schedule II controlled substances in
397.24the facility that are named in section 152.02, subdivision 3, must be stored in a locked
397.25storage area permitting access only by persons and staff authorized to administer the
397.26medication. This must be incorporated into the license holder's medication administration
397.27policy and procedures required under section 245D.11, subdivision 2, clause (3).
397.28Medications must be disposed of according to the Environmental Protection Agency
397.29recommendations.
397.30    Subd. 4. First aid must be available on site. (a) A staff person trained in first
397.31aid must be available on site and, when required in a person's coordinated service and
397.32support plan or coordinated service and support plan addendum, be able to provide
397.33cardiopulmonary resuscitation, whenever persons are present and staff are required to be
397.34at the site to provide direct service. The CPR training must include in-person instruction,
397.35hands-on practice, and an observed skills assessment under the direct supervision of a
397.36CPR instructor.
398.1(b) A facility must have first aid kits readily available for use by, and that meet
398.2the needs of, persons receiving services and staff. At a minimum, the first aid kit must
398.3be equipped with accessible first aid supplies including bandages, sterile compresses,
398.4scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
398.5adhesive tape, and first aid manual.
398.6    Subd. 5. Emergencies. (a) The license holder must have a written plan for
398.7responding to emergencies as defined in section 245D.02, subdivision 8, to ensure the
398.8safety of persons served in the facility. The plan must include:
398.9(1) procedures for emergency evacuation and emergency sheltering, including:
398.10(i) how to report a fire or other emergency;
398.11(ii) procedures to notify, relocate, and evacuate occupants, including use of adaptive
398.12procedures or equipment to assist with the safe evacuation of persons with physical or
398.13sensory disabilities; and
398.14(iii) instructions on closing off the fire area, using fire extinguishers, and activating
398.15and responding to alarm systems;
398.16(2) a floor plan that identifies:
398.17(i) the location of fire extinguishers;
398.18(ii) the location of audible or visual alarm systems, including but not limited to
398.19manual fire alarm boxes, smoke detectors, fire alarm enunciators and controls, and
398.20sprinkler systems;
398.21(iii) the location of exits, primary and secondary evacuation routes, and accessible
398.22egress routes, if any; and
398.23(iv) the location of emergency shelter within the facility;
398.24(3) a site plan that identifies:
398.25(i) designated assembly points outside the facility;
398.26(ii) the locations of fire hydrants; and
398.27(iii) the routes of fire department access;
398.28(4) the responsibilities each staff person must assume in case of emergency;
398.29(5) procedures for conducting quarterly drills each year and recording the date of
398.30each drill in the file of emergency plans;
398.31(6) procedures for relocation or service suspension when services are interrupted
398.32for more than 24 hours;
398.33(7) for a community residential setting with three or more dwelling units, a floor
398.34plan that identifies the location of enclosed exit stairs; and
398.35(8) an emergency escape plan for each resident.
398.36(b) The license holder must:
399.1(1) maintain a log of quarterly fire drills on file in the facility;
399.2(2) provide an emergency response plan that is readily available to staff and persons
399.3receiving services;
399.4(3) inform each person of a designated area within the facility where the person
399.5should go for emergency shelter during severe weather and the designated assembly points
399.6outside the facility; and
399.7(4) maintain emergency contact information for persons served at the facility that
399.8can be readily accessed in an emergency.
399.9    Subd. 6. Emergency equipment. The facility must have a flashlight and a portable
399.10radio or television set that do not require electricity and can be used if a power failure
399.11occurs.
399.12    Subd. 7. Telephone and posted numbers. A facility must have a non-coin operated
399.13telephone that is readily accessible. A list of emergency numbers must be posted in a
399.14prominent location. When an area has a 911 number or a mental health crisis intervention
399.15team number, both numbers must be posted and the emergency number listed must be
399.16911. In areas of the state without a 911 number, the numbers listed must be those of the
399.17local fire department, police department, emergency transportation, and poison control
399.18center. The names and telephone numbers of each person's representative, physician, and
399.19dentist must be readily available.
399.20EFFECTIVE DATE.This section is effective January 1, 2014.

399.21    Sec. 39. [245D.23] COMMUNITY RESIDENTIAL SETTINGS; SATELLITE
399.22LICENSURE REQUIREMENTS AND APPLICATION PROCESS.
399.23    Subdivision 1. Separate satellite license required for separate sites. (a) A license
399.24holder providing residential support services must obtain a separate satellite license for
399.25each community residential setting located at separate addresses when the community
399.26residential settings are to be operated by the same license holder. For purposes of this
399.27chapter, a community residential setting is a satellite of the home and community-based
399.28services license.
399.29(b) Community residential settings are permitted single-family use homes. After a
399.30license has been issued, the commissioner shall notify the local municipality where the
399.31residence is located of the approved license.
399.32    Subd. 2. Notification to local agency. The license holder must notify the local
399.33agency within 24 hours of the onset of changes in a residence resulting from construction,
399.34remodeling, or damages requiring repairs that require a building permit or may affect a
399.35licensing requirement in this chapter.
400.1    Subd. 3. Alternate overnight supervision. A license holder granted an alternate
400.2overnight supervision technology adult foster care license according to section 245A.11,
400.3subdivision 7a, that converts to a community residential setting satellite license according
400.4to this chapter, must retain that designation.
400.5EFFECTIVE DATE.This section is effective January 1, 2014.

400.6    Sec. 40. [245D.24] COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL
400.7PLANT AND ENVIRONMENT.
400.8    Subdivision 1. Occupancy. The residence must meet the definition of a dwelling
400.9unit in a residential occupancy.
400.10    Subd. 2. Common area requirements. The living area must be provided with an
400.11adequate number of furnishings for the usual functions of daily living and social activities.
400.12The dining area must be furnished to accommodate meals shared by all persons living in
400.13the residence. These furnishings must be in good repair and functional to meet the daily
400.14needs of the persons living in the residence.
400.15    Subd. 3. Bedrooms. (a) People receiving services must mutually consent, in
400.16writing, to sharing a bedroom with one another. No more than two people receiving
400.17services may share one bedroom.
400.18(b) A single occupancy bedroom must have at least 80 square feet of floor space with
400.19a 7-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor
400.20space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and
400.21other habitable rooms by floor to ceiling walls containing no openings except doorways
400.22and must not serve as a corridor to another room used in daily living.
400.23(c) A person's personal possessions and items for the person's own use are the only
400.24items permitted to be stored in a person's bedroom.
400.25(d) Unless otherwise documented through assessment as a safety concern for the
400.26person, each person must be provided with the following furnishings:
400.27(1) a separate bed of proper size and height for the convenience and comfort of the
400.28person, with a clean mattress in good repair;
400.29(2) clean bedding appropriate for the season for each person;
400.30(3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal
400.31possessions and clothing; and
400.32(4) a mirror for grooming.
400.33(e) When possible, a person must be allowed to have items of furniture that the
400.34person personally owns in the bedroom, unless doing so would interfere with safety
400.35precautions, violate a building or fire code, or interfere with another person's use of the
401.1bedroom. A person may choose not to have a cabinet, dresser, shelves, or a mirror in the
401.2bedroom, as otherwise required under paragraph (d), clause (3) or (4). A person may
401.3choose to use a mattress other than an innerspring mattress and may choose not to have
401.4the mattress on a mattress frame or support. If a person chooses not to have a piece of
401.5required furniture, the license holder must document this choice and is not required to
401.6provide the item. If a person chooses to use a mattress other than an innerspring mattress
401.7or chooses not to have a mattress frame or support, the license holder must document this
401.8choice and allow the alternative desired by the person.
401.9(f) A person must be allowed to bring personal possessions into the bedroom
401.10and other designated storage space, if such space is available, in the residence. The
401.11person must be allowed to accumulate possessions to the extent the residence is able to
401.12accommodate them, unless doing so is contraindicated for the person's physical or mental
401.13health, would interfere with safety precautions or another person's use of the bedroom, or
401.14would violate a building or fire code. The license holder must allow for locked storage
401.15of personal items. Any restriction on the possession or locked storage of personal items,
401.16including requiring a person to use a lock provided by the license holder, must comply
401.17with section 245D.04, subdivision 3, paragraph (c), and allow the person to be present if
401.18and when the license holder opens the lock.
401.19EFFECTIVE DATE.This section is effective January 1, 2014.

401.20    Sec. 41. [245D.25] COMMUNITY RESIDENTIAL SETTINGS; FOOD AND
401.21WATER.
401.22    Subdivision 1. Water. Potable water from privately owned wells must be tested
401.23annually by a Department of Health-certified laboratory for coliform bacteria and nitrate
401.24nitrogens to verify safety. The health authority may require retesting and corrective
401.25measures if results exceed state water standards in Minnesota Rules, chapter 4720, or in
401.26the event of flooding or an incident which may put the well at risk of contamination. To
401.27prevent scalding, the water temperature of faucets must not exceed 120 degrees Fahrenheit.
401.28    Subd. 2. Food. Food served must meet any special dietary needs of a person as
401.29prescribed by the person's physician or dietitian. Three nutritionally balanced meals a day
401.30must be served or made available to persons, and nutritious snacks must be available
401.31between meals.
401.32    Subd. 3. Food safety. Food must be obtained, handled, and properly stored to
401.33prevent contamination, spoilage, or a threat to the health of a person.
401.34EFFECTIVE DATE.This section is effective January 1, 2014.

402.1    Sec. 42. [245D.26] COMMUNITY RESIDENTIAL SETTINGS; SANITATION
402.2AND HEALTH.
402.3    Subdivision 1. Goods provided by the license holder. Individual clean bed linens
402.4appropriate for the season and the person's comfort, including towels and wash cloths,
402.5must be available for each person. Usual or customary goods for the operation of a
402.6residence which are communally used by all persons receiving services living in the
402.7residence must be provided by the license holder, including household items for meal
402.8preparation, cleaning supplies to maintain the cleanliness of the residence, window
402.9coverings on windows for privacy, toilet paper, and hand soap.
402.10    Subd. 2. Personal items. Personal health and hygiene items must be stored in a
402.11safe and sanitary manner.
402.12    Subd. 3. Pets and service animals. Pets and service animals housed within
402.13the residence must be immunized and maintained in good health as required by local
402.14ordinances and state law. The license holder must ensure that the person and the person's
402.15representative are notified before admission of the presence of pets in the residence.
402.16    Subd. 4. Smoking in the residence. License holders must comply with the
402.17requirements of the Minnesota Clean Indoor Air Act, sections 144.411 to 144.417, when
402.18smoking is permitted in the residence.
402.19    Subd. 5. Weapons. Weapons and ammunition must be stored separately in locked
402.20areas that are inaccessible to a person receiving services. For purposes of this subdivision,
402.21"weapons" means firearms and other instruments or devices designed for and capable of
402.22producing bodily harm.
402.23EFFECTIVE DATE.This section is effective January 1, 2014.

402.24    Sec. 43. [245D.27] DAY SERVICES FACILITIES; SATELLITE LICENSURE
402.25REQUIREMENTS AND APPLICATION PROCESS.
402.26Except for day service facilities on the same or adjoining lot, the license holder
402.27providing day services must apply for a separate license for each facility-based service
402.28site when the license holder is the owner, lessor, or tenant of the service site at which
402.29persons receive day services and the license holder's employees who provide day services
402.30are present for a cumulative total of more than 30 days within any 12-month period. For
402.31purposes of this chapter, a day services facility license is a satellite license of the day
402.32services program. A day services program may operate multiple licensed day service
402.33facilities in one or more counties in the state. For the purposes of this section, "adjoining
402.34lot" means day services facilities that are next door to or across the street from one another.
403.1EFFECTIVE DATE.This section is effective January 1, 2014.

403.2    Sec. 44. [245D.28] DAY SERVICES FACILITIES; PHYSICAL PLANT AND
403.3SPACE REQUIREMENTS.
403.4    Subdivision 1. Facility capacity and useable space requirements. (a) The facility
403.5capacity of each day service facility must be determined by the amount of primary space
403.6available, the scheduling of activities at other service sites, and the space requirements of
403.7all persons receiving services at the facility, not just the licensed services. The facility
403.8capacity must specify the maximum number of persons that may receive services on
403.9site at any one time.
403.10(b) When a facility is located in a multifunctional organization, the facility may
403.11share common space with the multifunctional organization if the required available
403.12primary space for use by persons receiving day services is maintained while the facility is
403.13operating. The license holder must comply at all times with all applicable fire and safety
403.14codes under section 245A.04, subdivision 2a, and adequate supervision requirements
403.15under section 245D.31 for all persons receiving day services.
403.16(c) A day services facility must have a minimum of 40 square feet of primary space
403.17available for each person receiving services who is present at the site at any one time.
403.18Primary space does not include:
403.19(1) common areas, such as hallways, stairways, closets, utility areas, bathrooms,
403.20and kitchens;
403.21(2) floor areas beneath stationary equipment; or
403.22(3) any space occupied by persons associated with the multifunctional organization
403.23while persons receiving day services are using common space.
403.24    Subd. 2. Individual personal articles. Each person must be provided space in a
403.25closet, cabinet, on a shelf, or a coat hook for storage of personal items for the person's own
403.26use while receiving services at the facility, unless doing so would interfere with safety
403.27precautions, another person's work space, or violate a building or fire code.
403.28EFFECTIVE DATE.This section is effective January 1, 2014.

403.29    Sec. 45. [245D.29] DAY SERVICES FACILITIES; HEALTH AND SAFETY
403.30REQUIREMENTS.
403.31    Subdivision 1. Refrigeration. If the license holder provides refrigeration at service
403.32sites owned or leased by the license holder for storing perishable foods and perishable
403.33portions of bag lunches, whether the foods are supplied by the license holder or the
404.1persons receiving services, the refrigeration must have a temperature of 40 degrees
404.2Fahrenheit or less.
404.3    Subd. 2. Drinking water. Drinking water must be available to all persons
404.4receiving services. If a person is unable to request or obtain drinking water, it must be
404.5provided according to that person's individual needs. Drinking water must be provided in
404.6single-service containers or from drinking fountains accessible to all persons.
404.7    Subd. 3. Individuals who become ill during the day. There must be an area in
404.8which a person receiving services can rest if:
404.9(1) the person becomes ill during the day;
404.10(2) the person does not live in a licensed residential site;
404.11(3) the person requires supervision; and
404.12(4) there is not a caretaker immediately available. Supervision must be provided
404.13until the caretaker arrives to bring the person home.
404.14    Subd. 4. Safety procedures. The license holder must establish general written
404.15safety procedures that include criteria for selecting, training, and supervising persons who
404.16work with hazardous machinery, tools, or substances. Safety procedures specific to each
404.17person's activities must be explained and be available in writing to all staff members
404.18and persons receiving services.
404.19EFFECTIVE DATE.This section is effective January 1, 2014.

404.20    Sec. 46. [245D.31] DAY SERVICES FACILITIES; STAFF RATIO AND
404.21FACILITY COVERAGE.
404.22    Subdivision 1. Scope. This section applies only to facility-based day services.
404.23    Subd. 2. Factors. (a) The number of direct support service staff members that a
404.24license holder must have on duty at the facility at a given time to meet the minimum
404.25staffing requirements established in this section varies according to:
404.26(1) the number of persons who are enrolled and receiving direct support services
404.27at that given time;
404.28(2) the staff ratio requirement established under subdivision 3 for each person who
404.29is present; and
404.30(3) whether the conditions described in subdivision 8 exist and warrant additional
404.31staffing beyond the number determined to be needed under subdivision 7.
404.32(b) The commissioner must consider the factors in paragraph (a) in determining a
404.33license holder's compliance with the staffing requirements and must further consider
404.34whether the staff ratio requirement established under subdivision 3 for each person
404.35receiving services accurately reflects the person's need for staff time.
405.1    Subd. 3. Staff ratio requirement for each person receiving services. The case
405.2manager, in consultation with the interdisciplinary team, must determine at least once each
405.3year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
405.4services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
405.5assigned each person and the documentation of how the ratio was arrived at must be kept
405.6in each person's individual service plan. Documentation must include an assessment of the
405.7person with respect to the characteristics in subdivisions 4, 5, and 6 recorded on a standard
405.8assessment form required by the commissioner.
405.9    Subd. 4. Person requiring staff ratio of one to four. A person must be assigned a
405.10staff ratio requirement of one to four if:
405.11(1) on a daily basis the person requires total care and monitoring or constant
405.12hand-over-hand physical guidance to successfully complete at least three of the following
405.13activities: toileting, communicating basic needs, eating, ambulating; or is not capable of
405.14taking appropriate action for self-preservation under emergency conditions; or
405.15(2) the person engages in conduct that poses an imminent risk of physical harm to
405.16self or others at a documented level of frequency, intensity, or duration requiring frequent
405.17daily ongoing intervention and monitoring as established in the person's coordinated
405.18service and support plan or coordinated service and support plan addendum.
405.19    Subd. 5. Person requiring staff ratio of one to eight. A person must be assigned a
405.20staff ratio requirement of one to eight if:
405.21(1) the person does not meet the requirements in subdivision 4; and
405.22(2) on a daily basis the person requires verbal prompts or spot checks and minimal
405.23or no physical assistance to successfully complete at least four of the following activities:
405.24toileting, communicating basic needs, eating, ambulating, or taking appropriate action for
405.25self-preservation under emergency conditions.
405.26    Subd. 6. Person requiring staff ratio of one to six. A person who does not have
405.27any of the characteristics described in subdivision 4 or 5 must be assigned a staff ratio
405.28requirement of one to six.
405.29    Subd. 7. Determining number of direct support service staff required. The
405.30minimum number of direct support service staff members required at any one time to
405.31meet the combined staff ratio requirements of the persons present at that time can be
405.32determined by the following steps:
405.33(1) assign to each person in attendance the three-digit decimal below that corresponds
405.34to the staff ratio requirement assigned to that person. A staff ratio requirement of one to
405.35four equals 0.250. A staff ratio requirement of one to eight equals 0.125. A staff ratio
405.36requirement of one to six equals 0.166. A staff ratio requirement of one to ten equals 0.100;
406.1(2) add all of the three-digit decimals (one three-digit decimal for every person in
406.2attendance) assigned in clause (1);
406.3(3) when the sum in clause (2) falls between two whole numbers, round off the sum
406.4to the larger of the two whole numbers; and
406.5(4) the larger of the two whole numbers in clause (3) equals the number of direct
406.6support service staff members needed to meet the staff ratio requirements of the persons
406.7in attendance.
406.8    Subd. 8. Staff to be included in calculating minimum staffing requirement.
406.9Only staff providing direct support must be counted as staff members in calculating
406.10the staff-to-participant ratio. A volunteer may be counted as a direct support staff in
406.11calculating the staff-to-participant ratio if the volunteer meets the same standards and
406.12requirements as paid staff. No person receiving services must be counted as or be
406.13substituted for a staff member in calculating the staff-to-participant ratio.
406.14    Subd. 9. Conditions requiring additional direct support staff. The license holder
406.15must increase the number of direct support staff members present at any one time beyond
406.16the number arrived at in subdivision 4 if necessary when any one or combination of the
406.17following circumstances can be documented by the commissioner as existing:
406.18(1) the health and safety needs of the persons receiving services cannot be met by
406.19the number of staff members available under the staffing pattern in effect even though the
406.20number has been accurately calculated under subdivision 7; or
406.21(2) the person's conduct frequently presents an imminent risk of physical harm to
406.22self or others.
406.23    Subd. 10. Supervision requirements. (a) At no time must one direct support
406.24staff member be assigned responsibility for supervision and training of more than ten
406.25persons receiving supervision and training, except as otherwise stated in each person's risk
406.26management plan.
406.27(b) In the temporary absence of the director or a supervisor, a direct support staff
406.28member must be designated to supervise the center.
406.29    Subd. 11. Multifunctional programs. A multifunctional program may count other
406.30employees of the organization besides direct support staff of the day service facility in
406.31calculating the staff-to-participant ratio if the employee is assigned to the day services
406.32facility for a specified amount of time, during which the employee is not assigned to
406.33another organization or program.
406.34EFFECTIVE DATE.This section is effective January 1, 2014.

406.35    Sec. 47. [245D.32] ALTERNATIVE LICENSING INSPECTIONS.
407.1    Subdivision 1. Eligibility for an alternative licensing inspection. (a) A license
407.2holder providing services licensed under this chapter, with a qualifying accreditation and
407.3meeting the eligibility criteria in paragraphs (b) and (c), may request approval for an
407.4alternative licensing inspection when all services provided under the license holder's
407.5license are accredited. A license holder with a qualifying accreditation and meeting
407.6the eligibility criteria in paragraphs (b) and (c) may request approval for an alternative
407.7licensing inspection for individual community residential settings or day services facilities
407.8licensed under this chapter.
407.9(b) In order to be eligible for an alternative licensing inspection, the program must
407.10have had at least one inspection by the commissioner following issuance of the initial
407.11license. For programs operating a day services facility, each facility must have had at least
407.12one on-site inspection by the commissioner following issuance of the initial license.
407.13(c) In order to be eligible for an alternative licensing inspection, the program must
407.14have been in substantial and consistent compliance at the time of the last licensing
407.15inspection and during the current licensing period. For purposes of this section,
407.16"substantial and consistent compliance" means:
407.17(1) the license holder's license was not made conditional, suspended, or revoked;
407.18(2) there have been no substantiated allegations of maltreatment against the license
407.19holder;
407.20(3) there were no program deficiencies identified that would jeopardize the health,
407.21safety, or rights of persons being served; and
407.22(4) the license holder maintained substantial compliance with the other requirements
407.23of chapters 245A and 245C and other applicable laws and rules.
407.24(d) For the purposes of this section, the license holder's license includes services
407.25licensed under this chapter that were previously licensed under chapter 245B until
407.26December 31, 2013.
407.27    Subd. 2. Qualifying accreditation. The commissioner must accept a three-year
407.28accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF)
407.29as a qualifying accreditation.
407.30    Subd. 3. Request for approval of an alternative inspection status. (a) A request
407.31for an alternative inspection must be made on the forms and in the manner prescribed
407.32by the commissioner. When submitting the request, the license holder must submit all
407.33documentation issued by the accrediting body verifying that the license holder has obtained
407.34and maintained the qualifying accreditation and has complied with recommendations
407.35or requirements from the accrediting body during the period of accreditation. Based
408.1on the request and the additional required materials, the commissioner may approve
408.2an alternative inspection status.
408.3(b) The commissioner must notify the license holder in writing that the request for
408.4an alternative inspection status has been approved. Approval must be granted until the
408.5end of the qualifying accreditation period.
408.6(c) The license holder must submit a written request for approval to be renewed
408.7one month before the end of the current approval period according to the requirements
408.8in paragraph (a). If the license holder does not submit a request to renew approval as
408.9required, the commissioner must conduct a licensing inspection.
408.10    Subd. 4. Programs approved for alternative licensing inspection; deemed
408.11compliance licensing requirements. (a) A license holder approved for alternative
408.12licensing inspection under this section is required to maintain compliance with all
408.13licensing standards according to this chapter.
408.14(b) A license holder approved for alternative licensing inspection under this section
408.15must be deemed to be in compliance with all the requirements of this chapter, and the
408.16commissioner must not perform routine licensing inspections.
408.17(c) Upon receipt of a complaint regarding the services of a license holder approved
408.18for alternative licensing inspection under this section, the commissioner must investigate
408.19the complaint and may take any action as provided under section 245A.06 or 245A.07.
408.20    Subd. 5. Investigations of alleged or suspected maltreatment. Nothing in this
408.21section changes the commissioner's responsibilities to investigate alleged or suspected
408.22maltreatment of a minor under section 626.556 or a vulnerable adult under section 626.557.
408.23    Subd. 6. Termination or denial of subsequent approval. Following approval of
408.24an alternative licensing inspection, the commissioner may terminate or deny subsequent
408.25approval of an alternative licensing inspection if the commissioner determines that:
408.26(1) the license holder has not maintained the qualifying accreditation;
408.27(2) the commissioner has substantiated maltreatment for which the license holder or
408.28facility is determined to be responsible during the qualifying accreditation period; or
408.29(3) during the qualifying accreditation period, the license holder has been issued
408.30an order for conditional license, fine, suspension, or license revocation that has not been
408.31reversed upon appeal.
408.32    Subd. 7. Appeals. The commissioner's decision that the conditions for approval for
408.33an alternative licensing inspection have not been met is final and not subject to appeal
408.34under the provisions of chapter 14.
409.1    Subd. 8. Commissioner's programs. Home and community-based services licensed
409.2under this chapter for which the commissioner is the license holder with a qualifying
409.3accreditation are excluded from being approved for an alternative licensing inspection.
409.4EFFECTIVE DATE.This section is effective January 1, 2014.

409.5    Sec. 48. [245D.33] ADULT MENTAL HEALTH CERTIFICATION STANDARDS.
409.6(a) The commissioner of human services shall issue a mental health certification
409.7for services licensed under this chapter when a license holder is determined to have met
409.8the requirements under paragraph (b). This certification is voluntary for license holders.
409.9The certification shall be printed on the license and identified on the commissioner's
409.10public Web site.
409.11(b) The requirements for certification are:
409.12(1) all staff have received at least seven hours of annual training covering all of
409.13the following topics:
409.14(i) mental health diagnoses;
409.15(ii) mental health crisis response and de-escalation techniques;
409.16(iii) recovery from mental illness;
409.17(iv) treatment options, including evidence-based practices;
409.18(v) medications and their side effects;
409.19(vi) co-occurring substance abuse and health conditions; and
409.20(vii) community resources;
409.21(2) a mental health professional, as defined in section 245.462, subdivision 18, or a
409.22mental health practitioner as defined in section 245.462, subdivision 17, is available
409.23for consultation and assistance;
409.24(3) there is a plan and protocol in place to address a mental health crisis; and
409.25(4) each person's individual service and support plan identifies who is providing
409.26clinical services and their contact information, and includes an individual crisis prevention
409.27and management plan developed with the person.
409.28(c) License holders seeking certification under this section must request this
409.29certification on forms and in the manner prescribed by the commissioner.
409.30(d) If the commissioner finds that the license holder has failed to comply with the
409.31certification requirements under paragraph (b), the commissioner may issue a correction
409.32order and an order of conditional license in accordance with section 245A.06 or may
409.33issue a sanction in accordance with section 245A.07, including and up to removal of
409.34the certification.
410.1(e) A denial of the certification or the removal of the certification based on a
410.2determination that the requirements under paragraph (b) have not been met is not subject to
410.3appeal. A license holder that has been denied a certification or that has had a certification
410.4removed may again request certification when the license holder is in compliance with the
410.5requirements of paragraph (b).
410.6EFFECTIVE DATE.This section is effective January 1, 2014.

410.7    Sec. 49. Minnesota Statutes 2012, section 256B.092, subdivision 1a, is amended to read:
410.8    Subd. 1a. Case management services. (a) Each recipient of a home and
410.9community-based waiver shall be provided case management services by qualified
410.10vendors as described in the federally approved waiver application.
410.11(b) Case management service activities provided to or arranged for a person include:
410.12(1) development of the coordinated service and support plan under subdivision 1b;
410.13(2) informing the individual or the individual's legal guardian or conservator, or
410.14parent if the person is a minor, of service options;
410.15(3) consulting with relevant medical experts or service providers;
410.16(4) assisting the person in the identification of potential providers;
410.17(5) assisting the person to access services and assisting in appeals under section
410.18256.045 ;
410.19(6) coordination of services, if coordination is not provided by another service
410.20provider;
410.21(7) evaluation and monitoring of the services identified in the coordinated service
410.22and support plan, which must incorporate at least one annual face-to-face visit by the case
410.23manager with each person; and
410.24(8) reviewing coordinated service and support plans and providing the lead agency
410.25with recommendations for service authorization based upon the individual's needs
410.26identified in the coordinated service and support plan.
410.27(c) Case management service activities that are provided to the person with a
410.28developmental disability shall be provided directly by county agencies or under contract.
410.29Case management services must be provided by a public or private agency that is enrolled
410.30as a medical assistance provider determined by the commissioner to meet all of the
410.31requirements in the approved federal waiver plans. Case management services must not
410.32be provided to a recipient by a private agency that has a financial interest in the provision
410.33of any other services included in the recipient's coordinated service and support plan. For
410.34purposes of this section, "private agency" means any agency that is not identified as a lead
410.35agency under section 256B.0911, subdivision 1a, paragraph (e).
411.1(d) Case managers are responsible for service provisions listed in paragraphs (a) and
411.2(b). Case managers shall collaborate with consumers, families, legal representatives, and
411.3relevant medical experts and service providers in the development and annual review of
411.4the coordinated service and support plan and habilitation plan.
411.5(e) For persons who need a positive support transition plan as required in chapter
411.6245D, the case manager shall participate in the development and ongoing evaluation
411.7of the plan with the expanded support team. At least quarterly, the case manager, in
411.8consultation with the expanded support team, shall evaluate the effectiveness of the plan
411.9based on progress evaluation data submitted by the licensed provider to the case manager.
411.10The evaluation must identify whether the plan has been developed and implemented in a
411.11manner to achieve the following within the required timelines:
411.12(1) phasing out the use of prohibited procedures;
411.13(2) acquisition of skills needed to eliminate the prohibited procedures within the
411.14plan's timeline; and
411.15(3) accomplishment of identified outcomes.
411.16If adequate progress is not being made, the case manager shall consult with the person's
411.17expanded support team to identify needed modifications and whether additional
411.18professional support is required to provide consultation.
411.19(e) (f) The Department of Human Services shall offer ongoing education in case
411.20management to case managers. Case managers shall receive no less than ten hours of case
411.21management education and disability-related training each year.
411.22EFFECTIVE DATE.This section is effective January 1, 2014.

411.23    Sec. 50. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
411.24    Subd. 11. Residential support services. (a) Upon federal approval, there is
411.25established a new service called residential support that is available on the community
411.26alternative care, community alternatives for disabled individuals, developmental
411.27disabilities, and brain injury waivers. Existing waiver service descriptions must be
411.28modified to the extent necessary to ensure there is no duplication between other services.
411.29Residential support services must be provided by vendors licensed as a community
411.30residential setting as defined in section 245A.11, subdivision 8, a foster care setting
411.31licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or an adult foster care
411.32setting licensed under Minnesota Rules, parts 9555.5105 to 9555.6265.
411.33    (b) Residential support services must meet the following criteria:
411.34    (1) providers of residential support services must own or control the residential site;
412.1    (2) the residential site must not be the primary residence of the license holder;
412.2    (3) (1) the residential site must have a designated program supervisor person
412.3 responsible for program management, oversight, development, and implementation of
412.4policies and procedures;
412.5    (4) (2) the provider of residential support services must provide supervision, training,
412.6and assistance as described in the person's coordinated service and support plan; and
412.7    (5) (3) the provider of residential support services must meet the requirements of
412.8licensure and additional requirements of the person's coordinated service and support plan.
412.9    (c) Providers of residential support services that meet the definition in paragraph (a)
412.10must be registered using a process determined by the commissioner beginning July 1, 2009
412.11 must be licensed according to chapter 245D. Providers licensed to provide child foster care
412.12under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult foster care licensed under
412.13Minnesota Rules, parts 9555.5105 to 9555.6265, and that meet the requirements in section
412.14245A.03, subdivision 7 , paragraph (g), are considered registered under this section.

412.15    Sec. 51. Minnesota Statutes 2012, section 256B.49, subdivision 13, is amended to read:
412.16    Subd. 13. Case management. (a) Each recipient of a home and community-based
412.17waiver shall be provided case management services by qualified vendors as described
412.18in the federally approved waiver application. The case management service activities
412.19provided must include:
412.20    (1) finalizing the written coordinated service and support plan within ten working
412.21days after the case manager receives the plan from the certified assessor;
412.22    (2) informing the recipient or the recipient's legal guardian or conservator of service
412.23options;
412.24    (3) assisting the recipient in the identification of potential service providers and
412.25available options for case management service and providers;
412.26    (4) assisting the recipient to access services and assisting with appeals under section
412.27256.045 ; and
412.28    (5) coordinating, evaluating, and monitoring of the services identified in the service
412.29plan.
412.30    (b) The case manager may delegate certain aspects of the case management service
412.31activities to another individual provided there is oversight by the case manager. The case
412.32manager may not delegate those aspects which require professional judgment including:
412.33(1) finalizing the coordinated service and support plan;
412.34(2) ongoing assessment and monitoring of the person's needs and adequacy of the
412.35approved coordinated service and support plan; and
413.1(3) adjustments to the coordinated service and support plan.
413.2(c) Case management services must be provided by a public or private agency that is
413.3enrolled as a medical assistance provider determined by the commissioner to meet all of
413.4the requirements in the approved federal waiver plans. Case management services must
413.5not be provided to a recipient by a private agency that has any financial interest in the
413.6provision of any other services included in the recipient's coordinated service and support
413.7plan. For purposes of this section, "private agency" means any agency that is not identified
413.8as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
413.9(d) For persons who need a positive support transition plan as required in chapter
413.10245D, the case manager shall participate in the development and ongoing evaluation
413.11of the plan with the expanded support team. At least quarterly, the case manager, in
413.12consultation with the expanded support team, shall evaluate the effectiveness of the plan
413.13based on progress evaluation data submitted by the licensed provider to the case manager.
413.14The evaluation must identify whether the plan has been developed and implemented in a
413.15manner to achieve the following within the required timelines:
413.16(1) phasing out the use of prohibited procedures;
413.17(2) acquisition of skills needed to eliminate the prohibited procedures within the
413.18plan's timeline; and
413.19(3) accomplishment of identified outcomes.
413.20If adequate progress is not being made, the case manager shall consult with the person's
413.21expanded support team to identify needed modifications and whether additional
413.22professional support is required to provide consultation.
413.23EFFECTIVE DATE.This section is effective January 1, 2014.

413.24    Sec. 52. Minnesota Statutes 2012, section 256B.4912, subdivision 1, is amended to read:
413.25    Subdivision 1. Provider qualifications. (a) For the home and community-based
413.26waivers providing services to seniors and individuals with disabilities under sections
413.27256B.0913, 256B.0915, 256B.092, and 256B.49, the commissioner shall establish:
413.28(1) agreements with enrolled waiver service providers to ensure providers meet
413.29Minnesota health care program requirements;
413.30(2) regular reviews of provider qualifications, and including requests of proof of
413.31documentation; and
413.32(3) processes to gather the necessary information to determine provider qualifications.
413.33    (b) Beginning July 1, 2012, staff that provide direct contact, as defined in section
413.34245C.02, subdivision 11 , for services specified in the federally approved waiver plans
414.1must meet the requirements of chapter 245C prior to providing waiver services and as
414.2part of ongoing enrollment. Upon federal approval, this requirement must also apply to
414.3consumer-directed community supports.
414.4    (c) Beginning January 1, 2014, service owners and managerial officials overseeing
414.5the management or policies of services that provide direct contact as specified in the
414.6federally approved waiver plans must meet the requirements of chapter 245C prior to
414.7reenrollment or, for new providers, prior to initial enrollment if they have not already done
414.8so as a part of service licensure requirements.

414.9    Sec. 53. Minnesota Statutes 2012, section 256B.4912, subdivision 7, is amended to read:
414.10    Subd. 7. Applicant and license holder training. An applicant or license holder
414.11for the home and community-based waivers providing services to seniors and individuals
414.12with disabilities under sections 256B.0913, 256B.0915, 256B.092, and 256B.49 that is
414.13not enrolled as a Minnesota health care program home and community-based services
414.14waiver provider at the time of application must ensure that at least one controlling
414.15individual completes a onetime training on the requirements for providing home and
414.16community-based services from a qualified source as determined by the commissioner,
414.17before a provider is enrolled or license is issued. Within six months of enrollment, a
414.18newly enrolled home and community-based waiver service provider must ensure that at
414.19least one controlling individual has completed training on waiver and related program
414.20billing. Exemptions to new waiver provider training requirements may be granted, as
414.21determined by the commissioner.

414.22    Sec. 54. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
414.23subdivision to read:
414.24    Subd. 8. Data on use of emergency use of manual restraint. Beginning July 1,
414.252013, facilities and services to be licensed under chapter 245D shall submit data regarding
414.26the use of emergency use of manual restraint as identified in section 245D.061 in a format
414.27and at a frequency identified by the commissioner.

414.28    Sec. 55. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
414.29subdivision to read:
414.30    Subd. 9. Definitions. (a) For the purposes of this section, the following terms
414.31have the meanings given them.
415.1(b) "Controlling individual" means a public body, governmental agency, business
415.2entity, officer, owner, or managerial official whose responsibilities include the direction of
415.3the management or policies of a program.
415.4(c) "Managerial official" means an individual who has decision-making authority
415.5related to the operation of the program and responsibility for the ongoing management of
415.6or direction of the policies, services, or employees of the program.
415.7(d) "Owner" means an individual who has direct or indirect ownership interest in
415.8a corporation or partnership, or business association enrolling with the Department of
415.9Human Services as a provider of waiver services.

415.10    Sec. 56. Minnesota Statutes 2012, section 256B.4912, is amended by adding a
415.11subdivision to read:
415.12    Subd. 10. Enrollment requirements. All home and community-based waiver
415.13providers must provide, at the time of enrollment and within 30 days of a request, in a
415.14format determined by the commissioner, information and documentation that includes, but
415.15is not limited to, the following:
415.16(1) proof of surety bond coverage in the amount of $50,000 or ten percent of the
415.17provider's payments from Medicaid in the previous calendar year, whichever is greater;
415.18(2) proof of fidelity bond coverage in the amount of $20,000; and
415.19(3) proof of liability insurance.

415.20    Sec. 57. Minnesota Statutes 2012, section 626.557, subdivision 9a, is amended to read:
415.21    Subd. 9a. Evaluation and referral of reports made to common entry point unit.
415.22    The common entry point must screen the reports of alleged or suspected maltreatment for
415.23immediate risk and make all necessary referrals as follows:
415.24    (1) if the common entry point determines that there is an immediate need for
415.25adult protective services, the common entry point agency shall immediately notify the
415.26appropriate county agency;
415.27    (2) if the report contains suspected criminal activity against a vulnerable adult, the
415.28common entry point shall immediately notify the appropriate law enforcement agency;
415.29    (3) the common entry point shall refer all reports of alleged or suspected
415.30maltreatment to the appropriate lead investigative agency as soon as possible, but in any
415.31event no longer than two working days; and
415.32    (4) if the report involves services licensed by the Department of Human Services
415.33and subject to chapter 245D, the common entry point shall refer the report to the county as
416.1the lead agency according to clause (3), but shall also notify the Department of Human
416.2Services of the report; and
416.3    (5) (4) if the report contains information about a suspicious death, the common
416.4entry point shall immediately notify the appropriate law enforcement agencies, the local
416.5medical examiner, and the ombudsman for mental health and developmental disabilities
416.6established under section 245.92. Law enforcement agencies shall coordinate with the
416.7local medical examiner and the ombudsman as provided by law.

416.8    Sec. 58. Minnesota Statutes 2012, section 626.5572, subdivision 13, is amended to read:
416.9    Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary
416.10administrative agency responsible for investigating reports made under section 626.557.
416.11(a) The Department of Health is the lead investigative agency for facilities or
416.12services licensed or required to be licensed as hospitals, home care providers, nursing
416.13homes, boarding care homes, hospice providers, residential facilities that are also federally
416.14certified as intermediate care facilities that serve people with developmental disabilities,
416.15or any other facility or service not listed in this subdivision that is licensed or required to
416.16be licensed by the Department of Health for the care of vulnerable adults. "Home care
416.17provider" has the meaning provided in section 144A.43, subdivision 4, and applies when
416.18care or services are delivered in the vulnerable adult's home, whether a private home or a
416.19housing with services establishment registered under chapter 144D, including those that
416.20offer assisted living services under chapter 144G.
416.21(b) Except as provided under paragraph (c), for services licensed according to chapter
416.22245D, The Department of Human Services is the lead investigative agency for facilities or
416.23services licensed or required to be licensed as adult day care, adult foster care, community
416.24residential settings, programs for people with developmental disabilities, family adult day
416.25services, mental health programs, mental health clinics, chemical dependency programs,
416.26the Minnesota sex offender program, or any other facility or service not listed in this
416.27subdivision that is licensed or required to be licensed by the Department of Human Services.
416.28(c) The county social service agency or its designee is the lead investigative agency
416.29for all other reports, including, but not limited to, reports involving vulnerable adults
416.30receiving services from a personal care provider organization under section 256B.0659,
416.31or receiving home and community-based services licensed by the Department of Human
416.32Services and subject to chapter 245D.

416.33    Sec. 59. REPORT ON TRANSFER OF VULNERABLE ADULT
416.34MALTREATMENT INVESTIGATION DUTIES.
417.1(a) The commissioner of human services shall provide a follow-up report on the
417.2collection of fees and actual licensing and maltreatment investigation costs resulting from
417.3the reform of the standards and oversight for home and community-based services as
417.4adopted and funded by the 2013 legislature.
417.5(b) The report must identify actual fees collected based on provider revenue,
417.6distinguish the amount of fees collected based on non-medical assistance revenue, and
417.7determine the impact of the non-medical assistance revenue on future licensing fees.
417.8(c) The report must recommend how maltreatment investigations, when conducted
417.9by the commissioner of human services, should be funded and at what amount. The
417.10recommendation must identify whether maltreatment investigation costs should be
417.11recovered through licensure fees, an appropriation from the general fund, provider
417.12fines for substantiated maltreatment, licensing fee surcharges related to substantiated
417.13maltreatment, or a combination of these sources.
417.14(d) The report must contain a cost comparison between similar maltreatment
417.15investigations completed by the Minnesota Department of Health and the Department of
417.16Human Services, and describe the method of funding for the investigations conducted by
417.17the Department of Health.
417.18(e) The report must make recommendations for changes that the commissioner
417.19determines are appropriate to reduce the costs of maltreatment investigations.
417.20(f) The commissioner must submit the report with draft legislation proposing
417.21alternative fees, if necessary, to the chairs and ranking minority members of the legislative
417.22committees with jurisdiction over health and human services policy and finance by July
417.231, 2015.

417.24    Sec. 60. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
417.25AND COMMUNITY-BASED SERVICES.
417.26(a) The Department of Health Compliance Monitoring Division and the Department
417.27of Human Services Licensing Division shall jointly develop an integrated licensing system
417.28for providers of both home care services subject to licensure under Minnesota Statutes,
417.29chapter 144A, and for home and community-based services subject to licensure under
417.30Minnesota Statutes, chapter 245D. The integrated licensing system shall:
417.31(1) require only one license of any provider of services under Minnesota Statutes,
417.32sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
417.33(2) promote quality services that recognize a person's individual needs and protect
417.34the person's health, safety, rights, and well-being;
418.1(3) promote provider accountability through application requirements, compliance
418.2inspections, investigations, and enforcement actions;
418.3(4) reference other applicable requirements in existing state and federal laws,
418.4including the federal Affordable Care Act;
418.5(5) establish internal procedures to facilitate ongoing communications between the
418.6agencies and with providers and services recipients about the regulatory activities;
418.7(6) create a link between the agency Web sites so that providers and the public can
418.8access the same information regardless of which Web site is accessed initially; and
418.9(7) collect data on identified outcome measures as necessary for the agencies to
418.10report to the Centers for Medicare and Medicaid Services.
418.11(b) The joint recommendations for legislative changes to implement the integrated
418.12licensing system are due to the legislature by February 15, 2014.
418.13(c) Before implementation of the integrated licensing system, providers licensed as
418.14home care providers under Minnesota Statutes, chapter 144A, may also provide home
418.15and community-based services subject to licensure under Minnesota Statutes, chapter
418.16245D, without obtaining a home and community-based services license under Minnesota
418.17Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
418.18apply to these providers:
418.19(1) the provider must comply with all requirements under Minnesota Statutes, chapter
418.20245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
418.21(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
418.22enforced by the Department of Health under the enforcement authority set forth in
418.23Minnesota Statutes, section 144A.475; and
418.24(3) the Department of Health will provide information to the Department of Human
418.25Services about each provider licensed under this section, including the provider's license
418.26application, licensing documents, inspections, information about complaints received, and
418.27investigations conducted for possible violations of Minnesota Statutes, chapter 245D.

418.28    Sec. 61. REPEALER.
418.29(a) Minnesota Statutes 2012, sections 245B.01; 245B.02; 245B.03; 245B.031;
418.30245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, and 7; 245B.055; 245B.06; 245B.07; and
418.31245B.08, are repealed effective January 1, 2014.
418.32(b) Minnesota Statutes 2012, section 245D.08, is repealed.


419.3    Section 1. Minnesota Statutes 2012, section 16C.10, subdivision 5, is amended to read:
419.4    Subd. 5. Specific purchases. The solicitation process described in this chapter is
419.5not required for acquisition of the following:
419.6(1) merchandise for resale purchased under policies determined by the commissioner;
419.7(2) farm and garden products which, as determined by the commissioner, may be
419.8purchased at the prevailing market price on the date of sale;
419.9(3) goods and services from the Minnesota correctional facilities;
419.10(4) goods and services from rehabilitation facilities and extended employment
419.11providers that are certified by the commissioner of employment and economic
419.12development, and day training and habilitation services licensed under sections 245B.01
419.13to 245B.08 chapter 245D;
419.14(5) goods and services for use by a community-based facility operated by the
419.15commissioner of human services;
419.16(6) goods purchased at auction or when submitting a sealed bid at auction provided
419.17that before authorizing such an action, the commissioner consult with the requesting
419.18agency to determine a fair and reasonable value for the goods considering factors
419.19including, but not limited to, costs associated with submitting a bid, travel, transportation,
419.20and storage. This fair and reasonable value must represent the limit of the state's bid;
419.21(7) utility services where no competition exists or where rates are fixed by law or
419.22ordinance; and
419.23(8) goods and services from Minnesota sex offender program facilities.
419.24EFFECTIVE DATE.This section is effective January 1, 2014.

419.25    Sec. 2. Minnesota Statutes 2012, section 16C.155, subdivision 1, is amended to read:
419.26    Subdivision 1. Service contracts. The commissioner of administration shall
419.27ensure that a portion of all contracts for janitorial services; document imaging;
419.28document shredding; and mailing, collating, and sorting services be awarded by the
419.29state to rehabilitation programs and extended employment providers that are certified
419.30by the commissioner of employment and economic development, and day training and
419.31habilitation services licensed under sections 245B.01 to 245B.08 chapter 245D. The
419.32amount of each contract awarded under this section may exceed the estimated fair market
419.33price as determined by the commissioner for the same goods and services by up to six
419.34percent. The aggregate value of the contracts awarded to eligible providers under this
420.1section in any given year must exceed 19 percent of the total value of all contracts for
420.2janitorial services; document imaging; document shredding; and mailing, collating, and
420.3sorting services entered into in the same year. For the 19 percent requirement to be
420.4applicable in any given year, the contract amounts proposed by eligible providers must be
420.5within six percent of the estimated fair market price for at least 19 percent of the contracts
420.6awarded for the corresponding service area.
420.7EFFECTIVE DATE.This section is effective January 1, 2014.

420.8    Sec. 3. Minnesota Statutes 2012, section 144D.01, subdivision 4, is amended to read:
420.9    Subd. 4. Housing with services establishment or establishment. (a) "Housing
420.10with services establishment" or "establishment" means:
420.11(1) an establishment providing sleeping accommodations to one or more adult
420.12residents, at least 80 percent of which are 55 years of age or older, and offering or
420.13providing, for a fee, one or more regularly scheduled health-related services or two or
420.14more regularly scheduled supportive services, whether offered or provided directly by the
420.15establishment or by another entity arranged for by the establishment; or
420.16(2) an establishment that registers under section 144D.025.
420.17(b) Housing with services establishment does not include:
420.18(1) a nursing home licensed under chapter 144A;
420.19(2) a hospital, certified boarding care home, or supervised living facility licensed
420.20under sections 144.50 to 144.56;
420.21(3) a board and lodging establishment licensed under chapter 157 and Minnesota
420.22Rules, parts 9520.0500 to 9520.0670, 9525.0215 to 9525.0355, 9525.0500 to 9525.0660,
420.23or 9530.4100 to 9530.4450, or under chapter 245B 245D;
420.24(4) a board and lodging establishment which serves as a shelter for battered women
420.25or other similar purpose;
420.26(5) a family adult foster care home licensed by the Department of Human Services;
420.27(6) private homes in which the residents are related by kinship, law, or affinity with
420.28the providers of services;
420.29(7) residential settings for persons with developmental disabilities in which the
420.30services are licensed under Minnesota Rules, parts 9525.2100 to 9525.2140, or applicable
420.31successor rules or laws;
420.32(8) a home-sharing arrangement such as when an elderly or disabled person or
420.33single-parent family makes lodging in a private residence available to another person
420.34in exchange for services or rent, or both;
421.1(9) a duly organized condominium, cooperative, common interest community, or
421.2owners' association of the foregoing where at least 80 percent of the units that comprise the
421.3condominium, cooperative, or common interest community are occupied by individuals
421.4who are the owners, members, or shareholders of the units; or
421.5(10) services for persons with developmental disabilities that are provided under
421.6a license according to Minnesota Rules, parts 9525.2000 to 9525.2140 in effect until
421.7January 1, 1998, or under chapter 245B 245D.
421.8EFFECTIVE DATE.This section is effective January 1, 2014.

421.9    Sec. 4. Minnesota Statutes 2012, section 174.30, subdivision 1, is amended to read:
421.10    Subdivision 1. Applicability. (a) The operating standards for special transportation
421.11service adopted under this section do not apply to special transportation provided by:
421.12(1) a common carrier operating on fixed routes and schedules;
421.13(2) a volunteer driver using a private automobile;
421.14(3) a school bus as defined in section 169.011, subdivision 71; or
421.15(4) an emergency ambulance regulated under chapter 144.
421.16(b) The operating standards adopted under this section only apply to providers
421.17of special transportation service who receive grants or other financial assistance from
421.18either the state or the federal government, or both, to provide or assist in providing that
421.19service; except that the operating standards adopted under this section do not apply
421.20to any nursing home licensed under section 144A.02, to any board and care facility
421.21licensed under section 144.50, or to any day training and habilitation services, day care,
421.22or group home facility licensed under sections 245A.01 to 245A.19 unless the facility or
421.23program provides transportation to nonresidents on a regular basis and the facility receives
421.24reimbursement, other than per diem payments, for that service under rules promulgated
421.25by the commissioner of human services.
421.26(c) Notwithstanding paragraph (b), the operating standards adopted under this
421.27section do not apply to any vendor of services licensed under chapter 245B 245D that
421.28provides transportation services to consumers or residents of other vendors licensed under
421.29chapter 245B 245D and transports 15 or fewer persons, including consumers or residents
421.30and the driver.
421.31EFFECTIVE DATE.This section is effective January 1, 2014.

421.32    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 1, is amended to read:
422.1    Subdivision 1. Scope. The terms used in this chapter and chapter 245B have the
422.2meanings given them in this section.
422.3EFFECTIVE DATE.This section is effective January 1, 2014.

422.4    Sec. 6. Minnesota Statutes 2012, section 245A.02, subdivision 9, is amended to read:
422.5    Subd. 9. License holder. "License holder" means an individual, corporation,
422.6partnership, voluntary association, or other organization that is legally responsible for the
422.7operation of the program, has been granted a license by the commissioner under this chapter
422.8or chapter 245B 245D and the rules of the commissioner, and is a controlling individual.
422.9EFFECTIVE DATE.This section is effective January 1, 2014.

422.10    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 9, is amended to read:
422.11    Subd. 9. Permitted services by an individual who is related. Notwithstanding
422.12subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
422.13person receiving supported living services may provide licensed services to that person if:
422.14(1) the person who receives supported living services received these services in a
422.15residential site on July 1, 2005;
422.16(2) the services under clause (1) were provided in a corporate foster care setting for
422.17adults and were funded by the developmental disabilities home and community-based
422.18services waiver defined in section 256B.092;
422.19(3) the individual who is related obtains and maintains both a license under chapter
422.20245B 245D and an adult foster care license under Minnesota Rules, parts 9555.5105
422.21to 9555.6265; and
422.22(4) the individual who is related is not the guardian of the person receiving supported
422.23living services.
422.24EFFECTIVE DATE.This section is effective January 1, 2014.

422.25    Sec. 8. Minnesota Statutes 2012, section 245A.04, subdivision 13, is amended to read:
422.26    Subd. 13. Funds and property; other requirements. (a) A license holder must
422.27ensure that persons served by the program retain the use and availability of personal funds
422.28or property unless restrictions are justified in the person's individual plan. This subdivision
422.29does not apply to programs governed by the provisions in section 245B.07, subdivision 10.
422.30(b) The license holder must ensure separation of funds of persons served by the
422.31program from funds of the license holder, the program, or program staff.
423.1(c) Whenever the license holder assists a person served by the program with the
423.2safekeeping of funds or other property, the license holder must:
423.3(1) immediately document receipt and disbursement of the person's funds or other
423.4property at the time of receipt or disbursement, including the person's signature, or the
423.5signature of the conservator or payee; and
423.6(2) return to the person upon the person's request, funds and property in the license
423.7holder's possession subject to restrictions in the person's treatment plan, as soon as
423.8possible, but no later than three working days after the date of request.
423.9(d) License holders and program staff must not:
423.10(1) borrow money from a person served by the program;
423.11(2) purchase personal items from a person served by the program;
423.12(3) sell merchandise or personal services to a person served by the program;
423.13(4) require a person served by the program to purchase items for which the license
423.14holder is eligible for reimbursement; or
423.15(5) use funds of persons served by the program to purchase items for which the
423.16facility is already receiving public or private payments.
423.17EFFECTIVE DATE.This section is effective January 1, 2014.

423.18    Sec. 9. Minnesota Statutes 2012, section 245A.07, subdivision 3, is amended to read:
423.19    Subd. 3. License suspension, revocation, or fine. (a) The commissioner may
423.20suspend or revoke a license, or impose a fine if:
423.21(1) a license holder fails to comply fully with applicable laws or rules;
423.22(2) a license holder, a controlling individual, or an individual living in the household
423.23where the licensed services are provided or is otherwise subject to a background study has
423.24a disqualification which has not been set aside under section 245C.22;
423.25(3) a license holder knowingly withholds relevant information from or gives false
423.26or misleading information to the commissioner in connection with an application for
423.27a license, in connection with the background study status of an individual, during an
423.28investigation, or regarding compliance with applicable laws or rules; or
423.29(4) after July 1, 2012, and upon request by the commissioner, a license holder fails
423.30to submit the information required of an applicant under section 245A.04, subdivision 1,
423.31paragraph (f) or (g).
423.32A license holder who has had a license suspended, revoked, or has been ordered
423.33to pay a fine must be given notice of the action by certified mail or personal service. If
423.34mailed, the notice must be mailed to the address shown on the application or the last
424.1known address of the license holder. The notice must state the reasons the license was
424.2suspended, revoked, or a fine was ordered.
424.3    (b) If the license was suspended or revoked, the notice must inform the license
424.4holder of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
424.51400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
424.6a license. The appeal of an order suspending or revoking a license must be made in writing
424.7by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
424.8the commissioner within ten calendar days after the license holder receives notice that the
424.9license has been suspended or revoked. If a request is made by personal service, it must be
424.10received by the commissioner within ten calendar days after the license holder received
424.11the order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits
424.12a timely appeal of an order suspending or revoking a license, the license holder may
424.13continue to operate the program as provided in section 245A.04, subdivision 7, paragraphs
424.14(g) and (h), until the commissioner issues a final order on the suspension or revocation.
424.15    (c)(1) If the license holder was ordered to pay a fine, the notice must inform the
424.16license holder of the responsibility for payment of fines and the right to a contested case
424.17hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal
424.18of an order to pay a fine must be made in writing by certified mail or personal service. If
424.19mailed, the appeal must be postmarked and sent to the commissioner within ten calendar
424.20days after the license holder receives notice that the fine has been ordered. If a request is
424.21made by personal service, it must be received by the commissioner within ten calendar
424.22days after the license holder received the order.
424.23    (2) The license holder shall pay the fines assessed on or before the payment date
424.24specified. If the license holder fails to fully comply with the order, the commissioner
424.25may issue a second fine or suspend the license until the license holder complies. If the
424.26license holder receives state funds, the state, county, or municipal agencies or departments
424.27responsible for administering the funds shall withhold payments and recover any payments
424.28made while the license is suspended for failure to pay a fine. A timely appeal shall stay
424.29payment of the fine until the commissioner issues a final order.
424.30    (3) A license holder shall promptly notify the commissioner of human services,
424.31in writing, when a violation specified in the order to forfeit a fine is corrected. If upon
424.32reinspection the commissioner determines that a violation has not been corrected as
424.33indicated by the order to forfeit a fine, the commissioner may issue a second fine. The
424.34commissioner shall notify the license holder by certified mail or personal service that a
424.35second fine has been assessed. The license holder may appeal the second fine as provided
424.36under this subdivision.
425.1    (4) Fines shall be assessed as follows: the license holder shall forfeit $1,000 for
425.2each determination of maltreatment of a child under section 626.556 or the maltreatment
425.3of a vulnerable adult under section 626.557 for which the license holder is determined
425.4responsible for the maltreatment under section 626.556, subdivision 10e, paragraph (i),
425.5or 626.557, subdivision 9c, paragraph (c); the license holder shall forfeit $200 for each
425.6occurrence of a violation of law or rule governing matters of health, safety, or supervision,
425.7including but not limited to the provision of adequate staff-to-child or adult ratios, and
425.8failure to comply with background study requirements under chapter 245C; and the license
425.9holder shall forfeit $100 for each occurrence of a violation of law or rule other than
425.10those subject to a $1,000 or $200 fine above. For purposes of this section, "occurrence"
425.11means each violation identified in the commissioner's fine order. Fines assessed against a
425.12license holder that holds a license to provide the residential-based habilitation home and
425.13community-based services, as defined under identified in section 245B.02, subdivision
425.1420 245D.03, subdivision 1, and a community residential setting or day services facility
425.15license to provide foster care under chapter 245D where the services are provided, may be
425.16assessed against both licenses for the same occurrence, but the combined amount of the
425.17fines shall not exceed the amount specified in this clause for that occurrence.
425.18    (5) When a fine has been assessed, the license holder may not avoid payment by
425.19closing, selling, or otherwise transferring the licensed program to a third party. In such an
425.20event, the license holder will be personally liable for payment. In the case of a corporation,
425.21each controlling individual is personally and jointly liable for payment.
425.22(d) Except for background study violations involving the failure to comply with an
425.23order to immediately remove an individual or an order to provide continuous, direct
425.24supervision, the commissioner shall not issue a fine under paragraph (c) relating to a
425.25background study violation to a license holder who self-corrects a background study
425.26violation before the commissioner discovers the violation. A license holder who has
425.27previously exercised the provisions of this paragraph to avoid a fine for a background
425.28study violation may not avoid a fine for a subsequent background study violation unless at
425.29least 365 days have passed since the license holder self-corrected the earlier background
425.30study violation.
425.31EFFECTIVE DATE.This section is effective January 1, 2014.

425.32    Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 19c, is amended to
425.33read:
425.34    Subd. 19c. Personal care. Medical assistance covers personal care assistance
425.35services provided by an individual who is qualified to provide the services according to
426.1subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
426.2plan, and supervised by a qualified professional.
426.3"Qualified professional" means a mental health professional as defined in section
426.4245.462, subdivision 18 , clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6);
426.5or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker
426.6as defined in sections 148E.010 and 148E.055, or a qualified developmental disabilities
426.7specialist under section 245B.07, subdivision 4 designated coordinator under section
426.8245D.081, subdivision 2. The qualified professional shall perform the duties required in
426.9section 256B.0659.
426.10EFFECTIVE DATE.This section is effective January 1, 2014.

426.11    Sec. 11. Minnesota Statutes 2012, section 256B.5011, subdivision 2, is amended to read:
426.12    Subd. 2. Contract provisions. (a) The service contract with each intermediate
426.13care facility must include provisions for:
426.14(1) modifying payments when significant changes occur in the needs of the
426.15consumers;
426.16(2) appropriate and necessary statistical information required by the commissioner;
426.17(3) annual aggregate facility financial information; and
426.18(4) additional requirements for intermediate care facilities not meeting the standards
426.19set forth in the service contract.
426.20(b) The commissioner of human services and the commissioner of health, in
426.21consultation with representatives from counties, advocacy organizations, and the provider
426.22community, shall review the consolidated standards under chapter 245B and the home and
426.23community-based services standards under chapter 245D and the supervised living facility
426.24rule under Minnesota Rules, chapter 4665, to determine what provisions in Minnesota
426.25Rules, chapter 4665, may be waived by the commissioner of health for intermediate care
426.26facilities in order to enable facilities to implement the performance measures in their
426.27contract and provide quality services to residents without a duplication of or increase in
426.28regulatory requirements.
426.29EFFECTIVE DATE.This section is effective January 1, 2014.

426.30    Sec. 12. Minnesota Statutes 2012, section 471.59, subdivision 1, is amended to read:
426.31    Subdivision 1. Agreement. Two or more governmental units, by agreement entered
426.32into through action of their governing bodies, may jointly or cooperatively exercise
426.33any power common to the contracting parties or any similar powers, including those
427.1which are the same except for the territorial limits within which they may be exercised.
427.2The agreement may provide for the exercise of such powers by one or more of the
427.3participating governmental units on behalf of the other participating units. The term
427.4"governmental unit" as used in this section includes every city, county, town, school
427.5district, independent nonprofit firefighting corporation, other political subdivision of
427.6this or another state, another state, federally recognized Indian tribe, the University
427.7of Minnesota, the Minnesota Historical Society, nonprofit hospitals licensed under
427.8sections 144.50 to 144.56, rehabilitation facilities and extended employment providers
427.9that are certified by the commissioner of employment and economic development, day
427.10training and habilitation services licensed under sections 245B.01 to 245B.08, day and
427.11supported employment services licensed under chapter 245D, and any agency of the state
427.12of Minnesota or the United States, and includes any instrumentality of a governmental
427.13unit. For the purpose of this section, an instrumentality of a governmental unit means an
427.14instrumentality having independent policy-making and appropriating authority.
427.15EFFECTIVE DATE.This section is effective January 1, 2014.

427.16    Sec. 13. Minnesota Statutes 2012, section 626.556, subdivision 2, is amended to read:
427.17    Subd. 2. Definitions. As used in this section, the following terms have the meanings
427.18given them unless the specific content indicates otherwise:
427.19    (a) "Family assessment" means a comprehensive assessment of child safety, risk
427.20of subsequent child maltreatment, and family strengths and needs that is applied to a
427.21child maltreatment report that does not allege substantial child endangerment. Family
427.22assessment does not include a determination as to whether child maltreatment occurred
427.23but does determine the need for services to address the safety of family members and the
427.24risk of subsequent maltreatment.
427.25    (b) "Investigation" means fact gathering related to the current safety of a child
427.26and the risk of subsequent maltreatment that determines whether child maltreatment
427.27occurred and whether child protective services are needed. An investigation must be used
427.28when reports involve substantial child endangerment, and for reports of maltreatment in
427.29facilities required to be licensed under chapter 245A or 245B; under sections 144.50 to
427.30144.58 and 241.021; in a school as defined in sections 120A.05, subdivisions 9, 11, and
427.3113, and 124D.10; or in a nonlicensed personal care provider association as defined in
427.32sections 256B.04, subdivision 16, and 256B.0625, subdivision 19a.
427.33    (c) "Substantial child endangerment" means a person responsible for a child's care,
427.34and in the case of sexual abuse includes a person who has a significant relationship to the
427.35child as defined in section 609.341, or a person in a position of authority as defined in
428.1section 609.341, who by act or omission commits or attempts to commit an act against a
428.2child under their care that constitutes any of the following:
428.3    (1) egregious harm as defined in section 260C.007, subdivision 14;
428.4    (2) sexual abuse as defined in paragraph (d);
428.5    (3) abandonment under section 260C.301, subdivision 2;
428.6    (4) neglect as defined in paragraph (f), clause (2), that substantially endangers the
428.7child's physical or mental health, including a growth delay, which may be referred to as
428.8failure to thrive, that has been diagnosed by a physician and is due to parental neglect;
428.9    (5) murder in the first, second, or third degree under section 609.185, 609.19, or
428.10609.195 ;
428.11    (6) manslaughter in the first or second degree under section 609.20 or 609.205;
428.12    (7) assault in the first, second, or third degree under section 609.221, 609.222, or
428.13609.223 ;
428.14    (8) solicitation, inducement, and promotion of prostitution under section 609.322;
428.15    (9) criminal sexual conduct under sections 609.342 to 609.3451;
428.16    (10) solicitation of children to engage in sexual conduct under section 609.352;
428.17    (11) malicious punishment or neglect or endangerment of a child under section
428.18609.377 or 609.378;
428.19    (12) use of a minor in sexual performance under section 617.246; or
428.20    (13) parental behavior, status, or condition which mandates that the county attorney
428.21file a termination of parental rights petition under section 260C.301, subdivision 3,
428.22paragraph (a).
428.23    (d) "Sexual abuse" means the subjection of a child by a person responsible for the
428.24child's care, by a person who has a significant relationship to the child, as defined in
428.25section 609.341, or by a person in a position of authority, as defined in section 609.341,
428.26subdivision 10, to any act which constitutes a violation of section 609.342 (criminal sexual
428.27conduct in the first degree), 609.343 (criminal sexual conduct in the second degree),
428.28609.344 (criminal sexual conduct in the third degree), 609.345 (criminal sexual conduct
428.29in the fourth degree), or 609.3451 (criminal sexual conduct in the fifth degree). Sexual
428.30abuse also includes any act which involves a minor which constitutes a violation of
428.31prostitution offenses under sections 609.321 to 609.324 or 617.246. Sexual abuse includes
428.32threatened sexual abuse which includes the status of a parent or household member
428.33who has committed a violation which requires registration as an offender under section
428.34243.166, subdivision 1b, paragraph (a) or (b), or required registration under section
428.35243.166, subdivision 1b, paragraph (a) or (b).
429.1    (e) "Person responsible for the child's care" means (1) an individual functioning
429.2within the family unit and having responsibilities for the care of the child such as a
429.3parent, guardian, or other person having similar care responsibilities, or (2) an individual
429.4functioning outside the family unit and having responsibilities for the care of the child
429.5such as a teacher, school administrator, other school employees or agents, or other lawful
429.6custodian of a child having either full-time or short-term care responsibilities including,
429.7but not limited to, day care, babysitting whether paid or unpaid, counseling, teaching,
429.8and coaching.
429.9    (f) "Neglect" means the commission or omission of any of the acts specified under
429.10clauses (1) to (9), other than by accidental means:
429.11    (1) failure by a person responsible for a child's care to supply a child with necessary
429.12food, clothing, shelter, health, medical, or other care required for the child's physical or
429.13mental health when reasonably able to do so;
429.14    (2) failure to protect a child from conditions or actions that seriously endanger the
429.15child's physical or mental health when reasonably able to do so, including a growth delay,
429.16which may be referred to as a failure to thrive, that has been diagnosed by a physician and
429.17is due to parental neglect;
429.18    (3) failure to provide for necessary supervision or child care arrangements
429.19appropriate for a child after considering factors as the child's age, mental ability, physical
429.20condition, length of absence, or environment, when the child is unable to care for the
429.21child's own basic needs or safety, or the basic needs or safety of another child in their care;
429.22    (4) failure to ensure that the child is educated as defined in sections 120A.22 and
429.23260C.163, subdivision 11 , which does not include a parent's refusal to provide the parent's
429.24child with sympathomimetic medications, consistent with section 125A.091, subdivision 5;
429.25    (5) nothing in this section shall be construed to mean that a child is neglected solely
429.26because the child's parent, guardian, or other person responsible for the child's care in
429.27good faith selects and depends upon spiritual means or prayer for treatment or care of
429.28disease or remedial care of the child in lieu of medical care; except that a parent, guardian,
429.29or caretaker, or a person mandated to report pursuant to subdivision 3, has a duty to report
429.30if a lack of medical care may cause serious danger to the child's health. This section does
429.31not impose upon persons, not otherwise legally responsible for providing a child with
429.32necessary food, clothing, shelter, education, or medical care, a duty to provide that care;
429.33    (6) prenatal exposure to a controlled substance, as defined in section 253B.02,
429.34subdivision 2, used by the mother for a nonmedical purpose, as evidenced by withdrawal
429.35symptoms in the child at birth, results of a toxicology test performed on the mother at
429.36delivery or the child at birth, medical effects or developmental delays during the child's
430.1first year of life that medically indicate prenatal exposure to a controlled substance, or the
430.2presence of a fetal alcohol spectrum disorder;
430.3    (7) "medical neglect" as defined in section 260C.007, subdivision 6, clause (5);
430.4    (8) chronic and severe use of alcohol or a controlled substance by a parent or
430.5person responsible for the care of the child that adversely affects the child's basic needs
430.6and safety; or
430.7    (9) emotional harm from a pattern of behavior which contributes to impaired
430.8emotional functioning of the child which may be demonstrated by a substantial and
430.9observable effect in the child's behavior, emotional response, or cognition that is not
430.10within the normal range for the child's age and stage of development, with due regard to
430.11the child's culture.
430.12    (g) "Physical abuse" means any physical injury, mental injury, or threatened injury,
430.13inflicted by a person responsible for the child's care on a child other than by accidental
430.14means, or any physical or mental injury that cannot reasonably be explained by the child's
430.15history of injuries, or any aversive or deprivation procedures, or regulated interventions,
430.16that have not been authorized under section 121A.67 or 245.825.
430.17    Abuse does not include reasonable and moderate physical discipline of a child
430.18administered by a parent or legal guardian which does not result in an injury. Abuse does
430.19not include the use of reasonable force by a teacher, principal, or school employee as
430.20allowed by section 121A.582. Actions which are not reasonable and moderate include,
430.21but are not limited to, any of the following that are done in anger or without regard to the
430.22safety of the child:
430.23    (1) throwing, kicking, burning, biting, or cutting a child;
430.24    (2) striking a child with a closed fist;
430.25    (3) shaking a child under age three;
430.26    (4) striking or other actions which result in any nonaccidental injury to a child
430.27under 18 months of age;
430.28    (5) unreasonable interference with a child's breathing;
430.29    (6) threatening a child with a weapon, as defined in section 609.02, subdivision 6;
430.30    (7) striking a child under age one on the face or head;
430.31    (8) purposely giving a child poison, alcohol, or dangerous, harmful, or controlled
430.32substances which were not prescribed for the child by a practitioner, in order to control or
430.33punish the child; or other substances that substantially affect the child's behavior, motor
430.34coordination, or judgment or that results in sickness or internal injury, or subjects the
430.35child to medical procedures that would be unnecessary if the child were not exposed
430.36to the substances;
431.1    (9) unreasonable physical confinement or restraint not permitted under section
431.2609.379 , including but not limited to tying, caging, or chaining; or
431.3    (10) in a school facility or school zone, an act by a person responsible for the child's
431.4care that is a violation under section 121A.58.
431.5    (h) "Report" means any report received by the local welfare agency, police
431.6department, county sheriff, or agency responsible for assessing or investigating
431.7maltreatment pursuant to this section.
431.8    (i) "Facility" means:
431.9    (1) a licensed or unlicensed day care facility, residential facility, agency, hospital,
431.10sanitarium, or other facility or institution required to be licensed under sections 144.50 to
431.11144.58 , 241.021, or 245A.01 to 245A.16, or chapter 245B 245D;
431.12    (2) a school as defined in sections 120A.05, subdivisions 9, 11, and 13; and
431.13124D.10 ; or
431.14    (3) a nonlicensed personal care provider organization as defined in sections 256B.04,
431.15subdivision 16, and 256B.0625, subdivision 19a.
431.16    (j) "Operator" means an operator or agency as defined in section 245A.02.
431.17    (k) "Commissioner" means the commissioner of human services.
431.18    (l) "Practice of social services," for the purposes of subdivision 3, includes but is
431.19not limited to employee assistance counseling and the provision of guardian ad litem and
431.20parenting time expeditor services.
431.21    (m) "Mental injury" means an injury to the psychological capacity or emotional
431.22stability of a child as evidenced by an observable or substantial impairment in the child's
431.23ability to function within a normal range of performance and behavior with due regard to
431.24the child's culture.
431.25    (n) "Threatened injury" means a statement, overt act, condition, or status that
431.26represents a substantial risk of physical or sexual abuse or mental injury. Threatened
431.27injury includes, but is not limited to, exposing a child to a person responsible for the
431.28child's care, as defined in paragraph (e), clause (1), who has:
431.29    (1) subjected a child to, or failed to protect a child from, an overt act or condition
431.30that constitutes egregious harm, as defined in section 260C.007, subdivision 14, or a
431.31similar law of another jurisdiction;
431.32    (2) been found to be palpably unfit under section 260C.301, paragraph (b), clause
431.33(4), or a similar law of another jurisdiction;
431.34    (3) committed an act that has resulted in an involuntary termination of parental rights
431.35under section 260C.301, or a similar law of another jurisdiction; or
432.1    (4) committed an act that has resulted in the involuntary transfer of permanent
432.2legal and physical custody of a child to a relative under Minnesota Statutes 2010, section
432.3260C.201, subdivision 11 , paragraph (d), clause (1), section 260C.515, subdivision 4, or a
432.4similar law of another jurisdiction.
432.5A child is the subject of a report of threatened injury when the responsible social
432.6services agency receives birth match data under paragraph (o) from the Department of
432.7Human Services.
432.8(o) Upon receiving data under section 144.225, subdivision 2b, contained in a
432.9birth record or recognition of parentage identifying a child who is subject to threatened
432.10injury under paragraph (n), the Department of Human Services shall send the data to the
432.11responsible social services agency. The data is known as "birth match" data. Unless the
432.12responsible social services agency has already begun an investigation or assessment of the
432.13report due to the birth of the child or execution of the recognition of parentage and the
432.14parent's previous history with child protection, the agency shall accept the birth match
432.15data as a report under this section. The agency may use either a family assessment or
432.16investigation to determine whether the child is safe. All of the provisions of this section
432.17apply. If the child is determined to be safe, the agency shall consult with the county
432.18attorney to determine the appropriateness of filing a petition alleging the child is in need
432.19of protection or services under section 260C.007, subdivision 6, clause (16), in order to
432.20deliver needed services. If the child is determined not to be safe, the agency and the county
432.21attorney shall take appropriate action as required under section 260C.301, subdivision 3.
432.22    (p) Persons who conduct assessments or investigations under this section shall take
432.23into account accepted child-rearing practices of the culture in which a child participates
432.24and accepted teacher discipline practices, which are not injurious to the child's health,
432.25welfare, and safety.
432.26    (q) "Accidental" means a sudden, not reasonably foreseeable, and unexpected
432.27occurrence or event which:
432.28    (1) is not likely to occur and could not have been prevented by exercise of due
432.29care; and
432.30    (2) if occurring while a child is receiving services from a facility, happens when the
432.31facility and the employee or person providing services in the facility are in compliance
432.32with the laws and rules relevant to the occurrence or event.
432.33(r) "Nonmaltreatment mistake" means:
432.34(1) at the time of the incident, the individual was performing duties identified in the
432.35center's child care program plan required under Minnesota Rules, part 9503.0045;
433.1(2) the individual has not been determined responsible for a similar incident that
433.2resulted in a finding of maltreatment for at least seven years;
433.3(3) the individual has not been determined to have committed a similar
433.4nonmaltreatment mistake under this paragraph for at least four years;
433.5(4) any injury to a child resulting from the incident, if treated, is treated only with
433.6remedies that are available over the counter, whether ordered by a medical professional or
433.7not; and
433.8(5) except for the period when the incident occurred, the facility and the individual
433.9providing services were both in compliance with all licensing requirements relevant to the
433.10incident.
433.11This definition only applies to child care centers licensed under Minnesota
433.12Rules, chapter 9503. If clauses (1) to (5) apply, rather than making a determination of
433.13substantiated maltreatment by the individual, the commissioner of human services shall
433.14determine that a nonmaltreatment mistake was made by the individual.
433.15EFFECTIVE DATE.This section is effective January 1, 2014.

433.16    Sec. 14. Minnesota Statutes 2012, section 626.556, subdivision 3, is amended to read:
433.17    Subd. 3. Persons mandated to report. (a) A person who knows or has reason
433.18to believe a child is being neglected or physically or sexually abused, as defined in
433.19subdivision 2, or has been neglected or physically or sexually abused within the preceding
433.20three years, shall immediately report the information to the local welfare agency, agency
433.21responsible for assessing or investigating the report, police department, or the county
433.22sheriff if the person is:
433.23    (1) a professional or professional's delegate who is engaged in the practice of
433.24the healing arts, social services, hospital administration, psychological or psychiatric
433.25treatment, child care, education, correctional supervision, probation and correctional
433.26services, or law enforcement; or
433.27    (2) employed as a member of the clergy and received the information while
433.28engaged in ministerial duties, provided that a member of the clergy is not required by
433.29this subdivision to report information that is otherwise privileged under section 595.02,
433.30subdivision 1 , paragraph (c).
433.31    The police department or the county sheriff, upon receiving a report, shall
433.32immediately notify the local welfare agency or agency responsible for assessing or
433.33investigating the report, orally and in writing. The local welfare agency, or agency
433.34responsible for assessing or investigating the report, upon receiving a report, shall
433.35immediately notify the local police department or the county sheriff orally and in writing.
434.1The county sheriff and the head of every local welfare agency, agency responsible
434.2for assessing or investigating reports, and police department shall each designate a
434.3person within their agency, department, or office who is responsible for ensuring that
434.4the notification duties of this paragraph and paragraph (b) are carried out. Nothing in
434.5this subdivision shall be construed to require more than one report from any institution,
434.6facility, school, or agency.
434.7    (b) Any person may voluntarily report to the local welfare agency, agency responsible
434.8for assessing or investigating the report, police department, or the county sheriff if the
434.9person knows, has reason to believe, or suspects a child is being or has been neglected or
434.10subjected to physical or sexual abuse. The police department or the county sheriff, upon
434.11receiving a report, shall immediately notify the local welfare agency or agency responsible
434.12for assessing or investigating the report, orally and in writing. The local welfare agency or
434.13agency responsible for assessing or investigating the report, upon receiving a report, shall
434.14immediately notify the local police department or the county sheriff orally and in writing.
434.15    (c) A person mandated to report physical or sexual child abuse or neglect occurring
434.16within a licensed facility shall report the information to the agency responsible for
434.17licensing the facility under sections 144.50 to 144.58; 241.021; 245A.01 to 245A.16; or
434.18chapter 245B 245D; or a nonlicensed personal care provider organization as defined in
434.19sections 256B.04, subdivision 16; and 256B.0625, subdivision 19. A health or corrections
434.20agency receiving a report may request the local welfare agency to provide assistance
434.21pursuant to subdivisions 10, 10a, and 10b. A board or other entity whose licensees
434.22perform work within a school facility, upon receiving a complaint of alleged maltreatment,
434.23shall provide information about the circumstances of the alleged maltreatment to the
434.24commissioner of education. Section 13.03, subdivision 4, applies to data received by the
434.25commissioner of education from a licensing entity.
434.26    (d) Any person mandated to report shall receive a summary of the disposition of
434.27any report made by that reporter, including whether the case has been opened for child
434.28protection or other services, or if a referral has been made to a community organization,
434.29unless release would be detrimental to the best interests of the child. Any person who is
434.30not mandated to report shall, upon request to the local welfare agency, receive a concise
434.31summary of the disposition of any report made by that reporter, unless release would be
434.32detrimental to the best interests of the child.
434.33    (e) For purposes of this section, "immediately" means as soon as possible but in
434.34no event longer than 24 hours.
434.35EFFECTIVE DATE.This section is effective January 1, 2014.

435.1    Sec. 15. Minnesota Statutes 2012, section 626.556, subdivision 10d, is amended to read:
435.2    Subd. 10d. Notification of neglect or abuse in facility. (a) When a report is
435.3received that alleges neglect, physical abuse, sexual abuse, or maltreatment of a child while
435.4in the care of a licensed or unlicensed day care facility, residential facility, agency, hospital,
435.5sanitarium, or other facility or institution required to be licensed according to sections
435.6144.50 to 144.58; 241.021; or 245A.01 to 245A.16; or chapter 245B 245D, or a school as
435.7defined in sections 120A.05, subdivisions 9, 11, and 13; and 124D.10; or a nonlicensed
435.8personal care provider organization as defined in section 256B.04, subdivision 16, and
435.9256B.0625, subdivision 19a , the commissioner of the agency responsible for assessing
435.10or investigating the report or local welfare agency investigating the report shall provide
435.11the following information to the parent, guardian, or legal custodian of a child alleged to
435.12have been neglected, physically abused, sexually abused, or the victim of maltreatment
435.13of a child in the facility: the name of the facility; the fact that a report alleging neglect,
435.14physical abuse, sexual abuse, or maltreatment of a child in the facility has been received;
435.15the nature of the alleged neglect, physical abuse, sexual abuse, or maltreatment of a child
435.16in the facility; that the agency is conducting an assessment or investigation; any protective
435.17or corrective measures being taken pending the outcome of the investigation; and that a
435.18written memorandum will be provided when the investigation is completed.
435.19(b) The commissioner of the agency responsible for assessing or investigating the
435.20report or local welfare agency may also provide the information in paragraph (a) to the
435.21parent, guardian, or legal custodian of any other child in the facility if the investigative
435.22agency knows or has reason to believe the alleged neglect, physical abuse, sexual
435.23abuse, or maltreatment of a child in the facility has occurred. In determining whether
435.24to exercise this authority, the commissioner of the agency responsible for assessing
435.25or investigating the report or local welfare agency shall consider the seriousness of the
435.26alleged neglect, physical abuse, sexual abuse, or maltreatment of a child in the facility; the
435.27number of children allegedly neglected, physically abused, sexually abused, or victims of
435.28maltreatment of a child in the facility; the number of alleged perpetrators; and the length
435.29of the investigation. The facility shall be notified whenever this discretion is exercised.
435.30(c) When the commissioner of the agency responsible for assessing or investigating
435.31the report or local welfare agency has completed its investigation, every parent, guardian,
435.32or legal custodian previously notified of the investigation by the commissioner or
435.33local welfare agency shall be provided with the following information in a written
435.34memorandum: the name of the facility investigated; the nature of the alleged neglect,
435.35physical abuse, sexual abuse, or maltreatment of a child in the facility; the investigator's
435.36name; a summary of the investigation findings; a statement whether maltreatment was
436.1found; and the protective or corrective measures that are being or will be taken. The
436.2memorandum shall be written in a manner that protects the identity of the reporter and
436.3the child and shall not contain the name, or to the extent possible, reveal the identity of
436.4the alleged perpetrator or of those interviewed during the investigation. If maltreatment
436.5is determined to exist, the commissioner or local welfare agency shall also provide the
436.6written memorandum to the parent, guardian, or legal custodian of each child in the facility
436.7who had contact with the individual responsible for the maltreatment. When the facility is
436.8the responsible party for maltreatment, the commissioner or local welfare agency shall also
436.9provide the written memorandum to the parent, guardian, or legal custodian of each child
436.10who received services in the population of the facility where the maltreatment occurred.
436.11This notification must be provided to the parent, guardian, or legal custodian of each child
436.12receiving services from the time the maltreatment occurred until either the individual
436.13responsible for maltreatment is no longer in contact with a child or children in the facility
436.14or the conclusion of the investigation. In the case of maltreatment within a school facility,
436.15as defined in sections 120A.05, subdivisions 9, 11, and 13, and 124D.10, the commissioner
436.16of education need not provide notification to parents, guardians, or legal custodians of
436.17each child in the facility, but shall, within ten days after the investigation is completed,
436.18provide written notification to the parent, guardian, or legal custodian of any student
436.19alleged to have been maltreated. The commissioner of education may notify the parent,
436.20guardian, or legal custodian of any student involved as a witness to alleged maltreatment.
436.21EFFECTIVE DATE.This section is effective January 1, 2014.

436.22    Sec. 16. REPEALER.
436.23Minnesota Statutes 2012, section 256B.49, subdivision 16a, is repealed effective
436.24January 1, 2014.


436.27    Section 1. Minnesota Statutes 2012, section 148B.17, subdivision 2, is amended to read:
436.28    Subd. 2. Licensure and application fees. Nonrefundable licensure and application
436.29fees charged established by the board are as follows shall not exceed the following amounts:
436.30(1) application fee for national examination is $220 $110;
436.31(2) application fee for Licensed Marriage and Family Therapist (LMFT) state
436.32examination is $110;
436.33(3) initial LMFT license fee is prorated, but cannot exceed $125;
437.1(4) annual renewal fee for LMFT license is $125;
437.2(5) late fee for initial Licensed Associate Marriage and Family Therapist LAMFT
437.3 LMFT license renewal is $50;
437.4(6) application fee for LMFT licensure by reciprocity is $340 $220;
437.5(7) fee for initial Licensed Associate Marriage and Family Therapist (LAMFT)
437.6license is $75;
437.7(8) annual renewal fee for LAMFT license is $75;
437.8(9) late fee for LAMFT renewal is $50 $25;
437.9(10) fee for reinstatement of license is $150; and
437.10(11) fee for emeritus status is $125.

437.11    Sec. 2. Minnesota Statutes 2012, section 151.19, subdivision 1, is amended to read:
437.12    Subdivision 1. Pharmacy registration licensure requirements. The board shall
437.13require and provide for the annual registration of every pharmacy now or hereafter doing
437.14business within this state. Upon the payment of any applicable fee specified in section
437.15151.065, the board shall issue a registration certificate in such form as it may prescribe to
437.16such persons as may be qualified by law to conduct a pharmacy. Such certificate shall
437.17be displayed in a conspicuous place in the pharmacy for which it is issued and expire on
437.18the 30th day of June following the date of issue. It shall be unlawful for any person to
437.19conduct a pharmacy unless such certificate has been issued to the person by the board. (a)
437.20No person shall operate a pharmacy without first obtaining a license from the board and
437.21paying any applicable fee specified in section 151.065. The license shall be displayed in a
437.22conspicuous place in the pharmacy for which it is issued and expires on June 30 following
437.23the date of issue. It is unlawful for any person to operate a pharmacy unless the license
437.24has been issued to the person by the board.
437.25    (b) Application for a pharmacy license under this section shall be made in a manner
437.26specified by the board.
437.27    (c) No license shall be issued or renewed for a pharmacy located within the state
437.28unless the applicant agrees to operate the pharmacy in a manner prescribed by federal and
437.29state law and according to rules adopted by the board. No license shall be issued for a
437.30pharmacy located outside of the state unless the applicant agrees to operate the pharmacy
437.31in a manner prescribed by federal law and, when dispensing medications for residents of
437.32this state, the laws of this state, and Minnesota Rules.
437.33    (d) No license shall be issued or renewed for a pharmacy that is required to be
437.34licensed or registered by the state in which it is physically located unless the applicant
437.35supplies the board with proof of such licensure or registration.
438.1    (e) The board shall require a separate license for each pharmacy located within
438.2the state and for each pharmacy located outside of the state at which any portion of the
438.3dispensing process occurs for drugs dispensed to residents of this state.
438.4    (f) The board shall not issue an initial or renewed license for a pharmacy unless the
438.5pharmacy passes an inspection conducted by an authorized representative of the board. In
438.6the case of a pharmacy located outside of the state, the board may require the applicant to
438.7pay the cost of the inspection, in addition to the license fee in section 151.065, unless the
438.8applicant furnishes the board with a report, issued by the appropriate regulatory agency of
438.9the state in which the facility is located, of an inspection that has occurred within the 24
438.10months immediately preceding receipt of the license application by the board. The board
438.11may deny licensure unless the applicant submits documentation satisfactory to the board
438.12that any deficiencies noted in an inspection report have been corrected.
438.13    (g) The board shall not issue an initial or renewed license for a pharmacy located
438.14outside of the state unless the applicant discloses and certifies:
438.15    (1) the location, names, and titles of all principal corporate officers and all
438.16pharmacists who are involved in dispensing drugs to residents of this state;
438.17    (2) that it maintains its records of drugs dispensed to residents of this state so that the
438.18records are readily retrievable from the records of other drugs dispensed;
438.19    (3) that it agrees to cooperate with, and provide information to, the board concerning
438.20matters related to dispensing drugs to residents of this state;
438.21    (4) that, during its regular hours of operation, but no less than six days per week, for
438.22a minimum of 40 hours per week, a toll-free telephone service is provided to facilitate
438.23communication between patients in this state and a pharmacist at the pharmacy who has
438.24access to the patients' records; the toll-free number must be disclosed on the label affixed
438.25to each container of drugs dispensed to residents of this state; and
438.26    (5) that, upon request of a resident of a long-term care facility located in this
438.27state, the resident's authorized representative, or a contract pharmacy or licensed health
438.28care facility acting on behalf of the resident, the pharmacy will dispense medications
438.29prescribed for the resident in unit-dose packaging or, alternatively, comply with section
438.30151.415, subdivision 5.

438.31    Sec. 3. Minnesota Statutes 2012, section 151.19, subdivision 3, is amended to read:
438.32    Subd. 3. Sale of federally restricted medical gases. The board shall require and
438.33provide for the annual registration of every person or establishment not licensed as a
438.34pharmacy or a practitioner engaged in the retail sale or distribution of federally restricted
438.35medical gases. Upon the payment of any applicable fee specified in section 151.065, the
439.1board shall issue a registration certificate in such form as it may prescribe to those persons
439.2or places that may be qualified to sell or distribute federally restricted medical gases. The
439.3certificate shall be displayed in a conspicuous place in the business for which it is issued
439.4and expire on the date set by the board. It is unlawful for a person to sell or distribute
439.5federally restricted medical gases unless a certificate has been issued to that person by the
439.6board. (a) A person or establishment not licensed as a pharmacy or a practitioner shall not
439.7engage in the retail sale or distribution of federally restricted medical gases without first
439.8obtaining a registration from the board and paying the applicable fee specified in section
439.9151.065. The registration shall be displayed in a conspicuous place in the business for
439.10which it is issued and expires on the date set by the board. It is unlawful for a person to
439.11sell or distribute federally restricted medical gases unless a certificate has been issued to
439.12that person by the board.
439.13    (b) Application for a medical gas distributor registration under this section shall be
439.14made in a manner specified by the board.
439.15    (c) No registration shall be issued or renewed for a medical gas distributor located
439.16within the state unless the applicant agrees to operate in a manner prescribed by federal
439.17and state law and according to the rules adopted by the board. No license shall be issued
439.18for a medical gas distributor located outside of the state unless the applicant agrees to
439.19operate in a manner prescribed by federal law and, when distributing medical gases for
439.20residents of this state, the laws of this state and Minnesota Rules.
439.21    (d) No registration shall be issued or renewed for a medical gas distributor that is
439.22required to be licensed or registered by the state in which it is physically located unless the
439.23applicant supplies the board with proof of the licensure or registration. The board may, by
439.24rule, establish standards for the registration of a medical gas distributor that is not required
439.25to be licensed or registered by the state in which it is physically located.
439.26    (e) The board shall require a separate registration for each medical gas distributor
439.27located within the state and for each facility located outside of the state from which
439.28medical gases are distributed to residents of this state.
439.29    (f) The board shall not issue an initial or renewed registration for a medical gas
439.30distributor unless the medical gas distributor passes an inspection conducted by an
439.31authorized representative of the board. In the case of a medical gas distributor located
439.32outside of the state, the board may require the applicant to pay the cost of the inspection,
439.33in addition to the license fee in section 151.065, unless the applicant furnishes the board
439.34with a report, issued by the appropriate regulatory agency of the state in which the facility
439.35is located, of an inspection that has occurred within the 24 months immediately preceding
439.36receipt of the license application by the board. The board may deny licensure unless the
440.1applicant submits documentation satisfactory to the board that any deficiencies noted in
440.2an inspection report have been corrected.

440.3    Sec. 4. [151.252] LICENSING OF DRUG MANUFACTURERS; FEES;
440.4PROHIBITIONS.
440.5    Subdivision 1. Requirements. (a) No person shall act as a drug manufacturer
440.6without first obtaining a license from the board and paying any applicable fee specified
440.7in section 151.065.
440.8    (b) Application for a drug manufacturer license under this section shall be made in a
440.9manner specified by the board.
440.10    (c) No license shall be issued or renewed for a drug manufacturer unless the
440.11applicant agrees to operate in a manner prescribed by federal and state law and according
440.12to Minnesota Rules.
440.13    (d) No license shall be issued or renewed for a drug manufacturer that is required
440.14to be registered pursuant to United State Code, title 21, section 360, unless the applicant
440.15supplies the board with proof of registration. The board may establish by rule the
440.16standards for licensure of drug manufacturers that are not required to be registered under
440.17United States Code, title 21, section 360.
440.18    (e) No license shall be issued or renewed for a drug manufacturer that is required to
440.19be licensed or registered by the state in which it is physically located unless the applicant
440.20supplies the board with proof of licensure or registration. The board may establish, by
440.21rule, standards for the licensure of a drug manufacturer that is not required to be licensed
440.22or registered by the state in which it is physically located.
440.23    (f) The board shall require a separate license for each facility located within the state
440.24at which drug manufacturing occurs and for each facility located outside of the state at
440.25which drugs that are shipped into the state are manufactured.
440.26    (g) The board shall not issue an initial or renewed license for a drug manufacturing
440.27facility unless the facility passes an inspection conducted by an authorized representative
440.28of the board. In the case of a drug manufacturing facility located outside of the state, the
440.29board may require the applicant to pay the cost of the inspection, in addition to the license
440.30fee in section 151.065, unless the applicant furnishes the board with a report, issued by the
440.31appropriate regulatory agency of the state in which the facility is located or by the United
440.32States Food and Drug Administration, of an inspection that has occurred within the 24
440.33months immediately preceding receipt of the license application by the board. The board
440.34may deny licensure unless the applicant submits documentation satisfactory to the board
440.35that any deficiencies noted in an inspection report have been corrected.
441.1    Subd. 2. Prohibition. It is unlawful for any person engaged in drug manufacturing
441.2to sell legend drugs to anyone located in this state except as provided in this chapter.
441.3    Subd. 3. Payment to practitioner; reporting. Unless prohibited by United States
441.4Code, title 42, section 1320a-7h, a drug manufacturer shall file with the board an annual
441.5report, in a form and on the date prescribed by the board, identifying all payments,
441.6honoraria, reimbursement, or other compensation authorized under section 151.461,
441.7clauses (4) and (5), paid to practitioners in Minnesota during the preceding calendar year.
441.8The report shall identify the nature and value of any payments totaling $100 or more to a
441.9particular practitioner during the year, and shall identify the practitioner. Reports filed
441.10under this subdivision are public data.

441.11    Sec. 5. Minnesota Statutes 2012, section 151.37, subdivision 4, is amended to read:
441.12    Subd. 4. Research. (a) Any qualified person may use legend drugs in the course
441.13of a bona fide research project, but cannot administer or dispense such drugs to human
441.14beings unless such drugs are prescribed, dispensed, and administered by a person lawfully
441.15authorized to do so.
441.16    (b) Drugs may be dispensed or distributed by a pharmacy licensed by the board for
441.17use by, or administration to, patients enrolled in a bona fide research study that is being
441.18conducted pursuant to either an investigational new drug application approved by the
441.19United States Food and Drug Administration or that has been approved by an institutional
441.20review board. For the purposes of this subdivision only:
441.21    (1) a prescription drug order is not required for a pharmacy to dispense a research
441.22drug, unless the study protocol requires the pharmacy to receive such an order;
441.23    (2) notwithstanding the prescription labeling requirements found in this chapter or
441.24the rules promulgated by the board, a research drug may be labeled as required by the
441.25study protocol; and
441.26    (3) dispensing and distribution of research drugs by pharmacies shall not be
441.27considered compounding, manufacturing, or wholesaling under this chapter.
441.28    (c) An entity that is under contract to a federal agency for the purpose of distributing
441.29drugs for bona fide research studies is exempt from the drug wholesaler licensing
441.30requirements of this chapter. Any other entity is exempt from the drug wholesaler
441.31licensing requirements of this chapter if the board finds that the entity is licensed or
441.32registered according to the laws of the state in which it is physically located and it is
441.33distributing drugs for use by, or administration to, patients enrolled in a bona fide research
441.34study that is being conducted pursuant to either an investigational new drug application
442.1approved by the United States Food and Drug Administration or that has been approved
442.2by an institutional review board.
442.3EFFECTIVE DATE.This section is effective the day following final enactment.

442.4    Sec. 6. Minnesota Statutes 2012, section 151.47, subdivision 1, is amended to read:
442.5    Subdivision 1. Requirements. (a) All wholesale drug distributors are subject to the
442.6requirements in paragraphs (a) to (f) of this subdivision.
442.7    (a) (b) No person or distribution outlet shall act as a wholesale drug distributor
442.8without first obtaining a license from the board and paying any applicable fee specified
442.9in section 151.065.
442.10    (c) Application for a wholesale drug distributor license under this section shall be
442.11made in a manner specified by the board.
442.12    (b) (d) No license shall be issued or renewed for a wholesale drug distributor to
442.13operate unless the applicant agrees to operate in a manner prescribed by federal and state
442.14law and according to the rules adopted by the board.
442.15    (c) The board may require a separate license for each facility directly or indirectly
442.16owned or operated by the same business entity within the state, or for a parent entity
442.17with divisions, subsidiaries, or affiliate companies within the state, when operations
442.18are conducted at more than one location and joint ownership and control exists among
442.19all the entities.
442.20    (e) No license may be issued or renewed for a drug wholesale distributor that is
442.21required to be licensed or registered by the state in which it is physically located unless
442.22the applicant supplies the board with proof of licensure or registration. The board may
442.23establish, by rule, standards for the licensure of a drug wholesale distributor that is not
442.24required to be licensed or registered by the state in which it is physically located.
442.25    (f) The board shall require a separate license for each drug wholesale distributor
442.26facility located within the state and for each drug wholesale distributor facility located
442.27outside of the state from which drugs are shipped into the state or to which drugs are
442.28reverse distributed.
442.29    (g) The board shall not issue an initial or renewed license for a drug wholesale
442.30distributor facility unless the facility passes an inspection conducted by an authorized
442.31representative of the board, or is accredited by an accreditation program approved by the
442.32board. In the case of a drug wholesale distributor facility located outside of the state, the
442.33board may require the applicant to pay the cost of the inspection, in addition to the license
442.34fee in section 151.065, unless the applicant furnishes the board with a report, issued by the
442.35appropriate regulatory agency of the state in which the facility is located, of an inspection
443.1that has occurred within the 24 months immediately preceding receipt of the license
443.2application by the board, or furnishes the board with proof of current accreditation. The
443.3board may deny licensure unless the applicant submits documentation satisfactory to the
443.4board that any deficiencies noted in an inspection report have been corrected.
443.5    (d) (h) As a condition for receiving and retaining a wholesale drug distributor license
443.6issued under sections 151.42 to 151.51, an applicant shall satisfy the board that it has
443.7and will continuously maintain:
443.8    (1) adequate storage conditions and facilities;
443.9    (2) minimum liability and other insurance as may be required under any applicable
443.10federal or state law;
443.11    (3) a viable security system that includes an after hours central alarm, or comparable
443.12entry detection capability; restricted access to the premises; comprehensive employment
443.13applicant screening; and safeguards against all forms of employee theft;
443.14    (4) a system of records describing all wholesale drug distributor activities set forth
443.15in section 151.44 for at least the most recent two-year period, which shall be reasonably
443.16accessible as defined by board regulations in any inspection authorized by the board;
443.17    (5) principals and persons, including officers, directors, primary shareholders,
443.18and key management executives, who must at all times demonstrate and maintain their
443.19capability of conducting business in conformity with sound financial practices as well
443.20as state and federal law;
443.21    (6) complete, updated information, to be provided to the board as a condition for
443.22obtaining and retaining a license, about each wholesale drug distributor to be licensed,
443.23including all pertinent corporate licensee information, if applicable, or other ownership,
443.24principal, key personnel, and facilities information found to be necessary by the board;
443.25    (7) written policies and procedures that assure reasonable wholesale drug distributor
443.26preparation for, protection against, and handling of any facility security or operation
443.27problems, including, but not limited to, those caused by natural disaster or government
443.28emergency, inventory inaccuracies or product shipping and receiving, outdated product
443.29or other unauthorized product control, appropriate disposition of returned goods, and
443.30product recalls;
443.31    (8) sufficient inspection procedures for all incoming and outgoing product
443.32shipments; and
443.33    (9) operations in compliance with all federal requirements applicable to wholesale
443.34drug distribution.
443.35    (e) (i) An agent or employee of any licensed wholesale drug distributor need not
443.36seek licensure under this section.
444.1    (f) A wholesale drug distributor shall file with the board an annual report, in a
444.2form and on the date prescribed by the board, identifying all payments, honoraria,
444.3reimbursement or other compensation authorized under section 151.461, clauses (3) to
444.4(5), paid to practitioners in Minnesota during the preceding calendar year. The report
444.5shall identify the nature and value of any payments totaling $100 or more, to a particular
444.6practitioner during the year, and shall identify the practitioner. Reports filed under this
444.7provision are public data.

444.8    Sec. 7. Minnesota Statutes 2012, section 151.47, is amended by adding a subdivision
444.9to read:
444.10    Subd. 3. Prohibition. It is unlawful for any person engaged in wholesale drug
444.11distribution to sell drugs to a person located within the state or to receive drugs in reverse
444.12distribution from a person located within the state except as provided in this chapter.

444.13    Sec. 8. Minnesota Statutes 2012, section 151.49, is amended to read:
444.14151.49 LICENSE RENEWAL APPLICATION PROCEDURES.
444.15    Application blanks or notices for renewal of a license required by sections 151.42
444.16to 151.51 shall be mailed or otherwise provided to each licensee on or before the first
444.17day of the month prior to the month in which the license expires and, if application for
444.18renewal of the license with the required fee and supporting documents is not made before
444.19the expiration date, the existing license or renewal shall lapse and become null and void
444.20upon the date of expiration.

444.21    Sec. 9. [214.075] HEALTH-RELATED LICENSING BOARDS; CRIMINAL
444.22BACKGROUND CHECKS.
444.23    Subdivision 1. Applications. (a) By January 1, 2018, each health-related licensing
444.24board, as defined in section 214.01, subdivision 2, shall require applicants for initial
444.25licensure, licensure by endorsement, or reinstatement or other relicensure after a lapse
444.26in licensure, as defined by the individual health-related licensing boards, to submit to
444.27a criminal history records check of state data completed by the Bureau of Criminal
444.28Apprehension (BCA) and a national criminal history records check, including a search of
444.29the records of the Federal Bureau of Investigation (FBI).
444.30(b) An applicant must complete a criminal background check if more than one year
444.31has elapsed since the applicant last submitted a background check to the board.
444.32    Subd. 2. Investigations. If a health-related licensing board has reasonable cause
444.33to believe a licensee has been charged with or convicted of a crime in this or any other
445.1jurisdiction, the health-related licensing board may require the licensee to submit to a
445.2criminal history records check of state data completed by the BCA and a national criminal
445.3history records check, including a search of the records of the FBI.
445.4    Subd. 3. Consent form; fees; fingerprints. (a) In order to effectuate the federal
445.5and state level, fingerprint-based criminal background check, the applicant or licensee
445.6must submit a completed criminal history records check consent form and a full set of
445.7fingerprints to the respective health-related licensing board or a designee in the manner
445.8and form specified by the board.
445.9(b) The applicant or licensee is responsible for all fees associated with preparation of
445.10the fingerprints, the criminal records check consent form, and the criminal background
445.11check. The fees for the criminal records background check shall be set by the BCA and
445.12the FBI and are not refundable. The fees shall be submitted to the respective health-related
445.13licensing board by the applicant or licensee as prescribed by the respective board.
445.14    (c) All fees received by the health-related licensing boards under this subdivision
445.15shall be deposited in a dedicated account in the special revenue fund and are appropriated
445.16to the Board of Nursing Home Administrators for the administrative services unit to pay
445.17for the criminal background checks conducted by the Bureau of Criminal Apprehension
445.18and Federal Bureau of Investigation.
445.19    Subd. 4. Refusal to consent. (a) The health-related licensing boards shall not issue
445.20a license to any applicant who refuses to consent to a criminal background check or fails
445.21to submit fingerprints within 90 days after submission of an application for licensure. Any
445.22fees paid by the applicant to the board shall be forfeited if the applicant refuses to consent
445.23to the criminal background check or fails to submit the required fingerprints.
445.24(b) The failure of a licensee to submit to a criminal background check as provided in
445.25subdivision 3 is grounds for disciplinary action by the respective health licensing board.
445.26    Subd. 5. Submission of fingerprints to the Bureau of Criminal Apprehension.
445.27The health-related licensing board or designee shall submit applicant or licensee
445.28fingerprints to the BCA. The BCA shall perform a check for state criminal justice
445.29information and shall forward the applicant's or licensee's fingerprints to the FBI to
445.30perform a check for national criminal justice information regarding the applicant or
445.31licensee. The BCA shall report to the board the results of the state and national criminal
445.32justice information checks.
445.33    Subd. 6. Alternatives to fingerprint-based criminal background checks. The
445.34health-related licensing board may require an alternative method of criminal history
445.35checks for an applicant or licensee who has submitted at least three sets of fingerprints in
445.36accordance with this section that have been unreadable by the BCA or the FBI.
446.1    Subd. 7. Opportunity to challenge accuracy of report. Prior to taking disciplinary
446.2action against an applicant or a licensee based on a criminal conviction, the health-related
446.3licensing board shall provide the applicant or the licensee an opportunity to complete or
446.4challenge the accuracy of the criminal history information reported to the board. The
446.5applicant or licensee shall have 30 calendar days following notice from the board of
446.6the intent to deny licensure or to take disciplinary action to request an opportunity to
446.7correct or complete the record prior to the board taking disciplinary action based on the
446.8information reported to the board. The board shall provide the applicant up to 180 days to
446.9challenge the accuracy or completeness of the report with the agency responsible for the
446.10record. This subdivision does not affect the right of the subject of the data to contest the
446.11accuracy or completeness under section 13.04, subdivision 4.
446.12    Subd. 8. Instructions to the board; plans. The health-related licensing boards, in
446.13collaboration with the commissioner of human services and the BCA, shall establish a
446.14plan for completing criminal background checks of all licensees who were licensed before
446.15the effective date requirement under subdivision 1. The plan must seek to minimize
446.16duplication of requirements for background checks of licensed health professionals. The
446.17plan for background checks of current licensees shall be developed no later than January
446.181, 2017, and may be contingent upon the implementation of a system by the BCA or FBI
446.19in which any new crimes that an applicant or licensee commits after an initial background
446.20check are flagged in the BCA's or FBI's database and reported back to the board. The plan
446.21shall include recommendations for any necessary statutory changes.

446.22    Sec. 10. Minnesota Statutes 2012, section 214.12, is amended by adding a subdivision
446.23to read:
446.24    Subd. 4. Parental depression. The health-related licensing boards that regulate
446.25professions that serve caregivers at risk of depression, or their children, including
446.26behavioral health and therapy, chiropractic, marriage and family therapy, medical practice,
446.27nursing, psychology, and social work, shall provide educational materials to licensees on
446.28the subject of parental depression and its potential effects on children if unaddressed,
446.29including how to:
446.30(1) screen mothers for depression;
446.31(2) identify children who are affected by their mother's depression; and
446.32(3) provide treatment or referral information on needed services.

446.33    Sec. 11. Minnesota Statutes 2012, section 214.40, subdivision 1, is amended to read:
447.1    Subdivision 1. Definitions. (a) The definitions in this subdivision apply to this
447.2section.
447.3(b) "Administrative services unit" means the administrative services unit for the
447.4health-related licensing boards.
447.5(c) "Charitable organization" means a charitable organization within the meaning of
447.6section 501(c)(3) of the Internal Revenue Code that has as a purpose the sponsorship or
447.7support of programs designed to improve the quality, awareness, and availability of health
447.8care services and that serves as a funding mechanism for providing those services.
447.9(d) "Health care facility or organization" means a health care facility licensed under
447.10chapter 144 or 144A, or a charitable organization.
447.11(e) "Health care provider" means a physician licensed under chapter 147, physician
447.12assistant registered licensed and practicing under chapter 147A, nurse licensed and
447.13registered to practice under chapter 148, or dentist or, dental hygienist, or dental therapist
447.14 licensed under chapter 150A, or an advanced dental therapist licensed and certified under
447.15chapter 150A.
447.16(f) "Health care services" means health promotion, health monitoring, health
447.17education, diagnosis, treatment, minor surgical procedures, the administration of local
447.18anesthesia for the stitching of wounds, and primary dental services, including preventive,
447.19diagnostic, restorative, and emergency treatment. Health care services do not include the
447.20administration of general anesthesia or surgical procedures other than minor surgical
447.21procedures.
447.22(g) "Medical professional liability insurance" means medical malpractice insurance
447.23as defined in section 62F.03.
447.24EFFECTIVE DATE.This section is effective the day following final enactment.

447.25    Sec. 12. INCLUSION OF OTHER HEALTH-RELATED OCCUPATIONS TO
447.26CRIMINAL BACKGROUND CHECKS.
447.27(a) If the Department of Health is not reviewed by the Sunset Advisory Commission
447.28according to the schedule in Minnesota Statutes, section 3D.21, the commissioner
447.29of health, as the regulator for occupational therapy practitioners, speech-language
447.30pathologists, audiologists, and hearing instrument dispensers, shall require applicants
447.31for licensure or renewal to submit to a criminal history records check as required under
447.32Minnesota Statutes, section 214.075, for other health-related licensed occupations
447.33regulated by the health-related licensing boards.
448.1(b) Any statutory changes necessary to include the commissioner of health to
448.2Minnesota Statutes, section 214.075, shall be included in the plan required in Minnesota
448.3Statutes, section 214.075, subdivision 8.

448.4    Sec. 13. REPEALER.
448.5Minnesota Statutes 2012, sections 151.19, subdivision 2; 151.25; 151.45; 151.47,
448.6subdivision 2; and 151.48, are repealed.


448.9    Section 1. Minnesota Statutes 2012, section 13.381, subdivision 2, is amended to read:
448.10    Subd. 2. Health occupations data. (a) Health-related licensees and registrants.
448.11The collection, analysis, reporting, and use of data on individuals licensed or registered by
448.12the commissioner of health or health-related licensing boards are governed by sections
448.13144.051, subdivision 2 subdivisions 2 to 6 , and 144.052.
448.14(b) Health services personnel. Data collected by the commissioner of health for the
448.15database on health services personnel are classified under section 144.1485.

448.16    Sec. 2. Minnesota Statutes 2012, section 13.381, subdivision 10, is amended to read:
448.17    Subd. 10. Home care and hospice provider. Data regarding a home care provider
448.18under sections 144A.43 to 144A.47 are governed by section 144A.45. Data regarding
448.19home care provider background studies are governed by section 144A.476, subdivision 1.
448.20Data regarding a hospice provider under sections 144A.75 to 144A.755 are governed by
448.21sections 144A.752 and 144A.754.

448.22    Sec. 3. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
448.23to read:
448.24    Subd. 3. Data classification; private data. For providers regulated pursuant to
448.25sections 144A.43 to 144A.482, the following data collected, created, or maintained by
448.26the commissioner are classified as private data on individuals as defined in section 13.02,
448.27subdivision 12:
448.28(1) data submitted by or on behalf of applicants for licenses prior to issuance of
448.29the license;
448.30(2) the identity of complainants who have made reports concerning licensees or
448.31applicants unless the complainant consents to the disclosure;
449.1(3) the identity of individuals who provide information as part of surveys and
449.2investigations;
449.3(4) Social Security numbers; and
449.4(5) health record data.

449.5    Sec. 4. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
449.6to read:
449.7    Subd. 4. Data classification; public data. For providers regulated pursuant to
449.8sections 144A.43 to 144A.482, the following data collected, created, or maintained by the
449.9commissioner are classified as public data as defined in section 13.02, subdivision 15:
449.10(1) all application data on licensees, license numbers, license status;
449.11(2) licensing information about licenses previously held under this chapter;
449.12(3) correction orders, including information about compliance with the order and
449.13whether the fine was paid;
449.14(4) final enforcement actions pursuant to chapter 14;
449.15(5) orders for hearing, findings of fact and conclusions of law; and
449.16(6) when the licensee and department agree to resolve the matter without a hearing,
449.17the agreement and specific reasons for the agreement are public data.

449.18    Sec. 5. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
449.19to read:
449.20    Subd. 5. Data classification; confidential data. For providers regulated pursuant to
449.21sections 144A.43 to 144A.482, the following data collected, created, or maintained by
449.22the Department of Health are classified as confidential data on individuals as defined in
449.23section 13.02, subdivision 3: active investigative data relating to the investigation of
449.24potential violations of law by a licensee including data from the survey process before the
449.25correction order is issued by the department.

449.26    Sec. 6. Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
449.27to read:
449.28    Subd. 6. Release of private or confidential data. For providers regulated pursuant
449.29to sections 144A.43 to 144A.482, the department may release private or confidential data,
449.30except Social Security numbers, to the appropriate state, federal, or local agency and law
449.31enforcement office to enhance investigative or enforcement efforts or further a public
449.32health protective process. Types of offices include Adult Protective Services, Office of the
449.33Ombudsmen for Long-Term Care and Office of the Ombudsmen for Mental Health and
450.1Developmental Disabilities, the health licensing boards, Department of Human Services,
450.2county or city attorney's offices, police, and local or county public health offices.

450.3    Sec. 7. Minnesota Statutes 2012, section 144A.43, is amended to read:
450.4144A.43 DEFINITIONS.
450.5    Subdivision 1. Applicability. The definitions in this section apply to sections
450.6144.699, subdivision 2 , and 144A.43 to 144A.47 144A.482.
450.7    Subd. 1a. Agent. "Agent" means the person upon whom all notices and orders shall
450.8be served and who is authorized to accept service of notices and orders on behalf of
450.9the home care provider.
450.10    Subd. 1b. Applicant. "Applicant" means an individual, organization, association,
450.11corporation, unit of government, or other entity that applies for a temporary license,
450.12license, or renewal of the applicant's home care provider license under section 144A.472.
450.13    Subd. 1c. Client. "Client" means a person to whom home care services are provided.
450.14    Subd. 1d. Client record. "Client record" means all records that document
450.15information about the home care services provided to the client by the home care provider.
450.16    Subd. 1e. Client representative. "Client representative" means a person who,
450.17because of the client's needs, makes decisions about the client's care on behalf of the
450.18client. A client representative may be a guardian, health care agent, family member, or
450.19other agent of the client. Nothing in this section expands or diminishes the rights of
450.20persons to act on behalf of clients under other law.
450.21    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.
450.22    Subd. 2a. Controlled substance. "Controlled substance" has the meaning given
450.23in section 152.01, subdivision 4.
450.24    Subd. 2b. Department. "Department" means the Minnesota Department of Health.
450.25    Subd. 2c. Dietary supplement. "Dietary supplement" means a product taken
450.26by mouth that contains a dietary ingredient intended to supplement the diet. Dietary
450.27ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and
450.28substances such as enzymes, organ tissue, glandulars, or metabolites.
450.29    Subd. 2d. Dietitian. "Dietitian" is a person licensed under sections 148.621 to
450.30148.633.
450.31    Subd. 2e. Dietetics or nutrition practice. "Dietetics or nutrition practice" is
450.32performed by a licensed dietitian or licensed nutritionist and includes the activities of
450.33assessment, setting priorities and objectives, providing nutrition counseling, developing
450.34and implementing nutrition care services, and evaluating and maintaining appropriate
450.35standards of quality of nutrition care under sections 148.621 to 148.633.
451.1    Subd. 3. Home care service. "Home care service" means any of the following
451.2services when delivered in a place of residence to the home of a person whose illness,
451.3disability, or physical condition creates a need for the service:
451.4(1) nursing services, including the services of a home health aide;
451.5(2) personal care services not included under sections 148.171 to 148.285;
451.6(3) physical therapy;
451.7(4) speech therapy;
451.8(5) respiratory therapy;
451.9(6) occupational therapy;
451.10(7) nutritional services;
451.11(8) home management services when provided to a person who is unable to perform
451.12these activities due to illness, disability, or physical condition. Home management
451.13services include at least two of the following services: housekeeping, meal preparation,
451.14and shopping;
451.15(9) medical social services;
451.16(10) the provision of medical supplies and equipment when accompanied by the
451.17provision of a home care service; and
451.18(11) other similar medical services and health-related support services identified by
451.19the commissioner in rule.
451.20"Home care service" does not include the following activities conducted by the
451.21commissioner of health or a board of health as defined in section 145A.02, subdivision 2:
451.22communicable disease investigations or testing; administering or monitoring a prescribed
451.23therapy necessary to control or prevent a communicable disease; or the monitoring
451.24of an individual's compliance with a health directive as defined in section 144.4172,
451.25subdivision 6 .
451.26(1) assistive tasks provided by unlicensed personnel;
451.27(2) services provided by a registered nurse or licensed practical nurse, physical
451.28therapist, respiratory therapist, occupational therapist, speech-language pathologist,
451.29dietitian or nutritionist, or social worker;
451.30(3) medication and treatment management services; or
451.31(4) the provision of durable medical equipment services when provided with any of
451.32the home care services listed in clauses (1) to (3).
451.33    Subd. 3a. Hands-on assistance. "Hands-on assistance" means physical help by
451.34another person without which the client is not able to perform the activity.
451.35    Subd. 3b. Home. "Home" means the client's temporary or permanent place of
451.36residence.
452.1    Subd. 4. Home care provider. "Home care provider" means an individual,
452.2organization, association, corporation, unit of government, or other entity that is regularly
452.3engaged in the delivery of at least one home care service, directly or by contractual
452.4arrangement, of home care services in a client's home for a fee and who has a valid current
452.5temporary license or license issued under sections 144A.43 to 144A.482. At least one
452.6home care service must be provided directly, although additional home care services may
452.7be provided by contractual arrangements. "Home care provider" does not include:
452.8(1) any home care or nursing services conducted by and for the adherents of any
452.9recognized church or religious denomination for the purpose of providing care and
452.10services for those who depend upon spiritual means, through prayer alone, for healing;
452.11(2) an individual who only provides services to a relative;
452.12(3) an individual not connected with a home care provider who provides assistance
452.13with home management services or personal care needs if the assistance is provided
452.14primarily as a contribution and not as a business;
452.15(4) an individual not connected with a home care provider who shares housing with
452.16and provides primarily housekeeping or homemaking services to an elderly or disabled
452.17person in return for free or reduced-cost housing;
452.18(5) an individual or agency providing home-delivered meal services;
452.19(6) an agency providing senior companion services and other older American
452.20volunteer programs established under the Domestic Volunteer Service Act of 1973,
452.21Public Law 98-288;
452.22(7) an employee of a nursing home licensed under this chapter or an employee of a
452.23boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
452.24emergency calls from individuals residing in a residential setting that is attached to or
452.25located on property contiguous to the nursing home or boarding care home;
452.26(8) a member of a professional corporation organized under chapter 319B that does
452.27not regularly offer or provide home care services as defined in subdivision 3;
452.28(9) the following organizations established to provide medical or surgical services
452.29that do not regularly offer or provide home care services as defined in subdivision 3:
452.30a business trust organized under sections 318.01 to 318.04, a nonprofit corporation
452.31organized under chapter 317A, a partnership organized under chapter 323, or any other
452.32entity determined by the commissioner;
452.33(10) an individual or agency that provides medical supplies or durable medical
452.34equipment, except when the provision of supplies or equipment is accompanied by a
452.35home care service;
452.36(11) an individual licensed under chapter 147; or
453.1(12) an individual who provides home care services to a person with a developmental
453.2disability who lives in a place of residence with a family, foster family, or primary caregiver.
453.3    Subd. 5. Medication reminder. "Medication reminder" means providing a verbal
453.4or visual reminder to a client to take medication. This includes bringing the medication
453.5to the client and providing liquids or nutrition to accompany medication that a client is
453.6self-administering.
453.7    Subd. 6. License. "License" means a basic or comprehensive home care license
453.8issued by the commissioner to a home care provider.
453.9    Subd. 7. Licensed health professional. "Licensed health professional" means a
453.10person, other than a registered nurse or licensed practical nurse, who provides home care
453.11services within the scope of practice of the person's health occupation license, registration,
453.12or certification as regulated and who is licensed by the appropriate Minnesota state board
453.13or agency.
453.14    Subd. 8. Licensee. "Licensee" means a home care provider that is licensed under
453.15this chapter.
453.16    Subd. 9. Managerial official. "Managerial official" means an administrator,
453.17director, officer, trustee, or employee of a home care provider, however designated, who
453.18has the authority to establish or control business policy.
453.19    Subd. 10. Medication. "Medication" means a prescription or over-the-counter drug.
453.20For purposes of this chapter only, medication includes dietary supplements.
453.21    Subd. 11. Medication administration. "Medication administration" means
453.22performing a set of tasks to ensure a client takes medications, and includes the following:
453.23(1) checking the client's medication record;
453.24(2) preparing the medication as necessary;
453.25(3) administering the medication to the client;
453.26(4) documenting the administration or reason for not administering the medication;
453.27and
453.28(5) reporting to a nurse any concerns about the medication, the client, or the client's
453.29refusal to take the medication.
453.30    Subd. 12. Medication management. "Medication management" means the
453.31provision of any of the following medication-related services to a client:
453.32(1) performing medication setup;
453.33(2) administering medication;
453.34(3) storing and securing medications;
453.35(4) documenting medication activities;
454.1(5) verifying and monitoring effectiveness of systems to ensure safe handling and
454.2administration;
454.3(6) coordinating refills;
454.4(7) handling and implementing changes to prescriptions;
454.5(8) communicating with the pharmacy about the client's medications; and
454.6(9) coordinating and communicating with the prescriber.
454.7    Subd. 13. Medication setup. "Medication setup" means arranging medications by a
454.8nurse, pharmacy, or authorized prescriber for later administration by the client or by
454.9comprehensive home care staff.
454.10    Subd. 14. Nurse. "Nurse" means a person who is licensed under sections 148.171 to
454.11148.285.
454.12    Subd. 15. Occupational therapist. "Occupational therapist" means a person who is
454.13licensed under sections 148.6401 to 148.6450.
454.14    Subd. 16. Over-the-counter drug. "Over-the-counter drug" means a drug that is
454.15not required by federal law to bear the symbol "Rx only."
454.16    Subd. 17. Owner. "Owner" means a proprietor, general partner, limited partner who
454.17has five percent or more equity interest in a limited partnership, a person who owns or
454.18controls voting stock in a corporation in an amount equal to or greater than five percent of
454.19the shares issued and outstanding, or a corporation that owns equity interest in a licensee
454.20or applicant for a license.
454.21    Subd. 18. Pharmacist. "Pharmacist" has the meaning given in section 151.01,
454.22subdivision 3.
454.23    Subd. 19. Physical therapist. "Physical therapist" means a person who is licensed
454.24under sections 148.65 to 148.78.
454.25    Subd. 20. Physician. "Physician" means a person who is licensed under chapter 147.
454.26    Subd. 21. Prescriber. "Prescriber" means a person who is authorized by sections
454.27148.235; 151.01, subdivision 23; and 151.37 to prescribe prescription drugs.
454.28    Subd. 22. Prescription. "Prescription" has the meaning given in section 151.01,
454.29subdivision 16.
454.30    Subd. 23. Regularly scheduled. "Regularly scheduled" means ordered or planned
454.31to be completed at predetermined times or according to a predetermined routine.
454.32    Subd. 24. Reminder. "Reminder" means providing a verbal or visual reminder
454.33to a client.
454.34    Subd. 25. Respiratory therapist. "Respiratory therapist" means a person who
454.35is licensed under chapter 147C.
455.1    Subd. 26. Revenues. "Revenues" means all money received by a licensee derived
455.2from the provision of home care services, including fees for services and appropriations
455.3of public money for home care services.
455.4    Subd. 27. Service plan. "Service plan" means the written plan between the client or
455.5client's representative and the temporary licensee or licensee about the services that will
455.6be provided to the client.
455.7    Subd. 28. Social worker. "Social worker" means a person who is licensed under
455.8chapter 148D or 148E.
455.9    Subd. 29. Speech-language pathologist. "Speech-language pathologist" has the
455.10meaning given in section 148.512.
455.11    Subd. 30. Standby assistance. "Standby assistance" means the presence of another
455.12person within arm's reach to minimize the risk of injury while performing daily activities
455.13through physical intervention or cuing.
455.14    Subd. 31. Substantial compliance. "Substantial compliance" means complying
455.15with the requirements in this chapter sufficiently to prevent unacceptable health or safety
455.16risks to the home care client.
455.17    Subd. 32. Survey. "Survey" means an inspection of a licensee or applicant for
455.18licensure for compliance with this chapter.
455.19    Subd. 33. Surveyor. "Surveyor" means a staff person of the department authorized
455.20to conduct surveys of home care providers and applicants.
455.21    Subd. 34. Temporary license. "Temporary license" means the initial basic or
455.22comprehensive home care license the department issues after approval of a complete
455.23written application and before the department completes the temporary license survey and
455.24determines that the temporary licensee is in substantial compliance.
455.25    Subd. 35. Treatment or therapy. "Treatment" or "therapy" means the provision
455.26of care, other than medications, ordered or prescribed by a licensed health professional
455.27provided to a client to cure, rehabilitate, or ease symptoms.
455.28    Subd. 36. Unit of government. "Unit of government" means every city, county,
455.29town, school district, other political subdivisions of the state, or agency of the state or
455.30federal government, which includes any instrumentality of a unit of government.
455.31    Subd. 37. Unlicensed personnel. "Unlicensed personnel" are individuals not
455.32otherwise licensed or certified by a governmental health board or agency who provide
455.33home care services in the client's home.
455.34    Subd. 38. Verbal. "Verbal" means oral and not in writing.

456.1    Sec. 8. Minnesota Statutes 2012, section 144A.44, is amended to read:
456.2144A.44 HOME CARE BILL OF RIGHTS.
456.3    Subdivision 1. Statement of rights. A person who receives home care services
456.4has these rights:
456.5(1) the right to receive written information about rights in advance of before
456.6receiving care or during the initial evaluation visit before the initiation of treatment
456.7 services, including what to do if rights are violated;
456.8(2) the right to receive care and services according to a suitable and up-to-date plan,
456.9and subject to accepted health care, medical or nursing standards, to take an active part
456.10in creating and changing the plan developing, modifying, and evaluating care the plan
456.11 and services;
456.12(3) the right to be told in advance of before receiving care about the services that will
456.13be provided, the disciplines that will furnish care the type and disciplines of staff who will
456.14be providing the services, the frequency of visits proposed to be furnished, other choices
456.15that are available for addressing home care needs, and the consequences of these choices
456.16including the potential consequences of refusing these services;
456.17(4) the right to be told in advance of any change recommended changes by the
456.18provider in the service plan of care and to take an active part in any change decisions
456.19about changes to the service plan;
456.20(5) the right to refuse services or treatment;
456.21(6) the right to know, in advance before receiving services or during the initial
456.22visit, any limits to the services available from a home care provider, and the provider's
456.23grounds for a termination of services;
456.24(7) the right to know in advance of receiving care whether the services are covered
456.25by health insurance, medical assistance, or other health programs, the charges for services
456.26that will not be covered by Medicare, and the charges that the individual may have to pay;
456.27(8) (7) the right to know be told before services are initiated what the provider
456.28charges are for the services, no matter who will be paying the bill; to what extent payment
456.29may be expected from health insurance, public programs, or other sources, if known; and
456.30what charges the client may be responsible for paying;
456.31(9) (8) the right to know that there may be other services available in the community,
456.32including other home care services and providers, and to know where to go for find
456.33 information about these services;
456.34(10) (9) the right to choose freely among available providers and to change providers
456.35after services have begun, within the limits of health insurance, long-term care insurance,
456.36medical assistance, or other health programs;
457.1(11) (10) the right to have personal, financial, and medical information kept private,
457.2and to be advised of the provider's policies and procedures regarding disclosure of such
457.3information;
457.4(12) (11) the right to be allowed access to the client's own records and written
457.5information from those records in accordance with sections 144.291 to 144.298;
457.6(13) (12) the right to be served by people who are properly trained and competent
457.7to perform their duties;
457.8(14) (13) the right to be treated with courtesy and respect, and to have the patient's
457.9 client's property treated with respect;
457.10(15) (14) the right to be free from physical and verbal abuse, neglect, financial
457.11exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and
457.12the Maltreatment of Minors Act;
457.13(16) (15) the right to reasonable, advance notice of changes in services or charges,
457.14including;
457.15(16) the right to know the provider's reason for termination of services;
457.16(17) the right to at least ten days' advance notice of the termination of a service by a
457.17provider, except in cases where:
457.18(i) the recipient of services client engages in conduct that significantly alters the
457.19conditions of employment as specified in the employment contract between terms of
457.20the service plan with the home care provider and the individual providing home care
457.21services, or creates;
457.22(ii) the client, person who lives with the client, or others create an abusive or unsafe
457.23work environment for the individual person providing home care services; or
457.24(ii) (iii) an emergency for the informal caregiver or a significant change in the
457.25recipient's client's condition has resulted in service needs that exceed the current service
457.26provider agreement plan and that cannot be safely met by the home care provider;
457.27(17) (18) the right to a coordinated transfer when there will be a change in the
457.28provider of services;
457.29(18) (19) the right to voice grievances regarding treatment or care that is complain
457.30about services that are provided, or fails to be, furnished, or regarding fail to be provided,
457.31and the lack of courtesy or respect to the patient client or the patient's client's property;
457.32(19) (20) the right to know how to contact an individual associated with the home
457.33care provider who is responsible for handling problems and to have the home care provider
457.34investigate and attempt to resolve the grievance or complaint;
457.35(20) (21) the right to know the name and address of the state or county agency to
457.36contact for additional information or assistance; and
458.1(21) (22) the right to assert these rights personally, or have them asserted by
458.2the patient's family or guardian when the patient has been judged incompetent, client's
458.3representative or by anyone on behalf of the client, without retaliation.
458.4    Subd. 2. Interpretation and enforcement of rights. These rights are established
458.5for the benefit of persons clients who receive home care services. "Home care services"
458.6means home care services as defined in section 144A.43, subdivision 3, and unlicensed
458.7personal care assistance services, including services covered by medical assistance under
458.8section 256B.0625, subdivision 19a. All home care providers, including those exempted
458.9under section 144A.471, must comply with this section. The commissioner shall enforce
458.10this section and the home care bill of rights requirement against home care providers
458.11exempt from licensure in the same manner as for licensees. A home care provider may
458.12not request or require a person client to surrender any of these rights as a condition of
458.13receiving services. A guardian or conservator or, when there is no guardian or conservator,
458.14a designated person, may seek to enforce these rights. This statement of rights does not
458.15replace or diminish other rights and liberties that may exist relative to persons clients
458.16 receiving home care services, persons providing home care services, or providers licensed
458.17under Laws 1987, chapter 378. A copy of these rights must be provided to an individual
458.18at the time home care services, including personal care assistance services, are initiated.
458.19The copy shall also contain the address and phone number of the Office of Health Facility
458.20Complaints and the Office of Ombudsman for Long-Term Care and a brief statement
458.21describing how to file a complaint with these offices. Information about how to contact
458.22the Office of Ombudsman for Long-Term Care shall be included in notices of change in
458.23client fees and in notices where home care providers initiate transfer or discontinuation of
458.24services sections 144A.43 to 144A.482.

458.25    Sec. 9. Minnesota Statutes 2012, section 144A.45, is amended to read:
458.26144A.45 REGULATION OF HOME CARE SERVICES.
458.27    Subdivision 1. Rules Regulations. The commissioner shall adopt rules for the
458.28regulation of regulate home care providers pursuant to sections 144A.43 to 144A.47
458.29 144A.482. The rules regulations shall include the following:
458.30    (1) provisions to assure, to the extent possible, the health, safety and, well-being,
458.31and appropriate treatment of persons who receive home care services while respecting
458.32a client's autonomy and choice;
458.33    (2) requirements that home care providers furnish the commissioner with specified
458.34information necessary to implement sections 144A.43 to 144A.47 144A.482;
459.1    (3) standards of training of home care provider personnel, which may vary according
459.2to the nature of the services provided or the health status of the consumer;
459.3(4) standards for provision of home care services;
459.4    (4) (5) standards for medication management which may vary according to the
459.5nature of the services provided, the setting in which the services are provided, or the
459.6status of the consumer. Medication management includes the central storage, handling,
459.7distribution, and administration of medications;
459.8    (5) (6) standards for supervision of home care services requiring supervision by a
459.9registered nurse or other appropriate health care professional which must occur on site
459.10at least every 62 days, or more frequently if indicated by a clinical assessment, and in
459.11accordance with sections 148.171 to 148.285 and rules adopted thereunder, except that a
459.12person performing home care aide tasks for a class B licensee providing paraprofessional
459.13services does not require nursing supervision;
459.14    (6) (7) standards for client evaluation or assessment which may vary according to
459.15the nature of the services provided or the status of the consumer;
459.16    (7) (8) requirements for the involvement of a consumer's physician client's health
459.17care provider, the documentation of physicians' health care providers' orders, if required,
459.18and the consumer's treatment client's service plan, and;
459.19(9) the maintenance of accurate, current clinical client records;
459.20    (8) (10) the establishment of different classes basic and comprehensive levels of
459.21licenses for different types of providers and different standards and requirements for
459.22different kinds of home care based on services provided; and
459.23    (9) operating procedures required to implement (11) provisions to enforce these
459.24regulations and the home care bill of rights.
459.25    Subd. 1a. Home care aide tasks. Notwithstanding the provisions of Minnesota
459.26Rules, part 4668.0110, subpart 1, item E, home care aide tasks also include assisting
459.27toileting, transfers, and ambulation if the client is ambulatory and if the client has no
459.28serious acute illness or infectious disease.
459.29    Subd. 1b. Home health aide qualifications. Notwithstanding the provisions of
459.30Minnesota Rules, part 4668.0100, subpart 5, a person may perform home health aide tasks
459.31if the person maintains current registration as a nursing assistant on the Minnesota nursing
459.32assistant registry. Maintaining current registration on the Minnesota nursing assistant
459.33registry satisfies the documentation requirements of Minnesota Rules, part 4668.0110,
459.34subpart 3.
459.35    Subd. 2. Regulatory functions. (a) The commissioner shall:
460.1(1) evaluate, monitor, and license, survey, and monitor without advance notice, home
460.2care providers in accordance with sections 144A.45 to 144A.47 144A.43 to 144A.482;
460.3(2) inspect the office and records of a provider during regular business hours without
460.4advance notice to the home care provider;
460.5(2) survey every temporary licensee within one year of the temporary license issuance
460.6date subject to the temporary licensee providing home care services to a client or clients;
460.7(3) survey all licensed home care providers on an interval that will promote the
460.8health and safety of clients;
460.9(3) (4) with the consent of the consumer client, visit the home where services are
460.10being provided;
460.11(4) (5) issue correction orders and assess civil penalties in accordance with section
460.12144.653, subdivisions 5 to 8 , for violations of sections 144A.43 to 144A.47 or the rules
460.13adopted under those sections 144A.482;
460.14(5) (6) take action as authorized in section 144A.46, subdivision 3 144A.475; and
460.15(6) (7) take other action reasonably required to accomplish the purposes of sections
460.16144A.43 to 144A.47 144A.482.
460.17(b) In the exercise of the authority granted in sections 144A.43 to 144A.47, the
460.18commissioner shall comply with the applicable requirements of section 144.122, the
460.19Government Data Practices Act, and the Administrative Procedure Act.
460.20    Subd. 4. Medicaid reimbursement. Notwithstanding the provisions of section
460.21256B.37 or state plan requirements to the contrary, certification by the federal Medicare
460.22program must not be a requirement of Medicaid payment for services delivered under
460.23section 144A.4605.
460.24    Subd. 5. Home care providers; services for Alzheimer's disease or related
460.25disorder. (a) If a home care provider licensed under section 144A.46 or 144A.4605 markets
460.26or otherwise promotes services for persons with Alzheimer's disease or related disorders,
460.27the facility's direct care staff and their supervisors must be trained in dementia care.
460.28(b) Areas of required training include:
460.29(1) an explanation of Alzheimer's disease and related disorders;
460.30(2) assistance with activities of daily living;
460.31(3) problem solving with challenging behaviors; and
460.32(4) communication skills.
460.33(c) The licensee shall provide to consumers in written or electronic form a
460.34description of the training program, the categories of employees trained, the frequency
460.35of training, and the basic topics covered.

461.1    Sec. 10. [144A.471] HOME CARE PROVIDER AND HOME CARE SERVICES.
461.2    Subdivision 1. License required. A home care provider may not open, operate,
461.3manage, conduct, maintain, or advertise itself as a home care provider or provide home
461.4care services in Minnesota without a temporary or current home care provider license
461.5issued by the commissioner of health.
461.6    Subd. 2. Determination of direct home care service. (a) "Direct home care
461.7service" means a home care service provided to a client by the home care provider or its
461.8employees, and not by contract. Factors that must be considered in determining whether
461.9an individual or a business entity provides at least one home care service directly include,
461.10but are not limited to, whether the individual or business entity:
461.11    (1) has the right to control, and does control, the types of services provided;
461.12(2) has the right to control, and does control, when and how the services are provided;
461.13    (3) establishes the charges;
461.14(4) collects fees from the clients or receives payment from third-party payers on
461.15the clients' behalf;
461.16(5) pays individuals providing services compensation on an hourly, weekly, or
461.17similar basis;
461.18(6) treats the individuals providing services as employees for the purposes of payroll
461.19taxes and workers' compensation insurance; and
461.20(7) holds itself out as a provider of home care services or acts in a manner that
461.21leads clients or potential clients to believe that it is a home care provider providing home
461.22care services.
461.23    (b) None of the factors listed in this subdivision is solely determinative.
461.24    Subd. 3. Determination of regularly engaged. (a) "Regularly engaged" means
461.25providing, or offering to provide, home care services as a regular part of a business. The
461.26following factors must be considered by the commissioner in determining whether an
461.27individual or a business entity is regularly engaged in providing home care services:
461.28    (1) whether the individual or business entity states or otherwise promotes that the
461.29individual or business entity provides home care services;
461.30    (2) whether persons receiving home care services constitute a substantial part of the
461.31individual's or the business entity's clientele; and
461.32(3) whether the home care services provided are other than occasional or incidental
461.33to the provision of services other than home care services.
461.34    (b) None of the factors listed in this subdivision is solely determinative.
461.35    Subd. 4. Penalties for operating without license. A person involved in the
461.36management, operation, or control of a home care provider that operates without an
462.1appropriate license is guilty of a misdemeanor. This section does not apply to a person
462.2who has no legal authority to affect or change decisions related to the management,
462.3operation, or control of a home care provider.
462.4    Subd. 5. Basic and comprehensive levels of licensure. An applicant seeking
462.5to become a home care provider must apply for either a basic or comprehensive home
462.6care license.
462.7    Subd. 6. Basic home care license provider. Home care services that can be
462.8provided with a basic home care license are assistive tasks provided by licensed or
462.9unlicensed personnel that include:
462.10(1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting,
462.11and bathing;
462.12(2) providing standby assistance;
462.13(3) providing verbal or visual reminders to the client to take regularly scheduled
462.14medication, which includes bringing the client previously set-up medication, medication
462.15in original containers, or liquid or food to accompany the medication;
462.16(4) providing verbal or visual reminders to the client to perform regularly scheduled
462.17treatments and exercises;
462.18(5) preparing modified diets ordered by a licensed health professional; and
462.19(6) assisting with laundry, housekeeping, meal preparation, shopping, or other
462.20household chores and services if the provider is also providing at least one of the activities
462.21in clauses (1) to (5)
462.22    Subd. 7. Comprehensive home care license provider. Home care services that
462.23may be provided with a comprehensive home care license include any of the basic home
462.24care services listed in subdivision 6, and one or more of the following:
462.25(1) services of an advanced practice nurse, registered nurse, licensed practical
462.26nurse, physical therapist, respiratory therapist, occupational therapist, speech-language
462.27pathologist, dietitian or nutritionist, or social worker;
462.28(2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a
462.29licensed health professional within the person's scope of practice;
462.30(3) medication management services;
462.31(4) hands-on assistance with transfers and mobility;
462.32(5) assisting clients with eating when the clients have complicating eating problems
462.33as identified in the client record or through an assessment such as difficulty swallowing,
462.34recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous
462.35instruments to be fed; or
462.36(6) providing other complex or specialty health care services.
463.1    Subd. 8. Exemptions from home care services licensure. (a) Except as otherwise
463.2provided in this chapter, home care services that are provided by the state, counties, or
463.3other units of government must be licensed under this chapter.
463.4(b) An exemption under this subdivision does not excuse the exempted individual or
463.5organization from complying with applicable provisions of the home care bill of rights
463.6in section 144A.44. The following individuals or organizations are exempt from the
463.7requirement to obtain a home care provider license:
463.8(1) an individual or organization that offers, provides, or arranges for personal care
463.9assistance services under the medical assistance program as authorized under sections
463.10256B.04, subdivision 16; 256B.0625, subdivision 19a; and 256B.0659;
463.11(2) a provider that is licensed by the commissioner of human services to provide
463.12semi-independent living services for persons with developmental disabilities under section
463.13252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020;
463.14(3) a provider that is licensed by the commissioner of human services to provide
463.15home and community-based services for persons with developmental disabilities under
463.16section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930;
463.17(4) an individual or organization that provides only home management services, if
463.18the individual or organization is registered under section 144A.482; or
463.19(5) an individual who is licensed in this state as a nurse, dietitian, social worker,
463.20occupational therapist, physical therapist, or speech-language pathologist who provides
463.21health care services in the home independently and not through any contractual or
463.22employment relationship with a home care provider or other organization.
463.23    Subd. 9. Exclusions from home care licensure. The following are excluded from
463.24home care licensure and are not required to provide the home care bill of rights:
463.25(1) an individual or business entity providing only coordination of home care that
463.26includes one or more of the following:
463.27(i) determination of whether a client needs home care services, or assisting a client
463.28in determining what services are needed;
463.29(ii) referral of clients to a home care provider;
463.30(iii) administration of payments for home care services; or
463.31(iv) administration of a health care home established under section 256B.0751;
463.32(2) an individual who is not an employee of a licensed home care provider if the
463.33individual:
463.34(i) only provides services as an independent contractor to one or more licensed
463.35home care providers;
463.36(ii) provides no services under direct agreements or contracts with clients; and
464.1(iii) is contractually bound to perform services in compliance with the contracting
464.2home care provider's policies and service plans;
464.3(3) a business that provides staff to home care providers, such as a temporary
464.4employment agency, if the business:
464.5(i) only provides staff under contract to licensed or exempt providers;
464.6(ii) provides no services under direct agreements with clients; and
464.7(iii) is contractually bound to perform services under the contracting home care
464.8provider's direction and supervision;
464.9(4) any home care services conducted by and for the adherents of any recognized
464.10church or religious denomination for its members through spiritual means, or by prayer
464.11for healing;
464.12(5) an individual who only provides home care services to a relative;
464.13(6) an individual not connected with a home care provider that provides assistance
464.14with basic home care needs if the assistance is provided primarily as a contribution and
464.15not as a business;
464.16(7) an individual not connected with a home care provider that shares housing with
464.17and provides primarily housekeeping or homemaking services to an elderly or disabled
464.18person in return for free or reduced-cost housing;
464.19(8) an individual or provider providing home-delivered meal services;
464.20(9) an individual providing senior companion services and other older American
464.21volunteer programs (OAVP) established under the Domestic Volunteer Service Act of
464.221973, United States Code, title 42, chapter 66;
464.23(10) an employee of a nursing home licensed under this chapter or an employee of a
464.24boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
464.25emergency calls from individuals residing in a residential setting that is attached to or
464.26located on property contiguous to the nursing home or boarding care home;
464.27(11) a member of a professional corporation organized under chapter 319B that
464.28does not regularly offer or provide home care services as defined in section 144A.43,
464.29subdivision 3;
464.30(12) the following organizations established to provide medical or surgical services
464.31that do not regularly offer or provide home care services as defined in section 144A.43,
464.32subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit
464.33corporation organized under chapter 317A, a partnership organized under chapter 323, or
464.34any other entity determined by the commissioner;
465.1(13) an individual or agency that provides medical supplies or durable medical
465.2equipment, except when the provision of supplies or equipment is accompanied by a
465.3home care service;
465.4(14) a physician licensed under chapter 147;
465.5(15) an individual who provides home care services to a person with a developmental
465.6disability who lives in a place of residence with a family, foster family, or primary caregiver;
465.7(16) a business that only provides services that are primarily instructional and not
465.8medical services or health-related support services;
465.9(17) an individual who performs basic home care services for no more than 14 hours
465.10each calendar week to no more than one client;
465.11(18) an individual or business licensed as hospice as defined in sections 144A.75 to
465.12144A.755 who is not providing home care services independent of hospice service;
465.13(19) activities conducted by the commissioner of health or a board of health as
465.14defined in section 145A.02, subdivision 2, including communicable disease investigations
465.15or testing; or
465.16(20) administering or monitoring a prescribed therapy necessary to control or
465.17prevent a communicable disease, or the monitoring of an individual's compliance with a
465.18health directive as defined in section 144.4172, subdivision 6.

465.19    Sec. 11. [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION
465.20AND RENEWAL.
465.21    Subdivision 1. License applications. Each application for a home care provider
465.22license must include information sufficient to show that the applicant meets the
465.23requirements of licensure, including:
465.24    (1) the applicant's name, e-mail address, physical address, and mailing address,
465.25including the name of the county in which the applicant resides and has a principal
465.26place of business;
465.27(2) the initial license fee in the amount specified in subdivision 7;
465.28(3) the e-mail address, physical address, mailing address, and telephone number of
465.29the principal administrative office;
465.30(4) the e-mail address, physical address, mailing address, and telephone number of
465.31each branch office, if any;
465.32(5) the names, e-mail and mailing addresses, and telephone numbers of all owners
465.33and managerial officials;
466.1(6) documentation of compliance with the background study requirements of section
466.2144A.476 for all persons involved in the management, operation, or control of the home
466.3care provider;
466.4(7) documentation of a background study as required by section 144.057 for any
466.5individual seeking employment, paid or volunteer, with the home care provider;
466.6(8) evidence of workers' compensation coverage as required by sections 176.181
466.7and 176.182;
466.8(9) documentation of liability coverage, if the provider has it;
466.9(10) identification of the license level the provider is seeking;
466.10(11) documentation that identifies the managerial official who is in charge of
466.11day-to-day operations and attestation that the person has reviewed and understands the
466.12home care provider regulations;
466.13(12) documentation that the applicant has designated one or more owners,
466.14managerial officials, or employees as an agent or agents, which shall not affect the legal
466.15responsibility of any other owner or managerial official under this chapter;
466.16(13) the signature of the officer or managing agent on behalf of an entity, corporation,
466.17association, or unit of government;
466.18(14) verification that the applicant has the following policies and procedures in place
466.19so that if a license is issued, the applicant will implement the policies and procedures
466.20and keep them current:
466.21    (i) requirements in sections 626.556, reporting of maltreatment of minors, and
466.22626.557, reporting of maltreatment of vulnerable adults;
466.23(ii) conducting and handling background studies on employees;
466.24(iii) orientation, training, and competency evaluations of home care staff, and a
466.25process for evaluating staff performance;
466.26(iv) handling complaints from clients, family members, or client representatives
466.27regarding staff or services provided by staff;
466.28(v) conducting initial evaluation of clients' needs and the providers' ability to provide
466.29those services;
466.30(vi) conducting initial and ongoing client evaluations and assessments and how
466.31changes in a client's condition are identified, managed, and communicated to staff and
466.32other health care providers as appropriate;
466.33(vii) orientation to and implementation of the home care client bill of rights;
466.34(viii) infection control practices;
466.35(ix) reminders for medications, treatments, or exercises, if provided; and
467.1(x) conducting appropriate screenings, or documentation of prior screenings, to
467.2show that staff are free of tuberculosis, consistent with current United States Centers for
467.3Disease Control and Prevention standards; and
467.4(15) other information required by the department.
467.5    Subd. 2. Comprehensive home care license applications. In addition to the
467.6information and fee required in subdivision 1, applicants applying for a comprehensive
467.7home care license must also provide verification that the applicant has the following
467.8policies and procedures in place so that if a license is issued, the applicant will implement
467.9the policies and procedures in this subdivision and keep them current:
467.10(1) conducting initial and ongoing assessments of the client's needs by a registered
467.11nurse or appropriate licensed health professional, including how changes in the client's
467.12conditions are identified, managed, and communicated to staff and other health care
467.13providers, as appropriate;
467.14(2) ensuring that nurses and licensed health professionals have current and valid
467.15licenses to practice;
467.16(3) medication and treatment management;
467.17(4) delegation of home care tasks by registered nurses or licensed health professionals;
467.18(5) supervision of registered nurses and licensed health professionals; and
467.19(6) supervision of unlicensed personnel performing delegated home care tasks.
467.20    Subd. 3. License renewal. (a) Except as provided in section 144A.475, a license
467.21may be renewed for a period of one year if the licensee satisfies the following:
467.22(1) submits an application for renewal in the format provided by the commissioner
467.23at least 30 days before expiration of the license;
467.24(2) submits the renewal fee in the amount specified in subdivision 7;
467.25(3) has provided home care services within the past 12 months;
467.26(4) complies with sections 144A.43 to 144A.4798;
467.27(5) provides information sufficient to show that the applicant meets the requirements
467.28of licensure, including items required under subdivision 1;
467.29(6) provides verification that all policies under subdivision 1 are current; and
467.30(7) provides any other information deemed necessary by the commissioner.
467.31(b) A renewal applicant who holds a comprehensive home care license must also
467.32provide verification that policies listed under subdivision 2 are current.
467.33    Subd. 4. Multiple units. Multiple units or branches of a licensee must be separately
467.34licensed if the commissioner determines that the units cannot adequately share supervision
467.35and administration of services from the main office.
468.1    Subd. 5. Transfers prohibited; changes in ownership. Any home care license
468.2issued by the commissioner may not be transferred to another party. Before acquiring
468.3ownership of a home care provider business, a prospective applicant must apply for a
468.4new temporary license. A change of ownership is a transfer of operational control to
468.5a different business entity and includes:
468.6(1) transfer of the business to a different or new corporation;
468.7(2) in the case of a partnership, the dissolution or termination of the partnership under
468.8chapter 323A, with the business continuing by a successor partnership or other entity;
468.9(3) relinquishment of control of the provider to another party, including to a contract
468.10management firm that is not under the control of the owner of the business' assets;
468.11(4) transfer of the business by a sole proprietor to another party or entity; or
468.12(5) in the case of a privately held corporation, the change in ownership or control of
468.1350 percent or more of the outstanding voting stock.
468.14    Subd. 6. Notification of changes of information. The temporary licensee or
468.15licensee shall notify the commissioner in writing within ten working days after any
468.16change in the information required in subdivision 1, except the information required in
468.17subdivision 1, clause (5), is required at the time of license renewal.
468.18    Subd. 7. Fees; application, change of ownership, and renewal. (a) An initial
468.19applicant seeking a temporary home care licensure must submit the following application
468.20fee to the commissioner along with a completed application:
468.21(1) for a basic home care provider, $2,100; or
468.22(2) for a comprehensive home care provider, $4,200.
468.23(b) A home care provider who is filing a change of ownership as required under
468.24subdivision 5 must submit the following application fee to the commissioner, along with
468.25the documentation required for the change of ownership:
468.26(1) for a basic home care provider, $2,100; or
468.27(2) for a comprehensive home care provider, $4,200.
468.28(c) A home care provider who is seeking to renew the provider's license shall pay a
468.29fee to the commissioner based on revenues derived from the provision of home care
468.30services during the calendar year prior to the year in which the application is submitted,
468.31according to the following schedule:
468.32License Renewal Fee

468.33	Provider Annual Revenue	Fee
468.34	greater than $1,500,000	$6,625
468.35 468.36	greater than $1,275,000 and no more than $1,500,000	$5,797
469.1 469.2	greater than $1,100,000 and no more than $1,275,000	$4,969
469.3 469.4	greater than $950,000 and no more than $1,100,000	$4,141
469.5 469.6	greater than $850,000 and no more than $950,000	$3,727
469.7 469.8	greater than $750,000 and no more than $850,000	$3,313
469.9 469.10	greater than $650,000 and no more than $750,000	$2,898
469.11 469.12	greater than $550,000 and no more than $650,000	$2,485
469.13 469.14	greater than $450,000 and no more than $550,000	$2,070
469.15 469.16	greater than $350,000 and no more than $450,000	$1,656
469.17 469.18	greater than $250,000 and no more than $350,000	$1,242
469.19 469.20	greater than $100,000 and no more than $250,000	$828
469.21	greater than $50,000 and no more than $100,000	$500
469.22	greater than $25,000 and no more than $50,000	$400
469.23	no more than $25,000	$200

469.24(d) If requested, the home care provider shall provide the commissioner information
469.25to verify the provider's annual revenues or other information as needed, including copies
469.26of documents submitted to the Department of Revenue.
469.27(e) At each annual renewal, a home care provider may elect to pay the highest
469.28renewal fee for its license category, and not provide annual revenue information to the
469.29commissioner.
469.30(f) A temporary license or license applicant, or temporary licensee or licensee that
469.31knowingly provides the commissioner incorrect revenue amounts for the purpose of
469.32paying a lower license fee shall be subject to a civil penalty in the amount of double the
469.33fee the provider should have paid.
469.34(g) Fees and penalties collected under this section shall be deposited in the state
469.35treasury and credited to the special state government revenue fund.
469.36(h) The license renewal fee schedule in this subdivision is effective July 1, 2016.

469.37    Sec. 12. [144A.473] ISSUANCE OF TEMPORARY LICENSE AND LICENSE
469.38RENEWAL.
469.39    Subdivision 1. Temporary license and renewal of license. (a) The department
469.40shall review each application to determine the applicant's knowledge of and compliance
469.41with Minnesota home care regulations. Before granting a temporary license or renewing a
470.1license, the commissioner may further evaluate the applicant or licensee by requesting
470.2additional information or documentation or by conducting an on-site survey of the
470.3applicant to determine compliance with sections 144A.43 to 144A.482.
470.4(b) Within 14 calendar days after receiving an application for a license,
470.5the commissioner shall acknowledge receipt of the application in writing. The
470.6acknowledgment must indicate whether the application appears to be complete or whether
470.7additional information is required before the application will be considered complete.
470.8(c) Within 90 days after receiving a complete application, the commissioner shall
470.9issue a temporary license, renew the license, or deny the license.
470.10(d) The commissioner shall issue a license that contains the home care provider's
470.11name, address, license level, expiration date of the license, and unique license number. All
470.12licenses are valid for one year from the date of issuance.
470.13    Subd. 2. Temporary license. (a) For new license applicants, the commissioner
470.14shall issue a temporary license for either the basic or comprehensive home care level. A
470.15temporary license is effective for one year from the date of issuance. Temporary licensees
470.16must comply with sections 144A.43 to 144A.482.
470.17(b) During the temporary license year, the commissioner shall survey the temporary
470.18licensee after the commissioner is notified or has evidence that the temporary licensee
470.19is providing home care services.
470.20(c) Within five days of beginning the provision of services, the temporary
470.21licensee must notify the commissioner that it is serving clients. The notification to the
470.22commissioner may be mailed or e-mailed to the commissioner at the address provided by
470.23the commissioner. If the temporary licensee does not provide home care services during
470.24the temporary license year, then the temporary license expires at the end of the year and
470.25the applicant must reapply for a temporary home care license.
470.26(d) A temporary licensee may request a change in the level of licensure prior to
470.27being surveyed and granted a license by notifying the commissioner in writing and
470.28providing additional documentation or materials required to update or complete the
470.29changed temporary license application. The applicant must pay the difference between
470.30the application fees when changing from the basic level to the comprehensive level of
470.31licensure. No refund will be made if the provider chooses to change the license application
470.32to the basic level.
470.33(e) If the temporary licensee notifies the commissioner that the licensee has clients
470.34within 45 days prior to the temporary license expiration, the commissioner may extend the
470.35temporary license for up to 60 days in order to allow the commissioner to complete the
470.36on-site survey required under this section and follow-up survey visits.
471.1    Subd. 3. Temporary licensee survey. (a) If the temporary licensee is in substantial
471.2compliance with the survey, the commissioner shall issue either a basic or comprehensive
471.3home care license. If the temporary licensee is not in substantial compliance with the
471.4survey, the commissioner shall not issue a basic or comprehensive license and there will
471.5be no contested hearing right under chapter 14.
471.6(b) If the temporary licensee whose basic or comprehensive license has been denied
471.7disagrees with the conclusions of the commissioner, then the licensee may request a
471.8reconsideration by the commissioner or commissioner's designee. The reconsideration
471.9request process must be conducted internally by the commissioner or commissioner's
471.10designee, and chapter 14 does not apply.
471.11(c) The temporary licensee requesting reconsideration must make the request in
471.12writing and must list and describe the reasons why the licensee disagrees with the decision
471.13to deny the basic or comprehensive home care license.
471.14(d) A temporary licensee whose license is denied must comply with the requirements
471.15for notification and transfer of clients in section 144A.475, subdivision 5.

471.16    Sec. 13. [144A.474] SURVEYS AND INVESTIGATIONS.
471.17    Subdivision 1. Surveys. The commissioner shall conduct surveys of each home
471.18care provider. By June 30, 2016, the commissioner shall conduct a survey of home care
471.19providers on a frequency of at least once every three years. Survey frequency may be
471.20based on the license level, the provider's compliance history, number of clients served,
471.21or other factors as determined by the department deemed necessary to ensure the health,
471.22safety, and welfare of clients and compliance with the law.
471.23    Subd. 2. Types of home care surveys. (a) "Initial full survey" means the survey of
471.24a new temporary licensee conducted after the department is notified or has evidence that
471.25the temporary licensee is providing home care services to determine if the provider is in
471.26compliance with home care requirements. Initial full surveys must be completed within 14
471.27months after the department's issuance of a temporary basic or comprehensive license.
471.28(b) "Core survey" means periodic inspection of home care providers to determine
471.29ongoing compliance with the home care requirements, focusing on the essential health and
471.30safety requirements. Core surveys are available to licensed home care providers who have
471.31been licensed for three years and surveyed at least once in the past three years with the
471.32latest survey having no widespread violations beyond Level 1 as provided in subdivision
471.3311. Providers must also not have had any substantiated licensing complaints, substantiated
471.34complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
471.35Act, or an enforcement action as authorized in section 144A.475 in the past three years.
472.1(1) The core survey for basic home care providers must review compliance in the
472.2following areas:
472.3(i) reporting of maltreatment;
472.4(ii) orientation to and implementation of Home Care Client Bill of Rights;
472.5(iii) statement of home care services;
472.6(iv) initial evaluation of clients and initiation of services;
472.7(v) client review and monitoring;
472.8(vi) service plan implementation and changes to the service plan;
472.9(vii) client complaint and investigative process;
472.10(viii) competency of unlicensed personnel; and
472.11(ix) infection control.
472.12(2) For comprehensive home care providers, the core survey must include everything
472.13in the basic core survey plus these areas:
472.14(i) delegation to unlicensed personnel;
472.15(ii) assessment, monitoring, and reassessment of clients; and
472.16(iii) medication, treatment, and therapy management.
472.17(c) "Full survey" means the periodic inspection of home care providers to determine
472.18ongoing compliance with the home care requirements that cover the core survey areas
472.19and all the legal requirements for home care providers. A full survey is conducted for all
472.20temporary licensees and for providers who do not meet the requirements needed for a core
472.21survey, and when a surveyor identifies unacceptable client health or safety risks during a
472.22core survey. A full survey must include all the tasks identified as part of the core survey
472.23and any additional review deemed necessary by the department, including additional
472.24observation, interviewing, or records review of additional clients and staff.
472.25(d) "Follow-up surveys" means surveys conducted to determine if a home care
472.26provider has corrected deficient issues and systems identified during a core survey, full
472.27survey, or complaint investigation. Follow-up surveys may be conducted via phone,
472.28e-mail, fax, mail, or on-site reviews. Follow-up surveys, other than complaint surveys,
472.29shall be concluded with an exit conference and written information provided on the
472.30process for requesting a reconsideration of the survey results.
472.31(e) Upon receiving information alleging that a home care provider has violated or
472.32is currently violating a requirement of sections 144A.43 to 144A.482, the commissioner
472.33shall investigate the complaint according to sections 144A.51 to 144A.54.
472.34    Subd. 3. Survey process. (a) The survey process for core surveys shall include the
472.35following as applicable to the particular licensee and setting surveyed:
473.1(1) presurvey review of pertinent documents and notification to the ombudsman
473.2for long-term care;
473.3(2) an entrance conference with available staff;
473.4(3) communication with managerial officials or the registered nurse in charge, if
473.5available, and ongoing communication with key staff throughout the survey regarding
473.6information needed by the surveyor, clarifications regarding home care requirements, and
473.7applicable standards of practice;
473.8(4) presentation of written contact information to the provider about the survey staff
473.9conducting the survey, the supervisor, and the process for requesting a reconsideration of
473.10the survey results;
473.11(5) a brief tour of a sample of the housing with services establishments in which the
473.12provider is providing home care services;
473.13(6) a sample selection of home care clients;
473.14(7) information-gathering through client and staff observations, client and staff
473.15interviews, and reviews of records, policies, procedures, practices, and other agency
473.16information;
473.17(8) interviews of clients' family members, if available, with clients' consent when the
473.18client can legally give consent;
473.19(9) except for complaint surveys conducted by the Office of Health Facilities
473.20Complaints, an on-site exit conference, with preliminary findings shared and discussed
473.21with the provider, documentation that an exit conference occurred, and written information
473.22provided on the process for requesting a reconsideration of the survey results; and
473.23(10) postsurvey analysis of findings and formulation of survey results, including
473.24correction orders when applicable.
473.25    Subd. 4. Scheduling surveys. Surveys and investigations shall be conducted
473.26without advance notice to home care providers. Surveyors may contact the home care
473.27provider on the day of a survey to arrange for someone to be available at the survey site.
473.28The contact does not constitute advance notice.
473.29    Subd. 5. Information provided by home care provider. The home care provider
473.30shall provide accurate and truthful information to the department during a survey,
473.31investigation, or other licensing activities.
473.32    Subd. 6. Providing client records. Upon request of a surveyor, home care providers
473.33shall provide a list of current and past clients or client representatives that includes
473.34addresses and telephone numbers and any other information requested about the services
473.35to clients within a reasonable period of time.
474.1    Subd. 7. Contacting and visiting clients. Surveyors may contact or visit a home
474.2care provider's clients to gather information without notice to the home care provider.
474.3Before visiting a client, a surveyor shall obtain the client's or client's representative's
474.4permission by telephone, mail, or in person. Surveyors shall inform all clients or client's
474.5representatives of their right to decline permission for a visit.
474.6    Subd. 8. Correction orders. (a) A correction order may be issued whenever the
474.7commissioner finds upon survey or during a complaint investigation that a home care
474.8provider, a managerial official, or an employee of the provider is not in compliance with
474.9sections 144A.43 to 144A.482. The correction order shall cite the specific statute and
474.10document areas of noncompliance and the time allowed for correction.
474.11(b) The commissioner shall mail copies of any correction order within 30 calendar
474.12days after an exit survey to the last known address of the home care provider. A copy of
474.13each correction order and copies of any documentation supplied to the commissioner shall
474.14be kept on file by the home care provider, and public documents shall be made available
474.15for viewing by any person upon request. Copies may be kept electronically.
474.16(c) By the correction order date, the home care provider must document in the
474.17provider's records any action taken to comply with the correction order. The commissioner
474.18may request a copy of this documentation and the home care provider's action to respond
474.19to the correction order in future surveys, upon a complaint investigation, and as otherwise
474.20needed.
474.21    Subd. 9. Follow-up surveys. For providers that have Level 3 or Level 4 violations,
474.22under subdivision 11, or any violations determined to be widespread, the department shall
474.23conduct a follow-up survey within 90 calendar days of the survey. When conducting a
474.24follow-up survey, the surveyor will focus on whether the previous violations have been
474.25corrected and may also address any new violations that are observed while evaluating the
474.26corrections that have been made. If a new violation is identified on a follow-up survey, no
474.27fine will be imposed unless it is not corrected on the next follow-up survey.
474.28    Subd. 10. Performance incentive. A licensee is eligible for a performance
474.29incentive if there are no violations identified in a core or full survey. The performance
474.30incentive is a ten percent discount on the licensee's next home care renewal license fee.
474.31    Subd. 11. Fines. (a) Fines and enforcement actions under this subdivision may be
474.32assessed based on the level and scope of the violations described in paragraph (c) as follows:
474.33(1) Level 1, no fines or enforcement;
474.34(2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
474.35mechanisms authorized in section 144A.475 for widespread violations;
475.1(3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
475.2mechanisms authorized in section 144A.475; and
475.3(4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the
475.4enforcement mechanisms authorized in section 144A.475.
475.5(b) Correction orders for violations are categorized by both level and scope and
475.6fines shall be assessed as follows:
475.7(1) Level of violation:
475.8(i) Level 1 is a violation that has no potential to cause more than a minimal impact
475.9on the client and does not affect health or safety;
475.10(ii) Level 2 is a violation that did not harm a client's health or safety but had the
475.11potential to have harmed a client's health or safety, but was not likely to cause serious
475.12injury, impairment, or death;
475.13(iii) Level 3 is a violation that harmed a client's health or safety, not including
475.14serious injury, impairment, or death, or a violation that has the potential to lead to serious
475.15injury, impairment, or death; and
475.16(iv) Level 4 is a violation that results in serious injury, impairment, or death.
475.17(2) Scope of violation:
475.18(i) isolated, when one or a limited number of clients are affected or one or a limited
475.19number of staff are involved or the situation has occurred only occasionally;
475.20(ii) pattern, when more than a limited number of clients are affected, more than a
475.21limited number of staff are involved, or the situation has occurred repeatedly but is not
475.22found to be pervasive; and
475.23(iii) widespread, when problems are pervasive or represent a systemic failure that
475.24has affected or has the potential to affect a large portion or all of the clients.
475.25(c) If the commissioner finds that the applicant or a home care provider required
475.26to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the
475.27date specified in the correction order or conditional license resulting from a survey or
475.28complaint investigation, the commissioner may impose a fine. A notice of noncompliance
475.29with a correction order must be mailed to the applicant's or provider's last known address.
475.30The noncompliance notice must list the violations not corrected.
475.31(d) The license holder must pay the fines assessed on or before the payment date
475.32specified. If the license holder fails to fully comply with the order, the commissioner
475.33may issue a second fine or suspend the license until the license holder complies by
475.34paying the fine. A timely appeal shall stay payment of the fine until the commissioner
475.35issues a final order.
476.1(e) A license holder shall promptly notify the commissioner in writing when a
476.2violation specified in the order is corrected. If upon reinspection the commissioner
476.3determines that a violation has not been corrected as indicated by the order, the
476.4commissioner may issue a second fine. The commissioner shall notify the license holder by
476.5mail to the last known address in the licensing record that a second fine has been assessed.
476.6The license holder may appeal the second fine as provided under this subdivision.
476.7(f) A home care provider that has been assessed a fine under this subdivision has a
476.8right to a reconsideration or a hearing under this section and chapter 14.
476.9(g) When a fine has been assessed, the license holder may not avoid payment by
476.10closing, selling, or otherwise transferring the licensed program to a third party. In such an
476.11event, the license holder shall be liable for payment of the fine.
476.12(h) In addition to any fine imposed under this section, the commissioner may assess
476.13costs related to an investigation that results in a final order assessing a fine or other
476.14enforcement action authorized by this chapter.
476.15(i) Fines collected under this subdivision shall be deposited in the state government
476.16special revenue fund and credited to an account separate from the revenue collected under
476.17section 144A.472. Subject to an appropriation by the legislature, the revenue from the
476.18fines collected may be used by the commissioner for special projects to improve home care
476.19in Minnesota as recommended by the advisory council established in section 144A.4799.
476.20    Subd. 12. Reconsideration. (a) The commissioner shall make available to home
476.21care providers a correction order reconsideration process. This process may be used
476.22to challenge the correction order issued, including the level and scope described in
476.23subdivision 11, and any fine assessed. During the correction order reconsideration
476.24request, the issuance for the correction orders under reconsideration are not stayed, but
476.25the department shall post information on the Web site with the correction order that the
476.26licensee has requested a reconsideration and that the review is pending.
476.27(b) A licensed home care provider may request from the commissioner, in writing,
476.28a correction order reconsideration regarding any correction order issued to the provider.
476.29The correction order reconsideration shall not be reviewed by any surveyor, investigator,
476.30or supervisor that participated in the writing or reviewing of the correction order
476.31being disputed. The correction order reconsiderations may be conducted in person, by
476.32telephone, by another electronic form, or in writing, as determined by the commissioner.
476.33The commissioner shall respond in writing to the request from a home care provider
476.34for a correction order reconsideration within 60 days of the date the provider requests a
476.35reconsideration. The commissioner's response shall identify the commissioner's decision
476.36regarding each citation challenged by the home care provider.
477.1(c) The findings of a correction order reconsideration process shall be one or more of
477.2the following:
477.3(1) supported in full, the correction order is supported in full, with no deletion of
477.4findings to the citation;
477.5(2) supported in substance, the correction order is supported, but one or more
477.6findings are deleted or modified without any change in the citation;
477.7(3) correction order cited an incorrect home care licensing requirement, the correction
477.8order is amended by changing the correction order to the appropriate statutory reference;
477.9(4) correction order was issued under an incorrect citation, the correction order is
477.10amended to be issued under the more appropriate correction order citation;
477.11(5) the correction order is rescinded;
477.12(6) fine is amended, it is determined that the fine assigned to the correction order
477.13was applied incorrectly; or
477.14(7) the level or scope of the citation is modified based on the reconsideration.
477.15(d) If the correction order findings are changed by the commissioner, the
477.16commissioner shall update the correction order Web site.
477.17    Subd. 13. Home care surveyor training. (a) Before conducting a home care
477.18survey, each home care surveyor must receive training on the following topics:
477.19(1) Minnesota home care licensure requirements;
477.20(2) Minnesota Home Care Client Bill of Rights;
477.21(3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
477.22(4) principles of documentation;
477.23(5) survey protocol and processes;
477.24(6) Offices of the Ombudsman roles;
477.25(7) Office of Health Facility Complaints;
477.26(8) Minnesota landlord-tenant and housing with services laws;
477.27(9) types of payors for home care services; and
477.28(10) Minnesota Nurse Practice Act for nurse surveyors.
477.29(b) Materials used for the training in paragraph (a) shall be posted on the department
477.30Web site. Requisite understanding of these topics will be reviewed as part of the quality
477.31improvement plan in section 144A.483.

477.32    Sec. 14. [144A.475] ENFORCEMENT.
477.33    Subdivision 1. Conditions. (a) The commissioner may refuse to grant a temporary
477.34license, renew a license, suspend or revoke a license, or impose a conditional license if the
477.35home care provider or owner or managerial official of the home care provider:
478.1(1) is in violation of, or during the term of the license has violated, any of the
478.2requirements in sections 144A.471 to 144A.482;
478.3(2) permits, aids, or abets the commission of any illegal act in the provision of
478.4home care;
478.5(3) performs any act detrimental to the health, safety, and welfare of a client;
478.6(4) obtains the license by fraud or misrepresentation;
478.7(5) knowingly made or makes a false statement of a material fact in the application
478.8for a license or in any other record or report required by this chapter;
478.9(6) denies representatives of the department access to any part of the home care
478.10provider's books, records, files, or employees;
478.11(7) interferes with or impedes a representative of the department in contacting the
478.12home care provider's clients;
478.13(8) interferes with or impedes a representative of the department in the enforcement
478.14of this chapter or has failed to fully cooperate with an inspection, survey, or investigation
478.15by the department;
478.16(9) destroys or makes unavailable any records or other evidence relating to the home
478.17care provider's compliance with this chapter;
478.18(10) refuses to initiate a background study under section 144.057 or 245A.04;
478.19(11) fails to timely pay any fines assessed by the department;
478.20(12) violates any local, city, or township ordinance relating to home care services;
478.21(13) has repeated incidents of personnel performing services beyond their
478.22competency level; or
478.23(14) has operated beyond the scope of the home care provider's license level.
478.24    (b) A violation by a contractor providing the home care services of the home care
478.25provider is a violation by the home care provider.
478.26    Subd. 2. Terms to suspension or conditional license. A suspension or conditional
478.27license designation may include terms that must be completed or met before a suspension
478.28or conditional license designation is lifted. A conditional license designation may include
478.29restrictions or conditions that are imposed on the provider. Terms for a suspension or
478.30conditional license may include one or more of the following and the scope of each will be
478.31determined by the commissioner:
478.32(1) requiring a consultant to review, evaluate, and make recommended changes to
478.33the home care provider's practices and submit reports to the commissioner at the cost of
478.34the home care provider;
479.1(2) requiring supervision of the home care provider or staff practices at the cost
479.2of the home care provider by an unrelated person who has sufficient knowledge and
479.3qualifications to oversee the practices and who will submit reports to the commissioner;
479.4(3) requiring the home care provider or employees to obtain training at the cost of
479.5the home care provider;
479.6(4) requiring the home care provider to submit reports to the commissioner;
479.7(5) prohibiting the home care provider from taking any new clients for a period
479.8of time; or
479.9(6) any other action reasonably required to accomplish the purpose of this
479.10subdivision and section 144A.45, subdivision 2.
479.11    Subd. 3. Notice. Prior to any suspension, revocation, or refusal to renew a license,
479.12the home care provider shall be entitled to notice and a hearing as provided by sections
479.1314.57 to 14.69. In addition to any other remedy provided by law, the commissioner may,
479.14without a prior contested case hearing, temporarily suspend a license or prohibit delivery
479.15of services by a provider for not more than 90 days if the commissioner determines that
479.16the health or safety of a consumer is in imminent danger, provided:
479.17(1) advance notice is given to the home care provider;
479.18(2) after notice, the home care provider fails to correct the problem;
479.19(3) the commissioner has reason to believe that other administrative remedies are not
479.20likely to be effective; and
479.21(4) there is an opportunity for a contested case hearing within the 90 days.
479.22    Subd. 4. Time limits for appeals. To appeal the assessment of civil penalties
479.23under section 144A.45, subdivision 2, clause (5), and an action against a license under
479.24this section, a provider must request a hearing no later than 15 days after the provider
479.25receives notice of the action.
479.26    Subd. 5. Plan required. (a) The process of suspending or revoking a license
479.27must include a plan for transferring affected clients to other providers by the home care
479.28provider, which will be monitored by the commissioner. Within three business days of
479.29being notified of the final revocation or suspension action, the home care provider shall
479.30provide the commissioner, the lead agencies as defined in section 256B.0911, and the
479.31ombudsman for long-term care with the following information:
479.32(1) a list of all clients, including full names and all contact information on file;
479.33(2) a list of each client's representative or emergency contact person, including full
479.34names and all contact information on file;
479.35(3) the location or current residence of each client;
480.1(4) the payor sources for each client, including payor source identification numbers;
480.2and
480.3(5) for each client, a copy of the client's service plan, and a list of the types of
480.4services being provided.
480.5(b) The revocation or suspension notification requirement is satisfied by mailing the
480.6notice to the address in the license record. The home care provider shall cooperate with
480.7the commissioner and the lead agencies during the process of transferring care of clients to
480.8qualified providers. Within three business days of being notified of the final revocation or
480.9suspension action, the home care provider must notify and disclose to each of the home
480.10care provider's clients, or the client's representative or emergency contact persons, that
480.11the commissioner is taking action against the home care provider's license by providing a
480.12copy of the revocation or suspension notice issued by the commissioner.
480.13    Subd. 6. Owners and managerial officials; refusal to grant license. (a) The
480.14owner and managerial officials of a home care provider whose Minnesota license has not
480.15been renewed or that has been revoked because of noncompliance with applicable laws or
480.16rules shall not be eligible to apply for nor will be granted a home care license, including
480.17other licenses under this chapter, or be given status as an enrolled personal care assistance
480.18provider agency or personal care assistant by the Department of Human Services under
480.19section 256B.0659 for five years following the effective date of the nonrenewal or
480.20revocation. If the owner and managerial officials already have enrollment status, their
480.21enrollment will be terminated by the Department of Human Services.
480.22(b) The commissioner shall not issue a license to a home care provider for five
480.23years following the effective date of license nonrenewal or revocation if the owner or
480.24managerial official, including any individual who was an owner or managerial official
480.25of another home care provider, had a Minnesota license that was not renewed or was
480.26revoked as described in paragraph (a).
480.27(c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall
480.28suspend or revoke, the license of any home care provider that includes any individual
480.29as an owner or managerial official who was an owner or managerial official of a home
480.30care provider whose Minnesota license was not renewed or was revoked as described in
480.31paragraph (a) for five years following the effective date of the nonrenewal or revocation.
480.32(d) The commissioner shall notify the home care provider 30 days in advance of
480.33the date of nonrenewal, suspension, or revocation of the license. Within ten days after
480.34the receipt of the notification, the home care provider may request, in writing, that the
480.35commissioner stay the nonrenewal, revocation, or suspension of the license. The home
480.36care provider shall specify the reasons for requesting the stay; the steps that will be taken
481.1to attain or maintain compliance with the licensure laws and regulations; any limits on the
481.2authority or responsibility of the owners or managerial officials whose actions resulted in
481.3the notice of nonrenewal, revocation, or suspension; and any other information to establish
481.4that the continuing affiliation with these individuals will not jeopardize client health, safety,
481.5or well-being. The commissioner shall determine whether the stay will be granted within
481.630 days of receiving the provider's request. The commissioner may propose additional
481.7restrictions or limitations on the provider's license and require that the granting of the stay
481.8be contingent upon compliance with those provisions. The commissioner shall take into
481.9consideration the following factors when determining whether the stay should be granted:
481.10(1) the threat that continued involvement of the owners and managerial officials with
481.11the home care provider poses to client health, safety, and well-being;
481.12(2) the compliance history of the home care provider; and
481.13(3) the appropriateness of any limits suggested by the home care provider.
481.14    If the commissioner grants the stay, the order shall include any restrictions or
481.15limitation on the provider's license. The failure of the provider to comply with any
481.16restrictions or limitations shall result in the immediate removal of the stay and the
481.17commissioner shall take immediate action to suspend, revoke, or not renew the license.
481.18    Subd. 7. Request for hearing. A request for a hearing must be in writing and must:
481.19(1) be mailed or delivered to the department or the commissioner's designee;
481.20(2) contain a brief and plain statement describing every matter or issue contested; and
481.21(3) contain a brief and plain statement of any new matter that the applicant or home
481.22care provider believes constitutes a defense or mitigating factor.
481.23    Subd. 8. Informal conference. At any time, the applicant or home care provider
481.24and the commissioner may hold an informal conference to exchange information, clarify
481.25issues, or resolve issues.
481.26    Subd. 9. Injunctive relief. In addition to any other remedy provided by law, the
481.27commissioner may bring an action in district court to enjoin a person who is involved in
481.28the management, operation, or control of a home care provider or an employee of the
481.29home care provider from illegally engaging in activities regulated by sections 144A.43 to
481.30144A.482. The commissioner may bring an action under this subdivision in the district
481.31court in Ramsey County or in the district in which a home care provider is providing
481.32services. The court may grant a temporary restraining order in the proceeding if continued
481.33activity by the person who is involved in the management, operation, or control of a home
481.34care provider, or by an employee of the home care provider, would create an imminent
481.35risk of harm to a recipient of home care services.
482.1    Subd. 10. Subpoena. In matters pending before the commissioner under sections
482.2144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance
482.3of witnesses and the production of all necessary papers, books, records, documents, and
482.4other evidentiary material. If a person fails or refuses to comply with a subpoena or
482.5order of the commissioner to appear or testify regarding any matter about which the
482.6person may be lawfully questioned or to produce any papers, books, records, documents,
482.7or evidentiary materials in the matter to be heard, the commissioner may apply to the
482.8district court in any district, and the court shall order the person to comply with the
482.9commissioner's order or subpoena. The commissioner of health may administer oaths to
482.10witnesses or take their affirmation. Depositions may be taken in or outside the state in the
482.11manner provided by law for the taking of depositions in civil actions. A subpoena or other
482.12process or paper may be served on a named person anywhere in the state by an officer
482.13authorized to serve subpoenas in civil actions, with the same fees and mileage and in the
482.14same manner as prescribed by law for a process issued out of a district court. A person
482.15subpoenaed under this subdivision shall receive the same fees, mileage, and other costs
482.16that are paid in proceedings in district court.

482.17    Sec. 15. [144A.476] BACKGROUND STUDIES.
482.18    Subdivision 1. Prior criminal convictions; owner and managerial officials. (a)
482.19Before the commissioner issues a temporary license or renews a license, an owner or
482.20managerial official is required to complete a background study under section 144.057. No
482.21person may be involved in the management, operation, or control of a home care provider
482.22if the person has been disqualified under chapter 245C. If an individual is disqualified
482.23under section 144.057 or chapter 245C, the individual may request reconsideration of
482.24the disqualification. If the individual requests reconsideration and the commissioner
482.25sets aside or rescinds the disqualification, the individual is eligible to be involved in the
482.26management, operation, or control of the provider. If an individual has a disqualification
482.27under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's
482.28disqualification is barred from a set aside, and the individual must not be involved in the
482.29management, operation, or control of the provider.
482.30(b) For purposes of this section, owners of a home care provider subject to the
482.31background check requirement are those individuals whose ownership interest provides
482.32sufficient authority or control to affect or change decisions related to the operation of the
482.33home care provider. An owner includes a sole proprietor, a general partner, or any other
482.34individual whose individual ownership interest can affect the management and direction
482.35of the policies of the home care provider.
483.1(c) For the purposes of this section, managerial officials subject to the background
483.2check requirement are individuals who provide direct contact as defined in section
483.3245C.02, subdivision 11, or individuals who have the responsibility for the ongoing
483.4management or direction of the policies, services, or employees of the home care provider.
483.5Data collected under this subdivision shall be classified as private data on individuals
483.6under section 13.02, subdivision 12.
483.7(d) The department shall not issue any license if the applicant or owner or managerial
483.8official has been unsuccessful in having a background study disqualification set aside
483.9under section 144.057 and chapter 245C; if the owner or managerial official, as an owner
483.10or managerial official of another home care provider, was substantially responsible for
483.11the other home care provider's failure to substantially comply with sections 144A.43 to
483.12144A.482; or if an owner that has ceased doing business, either individually or as an
483.13owner of a home care provider, was issued a correction order for failing to assist clients in
483.14violation of this chapter.
483.15    Subd. 2. Employees, contractors, and volunteers. (a) Employees, contractors,
483.16and volunteers of a home care provider are subject to the background study required by
483.17section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall
483.18be construed to prohibit a home care provider from requiring self-disclosure of criminal
483.19conviction information.
483.20(b) Termination of an employee in good faith reliance on information or records
483.21obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not
483.22subject the home care provider to civil liability or liability for unemployment benefits.

483.23    Sec. 16. [144A.477] COMPLIANCE.
483.24    Subdivision 1. Medicare-certified providers; coordination of surveys. If feasible,
483.25the commissioner shall survey licensees to determine compliance with this chapter at the
483.26same time as surveys for certification for Medicare if Medicare certification is based on
483.27compliance with the federal conditions of participation and on survey and enforcement
483.28by the Department of Health as agent for the United States Department of Health and
483.29Human Services.
483.30    Subd. 2. Medicare-certified providers; equivalent requirements. For home care
483.31providers licensed to provide comprehensive home care services that are also certified for
483.32participation in Medicare as a home health agency under Code of Federal Regulations,
483.33title 42, part 484, the following state licensure regulations are considered equivalent to
483.34the federal requirements:
483.35(1) quality management, section 144A.479, subdivision 3;
484.1(2) personnel records, section 144A.479, subdivision 7;
484.2(3) acceptance of clients, section 144A.4791, subdivision 4;
484.3(4) referrals, section 144A.4791, subdivision 5;
484.4(5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792,
484.5subdivisions 2 and 3;
484.6(6) individualized monitoring and reassessment, sections 144A.4791, subdivision
484.78, and 144A.4792, subdivisions 2 and 3;
484.8(7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792,
484.9subdivision 5, and 144A.4793, subdivision 3;
484.10(8) client complaint and investigation process, section 144A.4791, subdivision 11;
484.11(9) prescription orders, section 144A.4792, subdivisions 13 to 16;
484.12(10) client records, section 144A.4794, subdivisions 1 to 3;
484.13(11) qualifications for unlicensed personnel performing delegated tasks, section
484.14144A.4795;
484.15(12) training and competency staff, section 144A.4795;
484.16(13) training and competency for unlicensed personnel, section 144A.4795,
484.17subdivision 7;
484.18(14) delegation of home care services, section 144A.4795, subdivision 4;
484.19(15) availability of contact person, section 144A.4797, subdivision 1; and
484.20(16) supervision of staff, section 144A.4797, subdivisions 2 and 3.
484.21Violations of requirements in clauses (1) to (16) may lead to enforcement actions
484.22under section 144A.474.

484.23    Sec. 17. [144A.478] INNOVATION VARIANCE.
484.24    Subdivision 1. Definition. For purposes of this section, "innovation variance"
484.25means a specified alternative to a requirement of this chapter. An innovation variance
484.26may be granted to allow a home care provider to offer home care services of a type or
484.27in a manner that is innovative, will not impair the services provided, will not adversely
484.28affect the health, safety, or welfare of the clients, and is likely to improve the services
484.29provided. The innovative variance cannot change any of the client's rights under section
484.30144A.44, home care bill of rights.
484.31    Subd. 2. Conditions. The commissioner may impose conditions on the granting of
484.32an innovation variance that the commissioner considers necessary.
484.33    Subd. 3. Duration and renewal. The commissioner may limit the duration of any
484.34innovation variance and may renew a limited innovation variance.
485.1    Subd. 4. Applications; innovation variance. An application for innovation
485.2variance from the requirements of this chapter may be made at any time, must be made in
485.3writing to the commissioner, and must specify the following:
485.4(1) the statute or law from which the innovation variance is requested;
485.5(2) the time period for which the innovation variance is requested;
485.6(3) the specific alternative action that the licensee proposes;
485.7(4) the reasons for the request; and
485.8(5) justification that an innovation variance will not impair the services provided,
485.9will not adversely affect the health, safety, or welfare of clients, and is likely to improve
485.10the services provided.
485.11The commissioner may require additional information from the home care provider before
485.12acting on the request.
485.13    Subd. 5. Grants and denials. The commissioner shall grant or deny each request
485.14for an innovation variance in writing within 45 days of receipt of a complete request.
485.15Notice of a denial shall contain the reasons for the denial. The terms of a requested
485.16innovation variance may be modified upon agreement between the commissioner and
485.17the home care provider.
485.18    Subd. 6. Violation of innovation variances. A failure to comply with the terms of
485.19an innovation variance shall be deemed to be a violation of this chapter.
485.20    Subd. 7. Revocation or denial of renewal. The commissioner shall revoke or
485.21deny renewal of an innovation variance if:
485.22(1) it is determined that the innovation variance is adversely affecting the health,
485.23safety, or welfare of the licensee's clients;
485.24(2) the home care provider has failed to comply with the terms of the innovation
485.25variance;
485.26(3) the home care provider notifies the commissioner in writing that it wishes to
485.27relinquish the innovation variance and be subject to the statute previously varied; or
485.28(4) the revocation or denial is required by a change in law.

485.29    Sec. 18. [144A.479] HOME CARE PROVIDER RESPONSIBILITIES;
485.30BUSINESS OPERATION.
485.31    Subdivision 1. Display of license. The original current license must be displayed
485.32in the home care providers' principal business office and copies must be displayed in
485.33any branch office. The home care provider must provide a copy of the license to any
485.34person who requests it.
486.1    Subd. 2. Advertising. Home care providers shall not use false, fraudulent,
486.2or misleading advertising in the marketing of services. For purposes of this section,
486.3advertising includes any verbal, written, or electronic means of communicating to
486.4potential clients about the availability, nature, or terms of home care services.
486.5    Subd. 3. Quality management. The home care provider shall engage in quality
486.6management appropriate to the size of the home care provider and relevant to the type
486.7of services the home care provider provides. The quality management activity means
486.8evaluating the quality of care by periodically reviewing client services, complaints made,
486.9and other issues that have occurred and determining whether changes in services, staffing,
486.10or other procedures need to be made in order to ensure safe and competent services to
486.11clients. Documentation about quality management activity must be available for two
486.12years. Information about quality management must be available to the commissioner at
486.13the time of the survey, investigation, or renewal.
486.14    Subd. 4. Provider restrictions. (a) This subdivision does not apply to licensees
486.15that are Minnesota counties or other units of government.
486.16(b) A home care provider or staff cannot accept powers-of-attorney from clients for
486.17any purpose, and may not accept appointments as guardians or conservators of clients.
486.18(c) A home care provider cannot serve as a client's representative.
486.19    Subd. 5. Handling of client's finances and property. (a) A home care provider
486.20may assist clients with household budgeting, including paying bills and purchasing
486.21household goods, but may not otherwise manage a client's property. A home care provider
486.22must provide a client with receipts for all transactions and purchases paid with the client's
486.23funds. When receipts are not available, the transaction or purchase must be documented.
486.24A home care provider must maintain records of all such transactions.
486.25(b) A home care provider or staff may not borrow a client's funds or personal or
486.26real property, nor in any way convert a client's property to the home care provider's or
486.27staff's possession.
486.28(c) Nothing in this section precludes a home care provider or staff from accepting
486.29gifts of minimal value, or precludes the acceptance of donations or bequests made to a
486.30home care provider that are exempt from income tax under section 501(c) of the Internal
486.31Revenue Code of 1986.
486.32    Subd. 6. Reporting maltreatment of vulnerable adults and minors. (a) All home
486.33care providers must comply with requirements for the reporting of maltreatment of minors
486.34in section 626.556 and the requirements for the reporting of maltreatment of vulnerable
486.35adults in section 626.557. Each home care provider must establish and implement a
486.36written procedure to ensure that all cases of suspected maltreatment are reported.
487.1(b) Each home care provider must develop and implement an individual abuse
487.2prevention plan for each vulnerable minor or adult for whom home care services are
487.3provided by a home care provider. The plan shall contain an individualized review or
487.4assessment of the person's susceptibility to abuse by another individual, including other
487.5vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors;
487.6and statements of the specific measures to be taken to minimize the risk of abuse to that
487.7person and other vulnerable adults or minors. For purposes of the abuse prevention plan,
487.8the term abuse includes self-abuse.
487.9    Subd. 7. Employee records. The home care provider must maintain current records
487.10of each paid employee, regularly scheduled volunteers providing home care services, and
487.11of each individual contractor providing home care services. The records must include
487.12the following information:
487.13(1) evidence of current professional licensure, registration, or certification, if
487.14licensure, registration, or certification is required by this statute, or other rules;
487.15(2) records of orientation, required annual training and infection control training,
487.16and competency evaluations;
487.17(3) current job description, including qualifications, responsibilities, and
487.18identification of staff providing supervision;
487.19(4) documentation of annual performance reviews which identify areas of
487.20improvement needed and training needs;
487.21(5) for individuals providing home care services, verification that required health
487.22screenings under section 144A.4798 have taken place and the dates of those screenings; and
487.23(6) documentation of the background study as required under section 144.057.
487.24Each employee record must be retained for at least three years after a paid employee,
487.25home care volunteer, or contractor ceases to be employed by or under contract with the
487.26home care provider. If a home care provider ceases operation, employee records must be
487.27maintained for three years.

487.28    Sec. 19. [144A.4791] HOME CARE PROVIDER RESPONSIBILITIES WITH
487.29RESPECT TO CLIENTS.
487.30    Subdivision 1. Home care bill of rights; notification to client. (a) The home care
487.31provider shall provide the client or the client's representative a written notice of the rights
487.32under section 144A.44 before the initiation of services to that client. The provider shall
487.33make all reasonable efforts to provide notice of the rights to the client or the client's
487.34representative in a language the client or client's representative can understand.
488.1(b) In addition to the text of the home care bill of rights in section 144A.44,
488.2subdivision 1, the notice shall also contain the following statement describing how to file
488.3a complaint with these offices.
488.4"If you have a complaint about the provider or the person providing your
488.5home care services, you may call, write, or visit the Office of Health Facility
488.6Complaints, Minnesota Department of Health. You may also contact the Office of
488.7Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health
488.8and Developmental Disabilities."
488.9The statement should include the telephone number, Web site address, e-mail
488.10address, mailing address, and street address of the Office of Health Facility Complaints at
488.11the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care,
488.12and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The
488.13statement should also include the home care provider's name, address, e-mail, telephone
488.14number, and name or title of the person at the provider to whom problems or complaints
488.15may be directed. It must also include a statement that the home care provider will not
488.16retaliate because of a complaint.
488.17(c) The home care provider shall obtain written acknowledgment of the client's
488.18receipt of the home care bill of rights or shall document why an acknowledgment cannot
488.19be obtained. The acknowledgment may be obtained from the client or the client's
488.20representative. Acknowledgment of receipt shall be retained in the client's record.
488.21    Subd. 2. Notice of services for dementia, Alzheimer's disease, or related
488.22disorders. The home care provider that provides services to clients with dementia shall
488.23provide in written or electronic form, to clients and families or other persons who request
488.24it, a description of the training program and related training it provides, including the
488.25categories of employees trained, the frequency of training, and the basic topics covered.
488.26This information satisfies the disclosure requirements in section 325F.72, subdivision
488.272, clause (4).
488.28    Subd. 3. Statement of home care services. Prior to the initiation of services,
488.29a home care provider must provide to the client or the client's representative a written
488.30statement which identifies if the provider has a basic or comprehensive home care license,
488.31the services the provider is authorized to provide, and which services the provider cannot
488.32provide under the scope of the provider's license. The home care provider shall obtain
488.33written acknowledgment from the clients that the provider has provided the statement or
488.34must document why the provider could not obtain the acknowledgment.
488.35    Subd. 4. Acceptance of clients. No home care provider may accept a person as a
488.36client unless the home care provider has staff, sufficient in qualifications, competency,
489.1and numbers, to adequately provide the services agreed to in the service plan and that
489.2are within the provider's scope of practice.
489.3    Subd. 5. Referrals. If a home care provider reasonably believes that a client is in
489.4need of another medical or health service, including a licensed health professional, or
489.5social service provider, the home care provider shall:
489.6(1) determine the client's preferences with respect to obtaining the service; and
489.7(2) inform the client of resources available, if known, to assist the client in obtaining
489.8services.
489.9    Subd. 6. Initiation of services. When a provider initiates services and the
489.10individualized review or assessment required in subdivisions 7 and 8 has not been
489.11completed, the provider must complete a temporary plan and agreement with the client for
489.12services.
489.13    Subd. 7. Basic individualized client review and monitoring. (a) When services
489.14being provided are basic home care services, an individualized initial review of the client's
489.15needs and preferences must be conducted at the client's residence with the client or client's
489.16representative. This initial review must be completed within 30 days after the initiation of
489.17the home care services.
489.18(b) Client monitoring and review must be conducted as needed based on changes
489.19in the needs of the client and cannot exceed 90 days from the date of the last review.
489.20The monitoring and review may be conducted at the client's residence or through the
489.21utilization of telecommunication methods based on practice standards that meet the
489.22individual client's needs.
489.23    Subd. 8. Comprehensive assessment, monitoring, and reassessment. (a) When
489.24the services being provided are comprehensive home care services, an individualized
489.25initial assessment must be conducted in-person by a registered nurse. When the services
489.26are provided by other licensed health professionals, the assessment must be conducted by
489.27the appropriate health professional. This initial assessment must be completed within five
489.28days after initiation of home care services.
489.29(b) Client monitoring and reassessment must be conducted in the client's home no
489.30more than 14 days after initiation of services.
489.31(c) Ongoing client monitoring and reassessment must be conducted as needed based
489.32on changes in the needs of the client and cannot exceed 90 days from the last date of the
489.33assessment. The monitoring and reassessment may be conducted at the client's residence
489.34or through the utilization of telecommunication methods based on practice standards that
489.35meet the individual client's needs.
490.1    Subd. 9. Service plan, implementation, and revisions to service plan. (a) No later
490.2than 14 days after the initiation of services, a home care provider shall finalize a current
490.3written service plan.
490.4(b) The service plan and any revisions must include a signature or other
490.5authentication by the home care provider and by the client or the client's representative
490.6documenting agreement on the services to be provided. The service plan must be revised,
490.7if needed, based on client review or reassessment under subdivisions 7 and 8. The provider
490.8must provide information to the client about changes to the provider's fee for services and
490.9how to contact the Office of the Ombudsman for Long-Term Care.
490.10(c) The home care provider must implement and provide all services required by
490.11the current service plan.
490.12(d) The service plan and revised service plan must be entered into the client's record,
490.13including notice of a change in a client's fees when applicable.
490.14(e) Staff providing home care services must be informed of the current written
490.15service plan.
490.16(f) The service plan must include:
490.17(1) a description of the home care services to be provided, the fees for services, and
490.18the frequency of each service, according to the client's current review or assessment and
490.19client preferences;
490.20(2) the identification of the staff or categories of staff who will provide the services;
490.21(3) the schedule and methods of monitoring reviews or assessments of the client;
490.22(4) the frequency of sessions of supervision of staff and type of personnel who
490.23will supervise staff; and
490.24(5) a contingency plan that includes:
490.25(i) the action to be taken by the home care provider and by the client or client's
490.26representative if the scheduled service cannot be provided;
490.27(ii) information and method for a client or client's representative to contact the
490.28home care provider;
490.29(iii) names and contact information of persons the client wishes to have notified
490.30in an emergency or if there is a significant adverse change in the client's condition,
490.31including identification of and information as to who has authority to sign for the client in
490.32an emergency; and
490.33(iv) the circumstances in which emergency medical services are not to be summoned
490.34consistent with chapters 145B and 145C, and declarations made by the client under those
490.35chapters.
491.1    Subd. 10. Termination of service plan. (a) If a home care provider terminates a
491.2service plan with a client, and the client continues to need home care services, the home
491.3care provider shall provide the client and the client's representative, if any, with a written
491.4notice of termination which includes the following information:
491.5(1) the effective date of termination;
491.6(2) the reason for termination;
491.7(3) a list of known licensed home care providers in the client's immediate geographic
491.8area;
491.9(4) a statement that the home care provider will participate in a coordinated transfer
491.10of care of the client to another home care provider, health care provider, or caregiver, as
491.11required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
491.12(5) the name and contact information of a person employed by the home care
491.13provider with whom the client may discuss the notice of termination; and
491.14(6) if applicable, a statement that the notice of termination of home care services
491.15does not constitute notice of termination of the housing with services contract with a
491.16housing with services establishment.
491.17(b) When the home care provider voluntarily discontinues services to all clients, the
491.18home care provider must notify the commissioner, lead agencies, and the ombudsman for
491.19long-term care about its clients and comply with the requirements in this subdivision.
491.20    Subd. 11. Client complaint and investigative process. (a) The home care
491.21provider must have a written policy and system for receiving, investigating, reporting,
491.22and attempting to resolve complaints from its clients or clients' representatives. The
491.23policy should clearly identify the process by which clients may file a complaint or concern
491.24about home care services and an explicit statement that the home care provider will not
491.25discriminate or retaliate against a client for expressing concerns or complaints. A home
491.26care provider must have a process in place to conduct investigations of complaints made
491.27by the client or the client's representative about the services in the client's plan that are or
491.28are not being provided or other items covered in the client's home care bill of rights. This
491.29complaint system must provide reasonable accommodations for any special needs of the
491.30client or client's representative if requested.
491.31(b) The home care provider must document the complaint, name of the client,
491.32investigation, and resolution of each complaint filed. The home care provider must
491.33maintain a record of all activities regarding complaints received, including the date the
491.34complaint was received, and the home care provider's investigation and resolution of the
491.35complaint. This complaint record must be kept for each event for at least two years after
491.36the date of entry and must be available to the commissioner for review.
492.1(c) The required complaint system must provide for written notice to each client or
492.2client's representative that includes:
492.3(1) the client's right to complain to the home care provider about the services received;
492.4(2) the name or title of the person or persons with the home care provider to contact
492.5with complaints;
492.6(3) the method of submitting a complaint to the home care provider; and
492.7(4) a statement that the provider is prohibited against retaliation according to
492.8paragraph (d).
492.9(d) A home care provider must not take any action that negatively affects a client
492.10in retaliation for a complaint made or a concern expressed by the client or the client's
492.11representative.
492.12    Subd. 12. Disaster planning and emergency preparedness plan. The home care
492.13provider must have a written plan of action to facilitate the management of the client's care
492.14and services in response to a natural disaster, such as flood and storms, or other emergencies
492.15that may disrupt the home care provider's ability to provide care or services. The licensee
492.16must provide adequate orientation and training of staff on emergency preparedness.
492.17    Subd. 13. Request for discontinuation of life-sustaining treatment. (a) If a
492.18client, family member, or other caregiver of the client requests that an employee or other
492.19agent of the home care provider discontinue a life-sustaining treatment, the employee or
492.20agent receiving the request:
492.21(1) shall take no action to discontinue the treatment; and
492.22(2) shall promptly inform the supervisor or other agent of the home care provider of
492.23the client's request.
492.24(b) Upon being informed of a request for termination of treatment, the home care
492.25provider shall promptly:
492.26(1) inform the client that the request will be made known to the physician who
492.27ordered the client's treatment;
492.28(2) inform the physician of the client's request; and
492.29(3) work with the client and the client's physician to comply with the provisions of
492.30the Health Care Directive Act in chapter 145C.
492.31(c) This section does not require the home care provider to discontinue treatment,
492.32except as may be required by law or court order.
492.33(d) This section does not diminish the rights of clients to control their treatments,
492.34refuse services, or terminate their relationships with the home care provider.
492.35(e) This section shall be construed in a manner consistent with chapter 145B or
492.36145C, whichever applies, and declarations made by clients under those chapters.

493.1    Sec. 20. [144A.4792] MEDICATION MANAGEMENT.
493.2    Subdivision 1. Medication management services; comprehensive home care
493.3license. (a) This subdivision applies only to home care providers with a comprehensive
493.4home care license that provide medication management services to clients. Medication
493.5management services may not be provided by a home care provider who has a basic
493.6home care license.
493.7(b) A comprehensive home care provider who provides medication management
493.8services must develop, implement, and maintain current written medication management
493.9policies and procedures. The policies and procedures must be developed under the
493.10supervision and direction of a registered nurse, licensed health professional, or pharmacist
493.11consistent with current practice standards and guidelines.
493.12(c) The written policies and procedures must address requesting and receiving
493.13prescriptions for medications; preparing and giving medications; verifying that
493.14prescription drugs are administered as prescribed; documenting medication management
493.15activities; controlling and storing medications; monitoring and evaluating medication use;
493.16resolving medication errors; communicating with the prescriber, pharmacist, and client
493.17and client representative, if any; disposing of unused medications; and educating clients
493.18and client representatives about medications. When controlled substances are being
493.19managed, the policies and procedures must also identify how the provider will ensure
493.20security and accountability for the overall management, control, and disposition of those
493.21substances in compliance with state and federal regulations and with subdivision 22.
493.22    Subd. 2. Provision of medication management services. (a) For each client who
493.23requests medication management services, the comprehensive home care provider shall,
493.24prior to providing medication management services, have a registered nurse, licensed
493.25health professional, or authorized prescriber under section 151.37 conduct an assessment
493.26to determine what medication management services will be provided and how the services
493.27will be provided. This assessment must be conducted face-to-face with the client. The
493.28assessment must include an identification and review of all medications the client is known
493.29to be taking. The review and identification must include indications for medications, side
493.30effects, contraindications, allergic or adverse reactions, and actions to address these issues.
493.31(b) The assessment must identify interventions needed in management of
493.32medications to prevent diversion of medication by the client or others who may have
493.33access to the medications. "Diversion of medications" means the misuse, theft, or illegal
493.34or improper disposition of medications.
493.35    Subd. 3. Individualized medication monitoring and reassessment. The
493.36comprehensive home care provider must monitor and reassess the client's medication
494.1management services as needed under subdivision 14 when the client presents with
494.2symptoms or other issues that may be medication-related and, at a minimum, annually.
494.3    Subd. 4. Client refusal. The home care provider must document in the client's
494.4record any refusal for an assessment for medication management by the client. The
494.5provider must discuss with the client the possible consequences of the client's refusal and
494.6document the discussion in the client's record.
494.7    Subd. 5. Individualized medication management plan. (a) For each client
494.8receiving medication management services, the comprehensive home care provider must
494.9prepare and include in the service plan a written statement of the medication management
494.10services that will be provided to the client. The provider must develop and maintain a
494.11current individualized medication management record for each client based on the client's
494.12assessment that must contain the following:
494.13(1) a statement describing the medication management services that will be provided;
494.14(2) a description of storage of medications based on the client's needs and
494.15preferences, risk of diversion, and consistent with the manufacturer's directions;
494.16(3) documentation of specific client instructions relating to the administration
494.17of medications;
494.18(4) identification of persons responsible for monitoring medication supplies and
494.19ensuring that medication refills are ordered on a timely basis;
494.20(5) identification of medication management tasks that may be delegated to
494.21unlicensed personnel;
494.22(6) procedures for staff notifying a registered nurse or appropriate licensed health
494.23professional when a problem arises with medication management services; and
494.24(7) any client-specific requirements relating to documenting medication
494.25administration, verifications that all medications are administered as prescribed, and
494.26monitoring of medication use to prevent possible complications or adverse reactions.
494.27(b) The medication management record must be current and updated when there are
494.28any changes.
494.29    Subd. 6. Administration of medication. Medications may be administered by a
494.30nurse, physician, or other licensed health practitioner authorized to administer medications
494.31or by unlicensed personnel who have been delegated medication administration tasks by
494.32a registered nurse.
494.33    Subd. 7. Delegation of medication administration. When administration of
494.34medications is delegated to unlicensed personnel, the comprehensive home care provider
494.35must ensure that the registered nurse has:
495.1(1) instructed the unlicensed personnel in the proper methods to administer the
495.2medications, and the unlicensed personnel has demonstrated ability to competently follow
495.3the procedures;
495.4(2) specified, in writing, specific instructions for each client and documented those
495.5instructions in the client's records; and
495.6(3) communicated with the unlicensed personnel about the individual needs of
495.7the client.
495.8    Subd. 8. Documentation of administration of medications. Each medication
495.9administered by comprehensive home care provider staff must be documented in the
495.10client's record. The documentation must include the signature and title of the person
495.11who administered the medication. The documentation must include the medication
495.12name, dosage, date and time administered, and method and route of administration. The
495.13staff must document the reason why medication administration was not completed as
495.14prescribed and document any follow-up procedures that were provided to meet the client's
495.15needs when medication was not administered as prescribed and in compliance with the
495.16client's medication management plan.
495.17    Subd. 9. Documentation of medication setup. Documentation of dates of
495.18medication setup, name of medication, quantity of dose, times to be administered, route
495.19of administration, and name of person completing medication setup must be done at
495.20time of setup.
495.21    Subd. 10. Medication management for clients who will be away from home. (a)
495.22A home care provider who is providing medication management services to the client and
495.23controls the client's access to the medications must develop and implement policies and
495.24procedures for giving accurate and current medications to clients for planned or unplanned
495.25times away from home according to the client's individualized medication management
495.26plan. The policy and procedures must state that:
495.27(1) for planned time away, the medications must be obtained from the pharmacy or
495.28set up by the registered nurse according to appropriate state and federal laws and nursing
495.29standards of practice;
495.30(2) for unplanned time away, when the pharmacy is not able to provide the
495.31medications, a licensed nurse or unlicensed personnel shall give the client or client's
495.32representative medications in amounts and dosages needed for the length of the anticipated
495.33absence, not to exceed 120 hours;
495.34(3) the client, or the client's representative, must be provided written information
495.35on medications, including any special instructions for administering or handling the
495.36medications, including controlled substances;
496.1(4) the medications must be placed in a medication container or containers
496.2appropriate to the provider's medication system and must be labeled with the client's name
496.3and the dates and times that the medications are scheduled; and
496.4(5) the client or client's representative must be provided in writing the home care
496.5provider's name and information on how to contact the home care provider.
496.6(b) For unplanned time away when the licensed nurse is not available, the registered
496.7nurse may delegate this task to unlicensed personnel if:
496.8(1) the registered nurse has trained the unlicensed staff and determined the
496.9unlicensed staff is competent to follow the procedures for giving medications to clients;
496.10(2) the registered nurse has developed written procedures for the unlicensed
496.11personnel, including any special instructions or procedures regarding controlled substances
496.12that are prescribed for the client. The procedures must address:
496.13(i) the type of container or containers to be used for the medications appropriate to
496.14the provider's medication system;
496.15(ii) how the container or containers must be labeled;
496.16(iii) the written information about the medications to be given to the client or client's
496.17representative;
496.18(iv) how the unlicensed staff must document in the client's record that medications
496.19have been given to the client or the client's representative, including documenting the date
496.20the medications were given to the client or the client's representative and who received the
496.21medications, the person who gave the medications to the client, the number of medications
496.22that were given to the client, and other required information;
496.23(v) how the registered nurse shall be notified that medications have been given to
496.24the client or client's representative and whether the registered nurse needs to be contacted
496.25before the medications are given to the client or the client's representative; and
496.26(vi) a review by the registered nurse of the completion of this task to verify that this
496.27task was completed accurately by the unlicensed personnel.
496.28    Subd. 11. Prescribed and nonprescribed medication. The comprehensive home
496.29care provider must determine whether the comprehensive home care provider shall require
496.30a prescription for all medications the provider manages. The comprehensive home care
496.31provider must inform the client or the client's representative whether the comprehensive
496.32home care provider requires a prescription for all over-the-counter and dietary supplements
496.33before the comprehensive home care provider agrees to manage those medications.
496.34    Subd. 12. Medications; over-the-counter; dietary supplements not prescribed.
496.35A comprehensive home care provider providing medication management services for
496.36over-the-counter drugs or dietary supplements must retain those items in the original labeled
497.1container with directions for use prior to setting up for immediate or later administration.
497.2The provider must verify that the medications are up-to-date and stored as appropriate.
497.3    Subd. 13. Prescriptions. There must be a current written or electronically recorded
497.4prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed
497.5medications that the comprehensive home care provider is managing for the client.
497.6    Subd. 14. Renewal of prescriptions. Prescriptions must be renewed at least
497.7every 12 months or more frequently as indicated by the assessment in subdivision 2.
497.8Prescriptions for controlled substances must comply with chapter 152.
497.9    Subd. 15. Verbal prescription orders. Verbal prescription orders from an
497.10authorized prescriber must be received by a nurse or pharmacist. The order must be
497.11handled according to Minnesota Rules, part 6800.6200.
497.12    Subd. 16. Written or electronic prescription. When a written or electronic
497.13prescription is received, it must be communicated to the registered nurse in charge and
497.14recorded or placed in the client's record.
497.15    Subd. 17. Records confidential. A prescription or order received verbally, in
497.16writing, or electronically must be kept confidential according to sections 144.291 to
497.17144.298 and 144A.44.
497.18    Subd. 18. Medications provided by client or family members. When the
497.19comprehensive home care provider is aware of any medications or dietary supplements
497.20that are being used by the client and are not included in the assessment for medication
497.21management services, the staff must advise the registered nurse and document that in
497.22the client's record.
497.23    Subd. 19. Storage of medications. A comprehensive home care provider providing
497.24storage of medications outside of the client's private living space must store all prescription
497.25medications in securely locked and substantially constructed compartments according to
497.26the manufacturer's directions and permit only authorized personnel to have access.
497.27    Subd. 20. Prescription drugs. A prescription drug, prior to being set up for
497.28immediate or later administration, must be kept in the original container in which it was
497.29dispensed by the pharmacy bearing the original prescription label with legible information
497.30including the expiration or beyond-use date of a time-dated drug.
497.31    Subd. 21. Prohibitions. No prescription drug supply for one client may be used or
497.32saved for use by anyone other than the client.
497.33    Subd. 22. Disposition of medications. (a) Any current medications being managed
497.34by the comprehensive home care provider must be given to the client or the client's
497.35representative when the client's service plan ends or medication management services are
497.36no longer part of the service plan. Medications that have been stored in the client's private
498.1living space for a client who is deceased or that have been discontinued or that have
498.2expired may be given to the client or the client's representative for disposal.
498.3(b) The comprehensive home care provider will dispose of any medications
498.4remaining with the comprehensive home care provider that are discontinued or expired or
498.5upon the termination of the service contract or the client's death according to state and
498.6federal regulations for disposition of medications and controlled substances.
498.7(c) Upon disposition, the comprehensive home care provider must document in the
498.8client's record the disposition of the medication including the medication's name, strength,
498.9prescription number as applicable, quantity, to whom the medications were given, date of
498.10disposition, and names of staff and other individuals involved in the disposition.
498.11    Subd. 23. Loss or spillage. (a) Comprehensive home care providers providing
498.12medication management must develop and implement procedures for loss or spillage of all
498.13controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must
498.14require that when a spillage of a controlled substance occurs, a notation must be made
498.15in the client's record explaining the spillage and the actions taken. The notation must
498.16be signed by the person responsible for the spillage and include verification that any
498.17contaminated substance was disposed of according to state or federal regulations.
498.18(b) The procedures must require the comprehensive home care provider of
498.19medication management to investigate any known loss or unaccounted for prescription
498.20drugs and take appropriate action required under state or federal regulations and document
498.21the investigation in required records.

498.22    Sec. 21. [144A.4793] TREATMENT AND THERAPY MANAGEMENT
498.23SERVICES.
498.24    Subdivision 1. Providers with a comprehensive home care license. This section
498.25applies only to home care providers with a comprehensive home care license that provide
498.26treatment or therapy management services to clients. Treatment or therapy management
498.27services cannot be provided by a home care provider that has a basic home care license.
498.28    Subd. 2. Policies and procedures. (a) A comprehensive home care provider who
498.29provides treatment and therapy management services must develop, implement, and
498.30maintain up-to-date written treatment or therapy management policies and procedures.
498.31The policies and procedures must be developed under the supervision and direction of
498.32a registered nurse or appropriate licensed health professional consistent with current
498.33practice standards and guidelines.
498.34(b) The written policies and procedures must address requesting and receiving
498.35orders or prescriptions for treatments or therapies, providing the treatment or therapy,
499.1documenting of treatment or therapy activities, educating and communicating with clients
499.2about treatments or therapy they are receiving, monitoring and evaluating the treatment
499.3and therapy, and communicating with the prescriber.
499.4    Subd. 3. Individualized treatment or therapy management plan. For each
499.5client receiving management of ordered or prescribed treatments or therapy services, the
499.6comprehensive home care provider must prepare and include in the service plan a written
499.7statement of the treatment or therapy services that will be provided to the client. The
499.8provider must also develop and maintain a current individualized treatment and therapy
499.9management record for each client which must contain at least the following:
499.10(1) a statement of the type of services that will be provided;
499.11(2) documentation of specific client instructions relating to the treatments or therapy
499.12administration;
499.13(3) identification of treatment or therapy tasks that will be delegated to unlicensed
499.14personnel;
499.15(4) procedures for notifying a registered nurse or appropriate licensed health
499.16professional when a problem arises with treatments or therapy services; and
499.17(5) any client-specific requirements relating to documentation of treatment
499.18and therapy received, verification that all treatment and therapy was administered as
499.19prescribed, and monitoring of treatment or therapy to prevent possible complications or
499.20adverse reactions. The treatment or therapy management record must be current and
499.21updated when there are any changes.
499.22    Subd. 4. Administration of treatments and therapy. Ordered or prescribed
499.23treatments or therapies must be administered by a nurse, physician, or other licensed health
499.24professional authorized to perform the treatment or therapy, or may be delegated or assigned
499.25to unlicensed personnel by the licensed health professional according to the appropriate
499.26practice standards for delegation or assignment. When administration of a treatment or
499.27therapy is delegated or assigned to unlicensed personnel, the home care provider must
499.28ensure that the registered nurse or authorized licensed health professional has:
499.29(1) instructed the unlicensed personnel in the proper methods with respect to each
499.30client and the unlicensed personnel has demonstrated the ability to competently follow
499.31the procedures;
499.32(2) specified, in writing, specific instructions for each client and documented those
499.33instructions in the client's record; and
499.34(3) communicated with the unlicensed personnel about the individual needs of
499.35the client.
500.1    Subd. 5. Documentation of administration of treatments and therapies. Each
500.2treatment or therapy administered by a comprehensive home care provider must be
500.3documented in the client's record. The documentation must include the signature and title
500.4of the person who administered the treatment or therapy and must include the date and
500.5time of administration. When treatment or therapies are not administered as ordered or
500.6prescribed, the provider must document the reason why it was not administered and any
500.7follow-up procedures that were provided to meet the client's needs.
500.8    Subd. 6. Orders or prescriptions. There must be an up-to-date written or
500.9electronically recorded order or prescription for all treatments and therapies. The order
500.10must contain the name of the client, description of the treatment or therapy to be provided,
500.11and the frequency and other information needed to administer the treatment or therapy.

500.12    Sec. 22. [144A.4794] CLIENT RECORD REQUIREMENTS.
500.13    Subdivision 1. Client record. (a) The home care provider must maintain records
500.14for each client for whom it is providing services. Entries in the client records must be
500.15current, legible, permanently recorded, dated, and authenticated with the name and title
500.16of the person making the entry.
500.17(b) Client records, whether written or electronic, must be protected against loss,
500.18tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable
500.19relevant federal and state laws. The home care provider shall establish and implement
500.20written procedures to control use, storage, and security of client's records and establish
500.21criteria for release of client information.
500.22(c) The home care provider may not disclose to any other person any personal,
500.23financial, medical, or other information about the client, except:
500.24(1) as may be required by law;
500.25(2) to employees or contractors of the home care provider, another home care
500.26provider, other health care practitioner or provider, or inpatient facility needing
500.27information in order to provide services to the client, but only such information that
500.28is necessary for the provision of services;
500.29(3) to persons authorized in writing by the client or the client's representative to
500.30receive the information, including third-party payers; and
500.31(4) to representatives of the commissioner authorized to survey or investigate home
500.32care providers under this chapter or federal laws.
500.33    Subd. 2. Access to records. The home care provider must ensure that the
500.34appropriate records are readily available to employees or contractors authorized to access
501.1the records. Client records must be maintained in a manner that allows for timely access,
501.2printing, or transmission of the records.
501.3    Subd. 3. Contents of client record. Contents of a client record include the
501.4following for each client:
501.5(1) identifying information, including the client's name, date of birth, address, and
501.6telephone number;
501.7(2) the name, address, and telephone number of an emergency contact, family
501.8members, client's representative, if any, or others as identified;
501.9(3) names, addresses, and telephone numbers of the client's health and medical
501.10service providers and other home care providers, if known;
501.11(4) health information, including medical history, allergies, and when the provider
501.12is managing medications, treatments or therapies that require documentation, and other
501.13relevant health records;
501.14(5) client's advance directives, if any;
501.15(6) the home care provider's current and previous assessments and service plans;
501.16(7) all records of communications pertinent to the client's home care services;
501.17(8) documentation of significant changes in the client's status and actions taken in
501.18response to the needs of the client including reporting to the appropriate supervisor or
501.19health care professional;
501.20(9) documentation of incidents involving the client and actions taken in response
501.21to the needs of the client including reporting to the appropriate supervisor or health
501.22care professional;
501.23(10) documentation that services have been provided as identified in the service plan;
501.24(11) documentation that the client has received and reviewed the home care bill
501.25of rights;
501.26(12) documentation that the client has been provided the statement of disclosure on
501.27limitations of services under section 144A.4791, subdivision 3;
501.28(13) documentation of complaints received and resolution;
501.29(14) discharge summary, including service termination notice and related
501.30documentation, when applicable; and
501.31(15) other documentation required under this chapter and relevant to the client's
501.32services or status.
501.33    Subd. 4. Transfer of client records. If a client transfers to another home care
501.34provider or other health care practitioner or provider, or is admitted to an inpatient facility,
501.35the home care provider, upon request of the client or the client's representative, shall take
502.1steps to ensure a coordinated transfer including sending a copy or summary of the client's
502.2record to the new home care provider, facility, or the client, as appropriate.
502.3    Subd. 5. Record retention. Following the client's discharge or termination of
502.4services, a home care provider must retain a client's record for at least five years, or as
502.5otherwise required by state or federal regulations. Arrangements must be made for secure
502.6storage and retrieval of client records if the home care provider ceases business.

502.7    Sec. 23. [144A.4795] HOME CARE PROVIDER RESPONSIBILITIES; STAFF.
502.8    Subdivision 1. Qualifications, training, and competency. All staff providing home
502.9care services must: (1) be trained and competent in the provision of home care services
502.10consistent with current practice standards appropriate to the client's needs; and (2) be
502.11informed of the home care bill of rights under section 144A.44.
502.12    Subd. 2. Licensed health professionals and nurses. (a) Licensed health
502.13professionals and nurses providing home care services as an employee of a licensed home
502.14care provider must possess current Minnesota license or registration to practice.
502.15(b) Licensed health professionals and registered nurses must be competent in
502.16assessing client needs, planning appropriate home care services to meet client needs,
502.17implementing services, and supervising staff if assigned.
502.18(c) Nothing in this section limits or expands the rights of nurses or licensed health
502.19professionals to provide services within the scope of their licenses or registrations, as
502.20provided by law.
502.21    Subd. 3. Unlicensed personnel. (a) Unlicensed personnel providing basic home
502.22care services must have:
502.23(1) successfully completed a training and competency evaluation appropriate to
502.24the services provided by the home care provider and the topics listed in subdivision 7,
502.25paragraph (b); or
502.26(2) demonstrated competency by satisfactorily completing a written or oral test on
502.27the tasks the unlicensed personnel will perform and in the topics listed in subdivision
502.287, paragraph (b); and successfully demonstrate competency of topics in subdivision 7,
502.29paragraph (b), clauses (5), (7), and (8), by a practical skills test.
502.30Unlicensed personnel providing home care services for a basic home care provider may
502.31not perform delegated nursing or therapy tasks.
502.32(b) Unlicensed personnel performing delegated nursing tasks for a comprehensive
502.33home care provider must:
502.34(1) have successfully completed training and demonstrated competency by
502.35successfully completing a written or oral test of the topics in subdivision 7, paragraphs (b)
503.1and (c), and a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5)
503.2and (7), and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform;
503.3(2) satisfy the current requirements of Medicare for training or competency of home
503.4health aides or nursing assistants, as provided by Code of Federal Regulations, title 42,
503.5section 483 or section 484.36; or
503.6(3) have, before April 19, 1993, completed a training course for nursing assistants
503.7that was approved by the commissioner.
503.8(c) Unlicensed personnel performing therapy or treatment tasks delegated or
503.9assigned by a licensed health professional must meet the requirements for delegated
503.10tasks in subdivision 4 and any other training or competency requirements within the
503.11licensed health professional scope of practice relating to delegation or assignment of tasks
503.12to unlicensed personnel.
503.13    Subd. 4. Delegation of home care tasks. A registered nurse or licensed health
503.14professional may delegate tasks only to staff that are competent and possess the knowledge
503.15and skills consistent with the complexity of the tasks and according to the appropriate
503.16Minnesota Practice Act. The comprehensive home care provider must establish and
503.17implement a system to communicate up-to-date information to the registered nurse or
503.18licensed health professional regarding the current available staff and their competency so
503.19the registered nurse or licensed health professional has sufficient information to determine
503.20the appropriateness of delegating tasks to meet individual client needs and preferences.
503.21    Subd. 5. Individual contractors. When a home care provider contracts with an
503.22individual contractor excluded from licensure under section 144A.471 to provide home
503.23care services, the contractor must meet the same requirements required by this section for
503.24personnel employed by the home care provider.
503.25    Subd. 6. Temporary staff. When a home care provider contracts with a temporary
503.26staffing agency excluded from licensure under section 144A.471, those individuals must
503.27meet the same requirements required by this section for personnel employed by the home
503.28care provider and shall be treated as if they are staff of the home care provider.
503.29    Subd. 7. Requirements for instructors, training content, and competency
503.30evaluations for unlicensed personnel. (a) Instructors and competency evaluators must
503.31meet the following requirements:
503.32(1) training and competency evaluations of unlicensed personnel providing basic
503.33home care services must be conducted by individuals with work experience and training in
503.34providing home care services listed in section 144A.471, subdivisions 6 and 7; and
503.35(2) training and competency evaluations of unlicensed personnel providing
503.36comprehensive home care services must be conducted by a registered nurse, or another
504.1instructor may provide training in conjunction with the registered nurse. If the home care
504.2provider is providing services by licensed health professionals only, then that specific
504.3training and competency evaluation may be conducted by the licensed health professionals
504.4as appropriate.
504.5(b) Training and competency evaluations for all unlicensed personnel must include
504.6the following:
504.7(1) documentation requirements for all services provided;
504.8(2) reports of changes in the client's condition to the supervisor designated by the
504.9home care provider;
504.10(3) basic infection control, including blood-borne pathogens;
504.11(4) maintenance of a clean and safe environment;
504.12(5) appropriate and safe techniques in personal hygiene and grooming, including:
504.13(i) hair care and bathing;
504.14(ii) care of teeth, gums, and oral prosthetic devices;
504.15(iii) care and use of hearing aids; and
504.16(iv) dressing and assisting with toileting;
504.17(6) training on the prevention of falls for providers working with the elderly or
504.18individuals at risk of falls;
504.19(7) standby assistance techniques and how to perform them;
504.20(8) medication, exercise, and treatment reminders;
504.21(9) basic nutrition, meal preparation, food safety, and assistance with eating;
504.22(10) preparation of modified diets as ordered by a licensed health professional;
504.23(11) communication skills that include preserving the dignity of the client and
504.24showing respect for the client and the client's preferences, cultural background, and family;
504.25(12) awareness of confidentiality and privacy;
504.26(13) understanding appropriate boundaries between staff and clients and the client's
504.27family;
504.28(14) procedures to utilize in handling various emergency situations; and
504.29(15) awareness of commonly used health technology equipment and assistive devices.
504.30(c) In addition to paragraph (b), training and competency evaluation for unlicensed
504.31personnel providing comprehensive home care services must include:
504.32(1) observation, reporting, and documenting of client status;
504.33(2) basic knowledge of body functioning and changes in body functioning, injuries,
504.34or other observed changes that must be reported to appropriate personnel;
504.35(3) reading and recording temperature, pulse, and respirations of the client;
504.36(4) recognizing physical, emotional, cognitive, and developmental needs of the client;
505.1(5) safe transfer techniques and ambulation;
505.2(6) range of motioning and positioning; and
505.3(7) administering medications or treatments as required.
505.4(d) When the registered nurse or licensed health professional delegates tasks, they
505.5must ensure that prior to the delegation the unlicensed personnel is trained in the proper
505.6methods to perform the tasks or procedures for each client and are able to demonstrate
505.7the ability to competently follow the procedures and perform the tasks. If an unlicensed
505.8personnel has not regularly performed the delegated home care task for a period of 24
505.9consecutive months, the unlicensed personnel must demonstrate competency in the task
505.10to the registered nurse or appropriate licensed health professional. The registered nurse
505.11or licensed health professional must document instructions for the delegated tasks in
505.12the client's record.

505.13    Sec. 24. [144A.4796] ORIENTATION AND ANNUAL TRAINING
505.14REQUIREMENTS.
505.15    Subdivision 1. Orientation of staff and supervisors to home care. All staff
505.16providing and supervising direct home care services must complete an orientation to home
505.17care licensing requirements and regulations before providing home care services to clients.
505.18The orientation may be incorporated into the training required under subdivision 6. The
505.19orientation need only be completed once for each staff person and is not transferable
505.20to another home care provider.
505.21    Subd. 2. Content. The orientation must contain the following topics:
505.22    (1) an overview of sections 144A.43 to 144A.4798;
505.23(2) introduction and review of all the provider's policies and procedures related to
505.24the provision of home care services;
505.25(3) handling of emergencies and use of emergency services;
505.26(4) compliance with and reporting of the maltreatment of minors or vulnerable
505.27adults under sections 626.556 and 626.557;
505.28(5) home care bill of rights, under section 144A.44;
505.29(6) handling of clients' complaints; reporting of complaints and where to report
505.30complaints including information on the Office of Health Facility Complaints and the
505.31Common Entry Point;
505.32(7) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
505.33Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
505.34Ombudsman at the Department of Human Services, county managed care advocates,
505.35or other relevant advocacy services; and
506.1(8) review of the types of home care services the employee will be providing and
506.2the provider's scope of licensure.
506.3    Subd. 3. Verification and documentation of orientation. Each home care provider
506.4shall retain evidence in the employee record of each staff person having completed the
506.5orientation required by this section.
506.6    Subd. 4. Orientation to client. Staff providing home care services must be oriented
506.7specifically to each individual client and the services to be provided. This orientation may
506.8be provided in person, orally, in writing, or electronically.
506.9    Subd. 5. Training required relating to Alzheimer's disease and related disorders.
506.10For home care providers that provide services for persons with Alzheimer's or related
506.11disorders, all direct care staff and supervisors working with those clients must receive
506.12training that includes a current explanation of Alzheimer's disease and related disorders,
506.13effective approaches to use to problem solve when working with a client's challenging
506.14behaviors, and how to communicate with clients who have Alzheimer's or related disorders.
506.15    Subd. 6. Required annual training. All staff that perform direct home care
506.16services must complete at least eight hours of annual training for each 12 months of
506.17employment. The training may be obtained from the home care provider or another source
506.18and must include topics relevant to the provision of home care services. The annual
506.19training must include:
506.20(1) training on reporting of maltreatment of minors under section 626.556 and
506.21maltreatment of vulnerable adults under section 626.557, whichever is applicable to the
506.22services provided;
506.23(2) review of the home care bill of rights in section 144A.44;
506.24(3) review of infection control techniques used in the home and implementation of
506.25infection control standards including a review of hand washing techniques; the need for
506.26and use of protective gloves, gowns, and masks; appropriate disposal of contaminated
506.27materials and equipment, such as dressings, needles, syringes, and razor blades;
506.28disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of
506.29communicable diseases; and
506.30(4) review of the provider's policies and procedures relating to the provision of home
506.31care services and how to implement those policies and procedures.
506.32    Subd. 7. Documentation. A home care provider must retain documentation in the
506.33employee records of the staff that have satisfied the orientation and training requirements
506.34of this section.

506.35    Sec. 25. [144A.4797] PROVISION OF SERVICES.
507.1    Subdivision 1. Availability of contact person to staff. (a) A home care provider
507.2with a basic home care license must have a person available to staff for consultation on
507.3items relating to the provision of services or about the client.
507.4(b) A home care provider with a comprehensive home care license must have a
507.5registered nurse available for consultation to staff performing delegated nursing tasks
507.6and must have an appropriate licensed health professional available if performing other
507.7delegated services such as therapies.
507.8(c) The appropriate contact person must be readily available either in person, by
507.9telephone, or by other means to the staff at times when the staff is providing services.
507.10    Subd. 2. Supervision of staff; basic home care services. (a) Staff who perform
507.11basic home care services must be supervised periodically where the services are being
507.12provided to verify that the work is being performed competently and to identify problems
507.13and solutions to address issues relating to the staff's ability to provide the services. The
507.14supervision of the unlicensed personnel must be done by staff of the home care provider
507.15having the authority, skills, and ability to provide the supervision of unlicensed personnel
507.16and who can implement changes as needed, and train staff.
507.17(b) Supervision includes direct observation of unlicensed personnel while the
507.18unlicensed personnel are providing the services and may also include indirect methods of
507.19gaining input such as gathering feedback from the client. Supervisory review of staff must
507.20be provided at a frequency based on the staff person's competency and performance.
507.21(c) For an individual who is licensed as a home care provider, this section does
507.22not apply.
507.23    Subd. 3. Supervision of staff providing delegated nursing or therapy home
507.24care tasks. (a) Staff who perform delegated nursing or therapy home care tasks must be
507.25supervised by an appropriate licensed health professional or a registered nurse periodically
507.26where the services are being provided to verify that the work is being performed
507.27competently and to identify problems and solutions related to the staff person's ability to
507.28perform the tasks. Supervision of staff performing medication or treatment administration
507.29shall be provided by a registered nurse or appropriate licensed health professional and
507.30must include observation of the staff administering the medication or treatment and the
507.31interaction with the client.
507.32(b) The direct supervision of staff performing delegated tasks must be provided
507.33within 30 days after the individual begins working for the home care provider and
507.34thereafter as needed based on performance. This requirement also applies to staff who
507.35have not performed delegated tasks for one year or longer.
508.1    Subd. 4. Documentation. A home care provider must retain documentation of
508.2supervision activities in the personnel records.
508.3    Subd. 5. Exemption. This section does not apply to an individual licensed under
508.4sections 144A.43 to 144A.4798.

508.5    Sec. 26. [144A.4798] EMPLOYEE HEALTH STATUS.
508.6    Subdivision 1. Tuberculosis (TB) prevention and control. A home care provider
508.7must establish and maintain a TB prevention and control program based on the most
508.8current guidelines issued by the Centers for Disease Control and Prevention (CDC).
508.9Components of a TB prevention and control program include screening all staff providing
508.10home care services, both paid and unpaid, at the time of hire for active TB disease and
508.11latent TB infection, and developing and implementing a written TB infection control plan.
508.12The commissioner shall make the most recent CDC standards available to home care
508.13providers on the department's Web site.
508.14    Subd. 2. Communicable diseases. A home care provider must follow
508.15current federal or state guidelines for prevention, control, and reporting of human
508.16immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other
508.17communicable diseases as defined in Minnesota Rules, part 4605.7040.

508.18    Sec. 27. [144A.4799] DEPARTMENT OF HEALTH LICENSED HOME CARE
508.19PROVIDER ADVISORY COUNCIL.
508.20    Subdivision 1. Membership. The commissioner of health shall appoint eight
508.21persons to a home care provider advisory council consisting of the following:
508.22(1) three public members as defined in section 214.02 who shall be either persons
508.23who are currently receiving home care services or have family members receiving home
508.24care services, or persons who have family members who have received home care services
508.25within five years of the application date;
508.26(2) three Minnesota home care licensees representing basic and comprehensive
508.27levels of licensure who may be a managerial official, an administrator, a supervising
508.28registered nurse, or an unlicensed personnel performing home care tasks;
508.29(3) one member representing the Minnesota Board of Nursing; and
508.30(4) one member representing the ombudsman for long-term care.
508.31    Subd. 2. Organizations and meetings. The advisory council shall be organized
508.32and administered under section 15.059 with per diems and costs paid within the limits of
508.33available appropriations. Meetings will be held quarterly and hosted by the department.
509.1Subcommittees may be developed as necessary by the commissioner. Advisory council
509.2meetings are subject to the Open Meeting Law under chapter 13D.
509.3    Subd. 3. Duties. At the commissioner's request, the advisory council shall provide
509.4advice regarding regulations of Department of Health licensed home care providers in
509.5this chapter such as:
509.6(1) advice to the commissioner regarding community standards for home care
509.7practices;
509.8(2) advice to the commissioner on enforcement of licensing standards and whether
509.9certain disciplinary actions are appropriate;
509.10(3) advice to the commissioner about ways of distributing information to licensees
509.11and consumers of home care;
509.12(4) advice to the commissioner about training standards;
509.13(5) identify emerging issues and opportunities in the home care field, including the
509.14use of technology in home and telehealth capabilities; and
509.15(6) perform other duties as directed by the commissioner.

509.16    Sec. 28. [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR
509.17NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.
509.18    Subdivision 1. Temporary home care licenses and changes of ownership. (a)
509.19Beginning January 1, 2014, all temporary license applicants must apply for either a
509.20temporary basic or comprehensive home care license.
509.21(b) Temporary home care licenses issued beginning January 1, 2014, shall be
509.22issued according to sections 144A.43 to 144A.4798, and the fees in section 144A.472.
509.23Temporary licensees must comply with the requirements of this chapter.
509.24(c) No temporary license applications will be accepted nor temporary licenses issued
509.25between December 1, 2013, and December 31, 2013.
509.26(d) Beginning October 1, 2013, changes in ownership applications will require
509.27payment of the new fees listed in section 144A.472. Providers who are providing
509.28nursing, delegated nursing, or professional health care services, must submit the fee for
509.29comprehensive home care providers, and all other providers must submit the fee for basic
509.30home care providers as provided in section 144A.472. Change of ownership applicants will
509.31be issued a new home care license based on the licensure law in effect on June 30, 2013.
509.32    Subd. 2. Current home care licensees with licenses prior to July 1, 2013. (a)
509.33Beginning July 1, 2014, department licensed home care providers must apply for either
509.34the basic or comprehensive home care license on their regularly scheduled renewal date.
510.1(b) By June 30, 2015, all home care providers must either have a basic or
510.2comprehensive home care license or temporary license.
510.3    Subd. 3. Renewal application of home care licensure during transition period.
510.4(a) Renewal and change of ownership applications of home care licenses issued beginning
510.5July 1, 2014, will be issued according to sections 144A.43 to 144A.4798 and, upon license
510.6renewal or issuance of a new license for a change of ownership, providers must comply
510.7with sections 144A.43 to 144A.4798. Prior to renewal, providers must comply with the
510.8home care licensure law in effect on June 30, 2013.
510.9(b) The fees charged for licenses renewed between July 1, 2014, and June 30, 2016,
510.10shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000
510.11increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
510.12(c) For fiscal year 2014 only, the fees for providers with revenues greater than
510.13$25,000 and no more than $100,000 will be $313 and for providers with revenues no
510.14more than $25,000 the fee will be $125.

510.15    Sec. 29. [144A.482] REGISTRATION OF HOME MANAGEMENT
510.16PROVIDERS.
510.17(a) For purposes of this section, a home management provider is a person or
510.18organization that provides at least two of the following services: housekeeping, meal
510.19preparation, and shopping to a person who is unable to perform these activities due to
510.20illness, disability, or physical condition.
510.21(b) A person or organization that provides only home management services may not
510.22operate in the state without a current certificate of registration issued by the commissioner
510.23of health. To obtain a certificate of registration, the person or organization must annually
510.24submit to the commissioner the name, mailing and physical addresses, e-mail address, and
510.25telephone number of the person or organization and a signed statement declaring that the
510.26person or organization is aware that the home care bill of rights applies to their clients and
510.27that the person or organization will comply with the home care bill of rights provisions
510.28contained in section 144A.44. A person or organization applying for a certificate must
510.29also provide the name, business address, and telephone number of each of the persons
510.30responsible for the management or direction of the organization.
510.31(c) The commissioner shall charge an annual registration fee of $20 for persons and
510.32$50 for organizations. The registration fee shall be deposited in the state treasury and
510.33credited to the state government special revenue fund.
510.34(d) A home care provider that provides home management services and other home
510.35care services must be licensed, but licensure requirements other than the home care bill of
511.1rights do not apply to those employees or volunteers who provide only home management
511.2services to clients who do not receive any other home care services from the provider.
511.3A licensed home care provider need not be registered as a home management service
511.4provider but must provide an orientation on the home care bill of rights to its employees
511.5or volunteers who provide home management services.
511.6(e) An individual who provides home management services under this section must,
511.7within 120 days after beginning to provide services, attend an orientation session approved
511.8by the commissioner that provides training on the home care bill of rights and an orientation
511.9on the aging process and the needs and concerns of elderly and disabled persons.
511.10(f) The commissioner may suspend or revoke a provider's certificate of registration
511.11or assess fines for violation of the home care bill of rights. Any fine assessed for a
511.12violation of the home care bill of rights by a provider registered under this section shall be
511.13in the amount established in the licensure rules for home care providers. As a condition
511.14of registration, a provider must cooperate fully with any investigation conducted by the
511.15commissioner, including providing specific information requested by the commissioner on
511.16clients served and the employees and volunteers who provide services. Fines collected
511.17under this paragraph shall be deposited in the state treasury and credited to the fund
511.18specified in the statute or rule in which the penalty was established.
511.19(g) The commissioner may use any of the powers granted in sections 144A.43 to
511.20144A.4798 to administer the registration system and enforce the home care bill of rights
511.21under this section.

511.22    Sec. 30. [144A.483] AGENCY QUALITY IMPROVEMENT PROGRAM.
511.23    Subdivision 1. Annual legislative report on home care licensing. The
511.24commissioner shall establish a quality improvement program for the home care survey
511.25and home care complaint investigation processes. The commissioner shall submit to the
511.26legislature an annual report, beginning October 1, 2015, and each October 1 thereafter.
511.27Each report will review the previous state fiscal year of home care licensing and regulatory
511.28activities. The report must include, but is not limited to, an analysis of:
511.29(1) the number of FTE's in the Division of Compliance Monitoring, including the
511.30Office of Health Facility Complaints units assigned to home care licensing, survey,
511.31investigation and enforcement process;
511.32(2) numbers of and descriptive information about licenses issued, complaints
511.33received and investigated, including allegations made and correction orders issued,
511.34surveys completed and timelines, and correction order reconsiderations and results;
512.1(3) descriptions of emerging trends in home care provision and areas of concern
512.2identified by the department in its regulation of home care providers;
512.3(4) information and data regarding performance improvement projects underway
512.4and planned by the commissioner in the area of home care surveys; and
512.5(5) work of the Department of Health Home Care Advisory Council.
512.6    Subd. 2. Study of correction order appeal process. Starting July 1, 2015, the
512.7commissioner shall study whether to add a correction order appeal process conducted by
512.8an independent reviewer such as an administrative law judge or other office and submit a
512.9report to the legislature by February 1, 2016. The commissioner shall review home care
512.10regulatory systems in other states as part of that study. The commissioner shall consult
512.11with the home care providers and representatives.

512.12    Sec. 31. INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
512.13AND COMMUNITY-BASED SERVICES.
512.14(a) The Department of Health Compliance Monitoring Division and the Department
512.15of Human Services Licensing Division shall jointly develop an integrated licensing system
512.16for providers of both home care services subject to licensure under Minnesota Statutes,
512.17chapter 144A, and for home and community-based services subject to licensure under
512.18Minnesota Statutes, chapter 245D. The integrated licensing system shall:
512.19(1) require only one license of any provider of services under Minnesota Statutes,
512.20sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
512.21(2) promote quality services that recognize a person's individual needs and protect
512.22the person's health, safety, rights, and well-being;
512.23(3) promote provider accountability through application requirements, compliance
512.24inspections, investigations, and enforcement actions;
512.25(4) reference other applicable requirements in existing state and federal laws,
512.26including the federal Affordable Care Act;
512.27(5) establish internal procedures to facilitate ongoing communications between the
512.28agencies, and with providers and services recipients about the regulatory activities;
512.29(6) create a link between the agency Web sites so that providers and the public can
512.30access the same information regardless of which Web site is accessed initially; and
512.31(7) collect data on identified outcome measures as necessary for the agencies to
512.32report to the Centers for Medicare and Medicaid Services.
512.33(b) The joint recommendations for legislative changes to implement the integrated
512.34licensing system are due to the legislature by February 15, 2014.
513.1(c) Before implementation of the integrated licensing system, providers licensed as
513.2home care providers under Minnesota Statutes, chapter 144A, may also provide home
513.3and community-based services subject to licensure under Minnesota Statutes, chapter
513.4245D, without obtaining a home and community-based services license under Minnesota
513.5Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
513.6apply to these providers:
513.7(1) the provider must comply with all requirements under Minnesota Statutes, chapter
513.8245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
513.9(2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
513.10enforced by the Department of Health under the enforcement authority set forth in
513.11Minnesota Statutes, section 144A.475; and
513.12(3) the Department of Health will provide information to the Department of Human
513.13Services about each provider licensed under this section, including the provider's license
513.14application, licensing documents, inspections, information about complaints received, and
513.15investigations conducted for possible violations of Minnesota Statutes, chapter 245D.

513.16    Sec. 32. STUDY OF CORRECTION ORDER APPEAL PROCESS.
513.17Beginning July 1, 2015, the commissioner of health shall study whether to use
513.18a correction order appeal process conducted by an independent reviewer, such as
513.19an administrative law judge or other office. The commissioner shall review home
513.20care regulatory systems in other states and consult with the home care providers and
513.21representatives. By February 1, 2016, the commissioner shall submit a report to the chairs
513.22and ranking minority members of the committees of the legislature with jurisdiction over
513.23health and human services and judiciary issues with any recommendations regarding
513.24an independent appeal process.

513.25    Sec. 33. REPEALER.
513.26(a) Minnesota Statutes 2012, sections 144A.46; and 144A.461, are repealed.
513.27(b) Minnesota Rules, parts 4668.0002; 4668.0003; 4668.0005; 4668.0008;
513.284668.0012; 4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035; 4668.0040;
513.294668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075; 4668.0080; 4668.0100;
513.304668.0110; 4668.0120; 4668.0130; 4668.0140; 4668.0150; 4668.0160; 4668.0170;
513.314668.0180; 4668.0190; 4668.0200; 4668.0218; 4668.0220; 4668.0230; 4668.0240;
513.324668.0800; 4668.0805; 4668.0810; 4668.0815; 4668.0820; 4668.0825; 4668.0830;
513.334668.0835; 4668.0840; 4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870;
513.344669.0001; 4669.0010; 4669.0020; 4669.0030; 4669.0040; and 4669.0050, are repealed.

514.1    Sec. 34. EFFECTIVE DATE.
514.2This article is effective the day following final enactment.


514.5    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 2, is amended to read:
514.6    Subd. 2. Transfers. (a) Notwithstanding section 295.581, to the extent available
514.7resources in the health care access fund exceed expenditures in that fund, effective for
514.8the biennium beginning July 1, 2007, the commissioner of management and budget shall
514.9transfer the excess funds from the health care access fund to the general fund on June 30
514.10of each year, provided that the amount transferred in any fiscal biennium shall not exceed
514.11$96,000,000. The purpose of this transfer is to meet the rate increase required under Laws
514.122003, First Special Session chapter 14, article 13C, section 2, subdivision 6.
514.13    (b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and,
514.14if necessary, the commissioner shall reduce these transfers from the health care access
514.15fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary,
514.16transfer sufficient funds from the general fund to the health care access fund to meet
514.17annual MinnesotaCare expenditures.
514.18(c) Notwithstanding section 295.581, to the extent available resources in the health
514.19care access fund exceed expenditures in that fund after the transfer required in paragraph
514.20(a), effective for the biennium beginning July 1, 2013, the commissioner of management
514.21and budget shall transfer $1,000,000 each fiscal year from the health access fund to
514.22the medical education and research costs fund established under section 62J.692, for
514.23distribution under section 62J.692, subdivision 4, paragraph (c).

514.24    Sec. 2. Minnesota Statutes 2012, section 43A.23, is amended by adding a subdivision
514.25to read:
514.26    Subd. 4. Coverage for autism spectrum disorders. For participants in the state
514.27employee group insurance program, the commissioner of management and budget must
514.28administer the identical benefit as is required under section 62A.3094.
514.29EFFECTIVE DATE.This section is effective January 1, 2016, or the date a
514.30collective bargaining agreement or compensation plan that includes changes to this section
514.31is approved under Minnesota Statutes, section 3.855, whichever is earlier.

514.32    Sec. 3. [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
515.1    Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in
515.2paragraphs (b) to (d) have the meanings given.
515.3(b) "Autism spectrum disorders" means the conditions as determined by criteria
515.4set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental
515.5Disorders of the American Psychiatric Association.
515.6(c) "Medically necessary care" means health care services appropriate, in terms of
515.7type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
515.8testing and preventative services. Medically necessary care must be consistent with
515.9generally accepted practice parameters as determined by physicians and licensed
515.10psychologists who typically manage patients who have autism spectrum disorders.
515.11(d) "Mental health professional" means a mental health professional as defined in
515.12section 245.4871, subdivision 27, clause (1), (2), (3), (4), or (6), who has training and
515.13expertise in autism spectrum disorder and child development.
515.14    Subd. 2. Coverage required. (a) A health plan issued to a large employer, as
515.15defined in section 62Q.18, subdivision 1, must provide coverage for the diagnosis,
515.16evaluation, multidisciplinary assessment, and medically necessary care of children under
515.1718 with autism spectrum disorders, including but not limited to the following:
515.18(1) early intensive behavioral and developmental therapy based in behavioral and
515.19developmental science, including, but not limited to, all types of applied behavior analysis,
515.20intensive early intervention behavior therapy, and intensive behavior intervention;
515.21(2) neurodevelopmental and behavioral health treatments and management;
515.22(3) speech therapy;
515.23(4) occupational therapy;
515.24(5) physical therapy; and
515.25(6) medications.
515.26(b) The diagnosis, evaluation, and assessment must include an assessment of the
515.27child's developmental skills, functional behavior, needs, and capacities.
515.28(c) The coverage required under this subdivision must include treatment that is in
515.29accordance with an individualized treatment plan prescribed by the enrollee's treating
515.30physician or mental health professional.
515.31(d) A health carrier may not refuse to renew or reissue, or otherwise terminate or
515.32restrict, coverage of an individual solely because the individual is diagnosed with an
515.33autism spectrum disorder.
515.34(e) A health carrier may request an updated treatment plan only once every six
515.35months, unless the health carrier and the treating physician or mental health professional
515.36agree that a more frequent review is necessary due to emerging circumstances.
516.1(g) An independent progress evaluation conducted by a mental health professional
516.2with expertise and training in autism spectrum disorder and child development must be
516.3completed to determine if progress toward function and generalizable gains, as determined
516.4in the treatment plan, is being made.
516.5    Subd. 3. No effect on other law. Nothing in this section limits the coverage
516.6required under section 62Q.47.
516.7    Subd. 4. State health care programs. This section does not affect benefits available
516.8under the medical assistance and MinnesotaCare programs and does not limit, restrict, or
516.9otherwise reduce coverage under these programs.
516.10EFFECTIVE DATE.This section is effective for health plans offered, sold, issued,
516.11or renewed on or after January 1, 2014.

516.12    Sec. 4. Minnesota Statutes 2012, section 62J.692, subdivision 1, is amended to read:
516.13    Subdivision 1. Definitions. For purposes of this section, the following definitions
516.14apply:
516.15    (a) "Accredited clinical training" means the clinical training provided by a medical
516.16education program that is accredited through an organization recognized by the Department
516.17of Education, the Centers for Medicare and Medicaid Services, or another national body
516.18who reviews the accrediting organizations for multiple disciplines and whose standards
516.19for recognizing accrediting organizations are reviewed and approved by the commissioner
516.20of health in consultation with the Medical Education and Research Advisory Committee.
516.21    (b) "Commissioner" means the commissioner of health.
516.22    (c) "Clinical medical education program" means the accredited clinical training of
516.23physicians (medical students and residents), doctor of pharmacy practitioners, doctors
516.24of chiropractic, dentists, advanced practice nurses (clinical nurse specialists, certified
516.25registered nurse anesthetists, nurse practitioners, and certified nurse midwives), and
516.26 physician assistants, dental therapists and advanced dental therapists, psychologists,
516.27clinical social workers, community paramedics, and community health workers.
516.28    (d) "Sponsoring institution" means a hospital, school, or consortium located in
516.29Minnesota that sponsors and maintains primary organizational and financial responsibility
516.30for a clinical medical education program in Minnesota and which is accountable to the
516.31accrediting body.
516.32    (e) "Teaching institution" means a hospital, medical center, clinic, or other
516.33organization that conducts a clinical medical education program in Minnesota.
516.34    (f) "Trainee" means a student or resident involved in a clinical medical education
516.35program.
517.1    (g) "Eligible trainee FTE's" means the number of trainees, as measured by full-time
517.2equivalent counts, that are at training sites located in Minnesota with currently active
517.3medical assistance enrollment status and a National Provider Identification (NPI) number
517.4where training occurs in either an inpatient or ambulatory patient care setting and where
517.5the training is funded, in part, by patient care revenues. Training that occurs in nursing
517.6facility settings is not eligible for funding under this section.

517.7    Sec. 5. Minnesota Statutes 2012, section 62J.692, subdivision 3, is amended to read:
517.8    Subd. 3. Application process. (a) A clinical medical education program conducted
517.9in Minnesota by a teaching institution to train physicians, doctor of pharmacy practitioners,
517.10dentists, chiropractors, or physician assistants is, dental therapists and advanced dental
517.11therapists, psychologists, clinical social workers, community paramedics, or community
517.12health workers are eligible for funds under subdivision 4 if the program:
517.13(1) is funded, in part, by patient care revenues;
517.14(2) occurs in patient care settings that face increased financial pressure as a result
517.15of competition with nonteaching patient care entities; and
517.16(3) emphasizes primary care or specialties that are in undersupply in Minnesota.
517.17(b) A clinical medical education program for advanced practice nursing is eligible for
517.18funds under subdivision 4 if the program meets the eligibility requirements in paragraph
517.19(a), clauses (1) to (3), and is sponsored by the University of Minnesota Academic Health
517.20Center, the Mayo Foundation, or institutions that are part of the Minnesota State Colleges
517.21and Universities system or members of the Minnesota Private College Council.
517.22(c) Applications must be submitted to the commissioner by a sponsoring institution
517.23on behalf of an eligible clinical medical education program and must be received by
517.24October 31 of each year for distribution in the following year. An application for funds
517.25must contain the following information:
517.26(1) the official name and address of the sponsoring institution and the official
517.27name and site address of the clinical medical education programs on whose behalf the
517.28sponsoring institution is applying;
517.29(2) the name, title, and business address of those persons responsible for
517.30administering the funds;
517.31(3) for each clinical medical education program for which funds are being sought;
517.32the type and specialty orientation of trainees in the program; the name, site address, and
517.33medical assistance provider number and national provider identification number of each
517.34training site used in the program; the federal tax identification number of each training site
518.1used in the program, where available; the total number of trainees at each training site; and
518.2the total number of eligible trainee FTEs at each site; and
518.3(4) other supporting information the commissioner deems necessary to determine
518.4program eligibility based on the criteria in paragraphs (a) and (b) and to ensure the
518.5equitable distribution of funds.
518.6(d) An application must include the information specified in clauses (1) to (3) for
518.7each clinical medical education program on an annual basis for three consecutive years.
518.8After that time, an application must include the information specified in clauses (1) to (3)
518.9when requested, at the discretion of the commissioner:
518.10(1) audited clinical training costs per trainee for each clinical medical education
518.11program when available or estimates of clinical training costs based on audited financial
518.12data;
518.13(2) a description of current sources of funding for clinical medical education costs,
518.14including a description and dollar amount of all state and federal financial support,
518.15including Medicare direct and indirect payments; and
518.16(3) other revenue received for the purposes of clinical training.
518.17(e) An applicant that does not provide information requested by the commissioner
518.18shall not be eligible for funds for the current funding cycle.

518.19    Sec. 6. Minnesota Statutes 2012, section 62J.692, subdivision 4, is amended to read:
518.20    Subd. 4. Distribution of funds. (a) The commissioner shall annually distribute the
518.21available medical education funds to all qualifying applicants based on a distribution
518.22formula that reflects a summation of two factors:
518.23    (1) a public program volume factor, which is determined by the total volume of
518.24public program revenue received by each training site as a percentage of all public
518.25program revenue received by all training sites in the fund pool; and
518.26    (2) a supplemental public program volume factor, which is determined by providing
518.27a supplemental payment of 20 percent of each training site's grant to training sites whose
518.28public program revenue accounted for at least 0.98 percent of the total public program
518.29revenue received by all eligible training sites. Grants to training sites whose public
518.30program revenue accounted for less than 0.98 percent of the total public program revenue
518.31received by all eligible training sites shall be reduced by an amount equal to the total
518.32value of the supplemental payment.
518.33    Public program revenue for the distribution formula includes revenue from medical
518.34assistance, prepaid medical assistance, general assistance medical care, and prepaid
518.35general assistance medical care. Training sites that receive no public program revenue
519.1are ineligible for funds available under this subdivision. For purposes of determining
519.2training-site level grants to be distributed under paragraph (a) this paragraph, total
519.3statewide average costs per trainee for medical residents is based on audited clinical
519.4training costs per trainee in primary care clinical medical education programs for medical
519.5residents. Total statewide average costs per trainee for dental residents is based on
519.6audited clinical training costs per trainee in clinical medical education programs for
519.7dental students. Total statewide average costs per trainee for pharmacy residents is based
519.8on audited clinical training costs per trainee in clinical medical education programs for
519.9pharmacy students. Training sites whose training site level grant is less than $1,000
519.10 $5,000, based on the formula described in this paragraph, or that train fewer than 0.1 FTE
519.11eligible trainees, are ineligible for funds available under this subdivision. No training sites
519.12shall receive a grant per FTE trainee that is in excess of the 95th percentile grant per FTE
519.13across all eligible training sites; grants in excess of this amount will be redistributed to
519.14other eligible sites based on the formula described in this paragraph.
519.15(b) For funds distributed in fiscal years 2014 and 2015, the distribution formula shall
519.16include a supplemental public program volume factor, which is determined by providing
519.17a supplemental payment to training sites whose public program revenue accounted for
519.18at least 0.98 percent of the total public program revenue received by all eligible training
519.19sites. The supplemental public program volume factor shall be equal to ten percent of each
519.20training sites grant for funds distributed in fiscal year 2014 and for funds distributed in
519.21fiscal year 2015. Grants to training sites whose public program revenue accounted for less
519.22than 0.98 percent of the total public program revenue received by all eligible training sites
519.23shall be reduced by an amount equal to the total value of the supplemental payment. For
519.24fiscal year 2016 and beyond, the distribution of funds shall be based solely on the public
519.25program volume factor as described in paragraph (a).
519.26(c) Of available medical education funds, $1,000,000 shall be distributed each year
519.27for grants to family medicine residency programs located outside of the seven-county
519.28metropolitan area, as defined in section 473.121, subdivision 4, focused on eduction and
519.29training of family medicine physicians to serve communities outside the metropolitan area.
519.30To be eligible for a grant under this paragraph, a family medicine residency program must
519.31demonstrate that over the most recent three calendar years, at least 25 percent of its residents
519.32practice in Minnesota communities outside of the metropolitan area. Grant funds must be
519.33allocated proportionally based on the number of residents per eligible residency program.
519.34    (b) (d) Funds distributed shall not be used to displace current funding appropriations
519.35from federal or state sources.
520.1    (c) (e) Funds shall be distributed to the sponsoring institutions indicating the amount
520.2to be distributed to each of the sponsor's clinical medical education programs based on
520.3the criteria in this subdivision and in accordance with the commissioner's approval letter.
520.4Each clinical medical education program must distribute funds allocated under paragraph
520.5 paragraphs (a) and (b) to the training sites as specified in the commissioner's approval
520.6letter. Sponsoring institutions, which are accredited through an organization recognized
520.7by the Department of Education or the Centers for Medicare and Medicaid Services, may
520.8contract directly with training sites to provide clinical training. To ensure the quality of
520.9clinical training, those accredited sponsoring institutions must:
520.10    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical
520.11training conducted at sites; and
520.12    (2) take necessary action if the contract requirements are not met. Action may include
520.13the withholding of payments under this section or the removal of students from the site.
520.14    (d) (f) Use of funds is limited to expenses related to clinical training program costs
520.15for eligible programs.
520.16    (g) Any funds not distributed in accordance with the commissioner's approval letter
520.17must be returned to the medical education and research fund within 30 days of receiving
520.18notice from the commissioner. The commissioner shall distribute returned funds to the
520.19appropriate training sites in accordance with the commissioner's approval letter.
520.20    (e) (h) A maximum of $150,000 of the funds dedicated to the commissioner
520.21under section 297F.10, subdivision 1, clause (2), may be used by the commissioner for
520.22administrative expenses associated with implementing this section.

520.23    Sec. 7. Minnesota Statutes 2012, section 62J.692, subdivision 5, is amended to read:
520.24    Subd. 5. Report. (a) Sponsoring institutions receiving funds under this section
520.25must sign and submit a medical education grant verification report (GVR) to verify that
520.26the correct grant amount was forwarded to each eligible training site. If the sponsoring
520.27institution fails to submit the GVR by the stated deadline, or to request and meet
520.28the deadline for an extension, the sponsoring institution is required to return the full
520.29amount of funds received to the commissioner within 30 days of receiving notice from
520.30the commissioner. The commissioner shall distribute returned funds to the appropriate
520.31training sites in accordance with the commissioner's approval letter.
520.32    (b) The reports must provide verification of the distribution of the funds and must
520.33include:
520.34    (1) the total number of eligible trainee FTEs in each clinical medical education
520.35program;
521.1    (2) the name of each funded program and, for each program, the dollar amount
521.2distributed to each training site and a training site expenditure report;
521.3    (3) documentation of any discrepancies between the initial grant distribution notice
521.4included in the commissioner's approval letter and the actual distribution;
521.5    (4) a statement by the sponsoring institution stating that the completed grant
521.6verification report is valid and accurate; and
521.7    (5) other information the commissioner, with advice from the advisory committee,
521.8 deems appropriate to evaluate the effectiveness of the use of funds for medical education.
521.9    (c) By February 15 of Each year, the commissioner, with advice from the
521.10advisory committee, shall provide an annual summary report to the legislature on the
521.11implementation of this section.

521.12    Sec. 8. Minnesota Statutes 2012, section 62J.692, subdivision 9, is amended to read:
521.13    Subd. 9. Review of eligible providers. The commissioner and the Medical
521.14Education and Research Costs Advisory Committee may review provider groups included
521.15in the definition of a clinical medical education program to assure that the distribution
521.16of the funds continue to be consistent with the purpose of this section. The results of
521.17any such reviews must be reported to the chairs and ranking minority members of the
521.18legislative committees with jurisdiction over health care policy and finance.

521.19    Sec. 9. Minnesota Statutes 2012, section 62J.692, is amended by adding a subdivision
521.20to read:
521.21    Subd. 11. Distribution of funds. If federal approval is not received for the formula
521.22described in subdivision 4, paragraphs (a) and (b), 100 percent of available medical
521.23education and research funds shall be distributed based on a distribution formula that
521.24reflects as summation of two factors:
521.25(1) a public program volume factor, that is determined by the total volume of public
521.26program revenue received by each training site as a percentage of all public program
521.27revenue received by all training sites in the fund pool; and
521.28(2) a supplemental public program volume factor, that is determined by providing a
521.29supplemental payment of 20 percent of each training site's grant to training sites whose
521.30public program revenue accounted for a least 0.98 percent of the total public program
521.31revenue received by all eligible training sites. Grants to training sites whose public
521.32program revenue accounted for less than 0.98 percent of the total public program revenue
521.33received by all eligible training sites shall be reduced by an amount equal to the total
521.34value of the supplemental payment.

522.1    Sec. 10. Minnesota Statutes 2012, section 62Q.19, subdivision 1, is amended to read:
522.2    Subdivision 1. Designation. (a) The commissioner shall designate essential
522.3community providers. The criteria for essential community provider designation shall be
522.4the following:
522.5(1) a demonstrated ability to integrate applicable supportive and stabilizing services
522.6with medical care for uninsured persons and high-risk and special needs populations,
522.7underserved, and other special needs populations; and
522.8(2) a commitment to serve low-income and underserved populations by meeting the
522.9following requirements:
522.10(i) has nonprofit status in accordance with chapter 317A;
522.11(ii) has tax-exempt status in accordance with the Internal Revenue Service Code,
522.12section 501(c)(3);
522.13(iii) charges for services on a sliding fee schedule based on current poverty income
522.14guidelines; and
522.15(iv) does not restrict access or services because of a client's financial limitation;
522.16(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
522.17hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
522.18government, an Indian health service unit, or a community health board as defined in
522.19chapter 145A;
522.20(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
522.21bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
522.22conditions;
522.23(5) a sole community hospital. For these rural hospitals, the essential community
522.24provider designation applies to all health services provided, including both inpatient and
522.25outpatient services. For purposes of this section, "sole community hospital" means a
522.26rural hospital that:
522.27(i) is eligible to be classified as a sole community hospital according to Code
522.28of Federal Regulations, title 42, section 412.92, or is located in a community with a
522.29population of less than 5,000 and located more than 25 miles from a like hospital currently
522.30providing acute short-term services;
522.31(ii) has experienced net operating income losses in two of the previous three
522.32most recent consecutive hospital fiscal years for which audited financial information is
522.33available; and
522.34(iii) consists of 40 or fewer licensed beds; or
522.35(6) a birth center licensed under section 144.615; or
523.1(7) a hospital and affiliated specialty clinics that predominantly serve patients who
523.2are under 21 years of age and meet the following criteria:
523.3(i) provide intensive specialty pediatric services that are routinely provided in fewer
523.4than five hospitals in the state; and
523.5(ii) serve children from at least half of the counties in the state.
523.6(b) Prior to designation, the commissioner shall publish the names of all applicants
523.7in the State Register. The public shall have 30 days from the date of publication to submit
523.8written comments to the commissioner on the application. No designation shall be made
523.9by the commissioner until the 30-day period has expired.
523.10(c) The commissioner may designate an eligible provider as an essential community
523.11provider for all the services offered by that provider or for specific services designated by
523.12the commissioner.
523.13(d) For the purpose of this subdivision, supportive and stabilizing services include at
523.14a minimum, transportation, child care, cultural, and linguistic services where appropriate.
523.15EFFECTIVE DATE.This section is effective the day following final enactment.

523.16    Sec. 11. Minnesota Statutes 2012, section 103I.005, is amended by adding a
523.17subdivision to read:
523.18    Subd. 1a. Bored geothermal heat exchanger. "Bored geothermal heat exchanger"
523.19means an earth-coupled heating or cooling device consisting of a sealed closed-loop
523.20piping system installed in a boring in the ground to transfer heat to or from the surrounding
523.21earth with no discharge.

523.22    Sec. 12. Minnesota Statutes 2012, section 103I.521, is amended to read:
523.23103I.521 FEES DEPOSITED WITH COMMISSIONER OF MANAGEMENT
523.24AND BUDGET.
523.25Unless otherwise specified, fees collected for licenses or registration by the
523.26commissioner under this chapter shall be deposited in the state treasury and credited to
523.27the state government special revenue fund.

523.28    Sec. 13. Minnesota Statutes 2012, section 144.123, subdivision 1, is amended to read:
523.29    Subdivision 1. Who must pay. Except for the limitation contained in this section,
523.30the commissioner of health shall charge a handling fee may enter into a contractual
523.31agreement to recover costs incurred for analysis for diagnostic purposes for each specimen
523.32submitted to the Department of Health for analysis for diagnostic purposes by any hospital,
524.1private laboratory, private clinic, or physician. No fee shall be charged to any entity which
524.2receives direct or indirect financial assistance from state or federal funds administered by
524.3the Department of Health, including any public health department, nonprofit community
524.4clinic, sexually transmitted disease clinic, or similar entity. No fee will be charged The
524.5commissioner shall not charge for any biological materials submitted to the Department
524.6of Health as a requirement of Minnesota Rules, part 4605.7040, or for those biological
524.7materials requested by the department to gather information for disease prevention or
524.8control purposes. The commissioner of health may establish other exceptions to the
524.9handling fee as may be necessary to protect the public's health. All fees collected pursuant
524.10to this section shall be deposited in the state treasury and credited to the state government
524.11special revenue fund. Funds generated in a contractual agreement made pursuant to this
524.12section shall be deposited in a special account and are appropriated to the commissioner
524.13for purposes of providing the services specified in the contracts. All such contractual
524.14agreements shall be processed in accordance with the provisions of chapter 16C.
524.15EFFECTIVE DATE.This section is effective July 1, 2014.

524.16    Sec. 14. Minnesota Statutes 2012, section 144.125, subdivision 1, is amended to read:
524.17    Subdivision 1. Duty to perform testing. (a) It is the duty of (1) the administrative
524.18officer or other person in charge of each institution caring for infants 28 days or less
524.19of age, (2) the person required in pursuance of the provisions of section 144.215, to
524.20register the birth of a child, or (3) the nurse midwife or midwife in attendance at the
524.21birth, to arrange to have administered to every infant or child in its care tests for heritable
524.22and congenital disorders according to subdivision 2 and rules prescribed by the state
524.23commissioner of health.
524.24    (b) Testing and the, recording and of test results, reporting of test results, and
524.25follow-up of infants with heritable congenital disorders, including hearing loss detected
524.26through the early hearing detection and intervention program in section 144.966, shall be
524.27performed at the times and in the manner prescribed by the commissioner of health. The
524.28commissioner shall charge a fee so that the total of fees collected will approximate the
524.29costs of conducting the tests and implementing and maintaining a system to follow-up
524.30infants with heritable or congenital disorders, including hearing loss detected through the
524.31early hearing detection and intervention program under section 144.966.
524.32    (c) The fee is $101 per specimen. Effective July 1, 2010, the fee shall be increased
524.33to $106 to support the newborn screening program, including tests administered under
524.34this section and section 144.966, shall be $135 per specimen. The increased fee amount
524.35shall be deposited in the general fund. Costs associated with capital expenditures and
525.1the development of new procedures may be prorated over a three-year period when
525.2calculating the amount of the fees. This fee amount shall be deposited in the state treasury
525.3and credited to the state government special revenue fund.
525.4(d) The fee to offset the cost of the support services provided under section 144.966,
525.5subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury
525.6and credited to the general fund.

525.7    Sec. 15. [144.1251] NEWBORN SCREENING FOR CRITICAL CONGENITAL
525.8HEART DISEASE (CCHD).
525.9    Subdivision 1. Required testing and reporting. (a) Each licensed hospital or
525.10state-licensed birthing center or facility that provides maternity and newborn care services
525.11shall provide screening for congenital heart disease to all newborns prior to discharge
525.12using pulse oximetry screening. The screening must occur after the infant is 24 hours old,
525.13before discharge from the nursery. If discharge occurs before the infant is 24 hours old,
525.14the screening must occur as close as possible to the time of discharge.
525.15(b) For premature infants (less than 36 weeks of gestation) and infants admitted to a
525.16higher-level nursery (special care or intensive care), pulse oximetry must be performed
525.17when medically appropriate prior to discharge.
525.18(c) Results of the screening must be reported to the Department of Health.
525.19    Subd. 2. Implementation. The Department of Health shall:
525.20(1) communicate the screening protocol requirements;
525.21(2) make information and forms available to the hospitals, birthing centers, and other
525.22facilities that are required to provide the screening, health care providers who provide
525.23prenatal care and care to newborns, and expectant parents and parents of newborns. The
525.24information and forms must include screening protocol and reporting requirements and
525.25parental options;
525.26(3) provide training to ensure compliance with and appropriate implementation of
525.27the screening;
525.28(4) establish the mechanism for the required data collection and reporting of
525.29screening and follow-up diagnostic results to the Department of Health according to the
525.30Department of Health's recommendations;
525.31(5) coordinate the implementation of universal standardized screening;
525.32(6) act as a resource for providers as the screening program is implemented, and in
525.33consultation with the Advisory Committee on Heritable and Congenital Disorders, develop
525.34and implement policies for early medical and developmental intervention services and
525.35long-term follow-up services for children and their families identified with a CCHD; and
526.1(7) comply with sections 144.125 to 144.128.

526.2    Sec. 16. Minnesota Statutes 2012, section 144.212, is amended to read:
526.3144.212 DEFINITIONS.
526.4    Subdivision 1. Scope. As used in sections 144.211 to 144.227, the following terms
526.5have the meanings given.
526.6    Subd. 1a. Amendment. "Amendment" means completion or correction of made
526.7to certification items on a vital record. after a certification has been issued or more
526.8than one year after the event, whichever occurs first, that does not result in a sealed or
526.9replaced record.
526.10    Subd. 1b. Authorized representative. "Authorized representative" means an agent
526.11designated in a written and witnessed statement signed by the subject of the record or
526.12other qualified applicant.
526.13    Subd. 1c. Certification item. "Certification item" means all individual items
526.14appearing on a certificate of birth and the demographic and legal items on a certificate
526.15of death.
526.16    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.
526.17    Subd. 2a. Correction. "Correction" means a change made to a noncertification
526.18item, including information collected for medical and statistical purposes. A correction
526.19also means a change to a certification item within one year of the event provided that no
526.20certification, whether paper or electronic, has been issued.
526.21    Subd. 2b. Court of competent jurisdiction. "Court of competent jurisdiction"
526.22means a court within the United States with jurisdiction over the individual and such other
526.23individuals that the court deems necessary.
526.24    Subd. 2a 2c. Delayed registration. "Delayed registration" means registration of a
526.25record of birth or death filed one or more years after the date of birth or death.
526.26    Subd. 2d. Disclosure. "Disclosure" means to make available or make known
526.27personally identifiable information contained in a vital record, by any means of
526.28communication.
526.29    Subd. 3. File. "File" means to present a vital record or report for registration to the
526.30Office of the State Registrar Vital Records and to have the vital record or report accepted
526.31for registration by the Office of the State Registrar Vital Records.
526.32    Subd. 4. Final disposition. "Final disposition" means the burial, interment,
526.33cremation, removal from the state, or other authorized disposition of a dead body or
526.34dead fetus.
526.35    Subd. 4a. Institution. "Institution" means a public or private establishment that:
527.1(1) provides inpatient or outpatient medical, surgical, or diagnostic care or treatment;
527.2or
527.3(2) provides nursing, custodial, or domiciliary care, or to which persons are
527.4committed by law.
527.5    Subd. 4b. Legal representative. "Legal representative" means a licensed attorney
527.6representing an individual.
527.7    Subd. 4c. Local issuance office. "Local issuance office" means a county
527.8governmental office authorized by the state registrar to issue certified birth and death
527.9records.
527.10    Subd. 4d. Record. "Record" means a report of a vital event that has been registered
527.11by the state registrar.
527.12    Subd. 5. Registration. "Registration" means the process by which vital records
527.13are completed, filed, and incorporated into the official records of the Office of the State
527.14 Vital Records Registrar.
527.15    Subd. 6. State registrar. "State registrar" means the commissioner of health or a
527.16designee.
527.17    Subd. 7. System of vital statistics. "System of vital statistics" includes the
527.18registration, collection, preservation, amendment, verification, maintenance of the security
527.19and integrity of, and certification of vital records, the collection of other reports required
527.20by sections 144.211 to 144.227, and related activities including the tabulation, analysis,
527.21publication, and dissemination of vital statistics.
527.22    Subd. 7a. Verification. "Verification" means a confirmation of the information on a
527.23vital record based on the facts contained in a certification.
527.24    Subd. 8. Vital record. "Vital record" means a record or report of birth, stillbirth,
527.25death, marriage, dissolution and annulment, and data related thereto. The birth record is
527.26not a medical record of the mother or the child.
527.27    Subd. 9. Vital statistics. "Vital statistics" means the data derived from records and
527.28reports of birth, death, fetal death, induced abortion, marriage, dissolution and annulment,
527.29and related reports.
527.30    Subd. 10. Local registrar. "Local registrar" means an individual designated under
527.31section 144.214, subdivision 1, to perform the duties of a local registrar.
527.32    Subd. 11. Consent to disclosure. "Consent to disclosure" means an affidavit filed
527.33with the state registrar which sets forth the following information:
527.34(1) the current name and address of the affiant;
527.35(2) any previous name by which the affiant was known;
528.1(3) the original and adopted names, if known, of the adopted child whose original
528.2birth record is to be disclosed;
528.3(4) the place and date of birth of the adopted child;
528.4(5) the biological relationship of the affiant to the adopted child; and
528.5(6) the affiant's consent to disclosure of information from the original birth record of
528.6the adopted child.

528.7    Sec. 17. Minnesota Statutes 2012, section 144.213, is amended to read:
528.8144.213 OFFICE OF THE STATE REGISTRAR VITAL RECORDS.
528.9    Subdivision 1. Creation; state registrar; Office of Vital Records. The
528.10commissioner shall establish an Office of the State Registrar Vital Records under the
528.11supervision of the state registrar. The commissioner shall furnish to local registrars the
528.12forms necessary for correct reporting of vital statistics, and shall instruct the local registrars
528.13in the collection and compilation of the data. The commissioner shall promulgate rules for
528.14the collection, filing, and registering of vital statistics information by the state and local
528.15registrars registrar, physicians, morticians, and others. Except as otherwise provided in
528.16sections 144.211 to 144.227, rules previously promulgated by the commissioner relating to
528.17the collection, filing and registering of vital statistics shall remain in effect until repealed,
528.18modified or superseded by a rule promulgated by the commissioner.
528.19    Subd. 2. General duties. (a) The state registrar shall coordinate the work of
528.20local registrars to maintain a statewide system of vital statistics. The state registrar is
528.21responsible for the administration and enforcement of sections 144.211 to 144.227, and
528.22shall supervise local registrars in the enforcement of sections 144.211 to 144.227 and the
528.23rules promulgated thereunder. Local issuance offices that fail to comply with the statutes
528.24or rules or to properly train employees may have their issuance privileges and access to
528.25the vital records system revoked.
528.26(b) To preserve vital records the state registrar is authorized to prepare typewritten,
528.27photographic, electronic or other reproductions of original records and files in the Office
528.28of Vital Records. The reproductions when certified by the state registrar shall be accepted
528.29as the original records.
528.30(c) The state registrar shall also:
528.31(1) establish, designate, and eliminate offices in the state to aid in the efficient
528.32issuance of vital records;
528.33(2) direct the activities of all persons engaged in activities pertaining to the operation
528.34of the system of vital statistics;
529.1(3) develop and conduct training programs to promote uniformity of policy and
529.2procedures throughout the state in matters pertaining to the system of vital statistics; and
529.3(4) prescribe, furnish, and distribute all forms required by sections 144.211 to
529.4144.227 and any rules adopted under these sections, and prescribe other means for the
529.5transmission of data, including electronic submission, that will accomplish the purpose of
529.6complete, accurate, and timely reporting and registration.
529.7    Subd. 3. Record keeping. To preserve vital records the state registrar is authorized
529.8to prepare typewritten, photographic, electronic or other reproductions of original records
529.9and files in the Office of the State Registrar. The reproductions when certified by the state
529.10or local registrar shall be accepted as the original records.

529.11    Sec. 18. [144.2131] SECURITY OF VITAL RECORDS SYSTEM.
529.12The state registrar shall:
529.13(1) authenticate all users of the system of vital statistics and document that all users
529.14require access based on their official duties;
529.15(2) authorize authenticated users of the system of vital statistics to access specific
529.16components of the vital statistics systems necessary for their official roles and duties;
529.17(3) establish separation of duties between staff roles that may be susceptible to fraud
529.18or misuse and routinely perform audits of staff work for the purposes of identifying fraud
529.19or misuse within the vital statistics system;
529.20(4) require that authenticated and authorized users of the system of vital
529.21statistics maintain a specified level of training related to security and provide written
529.22acknowledgment of security procedures and penalties;
529.23(5) validate data submitted for registration through site visits or with independent
529.24sources outside the registration system at a frequency specified by the state registrar to
529.25maximize the integrity of the data collected;
529.26(6) protect personally identifiable information and maintain systems pursuant to
529.27applicable state and federal laws;
529.28(7) accept a report of death if the decedent was born in Minnesota or if the decedent
529.29was a resident of Minnesota from the United States Department of Defense or the United
529.30States Department of State when the death of a United States citizen occurs outside the
529.31United States;
529.32(8) match death records registered in Minnesota and death records provided from
529.33other jurisdictions to live birth records in Minnesota;
530.1(9) match death records received from the United States Department of Defense
530.2or the United States Department of State for deaths of United States citizens occurring
530.3outside the United States to live birth records in Minnesota;
530.4(10) work with law enforcement to initiate and provide evidence for active fraud
530.5investigations;
530.6(11) provide secure workplace, storage, and technology environments that have
530.7limited role-based access;
530.8(12) maintain overt, covert, and forensic security measures for certifications,
530.9verifications, and automated systems that are part of the vital statistics system; and
530.10(13) comply with applicable state and federal laws and rules associated with
530.11information technology systems and related information security requirements.

530.12    Sec. 19. Minnesota Statutes 2012, section 144.215, subdivision 3, is amended to read:
530.13    Subd. 3. Father's name; child's name. In any case in which paternity of a child is
530.14determined by a court of competent jurisdiction, a declaration of parentage is executed
530.15under section 257.34, or a recognition of parentage is executed under section 257.75, the
530.16name of the father shall be entered on the birth record. If the order of the court declares
530.17the name of the child, it shall also be entered on the birth record. If the order of the court
530.18does not declare the name of the child, or there is no court order, then upon the request of
530.19both parents in writing, the surname of the child shall be defined by both parents.

530.20    Sec. 20. Minnesota Statutes 2012, section 144.215, subdivision 4, is amended to read:
530.21    Subd. 4. Social Security number registration. (a) Parents of a child born within
530.22this state shall give the parents' Social Security numbers to the Office of the State Registrar
530.23 Vital Records at the time of filing the birth record, but the numbers shall not appear on
530.24the certified record.
530.25(b) The Social Security numbers are classified as private data, as defined in section
530.2613.02, subdivision 12, on individuals, but the Office of the State Registrar Vital Records
530.27 shall provide a Social Security number to the public authority responsible for child support
530.28services upon request by the public authority for use in the establishment of parentage and
530.29the enforcement of child support obligations.

530.30    Sec. 21. Minnesota Statutes 2012, section 144.216, subdivision 1, is amended to read:
530.31    Subdivision 1. Reporting a foundling. Whoever finds a live born infant of unknown
530.32parentage shall report within five days to the Office of the State Registrar Vital Records
530.33 such information as the commissioner may by rule require to identify the foundling.

531.1    Sec. 22. Minnesota Statutes 2012, section 144.217, subdivision 2, is amended to read:
531.2    Subd. 2. Court petition. If a delayed record of birth is rejected under subdivision
531.31, a person may petition the appropriate court in the county in which the birth allegedly
531.4occurred for an order establishing a record of the date and place of the birth and the
531.5parentage of the person whose birth is to be registered. The petition shall state:
531.6(1) that the person for whom a delayed record of birth is sought was born in this state;
531.7(2) that no record of birth can be found in the Office of the State Registrar Vital
531.8Records;
531.9(3) that diligent efforts by the petitioner have failed to obtain the evidence required
531.10in subdivision 1;
531.11(4) that the state registrar has refused to register a delayed record of birth; and
531.12(5) other information as may be required by the court.

531.13    Sec. 23. Minnesota Statutes 2012, section 144.218, subdivision 5, is amended to read:
531.14    Subd. 5. Replacement of vital records. Upon the order of a court of this state, upon
531.15the request of a court of another state, upon the filing of a declaration of parentage under
531.16section 257.34, or upon the filing of a recognition of parentage with a the state registrar, a
531.17replacement birth record must be registered consistent with the findings of the court, the
531.18declaration of parentage, or the recognition of parentage.

531.19    Sec. 24. [144.2181] AMENDMENT AND CORRECTION OF VITAL RECORDS.
531.20(a) A vital record registered under sections 144.212 to 144.227 may be amended
531.21or corrected only according to sections 144.212 to 144.227 and rules adopted by the
531.22commissioner of health to protect the integrity and accuracy of vital records.
531.23(b)(1) A vital record that is amended under this section shall indicate that it has been
531.24amended, except as otherwise provided in this section or by rule.
531.25(2) Electronic documentation shall be maintained by the state registrar that
531.26identifies the evidence upon which the amendment or correction was based, the date
531.27of the amendment or correction, and the identity of the authorized person making the
531.28amendment or correction.
531.29(c) Upon receipt of a certified copy of an order of a court of competent jurisdiction
531.30changing the name of a person whose birth is registered in Minnesota and upon request of
531.31such person if 18 years of age or older or having the status of emancipated minor, the state
531.32registrar shall amend the birth record to show the new name. If the person is a minor or
531.33an incapacitated person then a parent, guardian, or legal representative of the minor or
531.34incapacitated person may make the request.
532.1(d) When an applicant does not submit the minimum documentation required for
532.2amending a vital record or when the state registrar has cause to question the validity
532.3or completeness of the applicant's statements or the documentary evidence, and the
532.4deficiencies are not corrected, the state registrar shall not amend the vital record. The
532.5state registrar shall advise the applicant of the reason for this action and shall further
532.6advise the applicant of the right of appeal to a court with competent jurisdiction over
532.7the Department of Health.

532.8    Sec. 25. Minnesota Statutes 2012, section 144.225, subdivision 1, is amended to read:
532.9    Subdivision 1. Public information; access to vital records. Except as otherwise
532.10provided for in this section and section 144.2252, information contained in vital records
532.11shall be public information. Physical access to vital records shall be subject to the
532.12supervision and regulation of the state and local registrars registrar and their employees
532.13pursuant to rules promulgated by the commissioner in order to protect vital records from
532.14loss, mutilation or destruction and to prevent improper disclosure of vital records which
532.15are confidential or private data on individuals, as defined in section 13.02, subdivisions
532.163 and 12.

532.17    Sec. 26. Minnesota Statutes 2012, section 144.225, subdivision 4, is amended to read:
532.18    Subd. 4. Access to records for research purposes. The state registrar may permit
532.19persons performing medical research access to the information restricted in subdivision
532.202 or 2a if those persons agree in writing not to disclose private or confidential data on
532.21individuals.

532.22    Sec. 27. Minnesota Statutes 2012, section 144.225, subdivision 7, is amended to read:
532.23    Subd. 7. Certified birth or death record. (a) The state or local registrar or local
532.24issuance office shall issue a certified birth or death record or a statement of no vital record
532.25found to an individual upon the individual's proper completion of an attestation provided
532.26by the commissioner and payment of the required fee:
532.27    (1) to a person who has a tangible interest in the requested vital record. A person
532.28who has a tangible interest is:
532.29    (i) the subject of the vital record;
532.30    (ii) a child of the subject;
532.31    (iii) the spouse of the subject;
532.32    (iv) a parent of the subject;
532.33    (v) the grandparent or grandchild of the subject;
533.1    (vi) if the requested record is a death record, a sibling of the subject;
533.2    (vii) the party responsible for filing the vital record;
533.3    (viii) the legal custodian, guardian or conservator, or health care agent of the subject;
533.4    (ix) a personal representative, by sworn affidavit of the fact that the certified copy is
533.5required for administration of the estate;
533.6    (x) a successor of the subject, as defined in section 524.1-201, if the subject is
533.7deceased, by sworn affidavit of the fact that the certified copy is required for administration
533.8of the estate;
533.9    (xi) if the requested record is a death record, a trustee of a trust by sworn affidavit of
533.10the fact that the certified copy is needed for the proper administration of the trust;
533.11    (xii) a person or entity who demonstrates that a certified vital record is necessary for
533.12the determination or protection of a personal or property right, pursuant to rules adopted
533.13by the commissioner; or
533.14    (xiii) adoption agencies in order to complete confidential postadoption searches as
533.15required by section 259.83;
533.16    (2) to any local, state, or federal governmental agency upon request if the certified
533.17vital record is necessary for the governmental agency to perform its authorized duties.
533.18An authorized governmental agency includes the Department of Human Services, the
533.19Department of Revenue, and the United States Citizenship and Immigration Services;
533.20    (3) to an attorney upon evidence of the attorney's license;
533.21    (4) pursuant to a court order issued by a court of competent jurisdiction. For
533.22purposes of this section, a subpoena does not constitute a court order; or
533.23    (5) to a representative authorized by a person under clauses (1) to (4).
533.24    (b) The state or local registrar or local issuance office shall also issue a certified
533.25death record to an individual described in paragraph (a), clause (1), items (ii) to (viii), if,
533.26on behalf of the individual, a licensed mortician furnishes the registrar with a properly
533.27completed attestation in the form provided by the commissioner within 180 days of the
533.28time of death of the subject of the death record. This paragraph is not subject to the
533.29requirements specified in Minnesota Rules, part 4601.2600, subpart 5, item B.

533.30    Sec. 28. Minnesota Statutes 2012, section 144.225, subdivision 8, is amended to read:
533.31    Subd. 8. Standardized format for certified birth and death records. No later than
533.32July 1, 2000, The commissioner shall develop maintain a standardized format for certified
533.33birth records and death records issued by the state and local registrars registrar and local
533.34issuance offices. The format shall incorporate security features in accordance with this
533.35section. The standardized format must be implemented on a statewide basis by July 1, 2001.

534.1    Sec. 29. Minnesota Statutes 2012, section 144.226, is amended to read:
534.2144.226 FEES.
534.3    Subdivision 1. Which services are for fee. The fees for the following services shall
534.4be the following or an amount prescribed by rule of the commissioner:
534.5(a) The fee for the issuance of administrative review and processing of a request for
534.6 a certified vital record or a certification that the vital record cannot be found is $9. No
534.7fee shall be charged for a certified birth, stillbirth, or death record that is reissued within
534.8one year of the original issue, if an amendment is made to the vital record and if the
534.9previously issued vital record is surrendered. The fee is payable at the time of application
534.10and is nonrefundable.
534.11(b) The fee for processing a request for the replacement of a birth record for
534.12all events, except when filing a recognition of parentage pursuant to section 257.73,
534.13subdivision 1 , is $40. The fee is payable at the time of application and is nonrefundable.
534.14(c) The fee for administrative review and processing of a request for the filing of a
534.15delayed registration of birth, stillbirth, or death is $40. The fee is payable at the time of
534.16application and is nonrefundable. This fee includes one subsequent review of the request
534.17if the request is not acceptable upon the initial receipt.
534.18(d) The fee for administrative review and processing of a request for the amendment
534.19of any vital record when requested more than 45 days after the filing of the vital record is
534.20$40. No fee shall be charged for an amendment requested within 45 days after the filing
534.21of the vital record. The fee is payable at the time of application and is nonrefundable.
534.22This fee includes one subsequent review of the request if the request is not acceptable
534.23upon the initial receipt.
534.24(e) The fee for administrative review and processing of a request for the verification
534.25of information from vital records is $9 when the applicant furnishes the specific
534.26information to locate the vital record. When the applicant does not furnish specific
534.27information, the fee is $20 per hour for staff time expended. Specific information includes
534.28the correct date of the event and the correct name of the registrant subject of the record.
534.29Fees charged shall approximate the costs incurred in searching and copying the vital
534.30records. The fee is payable at the time of application and is nonrefundable.
534.31(f) The fee for administrative review and processing of a request for the issuance
534.32of a copy of any document on file pertaining to a vital record or statement that a related
534.33document cannot be found is $9. The fee is payable at the time of application and is
534.34nonrefundable.
535.1    Subd. 2. Fees to state government special revenue fund. Fees collected under
535.2this section by the state registrar shall be deposited in the state treasury and credited to
535.3the state government special revenue fund.
535.4    Subd. 3. Birth record surcharge. (a) In addition to any fee prescribed under
535.5subdivision 1, there shall be a nonrefundable surcharge of $3 for each certified birth or
535.6stillbirth record and for a certification that the vital record cannot be found. The local or
535.7 state registrar or local issuance office shall forward this amount to the commissioner of
535.8management and budget for deposit into the account for the children's trust fund for the
535.9prevention of child abuse established under section 256E.22. This surcharge shall not be
535.10charged under those circumstances in which no fee for a certified birth or stillbirth record
535.11is permitted under subdivision 1, paragraph (a). Upon certification by the commissioner of
535.12management and budget that the assets in that fund exceed $20,000,000, this surcharge
535.13shall be discontinued.
535.14(b) In addition to any fee prescribed under subdivision 1, there shall be a
535.15nonrefundable surcharge of $10 for each certified birth record. The local or state registrar
535.16or local issuance office shall forward this amount to the commissioner of management and
535.17budget for deposit in the general fund. This surcharge shall not be charged under those
535.18circumstances in which no fee for a certified birth record is permitted under subdivision 1,
535.19paragraph (a).
535.20    Subd. 4. Vital records surcharge. (a) In addition to any fee prescribed under
535.21subdivision 1, there is a nonrefundable surcharge of $2 $4 for each certified and
535.22noncertified birth, stillbirth, or death record, and for a certification that the record cannot
535.23be found. The local issuance office or state registrar shall forward this amount to the
535.24commissioner of management and budget to be deposited into the state government special
535.25revenue fund. This surcharge shall not be charged under those circumstances in which no
535.26fee for a birth, stillbirth, or death record is permitted under subdivision 1, paragraph (a).
535.27(b) Effective August 1, 2005, the surcharge in paragraph (a) is $4.
535.28    Subd. 5. Electronic verification. A fee for the electronic verification or electronic
535.29certification of a vital event, when the information being verified or certified is obtained
535.30from a certified birth or death record, shall be established through contractual or
535.31interagency agreements with interested local, state, or federal government agencies.
535.32    Subd. 6. Alternative payment methods. Notwithstanding subdivision 1, alternative
535.33payment methods may be approved and implemented by the state registrar or a local
535.34registrar issuance office.

535.35    Sec. 30. [144.492] DEFINITIONS.
536.1    Subdivision 1. Applicability. For the purposes of sections 144.492 to 144.494, the
536.2terms defined in this section have the meanings given them.
536.3    Subd. 2. Commissioner. "Commissioner" means the commissioner of health.
536.4    Subd. 3. Joint commission. "Joint commission" means the independent,
536.5not-for-profit organization that accredits and certifies health care organizations and
536.6programs in the United States.
536.7    Subd. 4. Stroke. "Stroke" means the sudden death of brain cells in a localized
536.8area due to inadequate blood flow.

536.9    Sec. 31. [144.493] CRITERIA.
536.10    Subdivision 1. Comprehensive stroke center. A hospital meets the criteria for a
536.11comprehensive stroke center if the hospital has been certified as a comprehensive stroke
536.12center by the joint commission or another nationally recognized accreditation entity.
536.13    Subd. 2. Primary stroke center. A hospital meets the criteria for a primary stroke
536.14center if the hospital has been certified as a primary stroke center by the joint commission
536.15or another nationally recognized accreditation entity.
536.16    Subd. 3. Acute stroke ready hospital. A hospital meets the criteria for an acute
536.17stroke ready hospital if the hospital has the following elements of an acute stroke ready
536.18hospital:
536.19(1) an acute stroke team available or on-call 24 hours a days, seven days a week;
536.20(2) written stroke protocols, including triage, stabilization of vital functions, initial
536.21diagnostic tests, and use of medications;
536.22(3) a written plan and letter of cooperation with emergency medical services regarding
536.23triage and communication that are consistent with regional patient care procedures;
536.24(4) emergency department personnel who are trained in diagnosing and treating
536.25acute stroke;
536.26(5) the capacity to complete basic laboratory tests, electrocardiograms, and chest
536.27x-rays 24 hours a day, seven days a week;
536.28(6) the capacity to perform and interpret brain injury imaging studies 24 hours a
536.29day, seven days a week;
536.30(7) written protocols that detail available emergent therapies and reflect current
536.31treatment guidelines, which include performance measures and are revised at least annually;
536.32(8) a neurosurgery coverage plan, call schedule, and a triage and transportation plan;
536.33(9) transfer protocols and agreements for stroke patients; and
536.34(10) a designated medical director with experience and expertise in acute stroke care.

537.1    Sec. 32. [144.494] DESIGNATING STROKE CENTERS AND STROKE
537.2HOSPITALS.
537.3    Subdivision 1. Naming privileges. Unless it has been designated as a stroke center
537.4or stroke hospital pursuant to section 144.493, no hospital shall use the term "stroke
537.5center" or "stroke hospital" in its name or its advertising or shall otherwise indicate it
537.6has stroke treatment capabilities.
537.7    Subd. 2. Designation. A hospital that voluntarily meets the criteria for a
537.8comprehensive stroke center, primary stroke center, or acute stroke ready hospital may
537.9apply to the commissioner for designation, and upon the commissioner's review and
537.10approval of the application, shall be designated as a comprehensive stroke center, a
537.11primary stroke center, or an acute stroke ready hospital for a three-year period. If a hospital
537.12loses its certification as a comprehensive stroke center or primary stroke center from
537.13the joint commission or other nationally recognized accreditation entity, its Minnesota
537.14designation shall be immediately withdrawn. Prior to the expiration of the three-year
537.15designation, a hospital seeking to remain part of the voluntary acute stroke system may
537.16reapply to the commissioner for designation.

537.17    Sec. 33. [144.554] HEALTH FACILITIES CONSTRUCTION PLAN
537.18SUBMITTAL AND FEES.
537.19For hospitals, nursing homes, boarding care homes, residential hospices, supervised
537.20living facilities, freestanding outpatient surgical centers, and end-stage renal disease
537.21facilities, the commissioner shall collect a fee for the review and approval of architectural,
537.22mechanical, and electrical plans and specifications submitted before construction begins
537.23for each project relative to construction of new buildings, additions to existing buildings,
537.24or remodeling or alterations of existing buildings. All fees collected in this section shall
537.25be deposited in the state treasury and credited to the state government special revenue
537.26fund. Fees must be paid at the time of submission of final plans for review and are not
537.27refundable. The fee is calculated as follows:

537.28	Construction project total estimated cost	Fee
537.29	$0 - $10,000	$30
537.30	$10,001 - $50,000	$150
537.31	$50,001 - $100,000	$300
537.32	$100,001 - $150,000	$450
537.33	$150,001 - $200,000	$600
537.34	$200,001 - $250,000	$750
537.35	$250,001 - $300,000	$900
537.36	$300,001 - $350,000	$1,050
538.1	$350,001 - $400,000	$1,200
538.2	$400,001 - $450,000	$1,350
538.3	$450,001 - $500,000	$1,500
538.4	$500,001 - $550,000	$1,650
538.5	$550,001 - $600,000	$1,800
538.6	$600,001 - $650,000	$1,950
538.7	$650,001 - $700,000	$2,100
538.8	$700,001 - $750,000	$2,250
538.9	$750,001 - $800,000	$2,400
538.10	$800,001 - $850,000	$2,550
538.11	$850,001 - $900,000	$2,700
538.12	$900,001 - $950,000	$2,850
538.13	$950,001 - $1,000,000	$3,000
538.14	$1,000,001 - $1,050,000	$3,150
538.15	$1,050,001 - $1,100,000	$3,300
538.16	$1,100,001 - $1,150,000	$3,450
538.17	$1,150,001 - $1,200,000	$3,600
538.18	$1,200,001 - $1,250,000	$3,750
538.19	$1,250,001 - $1,300,000	$3,900
538.20	$1,300,001 - $1,350,000	$4,050
538.21	$1,350,001 - $1,400,000	$4,200
538.22	$1,400,001 - $1,450,000	$4,350
538.23	$1,450,001 - $1,500,000	$4,500
538.24	$1,500,001 and over	$4,800

538.25    Sec. 34. Minnesota Statutes 2012, section 144.966, subdivision 2, is amended to read:
538.26    Subd. 2. Newborn Hearing Screening Advisory Committee. (a) The
538.27commissioner of health shall establish a Newborn Hearing Screening Advisory Committee
538.28to advise and assist the Department of Health and the Department of Education in:
538.29    (1) developing protocols and timelines for screening, rescreening, and diagnostic
538.30audiological assessment and early medical, audiological, and educational intervention
538.31services for children who are deaf or hard-of-hearing;
538.32    (2) designing protocols for tracking children from birth through age three that may
538.33have passed newborn screening but are at risk for delayed or late onset of permanent
538.34hearing loss;
538.35    (3) designing a technical assistance program to support facilities implementing the
538.36screening program and facilities conducting rescreening and diagnostic audiological
538.37assessment;
538.38    (4) designing implementation and evaluation of a system of follow-up and tracking;
538.39and
539.1    (5) evaluating program outcomes to increase effectiveness and efficiency and ensure
539.2culturally appropriate services for children with a confirmed hearing loss and their families.
539.3    (b) The commissioner of health shall appoint at least one member from each of the
539.4following groups with no less than two of the members being deaf or hard-of-hearing:
539.5    (1) a representative from a consumer organization representing culturally deaf
539.6persons;
539.7    (2) a parent with a child with hearing loss representing a parent organization;
539.8    (3) a consumer from an organization representing oral communication options;
539.9    (4) a consumer from an organization representing cued speech communication
539.10options;
539.11    (5) an audiologist who has experience in evaluation and intervention of infants
539.12and young children;
539.13    (6) a speech-language pathologist who has experience in evaluation and intervention
539.14of infants and young children;
539.15    (7) two primary care providers who have experience in the care of infants and young
539.16children, one of which shall be a pediatrician;
539.17    (8) a representative from the early hearing detection intervention teams;
539.18    (9) a representative from the Department of Education resource center for the deaf
539.19and hard-of-hearing or the representative's designee;
539.20    (10) a representative of the Commission of Deaf, DeafBlind and Hard-of-Hearing
539.21Minnesotans;
539.22    (11) a representative from the Department of Human Services Deaf and
539.23Hard-of-Hearing Services Division;
539.24    (12) one or more of the Part C coordinators from the Department of Education, the
539.25Department of Health, or the Department of Human Services or the department's designees;
539.26    (13) the Department of Health early hearing detection and intervention coordinators;
539.27    (14) two birth hospital representatives from one rural and one urban hospital;
539.28    (15) a pediatric geneticist;
539.29    (16) an otolaryngologist;
539.30    (17) a representative from the Newborn Screening Advisory Committee under
539.31this subdivision; and
539.32    (18) a representative of the Department of Education regional low-incidence
539.33facilitators.
539.34The commissioner must complete the appointments required under this subdivision by
539.35September 1, 2007.
540.1    (c) The Department of Health member shall chair the first meeting of the committee.
540.2At the first meeting, the committee shall elect a chair from its membership. The committee
540.3shall meet at the call of the chair, at least four times a year. The committee shall adopt
540.4written bylaws to govern its activities. The Department of Health shall provide technical
540.5and administrative support services as required by the committee. These services shall
540.6include technical support from individuals qualified to administer infant hearing screening,
540.7rescreening, and diagnostic audiological assessments.
540.8    Members of the committee shall receive no compensation for their service, but
540.9shall be reimbursed as provided in section 15.059 for expenses incurred as a result of
540.10their duties as members of the committee.
540.11    (d) This subdivision expires June 30, 2013 2019.

540.12    Sec. 35. Minnesota Statutes 2012, section 144.966, subdivision 3a, is amended to read:
540.13    Subd. 3a. Support services to families. (a) The commissioner shall contract with a
540.14nonprofit organization to provide support and assistance to families with children who are
540.15deaf or have a hearing loss. The family support provided must include:
540.16    (1) direct hearing loss specific parent-to-parent assistance and unbiased information
540.17on communication, educational, and medical options; and
540.18    (2) individualized deaf or hard-of-hearing mentors who provide education, including
540.19instruction in American Sign Language as an available option.
540.20The commissioner shall give preference to a nonprofit organization that has the ability to
540.21provide these services throughout the state.
540.22    (b) Family participation in the support and assistance services is voluntary.

540.23    Sec. 36. Minnesota Statutes 2012, section 144.98, subdivision 3, is amended to read:
540.24    Subd. 3. Annual fees. (a) An application for accreditation under subdivision 6 must
540.25be accompanied by the annual fees specified in this subdivision. The annual fees include:
540.26(1) base accreditation fee, $1,500 $600;
540.27(2) sample preparation techniques fee, $200 per technique;
540.28(3) an administrative fee for laboratories located outside this state, $3,750 $2,000; and
540.29(4) test category fees.
540.30(b) For the programs in subdivision 3a, the commissioner may accredit laboratories
540.31for fields of testing under the categories listed in clauses (1) to (10) upon completion of
540.32the application requirements provided by subdivision 6 and receipt of the fees for each
540.33category under each program that accreditation is requested. The categories offered and
540.34related fees include:
541.1(1) microbiology, $450 $200;
541.2(2) inorganics, $450 $200;
541.3(3) metals, $1,000 $500;
541.4(4) volatile organics, $1,300 $1,000;
541.5(5) other organics, $1,300 $1,000;
541.6(6) radiochemistry, $1,500 $750;
541.7(7) emerging contaminants, $1,500 $1,000;
541.8(8) agricultural contaminants, $1,250 $1,000;
541.9(9) toxicity (bioassay), $1,000 $500; and
541.10(10) physical characterization, $250.
541.11(c) The total annual fee includes the base fee, the sample preparation techniques
541.12fees, the test category fees per program, and, when applicable, an administrative fee for
541.13out-of-state laboratories.
541.14EFFECTIVE DATE.This section is effective the day following final enactment.

541.15    Sec. 37. Minnesota Statutes 2012, section 144.98, subdivision 5, is amended to read:
541.16    Subd. 5. State government special revenue fund. Fees collected by the
541.17commissioner under this section must be deposited in the state treasury and credited to
541.18the state government special revenue fund.
541.19EFFECTIVE DATE.This section is effective the day following final enactment.

541.20    Sec. 38. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
541.21to read:
541.22    Subd. 10. Establishing a selection committee. (a) The commissioner shall
541.23establish a selection committee for the purpose of recommending approval of qualified
541.24laboratory assessors and assessment bodies. Committee members shall demonstrate
541.25competence in assessment practices. The committee shall initially consist of seven
541.26members appointed by the commissioner as follows:
541.27(1) one member from a municipal laboratory accredited by the commissioner;
541.28(2) one member from an industrial treatment laboratory accredited by the
541.29commissioner;
541.30(3) one member from a commercial laboratory located in this state and accredited by
541.31the commissioner;
541.32(4) one member from a commercial laboratory located outside the state and
541.33accredited by the commissioner;
542.1(5) one member from a nongovernmental client of environmental laboratories;
542.2(6) one member from a professional organization with a demonstrated interest in
542.3environmental laboratory data and accreditation; and
542.4(7) one employee of the laboratory accreditation program administered by the
542.5department.
542.6(b) Committee appointments begin on January 1 and end on December 31 of the
542.7same year.
542.8(c) The commissioner shall appoint persons to fill vacant committee positions,
542.9expand the total number of appointed positions, or change the designated positions upon
542.10the advice of the committee.
542.11(d) The commissioner shall rescind the appointment of a selection committee
542.12member for sufficient cause as the commissioner determines, such as:
542.13(1) neglect of duty;
542.14(2) failure to notify the commissioner of a real or perceived conflict of interest;
542.15(3) nonconformance with committee procedures;
542.16(4) failure to demonstrate competence in assessment practices; or
542.17(5) official misconduct.
542.18(e) Members of the selection committee shall be compensated according to the
542.19provisions in section 15.059, subdivision 3.

542.20    Sec. 39. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
542.21to read:
542.22    Subd. 11. Activities of the selection committee. (a) The selection committee shall
542.23determine assessor and assessment organization application requirements, the frequency
542.24of application submittal, and the application review schedule. The commissioner shall
542.25publish the application requirements and procedures on the accreditation program Web site.
542.26(b) In its selection process, the committee shall ensure its application requirements
542.27and review process:
542.28(1) meet the standards implemented in subdivision 2a;
542.29(2) ensure assessors have demonstrated competence in technical disciplines offered
542.30for accreditation by the commissioner; and
542.31(3) consider any history of repeated nonconformance or complaints regarding
542.32assessors or assessment bodies.
542.33(c) The selection committee shall consider an application received from qualified
542.34applicants and shall supply a list of recommended assessors and assessment bodies to
543.1the commissioner of health no later than 90 days after the commissioner notifies the
543.2committee of the need for review of applications.

543.3    Sec. 40. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
543.4to read:
543.5    Subd. 12. Commissioner approval of assessors and scheduling of assessments.
543.6(a) The commissioner shall approve assessors who:
543.7(1) are employed by the commissioner for the purpose of accrediting laboratories
543.8and demonstrate competence in assessment practices for environmental laboratories; or
543.9(2) are employed by a state or federal agency with established agreements for
543.10mutual assistance or recognition with the commissioner and demonstrate competence in
543.11assessment practices for environmental laboratories.
543.12(b) The commissioner may approve other assessors or assessment organizations who
543.13are recommended by the selection committee according to subdivision 11, paragraph
543.14(c). The commissioner shall publish the list of assessors and assessment organizations
543.15approved from the recommendations.
543.16(c) The commissioner shall rescind approval for an assessor or assessment
543.17organization for sufficient cause as the commissioner determines, such as:
543.18(1) failure to meet the minimum qualifications for performing assessments;
543.19(2) lack of availability;
543.20(3) nonconformance with the applicable laws, rules, standards, policies, and
543.21procedures;
543.22(4) misrepresentation of application information regarding qualifications and
543.23training; or
543.24(5) excessive cost to perform the assessment activities.

543.25    Sec. 41. Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
543.26to read:
543.27    Subd. 13. Laboratory requirements for assessor selection and scheduling
543.28assessments. (a) A laboratory accredited or seeking accreditation that requires an
543.29assessment by the commissioner must select an assessor, group of assessors, or assessment
543.30organization from the published list specified in subdivision 12, paragraph (b). An
543.31accredited laboratory must complete an assessment and make all corrective actions at least
543.32once every 24 months. Unless the commissioner grants interim accreditation, a laboratory
543.33seeking accreditation must complete an assessment and make all corrective actions
544.1prior to, but no earlier than, 18 months prior to the date the application is submitted to
544.2the commissioner.
544.3(b) A laboratory shall not select the same assessor more than twice in succession
544.4for assessments of the same facility unless the laboratory receives written approval
544.5from the commissioner for the selection. The laboratory must supply a written request
544.6to the commissioner for approval and must justify the reason for the request and provide
544.7the alternate options considered.
544.8(c) A laboratory must select assessors appropriate to the size and scope of the
544.9laboratory's application or existing accreditation.
544.10(d) A laboratory must enter into its own contract for direct payment of the assessors
544.11or assessment organization. The contract must authorize the assessor, assessment
544.12organization, or subcontractors to release all records to the commissioner regarding the
544.13assessment activity, when the assessment is performed in compliance with this section.
544.14(e) A laboratory must agree to permit other assessors as selected by the commissioner
544.15to participate in the assessment activities.
544.16(f) If the laboratory determines no approved assessor is available to perform
544.17the assessment, the laboratory must notify the commissioner in writing and provide a
544.18justification for the determination. If the commissioner confirms no approved assessor
544.19is available, the commissioner may designate an alternate assessor from those approved
544.20in subdivision 12, paragraph (a), or the commissioner may delay the assessment until
544.21an assessor is available. If an approved alternate assessor performs the assessment, the
544.22commissioner may collect fees equivalent to the cost of performing the assessment
544.23activities.
544.24(g) Fees collected under this section are deposited in a special account and are
544.25annually appropriated to the commissioner for the purpose of performing assessment
544.26activities.
544.27EFFECTIVE DATE.This section is effective the day following final enactment.

544.28    Sec. 42. Minnesota Statutes 2012, section 144.99, subdivision 4, is amended to read:
544.29    Subd. 4. Administrative penalty orders. (a) The commissioner may issue an
544.30order requiring violations to be corrected and administratively assessing monetary
544.31penalties for violations of the statutes, rules, and other actions listed in subdivision 1. The
544.32procedures in section 144.991 must be followed when issuing administrative penalty
544.33orders. Except in the case of repeated or serious violations, the penalty assessed in the
544.34order must be forgiven if the person who is subject to the order demonstrates in writing
544.35to the commissioner before the 31st day after receiving the order that the person has
545.1corrected the violation or has developed a corrective plan acceptable to the commissioner.
545.2The maximum amount of an administrative penalty order is $10,000 for each violator for
545.3all violations by that violator identified in an inspection or review of compliance.
545.4(b) Notwithstanding paragraph (a), the commissioner may issue to a large public
545.5water supply, serving a population of more than 10,000 persons, an administrative penalty
545.6order imposing a penalty of at least $1,000 per day per violation, not to exceed $10,000
545.7for each violation of sections 144.381 to 144.385 and rules adopted thereunder.
545.8(c) Notwithstanding paragraph (a), the commissioner may issue to a certified lead
545.9firm or person performing regulated lead work, an administrative penalty order imposing a
545.10penalty of at least $5,000 per violation per day, not to exceed $10,000 for each violation of
545.11sections 144.9501 to 144.9512 and rules adopted thereunder. All revenue collected from
545.12monetary penalties in this section shall be deposited in the state treasury and credited to
545.13the state government special revenue fund.

545.14    Sec. 43. [145.4716] SAFE HARBOR FOR SEXUALLY EXPLOITED YOUTH.
545.15    Subdivision 1. Director. The commissioner of health shall establish a position for a
545.16director of child sex trafficking prevention.
545.17    Subd. 2. Duties of director. The director of child sex trafficking prevention is
545.18responsible for the following:
545.19    (1) developing and providing comprehensive training on sexual exploitation of
545.20youth for social service professionals, medical professionals, public health workers, and
545.21criminal justice professionals;
545.22    (2) collecting, organizing, maintaining, and disseminating information on sexual
545.23exploitation and services across the state, including maintaining a list of resources on the
545.24Department of Health Web site;
545.25    (3) monitoring and applying for federal funding for antitrafficking efforts that may
545.26benefit victims in the state;
545.27    (4) managing grant programs established under this act;
545.28    (5) identifying best practices in serving sexually exploited youth, as defined in
545.29section 260C.007, subdivision 31;
545.30    (6) providing oversight of and technical support to regional navigators pursuant to
545.31section 145.4717;
545.32    (7) conducting a comprehensive evaluation of the statewide program for safe harbor
545.33of sexually exploited youth; and
546.1    (8) developing a policy, consistent with the requirements of chapter 13, for sharing
546.2data related to sexually exploited youth, as defined in section 260C.007, subdivision 31,
546.3among regional navigators and community-based advocates.

546.4    Sec. 44. [145.4717] REGIONAL NAVIGATOR GRANTS.
546.5    The commissioner of health, through its director of child sex trafficking prevention,
546.6established in section 145.4716, shall provide grants to regional navigators serving six
546.7regions of the state to be determined by the commissioner. Each regional navigator must
546.8develop and annually submit a work plan to the director of child sex trafficking prevention.
546.9The work plans must include, but are not limited to, the following information:
546.10    (1) a needs statement specific to the region, including an examination of the
546.11population at risk;
546.12    (2) regional resources available to sexually exploited youth, as defined in section
546.13260C.007, subdivision 31;
546.14    (3) grant goals and measurable outcomes; and
546.15    (4) grant activities including timelines.

546.16    Sec. 45. [145.4718] PROGRAM EVALUATION.
546.17    (a) The director of child sex trafficking prevention, established under section
546.18145.4716, must conduct, or contract for, comprehensive evaluation of the statewide
546.19program for safe harbor for sexually exploited youth. The first evaluation must be
546.20completed by June 30, 2015, and must be submitted to the commissioner of health by
546.21September 1, 2015, and every two years thereafter. The evaluation must consider whether
546.22the program is reaching intended victims and whether support services are available,
546.23accessible, and adequate for sexually exploited youth, as defined in section 260C.007,
546.24subdivision 31.
546.25    (b) In conducting the evaluation, the director of child sex trafficking prevention must
546.26consider evaluation of outcomes, including whether the program increases identification
546.27of sexually exploited youth, coordination of investigations, access to services and housing
546.28available for sexually exploited youth, and improved effectiveness of services. The
546.29evaluation must also include examination of the ways in which penalties under section
546.30609.3241 are assessed, collected, and distributed to ensure funding for investigation,
546.31prosecution, and victim services to combat sexual exploitation of youth.

546.32    Sec. 46. Minnesota Statutes 2012, section 145.906, is amended to read:
546.33145.906 POSTPARTUM DEPRESSION EDUCATION AND INFORMATION.
547.1(a) The commissioner of health shall work with health care facilities, licensed health
547.2and mental health care professionals, the women, infants, and children (WIC) program,
547.3mental health advocates, consumers, and families in the state to develop materials and
547.4information about postpartum depression, including treatment resources, and develop
547.5policies and procedures to comply with this section.
547.6(b) Physicians, traditional midwives, and other licensed health care professionals
547.7providing prenatal care to women must have available to women and their families
547.8information about postpartum depression.
547.9(c) Hospitals and other health care facilities in the state must provide departing new
547.10mothers and fathers and other family members, as appropriate, with written information
547.11about postpartum depression, including its symptoms, methods of coping with the illness,
547.12and treatment resources.
547.13(d) Information about postpartum depression, including its symptoms, potential
547.14impact on families, and treatment resources, must be available at WIC sites.
547.15(e) The commissioner of health, in collaboration with the commissioner of human
547.16services and to the extent authorized by the federal Centers for Disease Control and
547.17Prevention, shall review the materials and information related to postpartum depression to
547.18determine their effectiveness in transmitting the information in a way that reduces racial
547.19health disparities as reported in surveys of maternal attitudes and experiences before,
547.20during, and after pregnancy, including those conducted by the commissioner of health. The
547.21commissioner shall implement changes to reduce racial health disparities in the information
547.22reviewed, as needed, and ensure that women of color are receiving the information.

547.23    Sec. 47. [145.907] MATERNAL DEPRESSION; DEFINITION.
547.24"Maternal depression" means depression or other perinatal mood or anxiety disorder
547.25experienced by a woman during pregnancy or during the first year following the birth of
547.26her child.

547.27    Sec. 48. Minnesota Statutes 2012, section 145.986, is amended to read:
547.28145.986 STATEWIDE HEALTH IMPROVEMENT PROGRAM.
547.29    Subdivision 1. Grants to local communities Purpose. The purpose of the statewide
547.30health improvement program is to:
547.31(1) address the top three leading preventable causes of illness and death: tobacco use
547.32and exposure, poor diet, and lack of regular physical activity;
547.33(2) promote the development, availability, and use of evidence-based, community
547.34level, comprehensive strategies to create healthy communities; and
548.1(3) measure the impact of the evidence-based, community health improvement
548.2practices which over time work to contain health care costs and reduce chronic diseases.
548.3    Subd. 1a. Grants to local communities. (a) Beginning July 1, 2009, the
548.4commissioner of health shall award competitive grants to community health boards
548.5established pursuant to section 145A.09 and tribal governments to convene, coordinate,
548.6and implement evidence-based strategies targeted at reducing the percentage of
548.7Minnesotans who are obese or overweight and to reduce the use of tobacco. Grants shall
548.8be awarded to all community health boards and tribal governments whose proposals
548.9demonstrate the ability to implement programs designed to achieve the purposes in
548.10subdivision 1 and other requirements of this section.
548.11    (b) Grantee activities shall:
548.12    (1) be based on scientific evidence;
548.13    (2) be based on community input;
548.14    (3) address behavior change at the individual, community, and systems levels;
548.15    (4) occur in community, school, worksite, and health care settings; and
548.16    (5) be focused on policy, systems, and environmental changes that support healthy
548.17behaviors.; and
548.18(6) address the health disparities and inequities that exist in the grantee's community.
548.19    (c) To receive a grant under this section, community health boards and tribal
548.20governments must submit proposals to the commissioner. A local match of ten percent
548.21of the total funding allocation is required. This local match may include funds donated
548.22by community partners.
548.23    (d) In order to receive a grant, community health boards and tribal governments
548.24must submit a health improvement plan to the commissioner of health for approval. The
548.25commissioner may require the plan to identify a community leadership team, community
548.26partners, and a community action plan that includes an assessment of area strengths and
548.27needs, proposed action strategies, technical assistance needs, and a staffing plan.
548.28    (e) The grant recipient must implement the health improvement plan, evaluate the
548.29effectiveness of the interventions strategies, and modify or discontinue interventions
548.30 strategies found to be ineffective.
548.31    (f) By January 15, 2011, the commissioner of health shall recommend whether any
548.32funding should be distributed to community health boards and tribal governments based
548.33on health disparities demonstrated in the populations served.
548.34    (g) (f) Grant recipients shall report their activities and their progress toward the
548.35outcomes established under subdivision 2 to the commissioner in a format and at a time
548.36specified by the commissioner.
549.1    (h) (g) All grant recipients shall be held accountable for making progress toward
549.2the measurable outcomes established in subdivision 2. The commissioner shall require a
549.3corrective action plan and may reduce the funding level of grant recipients that do not
549.4make adequate progress toward the measurable outcomes.
549.5    Subd. 2. Outcomes. (a) The commissioner shall set measurable outcomes to meet
549.6the goals specified in subdivision 1, and annually review the progress of grant recipients
549.7in meeting the outcomes.
549.8    (b) The commissioner shall measure current public health status, using existing
549.9measures and data collection systems when available, to determine baseline data against
549.10which progress shall be monitored.
549.11    Subd. 3. Technical assistance and oversight. (a) The commissioner shall provide
549.12content expertise, technical expertise, and training to grant recipients and advice on
549.13evidence-based strategies, including those based on populations and types of communities
549.14served. The commissioner shall ensure that the statewide health improvement program
549.15meets the outcomes established under subdivision 2 by conducting a comprehensive
549.16statewide evaluation and assisting grant recipients to modify or discontinue interventions
549.17found to be ineffective.
549.18(b) For the purposes of carrying out the grant program under this section, including
549.19for administrative purposes, the commissioner shall award contracts to appropriate entities
549.20to assist in training and provide technical assistance to grantees.
549.21(c) Contracts awarded under paragraph (b) may be used to provide technical
549.22assistance and training in the areas of:
549.23(1) community engagement and capacity building;
549.24(2) tribal support;
549.25(3) community asset building and risk behavior reduction;
549.26(4) legal;
549.27(5) communications;
549.28(6) community, school, health care, work site, and other site-specific strategies; and
549.29(7) health equity.
549.30    Subd. 4. Evaluation. (a) Using the outcome measures established in subdivision 3,
549.31the commissioner shall conduct a biennial evaluation of the statewide health improvement
549.32program funded under this section. Grant recipients shall cooperate with the commissioner
549.33in the evaluation and provide the commissioner with the information necessary to conduct
549.34the evaluation.
550.1(b) Grant recipients will collect, monitor, and submit to the Department of Health
550.2baseline and annual data and provide information to improve the quality and impact of
550.3community health improvement strategies.
550.4(c) For the purposes of carrying out the grant program under this section, including
550.5for administrative purposes, the commissioner shall award contracts to appropriate entities
550.6to assist in designing and implementing evaluation systems.
550.7(d) Contracts awarded under paragraph (c) may be used to:
550.8(1) develop grantee monitoring and reporting systems to track grantee progress,
550.9including aggregated and disaggregated data;
550.10(2) manage, analyze, and report program evaluation data results; and
550.11(3) utilize innovative support tools to analyze and predict the impact of prevention
550.12strategies on health outcomes and state health care costs over time.
550.13    Subd. 5. Report. The commissioner shall submit a biennial report to the legislature
550.14on the statewide health improvement program funded under this section. These reports
550.15 The report must include information on each grant recipients recipient, including the
550.16activities that were conducted by the grantee using grant funds, evaluation data, and
550.17outcome measures, if available. the grantee's progress toward achieving the measurable
550.18outcomes established under subdivision 2, and the data provided to the commissioner by
550.19the grantee to measure these outcomes for grant activities. The commissioner shall provide
550.20information on grants in which a corrective action plan was required under subdivision
550.211a, the types of plan action, and the progress that has been made toward meeting the
550.22measurable outcomes. In addition, the commissioner shall provide recommendations
550.23on future areas of focus for health improvement. These reports are due by January 15
550.24of every other year, beginning in 2010. In the report due on January 15, 2010, the
550.25commissioner shall include recommendations on a sustainable funding source for the
550.26statewide health improvement program other than the health care access fund In the report
550.27due on January 15, 2014, the commissioner shall include a description of the contracts
550.28awarded under subdivision 4, paragraph (c), and the monitoring and evaluation systems
550.29that were designed and implemented under these contracts.
550.30    Subd. 6. Supplantation of existing funds. Community health boards and tribal
550.31governments must use funds received under this section to develop new programs, expand
550.32current programs that work to reduce the percentage of Minnesotans who are obese or
550.33overweight or who use tobacco, or replace discontinued state or federal funds previously
550.34used to reduce the percentage of Minnesotans who are obese or overweight or who use
550.35tobacco. Funds must not be used to supplant current state or local funding to community
551.1health boards or tribal governments used to reduce the percentage of Minnesotans who are
551.2obese or overweight or to reduce tobacco use.

551.3    Sec. 49. Minnesota Statutes 2012, section 145A.17, subdivision 1, is amended to read:
551.4    Subdivision 1. Establishment; goals. The commissioner shall establish a program
551.5to fund family home visiting programs designed to foster healthy beginnings, improve
551.6pregnancy outcomes, promote school readiness, prevent child abuse and neglect, reduce
551.7juvenile delinquency, promote positive parenting and resiliency in children, and promote
551.8family health and economic self-sufficiency for children and families. The commissioner
551.9shall promote partnerships, collaboration, and multidisciplinary visiting done by teams of
551.10professionals and paraprofessionals from the fields of public health nursing, social work,
551.11and early childhood education. A program funded under this section must serve families
551.12at or below 200 percent of the federal poverty guidelines, and other families determined
551.13to be at risk, including but not limited to being at risk for child abuse, child neglect, or
551.14juvenile delinquency. Programs must begin prenatally whenever possible and must be
551.15targeted to families with:
551.16    (1) adolescent parents;
551.17    (2) a history of alcohol or other drug abuse;
551.18    (3) a history of child abuse, domestic abuse, or other types of violence;
551.19    (4) a history of domestic abuse, rape, or other forms of victimization;
551.20    (5) reduced cognitive functioning;
551.21    (6) a lack of knowledge of child growth and development stages;
551.22    (7) low resiliency to adversities and environmental stresses;
551.23    (8) insufficient financial resources to meet family needs;
551.24    (9) a history of homelessness;
551.25    (10) a risk of long-term welfare dependence or family instability due to employment
551.26barriers; or
551.27(11) a serious mental health disorder, including maternal depression as defined in
551.28section 145.907; or
551.29    (11) (12) other risk factors as determined by the commissioner.

551.30    Sec. 50. Minnesota Statutes 2012, section 149A.02, subdivision 1a, is amended to read:
551.31    Subd. 1a. Alkaline hydrolysis. "Alkaline hydrolysis" means the reduction of a dead
551.32human body to essential elements through exposure to a combination of heat and alkaline
551.33hydrolysis and the repositioning or movement of the body during the process to facilitate
551.34reduction, a water-based dissolution process using alkaline chemicals, heat, agitation, and
552.1pressure to accelerate natural decomposition; the processing of the hydrolyzed remains
552.2after removal from the alkaline hydrolysis chamber, vessel; placement of the processed
552.3remains in a hydrolyzed remains container,; and release of the hydrolyzed remains to an
552.4appropriate party. Alkaline hydrolysis is a form of final disposition.

552.5    Sec. 51. Minnesota Statutes 2012, section 149A.02, is amended by adding a
552.6subdivision to read:
552.7    Subd. 1b. Alkaline hydrolysis container. "Alkaline hydrolysis container" means a
552.8hydrolyzable or biodegradable closed container or pouch resistant to leakage of bodily
552.9fluids that encases the body and into which a dead human body is placed prior to insertion
552.10into an alkaline hydrolysis vessel. Alkaline hydrolysis containers may be hydrolyzable or
552.11biodegradable alternative containers or caskets.

552.12    Sec. 52. Minnesota Statutes 2012, section 149A.02, is amended by adding a
552.13subdivision to read:
552.14    Subd. 1c. Alkaline hydrolysis facility. "Alkaline hydrolysis facility" means a
552.15building or structure containing one or more alkaline hydrolysis vessels for the alkaline
552.16hydrolysis of dead human bodies.

552.17    Sec. 53. Minnesota Statutes 2012, section 149A.02, is amended by adding a
552.18subdivision to read:
552.19    Subd. 1d. Alkaline hydrolysis vessel. "Alkaline hydrolysis vessel" means the
552.20container in which the alkaline hydrolysis of a dead human body is performed.

552.21    Sec. 54. Minnesota Statutes 2012, section 149A.02, subdivision 2, is amended to read:
552.22    Subd. 2. Alternative container. "Alternative container" means a nonmetal
552.23receptacle or enclosure, without ornamentation or a fixed interior lining, which is designed
552.24for the encasement of dead human bodies and is made of hydrolyzable or biodegradable
552.25materials, corrugated cardboard, fiberboard, pressed-wood, or other like materials.

552.26    Sec. 55. Minnesota Statutes 2012, section 149A.02, subdivision 3, is amended to read:
552.27    Subd. 3. Arrangements for disposition. "Arrangements for disposition" means
552.28any action normally taken by a funeral provider in anticipation of or preparation for the
552.29entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.

552.30    Sec. 56. Minnesota Statutes 2012, section 149A.02, subdivision 4, is amended to read:
553.1    Subd. 4. Cash advance item. "Cash advance item" means any item of service
553.2or merchandise described to a purchaser as a "cash advance," "accommodation," "cash
553.3disbursement," or similar term. A cash advance item is also any item obtained from a
553.4third party and paid for by the funeral provider on the purchaser's behalf. Cash advance
553.5items include, but are not limited to, cemetery, alkaline hydrolysis, or crematory services,
553.6pallbearers, public transportation, clergy honoraria, flowers, musicians or singers, obituary
553.7notices, gratuities, and death records.

553.8    Sec. 57. Minnesota Statutes 2012, section 149A.02, subdivision 5, is amended to read:
553.9    Subd. 5. Casket. "Casket" means a rigid container which is designed for the
553.10encasement of a dead human body and is usually constructed of hydrolyzable or
553.11biodegradable materials, wood, metal, fiberglass, plastic, or like material, and ornamented
553.12and lined with fabric.

553.13    Sec. 58. Minnesota Statutes 2012, section 149A.02, is amended by adding a
553.14subdivision to read:
553.15    Subd. 12a. Crypt. "Crypt" means a space in a mausoleum of sufficient size, used or
553.16intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.

553.17    Sec. 59. Minnesota Statutes 2012, section 149A.02, is amended by adding a
553.18subdivision to read:
553.19    Subd. 12b. Direct alkaline hydrolysis. "Direct alkaline hydrolysis" means a
553.20final disposition of a dead human body by alkaline hydrolysis, without formal viewing,
553.21visitation, or ceremony with the body present.

553.22    Sec. 60. Minnesota Statutes 2012, section 149A.02, subdivision 16, is amended to read:
553.23    Subd. 16. Final disposition. "Final disposition" means the acts leading to and the
553.24entombment, burial in a cemetery, alkaline hydrolysis, or cremation of a dead human body.

553.25    Sec. 61. Minnesota Statutes 2012, section 149A.02, subdivision 23, is amended to read:
553.26    Subd. 23. Funeral services. "Funeral services" means any services which may
553.27be used to: (1) care for and prepare dead human bodies for burial, alkaline hydrolysis,
553.28cremation, or other final disposition; and (2) arrange, supervise, or conduct the funeral
553.29ceremony or the final disposition of dead human bodies.

554.1    Sec. 62. Minnesota Statutes 2012, section 149A.02, is amended by adding a
554.2subdivision to read:
554.3    Subd. 24b. Hydrolyzed remains. "Hydrolyzed remains" means the remains of a
554.4dead human body following the alkaline hydrolysis process. Hydrolyzed remains does not
554.5include pacemakers, prostheses, or similar foreign materials.

554.6    Sec. 63. Minnesota Statutes 2012, section 149A.02, is amended by adding a
554.7subdivision to read:
554.8    Subd. 24c. Hydrolyzed remains container. "Hydrolyzed remains container" means
554.9a receptacle in which hydrolyzed remains are placed. For purposes of this chapter, a
554.10hydrolyzed remains container is interchangeable with "urn" or similar keepsake storage
554.11jewelry.

554.12    Sec. 64. Minnesota Statutes 2012, section 149A.02, is amended by adding a
554.13subdivision to read:
554.14    Subd. 26a. Inurnment. "Inurnment" means placing hydrolyzed or cremated remains
554.15in a hydrolyzed or cremated remains container suitable for placement, burial, or shipment.

554.16    Sec. 65. Minnesota Statutes 2012, section 149A.02, subdivision 27, is amended to read:
554.17    Subd. 27. Licensee. "Licensee" means any person or entity that has been issued
554.18a license to practice mortuary science, to operate a funeral establishment, to operate an
554.19alkaline hydrolysis facility, or to operate a crematory by the Minnesota commissioner
554.20of health.

554.21    Sec. 66. Minnesota Statutes 2012, section 149A.02, is amended by adding a
554.22subdivision to read:
554.23    Subd. 30a. Niche. "Niche" means a space in a columbarium used, or intended to be
554.24used, for the placement of hydrolyzed or cremated remains.

554.25    Sec. 67. Minnesota Statutes 2012, section 149A.02, is amended by adding a
554.26subdivision to read:
554.27    Subd. 32a. Placement. "Placement" means the placing of a container holding
554.28hydrolyzed or cremated remains in a crypt, vault, or niche.

554.29    Sec. 68. Minnesota Statutes 2012, section 149A.02, subdivision 34, is amended to read:
555.1    Subd. 34. Preparation of the body. "Preparation of the body" means placement of
555.2the body into an appropriate cremation or alkaline hydrolysis container, embalming of
555.3the body or such items of care as washing, disinfecting, shaving, positioning of features,
555.4restorative procedures, application of cosmetics, dressing, and casketing.

555.5    Sec. 69. Minnesota Statutes 2012, section 149A.02, subdivision 35, is amended to read:
555.6    Subd. 35. Processing. "Processing" means the removal of foreign objects, drying or
555.7cooling, and the reduction of the hydrolyzed or cremated remains by mechanical means
555.8including, but not limited to, grinding, crushing, or pulverizing, to a granulated appearance
555.9appropriate for final disposition.

555.10    Sec. 70. Minnesota Statutes 2012, section 149A.02, subdivision 37, is amended to read:
555.11    Subd. 37. Public transportation. "Public transportation" means all manner of
555.12transportation via common carrier available to the general public including airlines, buses,
555.13railroads, and ships. For purposes of this chapter, a livery service providing transportation
555.14to private funeral establishments, alkaline hydrolysis facilities, or crematories is not public
555.15transportation.

555.16    Sec. 71. Minnesota Statutes 2012, section 149A.02, is amended by adding a
555.17subdivision to read:
555.18    Subd. 37c. Scattering. "Scattering" means the authorized dispersal of hydrolyzed
555.19or cremated remains in a defined area of a dedicated cemetery or in areas where no local
555.20prohibition exists provided that the hydrolyzed or cremated remains are not distinguishable
555.21to the public, are not in a container, and that the person who has control over disposition
555.22of the hydrolyzed or cremated remains has obtained written permission of the property
555.23owner or governing agency to scatter on the property.

555.24    Sec. 72. Minnesota Statutes 2012, section 149A.02, is amended by adding a
555.25subdivision to read:
555.26    Subd. 41. Vault. "Vault" means a space in a mausoleum of sufficient size, used or
555.27intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.
555.28Vault may also mean a sealed and lined casket enclosure.

555.29    Sec. 73. Minnesota Statutes 2012, section 149A.03, is amended to read:
555.30149A.03 DUTIES OF COMMISSIONER.
555.31    The commissioner shall:
556.1    (1) enforce all laws and adopt and enforce rules relating to the:
556.2    (i) removal, preparation, transportation, arrangements for disposition, and final
556.3disposition of dead human bodies;
556.4    (ii) licensure and professional conduct of funeral directors, morticians, interns,
556.5practicum students, and clinical students;
556.6    (iii) licensing and operation of a funeral establishment; and
556.7(iv) licensing and operation of an alkaline hydrolysis facility; and
556.8    (iv) (v) licensing and operation of a crematory;
556.9    (2) provide copies of the requirements for licensure and permits to all applicants;
556.10    (3) administer examinations and issue licenses and permits to qualified persons
556.11and other legal entities;
556.12    (4) maintain a record of the name and location of all current licensees and interns;
556.13    (5) perform periodic compliance reviews and premise inspections of licensees;
556.14    (6) accept and investigate complaints relating to conduct governed by this chapter;
556.15    (7) maintain a record of all current preneed arrangement trust accounts;
556.16    (8) maintain a schedule of application, examination, permit, and licensure fees,
556.17initial and renewal, sufficient to cover all necessary operating expenses;
556.18    (9) educate the public about the existence and content of the laws and rules for
556.19mortuary science licensing and the removal, preparation, transportation, arrangements
556.20for disposition, and final disposition of dead human bodies to enable consumers to file
556.21complaints against licensees and others who may have violated those laws or rules;
556.22    (10) evaluate the laws, rules, and procedures regulating the practice of mortuary
556.23science in order to refine the standards for licensing and to improve the regulatory and
556.24enforcement methods used; and
556.25    (11) initiate proceedings to address and remedy deficiencies and inconsistencies in
556.26the laws, rules, or procedures governing the practice of mortuary science and the removal,
556.27preparation, transportation, arrangements for disposition, and final disposition of dead
556.28human bodies.

556.29    Sec. 74. [149A.54] LICENSE TO OPERATE AN ALKALINE HYDROLYSIS
556.30FACILITY.
556.31    Subdivision 1. License requirement. Except as provided in section 149A.01,
556.32subdivision 3, a place or premise shall not be maintained, managed, or operated which
556.33is devoted to or used in the holding and alkaline hydrolysis of a dead human body
556.34without possessing a valid license to operate an alkaline hydrolysis facility issued by the
556.35commissioner of health.
557.1    Subd. 2. Requirements for an alkaline hydrolysis facility. (a) An alkaline
557.2hydrolysis facility licensed under this section must consist of:
557.3(1) a building or structure that complies with applicable local and state building
557.4codes, zoning laws and ordinances, and wastewater management and environmental
557.5standards, containing one or more alkaline hydrolysis vessels for the alkaline hydrolysis of
557.6dead human bodies;
557.7(2) a method approved by the commissioner of health to dry the hydrolyzed remains
557.8and which is located within the licensed facility;
557.9(3) a means approved by the commissioner of health for refrigeration of dead human
557.10bodies awaiting alkaline hydrolysis;
557.11(4) an appropriate means of processing hydrolyzed remains to a granulated
557.12appearance appropriate for final disposition; and
557.13(5) an appropriate holding facility for dead human bodies awaiting alkaline
557.14hydrolysis.
557.15(b) An alkaline hydrolysis facility licensed under this section may also contain a
557.16display room for funeral goods.
557.17    Subd. 3. Application procedure; documentation; initial inspection. An
557.18application to license and operate an alkaline hydrolysis facility shall be submitted to the
557.19commissioner of health. A completed application includes:
557.20(1) a completed application form, as provided by the commissioner;
557.21(2) proof of business form and ownership;
557.22(3) proof of liability insurance coverage or other financial documentation, as
557.23determined by the commissioner, that demonstrates the applicant's ability to respond in
557.24damages for liability arising from the ownership, maintenance management, or operation
557.25of an alkaline hydrolysis facility; and
557.26(4) copies of wastewater and other environmental regulatory permits and
557.27environmental regulatory licenses necessary to conduct operations.
557.28Upon receipt of the application and appropriate fee, the commissioner shall review and
557.29verify all information. Upon completion of the verification process and resolution of any
557.30deficiencies in the application information, the commissioner shall conduct an initial
557.31inspection of the premises to be licensed. After the inspection and resolution of any
557.32deficiencies found and any reinspections as may be necessary, the commissioner shall
557.33make a determination, based on all the information available, to grant or deny licensure. If
557.34the commissioner's determination is to grant the license, the applicant shall be notified and
557.35the license shall issue and remain valid for a period prescribed on the license, but not to
557.36exceed one calendar year from the date of issuance of the license. If the commissioner's
558.1determination is to deny the license, the commissioner must notify the applicant in writing
558.2of the denial and provide the specific reason for denial.
558.3    Subd. 4. Nontransferability of license. A license to operate an alkaline hydrolysis
558.4facility is not assignable or transferable and shall not be valid for any entity other than the
558.5one named. Each license issued to operate an alkaline hydrolysis facility is valid only for the
558.6location identified on the license. A 50 percent or more change in ownership or location of
558.7the alkaline hydrolysis facility automatically terminates the license. Separate licenses shall
558.8be required of two or more persons or other legal entities operating from the same location.
558.9    Subd. 5. Display of license. Each license to operate an alkaline hydrolysis
558.10facility must be conspicuously displayed in the alkaline hydrolysis facility at all times.
558.11Conspicuous display means in a location where a member of the general public within the
558.12alkaline hydrolysis facility is able to observe and read the license.
558.13    Subd. 6. Period of licensure. All licenses to operate an alkaline hydrolysis facility
558.14issued by the commissioner are valid for a period of one calendar year beginning on July 1
558.15and ending on June 30, regardless of the date of issuance.
558.16    Subd. 7. Reporting changes in license information. Any change of license
558.17information must be reported to the commissioner, on forms provided by the
558.18commissioner, no later than 30 calendar days after the change occurs. Failure to report
558.19changes is grounds for disciplinary action.
558.20    Subd. 8. Notification to the commissioner. If the licensee is operating under a
558.21wastewater or an environmental permit or license that is subsequently revoked, denied,
558.22or terminated, the licensee shall notify the commissioner.
558.23    Subd. 9. Application information. All information submitted to the commissioner
558.24for a license to operate an alkaline hydrolysis facility is classified as licensing data under
558.25section 13.41, subdivision 5.

558.26    Sec. 75. [149A.55] RENEWAL OF LICENSE TO OPERATE AN ALKALINE
558.27HYDROLYSIS FACILITY.
558.28    Subdivision 1. Renewal required. All licenses to operate an alkaline hydrolysis
558.29facility issued by the commissioner expire on June 30 following the date of issuance of the
558.30license and must be renewed to remain valid.
558.31    Subd. 2. Renewal procedure and documentation. Licensees who wish to renew
558.32their licenses must submit to the commissioner a completed renewal application no later
558.33than June 30 following the date the license was issued. A completed renewal application
558.34includes:
558.35(1) a completed renewal application form, as provided by the commissioner; and
559.1(2) proof of liability insurance coverage or other financial documentation, as
559.2determined by the commissioner, that demonstrates the applicant's ability to respond in
559.3damages for liability arising from the ownership, maintenance, management, or operation
559.4of an alkaline hydrolysis facility.
559.5Upon receipt of the completed renewal application, the commissioner shall review and
559.6verify the information. Upon completion of the verification process and resolution of
559.7any deficiencies in the renewal application information, the commissioner shall make a
559.8determination, based on all the information available, to reissue or refuse to reissue the
559.9license. If the commissioner's determination is to reissue the license, the applicant shall
559.10be notified and the license shall issue and remain valid for a period prescribed on the
559.11license, but not to exceed one calendar year from the date of issuance of the license. If
559.12the commissioner's determination is to refuse to reissue the license, section 149A.09,
559.13subdivision 2, applies.
559.14    Subd. 3. Penalty for late filing. Renewal applications received after the expiration
559.15date of a license will result in the assessment of a late filing penalty. The late filing penalty
559.16must be paid before the reissuance of the license and received by the commissioner no
559.17later than 31 calendar days after the expiration date of the license.
559.18    Subd. 4. Lapse of license. Licenses to operate alkaline hydrolysis facilities
559.19shall automatically lapse when a completed renewal application is not received by the
559.20commissioner within 31 calendar days after the expiration date of a license, or a late
559.21filing penalty assessed under subdivision 3 is not received by the commissioner within 31
559.22calendar days after the expiration of a license.
559.23    Subd. 5. Effect of lapse of license. Upon the lapse of a license, the person to whom
559.24the license was issued is no longer licensed to operate an alkaline hydrolysis facility in
559.25Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed
559.26license holder from operating an alkaline hydrolysis facility in Minnesota and may pursue
559.27any additional lawful remedies as justified by the case.
559.28    Subd. 6. Restoration of lapsed license. The commissioner may restore a lapsed
559.29license upon receipt and review of a completed renewal application, receipt of the late
559.30filing penalty, and reinspection of the premises, provided that the receipt is made within
559.31one calendar year from the expiration date of the lapsed license and the cease and desist
559.32order issued by the commissioner has not been violated. If a lapsed license is not restored
559.33within one calendar year from the expiration date of the lapsed license, the holder of the
559.34lapsed license cannot be relicensed until the requirements in section 149A.54 are met.
559.35    Subd. 7. Reporting changes in license information. Any change of license
559.36information must be reported to the commissioner, on forms provided by the
560.1commissioner, no later than 30 calendar days after the change occurs. Failure to report
560.2changes is grounds for disciplinary action.
560.3    Subd. 8. Application information. All information submitted to the commissioner
560.4by an applicant for renewal of licensure to operate an alkaline hydrolysis facility is
560.5classified as licensing data under section 13.41, subdivision 5.

560.6    Sec. 76. Minnesota Statutes 2012, section 149A.65, is amended by adding a
560.7subdivision to read:
560.8    Subd. 6. Alkaline hydrolysis facilities. The initial and renewal fee for an alkaline
560.9hydrolysis facility is $300. The late fee charge for a license renewal is $25.

560.10    Sec. 77. Minnesota Statutes 2012, section 149A.65, is amended by adding a
560.11subdivision to read:
560.12    Subd. 7. State government special revenue fund. Fees collected by the
560.13commissioner under this section must be deposited in the state treasury and credited to
560.14the state government special revenue fund.

560.15    Sec. 78. Minnesota Statutes 2012, section 149A.70, subdivision 1, is amended to read:
560.16    Subdivision 1. Use of titles. Only a person holding a valid license to practice
560.17mortuary science issued by the commissioner may use the title of mortician, funeral
560.18director, or any other title implying that the licensee is engaged in the business or practice
560.19of mortuary science. Only the holder of a valid license to operate an alkaline hydrolysis
560.20facility issued by the commissioner may use the title of alkaline hydrolysis facility, water
560.21cremation, water-reduction, biocremation, green-cremation, resomation, dissolution, or
560.22any other title, word, or term implying that the licensee operates an alkaline hydrolysis
560.23facility. Only the holder of a valid license to operate a funeral establishment issued by the
560.24commissioner may use the title of funeral home, funeral chapel, funeral service, or any
560.25other title, word, or term implying that the licensee is engaged in the business or practice
560.26of mortuary science. Only the holder of a valid license to operate a crematory issued by
560.27the commissioner may use the title of crematory, crematorium, green-cremation, or any
560.28other title, word, or term implying that the licensee operates a crematory or crematorium.

560.29    Sec. 79. Minnesota Statutes 2012, section 149A.70, subdivision 2, is amended to read:
560.30    Subd. 2. Business location. A funeral establishment, alkaline hydrolysis facility, or
560.31crematory shall not do business in a location that is not licensed as a funeral establishment,
561.1alkaline hydrolysis facility, or crematory and shall not advertise a service that is available
561.2from an unlicensed location.

561.3    Sec. 80. Minnesota Statutes 2012, section 149A.70, subdivision 3, is amended to read:
561.4    Subd. 3. Advertising. No licensee, clinical student, practicum student, or intern
561.5shall publish or disseminate false, misleading, or deceptive advertising. False, misleading,
561.6or deceptive advertising includes, but is not limited to:
561.7    (1) identifying, by using the names or pictures of, persons who are not licensed to
561.8practice mortuary science in a way that leads the public to believe that those persons will
561.9provide mortuary science services;
561.10    (2) using any name other than the names under which the funeral establishment,
561.11alkaline hydrolysis facility, or crematory is known to or licensed by the commissioner;
561.12    (3) using a surname not directly, actively, or presently associated with a licensed
561.13funeral establishment, alkaline hydrolysis facility, or crematory, unless the surname had
561.14been previously and continuously used by the licensed funeral establishment, alkaline
561.15hydrolysis facility, or crematory; and
561.16    (4) using a founding or establishing date or total years of service not directly or
561.17continuously related to a name under which the funeral establishment, alkaline hydrolysis
561.18facility, or crematory is currently or was previously licensed.
561.19    Any advertising or other printed material that contains the names or pictures of
561.20persons affiliated with a funeral establishment, alkaline hydrolysis facility, or crematory
561.21shall state the position held by the persons and shall identify each person who is licensed
561.22or unlicensed under this chapter.

561.23    Sec. 81. Minnesota Statutes 2012, section 149A.70, subdivision 5, is amended to read:
561.24    Subd. 5. Reimbursement prohibited. No licensee, clinical student, practicum
561.25student, or intern shall offer, solicit, or accept a commission, fee, bonus, rebate, or other
561.26reimbursement in consideration for recommending or causing a dead human body to
561.27be disposed of by a specific body donation program, funeral establishment, alkaline
561.28hydrolysis facility, crematory, mausoleum, or cemetery.

561.29    Sec. 82. Minnesota Statutes 2012, section 149A.71, subdivision 2, is amended to read:
561.30    Subd. 2. Preventive requirements. (a) To prevent unfair or deceptive acts or
561.31practices, the requirements of this subdivision must be met.
561.32    (b) Funeral providers must tell persons who ask by telephone about the funeral
561.33provider's offerings or prices any accurate information from the price lists described in
562.1paragraphs (c) to (e) and any other readily available information that reasonably answers
562.2the questions asked.
562.3    (c) Funeral providers must make available for viewing to people who inquire in
562.4person about the offerings or prices of funeral goods or burial site goods, separate printed
562.5or typewritten price lists using a ten-point font or larger. Each funeral provider must have a
562.6separate price list for each of the following types of goods that are sold or offered for sale:
562.7    (1) caskets;
562.8    (2) alternative containers;
562.9    (3) outer burial containers;
562.10(4) alkaline hydrolysis containers;
562.11    (4) (5) cremation containers;
562.12(6) hydrolyzed remains containers;
562.13    (5) (7) cremated remains containers;
562.14    (6) (8) markers; and
562.15    (7) (9) headstones.
562.16    (d) Each separate price list must contain the name of the funeral provider's place
562.17of business, address, and telephone number and a caption describing the list as a price
562.18list for one of the types of funeral goods or burial site goods described in paragraph (c),
562.19clauses (1) to (7) (9). The funeral provider must offer the list upon beginning discussion
562.20of, but in any event before showing, the specific funeral goods or burial site goods and
562.21must provide a photocopy of the price list, for retention, if so asked by the consumer. The
562.22list must contain, at least, the retail prices of all the specific funeral goods and burial site
562.23goods offered which do not require special ordering, enough information to identify each,
562.24and the effective date for the price list. However, funeral providers are not required to
562.25make a specific price list available if the funeral providers place the information required
562.26by this paragraph on the general price list described in paragraph (e).
562.27    (e) Funeral providers must give a printed price list, for retention, to persons who
562.28inquire in person about the funeral goods, funeral services, burial site goods, or burial site
562.29services or prices offered by the funeral provider. The funeral provider must give the list
562.30upon beginning discussion of either the prices of or the overall type of funeral service or
562.31disposition or specific funeral goods, funeral services, burial site goods, or burial site
562.32services offered by the provider. This requirement applies whether the discussion takes
562.33place in the funeral establishment or elsewhere. However, when the deceased is removed
562.34for transportation to the funeral establishment, an in-person request for authorization to
562.35embalm does not, by itself, trigger the requirement to offer the general price list. If the
562.36provider, in making an in-person request for authorization to embalm, discloses that
563.1embalming is not required by law except in certain special cases, the provider is not
563.2required to offer the general price list. Any other discussion during that time about prices
563.3or the selection of funeral goods, funeral services, burial site goods, or burial site services
563.4triggers the requirement to give the consumer a general price list. The general price list
563.5must contain the following information:
563.6    (1) the name, address, and telephone number of the funeral provider's place of
563.7business;
563.8    (2) a caption describing the list as a "general price list";
563.9    (3) the effective date for the price list;
563.10    (4) the retail prices, in any order, expressed either as a flat fee or as the prices per
563.11hour, mile, or other unit of computation, and other information described as follows:
563.12    (i) forwarding of remains to another funeral establishment, together with a list of
563.13the services provided for any quoted price;
563.14    (ii) receiving remains from another funeral establishment, together with a list of
563.15the services provided for any quoted price;
563.16    (iii) separate prices for each alkaline hydrolysis or cremation offered by the funeral
563.17provider, with the price including an alternative container or alkaline hydrolysis or
563.18cremation container, any alkaline hydrolysis or crematory charges, and a description of the
563.19services and container included in the price, where applicable, and the price of alkaline
563.20hydrolysis or cremation where the purchaser provides the container;
563.21    (iv) separate prices for each immediate burial offered by the funeral provider,
563.22including a casket or alternative container, and a description of the services and container
563.23included in that price, and the price of immediate burial where the purchaser provides the
563.24casket or alternative container;
563.25    (v) transfer of remains to the funeral establishment or other location;
563.26    (vi) embalming;
563.27    (vii) other preparation of the body;
563.28    (viii) use of facilities, equipment, or staff for viewing;
563.29    (ix) use of facilities, equipment, or staff for funeral ceremony;
563.30    (x) use of facilities, equipment, or staff for memorial service;
563.31    (xi) use of equipment or staff for graveside service;
563.32    (xii) hearse or funeral coach;
563.33    (xiii) limousine; and
563.34    (xiv) separate prices for all cemetery-specific goods and services, including all goods
563.35and services associated with interment and burial site goods and services and excluding
563.36markers and headstones;
564.1    (5) the price range for the caskets offered by the funeral provider, together with the
564.2statement "A complete price list will be provided at the funeral establishment or casket
564.3sale location." or the prices of individual caskets, as disclosed in the manner described
564.4in paragraphs (c) and (d);
564.5    (6) the price range for the alternative containers offered by the funeral provider,
564.6together with the statement "A complete price list will be provided at the funeral
564.7establishment or alternative container sale location." or the prices of individual alternative
564.8containers, as disclosed in the manner described in paragraphs (c) and (d);
564.9    (7) the price range for the outer burial containers offered by the funeral provider,
564.10together with the statement "A complete price list will be provided at the funeral
564.11establishment or outer burial container sale location." or the prices of individual outer
564.12burial containers, as disclosed in the manner described in paragraphs (c) and (d);
564.13(8) the price range for the alkaline hydrolysis container offered by the funeral
564.14provider, together with the statement: "A complete price list will be provided at the funeral
564.15establishment or alkaline hydrolysis container sale location.", or the prices of individual
564.16alkaline hydrolysis containers, as disclosed in the manner described in paragraphs (c)
564.17and (d);
564.18(9) the price range for the hydrolyzed remains container offered by the funeral
564.19provider, together with the statement: "A complete price list will be provided at the
564.20funeral establishment or hydrolyzed remains container sale location.", or the prices
564.21of individual hydrolyzed remains container, as disclosed in the manner described in
564.22paragraphs (c) and (d);
564.23    (8) (10) the price range for the cremation containers offered by the funeral provider,
564.24together with the statement "A complete price list will be provided at the funeral
564.25establishment or cremation container sale location." or the prices of individual cremation
564.26containers and cremated remains containers, as disclosed in the manner described in
564.27paragraphs (c) and (d);
564.28    (9) (11) the price range for the cremated remains containers offered by the funeral
564.29provider, together with the statement, "A complete price list will be provided at the funeral
564.30establishment or cremation cremated remains container sale location," or the prices of
564.31individual cremation containers as disclosed in the manner described in paragraphs (c)
564.32and (d);
564.33    (10) (12) the price for the basic services of funeral provider and staff, together with a
564.34list of the principal basic services provided for any quoted price and, if the charge cannot
564.35be declined by the purchaser, the statement "This fee for our basic services will be added
564.36to the total cost of the funeral arrangements you select. (This fee is already included in
565.1our charges for alkaline hydrolysis, direct cremations, immediate burials, and forwarding
565.2or receiving remains.)" If the charge cannot be declined by the purchaser, the quoted
565.3price shall include all charges for the recovery of unallocated funeral provider overhead,
565.4and funeral providers may include in the required disclosure the phrase "and overhead"
565.5after the word "services." This services fee is the only funeral provider fee for services,
565.6facilities, or unallocated overhead permitted by this subdivision to be nondeclinable,
565.7unless otherwise required by law;
565.8    (11) (13) the price range for the markers and headstones offered by the funeral
565.9provider, together with the statement "A complete price list will be provided at the funeral
565.10establishment or marker or headstone sale location." or the prices of individual markers
565.11and headstones, as disclosed in the manner described in paragraphs (c) and (d); and
565.12    (12) (14) any package priced funerals offered must be listed in addition to and
565.13following the information required in paragraph (e) and must clearly state the funeral
565.14goods and services being offered, the price being charged for those goods and services,
565.15and the discounted savings.
565.16    (f) Funeral providers must give an itemized written statement, for retention, to each
565.17consumer who arranges an at-need funeral or other disposition of human remains at the
565.18conclusion of the discussion of the arrangements. The itemized written statement must be
565.19signed by the consumer selecting the goods and services as required in section 149A.80.
565.20If the statement is provided by a funeral establishment, the statement must be signed by
565.21the licensed funeral director or mortician planning the arrangements. If the statement is
565.22provided by any other funeral provider, the statement must be signed by an authorized
565.23agent of the funeral provider. The statement must list the funeral goods, funeral services,
565.24burial site goods, or burial site services selected by that consumer and the prices to be paid
565.25for each item, specifically itemized cash advance items (these prices must be given to the
565.26extent then known or reasonably ascertainable if the prices are not known or reasonably
565.27ascertainable, a good faith estimate shall be given and a written statement of the actual
565.28charges shall be provided before the final bill is paid), and the total cost of goods and
565.29services selected. At the conclusion of an at-need arrangement, the funeral provider is
565.30required to give the consumer a copy of the signed itemized written contract that must
565.31contain the information required in this paragraph.
565.32    (g) Upon receiving actual notice of the death of an individual with whom a funeral
565.33provider has entered a preneed funeral agreement, the funeral provider must provide
565.34a copy of all preneed funeral agreement documents to the person who controls final
565.35disposition of the human remains or to the designee of the person controlling disposition.
565.36The person controlling final disposition shall be provided with these documents at the time
566.1of the person's first in-person contact with the funeral provider, if the first contact occurs
566.2in person at a funeral establishment, alkaline hydrolysis facility, crematory, or other place
566.3of business of the funeral provider. If the contact occurs by other means or at another
566.4location, the documents must be provided within 24 hours of the first contact.

566.5    Sec. 83. Minnesota Statutes 2012, section 149A.71, subdivision 4, is amended to read:
566.6    Subd. 4. Casket, alternate container, alkaline hydrolysis container, and
566.7cremation container sales; records; required disclosures. Any funeral provider who
566.8sells or offers to sell a casket, alternate container, or alkaline hydrolysis container,
566.9hydrolyzed remains container, cremation container, or cremated remains container to
566.10the public must maintain a record of each sale that includes the name of the purchaser,
566.11the purchaser's mailing address, the name of the decedent, the date of the decedent's
566.12death, and the place of death. These records shall be open to inspection by the regulatory
566.13agency. Any funeral provider selling a casket, alternate container, or cremation container
566.14to the public, and not having charge of the final disposition of the dead human body,
566.15shall provide a copy of the statutes and rules controlling the removal, preparation,
566.16transportation, arrangements for disposition, and final disposition of a dead human body.
566.17This subdivision does not apply to morticians, funeral directors, funeral establishments,
566.18crematories, or wholesale distributors of caskets, alternate containers, alkaline hydrolysis
566.19containers, or cremation containers.

566.20    Sec. 84. Minnesota Statutes 2012, section 149A.72, subdivision 3, is amended to read:
566.21    Subd. 3. Casket for alkaline hydrolysis or cremation provisions; deceptive acts
566.22or practices. In selling or offering to sell funeral goods or funeral services to the public, it
566.23is a deceptive act or practice for a funeral provider to represent that a casket is required for
566.24alkaline hydrolysis or cremations by state or local law or otherwise.

566.25    Sec. 85. Minnesota Statutes 2012, section 149A.72, is amended by adding a
566.26subdivision to read:
566.27    Subd. 3a. Casket for alkaline hydrolysis provision; preventive measures. To
566.28prevent deceptive acts or practices, funeral providers must place the following disclosure
566.29in immediate conjunction with the prices shown for alkaline hydrolysis: "Minnesota
566.30law does not require you to purchase a casket for alkaline hydrolysis. If you want to
566.31arrange for alkaline hydrolysis, you can use an alkaline hydrolysis container. An alkaline
566.32hydrolysis container is a hydrolyzable or biodegradable closed container or pouch resistant
566.33to leakage of bodily fluids that encases the body and into which a dead human body is
567.1placed prior to insertion into an alkaline hydrolysis vessel. The containers we provide
567.2are (specify containers provided)." This disclosure is required only if the funeral provider
567.3arranges alkaline hydrolysis.

567.4    Sec. 86. Minnesota Statutes 2012, section 149A.72, subdivision 9, is amended to read:
567.5    Subd. 9. Deceptive acts or practices. In selling or offering to sell funeral goods,
567.6funeral services, burial site goods, or burial site services to the public, it is a deceptive act
567.7or practice for a funeral provider to represent that federal, state, or local laws, or particular
567.8cemeteries, alkaline hydrolysis facilities, or crematories, require the purchase of any funeral
567.9goods, funeral services, burial site goods, or burial site services when that is not the case.

567.10    Sec. 87. Minnesota Statutes 2012, section 149A.73, subdivision 1, is amended to read:
567.11    Subdivision 1. Casket for alkaline hydrolysis or cremation provisions; deceptive
567.12acts or practices. In selling or offering to sell funeral goods, funeral services, burial site
567.13goods, or burial site services to the public, it is a deceptive act or practice for a funeral
567.14provider to require that a casket be purchased for alkaline hydrolysis or cremation.

567.15    Sec. 88. Minnesota Statutes 2012, section 149A.73, subdivision 2, is amended to read:
567.16    Subd. 2. Casket for alkaline hydrolysis or cremation; preventive requirements.
567.17To prevent unfair or deceptive acts or practices, if funeral providers arrange for alkaline
567.18hydrolysis or cremations, they must make a an alkaline hydrolysis container or cremation
567.19container available for alkaline hydrolysis or cremations.

567.20    Sec. 89. Minnesota Statutes 2012, section 149A.73, subdivision 4, is amended to read:
567.21    Subd. 4. Required purchases of funeral goods or services; preventive
567.22requirements. To prevent unfair or deceptive acts or practices, funeral providers must
567.23place the following disclosure in the general price list, immediately above the prices
567.24required by section 149A.71, subdivision 2, paragraph (e), clauses (4) to (10): "The goods
567.25and services shown below are those we can provide to our customers. You may choose
567.26only the items you desire. If legal or other requirements mean that you must buy any items
567.27you did not specifically ask for, we will explain the reason in writing on the statement we
567.28provide describing the funeral goods, funeral services, burial site goods, and burial site
567.29services you selected." However, if the charge for "services of funeral director and staff"
567.30cannot be declined by the purchaser, the statement shall include the sentence "However,
567.31any funeral arrangements you select will include a charge for our basic services." between
567.32the second and third sentences of the sentences specified in this subdivision. The statement
568.1may include the phrase "and overhead" after the word "services" if the fee includes a
568.2charge for the recovery of unallocated funeral overhead. If the funeral provider does
568.3not include this disclosure statement, then the following disclosure statement must be
568.4placed in the statement of funeral goods, funeral services, burial site goods, and burial site
568.5services selected, as described in section 149A.71, subdivision 2, paragraph (f): "Charges
568.6are only for those items that you selected or that are required. If we are required by law or
568.7by a cemetery, alkaline hydrolysis facility, or crematory to use any items, we will explain
568.8the reasons in writing below." A funeral provider is not in violation of this subdivision by
568.9failing to comply with a request for a combination of goods or services which would be
568.10impossible, impractical, or excessively burdensome to provide.

568.11    Sec. 90. Minnesota Statutes 2012, section 149A.74, is amended to read:
568.12149A.74 FUNERAL SERVICES PROVIDED WITHOUT PRIOR APPROVAL.
568.13    Subdivision 1. Services provided without prior approval; deceptive acts or
568.14practices. In selling or offering to sell funeral goods or funeral services to the public, it
568.15is a deceptive act or practice for any funeral provider to embalm a dead human body
568.16unless state or local law or regulation requires embalming in the particular circumstances
568.17regardless of any funeral choice which might be made, or prior approval for embalming
568.18has been obtained from an individual legally authorized to make such a decision. In
568.19seeking approval to embalm, the funeral provider must disclose that embalming is not
568.20required by law except in certain circumstances; that a fee will be charged if a funeral
568.21is selected which requires embalming, such as a funeral with viewing; and that no
568.22embalming fee will be charged if the family selects a service which does not require
568.23embalming, such as direct alkaline hydrolysis, direct cremation, or immediate burial.
568.24    Subd. 2. Services provided without prior approval; preventive requirement.
568.25To prevent unfair or deceptive acts or practices, funeral providers must include on
568.26the itemized statement of funeral goods or services, as described in section 149A.71,
568.27subdivision 2 , paragraph (f), the statement "If you selected a funeral that may require
568.28embalming, such as a funeral with viewing, you may have to pay for embalming. You do
568.29not have to pay for embalming you did not approve if you selected arrangements such
568.30as direct alkaline hydrolysis, direct cremation, or immediate burial. If we charged for
568.31embalming, we will explain why below."

568.32    Sec. 91. Minnesota Statutes 2012, section 149A.91, subdivision 9, is amended to read:
568.33    Subd. 9. Embalmed Bodies awaiting final disposition. All embalmed bodies
568.34awaiting final disposition shall be kept in an appropriate holding facility or preparation
569.1and embalming room. The holding facility must be secure from access by anyone except
569.2the authorized personnel of the funeral establishment, preserve the dignity and integrity of
569.3the body, and protect the health and safety of the personnel of the funeral establishment.

569.4    Sec. 92. Minnesota Statutes 2012, section 149A.93, subdivision 3, is amended to read:
569.5    Subd. 3. Disposition permit. A disposition permit is required before a body can
569.6be buried, entombed, alkaline hydrolyzed, or cremated. No disposition permit shall be
569.7issued until a fact of death record has been completed and filed with the local or state
569.8registrar of vital statistics.

569.9    Sec. 93. Minnesota Statutes 2012, section 149A.93, subdivision 6, is amended to read:
569.10    Subd. 6. Conveyances permitted for transportation. A dead human body may be
569.11transported by means of private vehicle or private aircraft, provided that the body must be
569.12encased in an appropriate container, that meets the following standards:
569.13    (1) promotes respect for and preserves the dignity of the dead human body;
569.14    (2) shields the body from being viewed from outside of the conveyance;
569.15    (3) has ample enclosed area to accommodate a cot, stretcher, rigid tray, casket,
569.16alternative container, alkaline hydrolysis container, or cremation container in a horizontal
569.17position;
569.18    (4) is designed to permit loading and unloading of the body without excessive tilting
569.19of the cot, stretcher, rigid tray, casket, alternative container, alkaline hydrolysis container,
569.20 or cremation container; and
569.21    (5) if used for the transportation of more than one dead human body at one time,
569.22the vehicle must be designed so that a body or container does not rest directly on top of
569.23another body or container and that each body or container is secured to prevent the body
569.24or container from excessive movement within the conveyance.
569.25    A vehicle that is a dignified conveyance and was specified for use by the deceased
569.26or by the family of the deceased may be used to transport the body to the place of final
569.27disposition.

569.28    Sec. 94. Minnesota Statutes 2012, section 149A.94, is amended to read:
569.29149A.94 FINAL DISPOSITION.
569.30    Subdivision 1. Generally. Every dead human body lying within the state, except
569.31unclaimed bodies delivered for dissection by the medical examiner, those delivered for
569.32anatomical study pursuant to section 149A.81, subdivision 2, or lawfully carried through
569.33the state for the purpose of disposition elsewhere; and the remains of any dead human
570.1body after dissection or anatomical study, shall be decently buried, or entombed in a
570.2public or private cemetery, alkaline hydrolyzed or cremated, within a reasonable time
570.3after death. Where final disposition of a body will not be accomplished within 72 hours
570.4following death or release of the body by a competent authority with jurisdiction over the
570.5body, the body must be properly embalmed, refrigerated, or packed with dry ice. A body
570.6may not be kept in refrigeration for a period exceeding six calendar days, or packed in dry
570.7ice for a period that exceeds four calendar days, from the time of death or release of the
570.8body from the coroner or medical examiner.
570.9    Subd. 3. Permit required. No dead human body shall be buried, entombed, or
570.10cremated without a disposition permit. The disposition permit must be filed with the person
570.11in charge of the place of final disposition. Where a dead human body will be transported out
570.12of this state for final disposition, the body must be accompanied by a certificate of removal.
570.13    Subd. 4. Alkaline hydrolysis or cremation. Inurnment of alkaline hydrolyzed or
570.14cremated remains and release to an appropriate party is considered final disposition and no
570.15further permits or authorizations are required for transportation, interment, entombment, or
570.16placement of the cremated remains, except as provided in section 149A.95, subdivision 16.

570.17    Sec. 95. [149A.941] ALKALINE HYDROLYSIS FACILITIES AND ALKALINE
570.18HYDROLYSIS.
570.19    Subdivision 1. License required. A dead human body may only be hydrolyzed in
570.20this state at an alkaline hydrolysis facility licensed by the commissioner of health.
570.21    Subd. 2. General requirements. Any building to be used as an alkaline hydrolysis
570.22facility must comply with all applicable local and state building codes, zoning laws and
570.23ordinances, wastewater management regulations, and environmental statutes, rules, and
570.24standards. An alkaline hydrolysis facility must have, on site, a purpose built human
570.25alkaline hydrolysis system approved by the commissioner of health, a system approved by
570.26the commissioner of health for drying the hydrolyzed remains, a motorized mechanical
570.27device approved by the commissioner of health for processing hydrolyzed remains, and in
570.28the building a holding facility approved by the commissioner of health for the retention
570.29of dead human bodies awaiting alkaline hydrolysis. The holding facility must be secure
570.30from access by anyone except the authorized personnel of the alkaline hydrolysis facility,
570.31preserve the dignity of the remains, and protect the health and safety of the alkaline
570.32hydrolysis facility personnel.
570.33    Subd. 3. Lighting and ventilation. The room where the alkaline hydrolysis vessel
570.34is located and the room where the chemical storage takes place shall be properly lit and
570.35ventilated with an exhaust fan that provides at least 12 air changes per hour.
571.1    Subd. 4. Plumbing connections. All plumbing fixtures, water supply lines,
571.2plumbing vents, and waste drains shall be properly vented and connected pursuant to the
571.3Minnesota Plumbing Code. The alkaline hydrolysis facility shall be equipped with a
571.4functional sink with hot and cold running water.
571.5    Subd. 5. Flooring, walls, ceiling, doors, and windows. The room where the
571.6alkaline hydrolysis vessel is located and the room where the chemical storage takes place
571.7shall have nonporous flooring, so that a sanitary condition is provided. The walls and
571.8ceiling of the room where the alkaline hydrolysis vessel is located and the room where
571.9the chemical storage takes place shall run from floor to ceiling and be covered with tile,
571.10or by plaster or sheetrock painted with washable paint or other appropriate material so
571.11that a sanitary condition is provided. The doors, walls, ceiling, and windows shall be
571.12constructed to prevent odors from entering any other part of the building. All windows
571.13or other openings to the outside must be screened, and all windows must be treated in a
571.14manner that prevents viewing into the room where the alkaline hydrolysis vessel is located
571.15and the room where the chemical storage takes place. A viewing window for authorized
571.16family members or their designees is not a violation of this subdivision.
571.17    Subd. 6. Equipment and supplies. The alkaline hydrolysis facility must have a
571.18functional emergency eye wash and quick drench shower.
571.19    Subd. 7. Access and privacy. (a) The room where the alkaline hydrolysis vessel is
571.20located and the room where the chemical storage takes place must be private and have no
571.21general passageway through it. The room shall, at all times, be secure from the entrance of
571.22unauthorized persons. Authorized persons are:
571.23(1) licensed morticians;
571.24(2) registered interns or students as described in section 149A.91, subdivision 6;
571.25(3) public officials or representatives in the discharge of their official duties;
571.26(4) trained alkaline hydrolysis facility operators; and
571.27(5) the person or persons with the right to control the dead human body as defined in
571.28section 149A.80, subdivision 2, and their designees.
571.29    (b) Each door allowing ingress or egress shall carry a sign that indicates that the
571.30room is private and access is limited. All authorized persons who are present in or enter
571.31the room where the alkaline hydrolysis vessel is located while a body is being prepared for
571.32final disposition must be attired according to all applicable state and federal regulations
571.33regarding the control of infectious disease and occupational and workplace health and
571.34safety.
571.35    Subd. 8. Sanitary conditions and permitted use. The room where the alkaline
571.36hydrolysis vessel is located and the room where the chemical storage takes place and all
572.1fixtures, equipment, instruments, receptacles, clothing, and other appliances or supplies
572.2stored or used in the room must be maintained in a clean and sanitary condition at all times.
572.3    Subd. 9. Boiler use. When a boiler is required by the manufacturer of the alkaline
572.4hydrolysis vessel for its operation, all state and local regulations for that boiler must be
572.5followed.
572.6    Subd. 10. Occupational and workplace safety. All applicable provisions of state
572.7and federal regulations regarding exposure to workplace hazards and accidents shall be
572.8followed in order to protect the health and safety of all authorized persons at the alkaline
572.9hydrolysis facility.
572.10    Subd. 11. Licensed personnel. A licensed alkaline hydrolysis facility must employ
572.11a licensed mortician to carry out the process of alkaline hydrolysis of a dead human body.
572.12It is the duty of the licensed alkaline hydrolysis facility to provide proper procedures for
572.13all personnel, and the licensed alkaline hydrolysis facility shall be strictly accountable for
572.14compliance with this chapter and other applicable state and federal regulations regarding
572.15occupational and workplace health and safety.
572.16    Subd. 12. Authorization to hydrolyze required. No alkaline hydrolysis facility
572.17shall hydrolyze or cause to be hydrolyzed any dead human body or identifiable body part
572.18without receiving written authorization to do so from the person or persons who have the
572.19legal right to control disposition as described in section 149A.80 or the person's legal
572.20designee. The written authorization must include:
572.21(1) the name of the deceased and the date of death of the deceased;
572.22(2) a statement authorizing the alkaline hydrolysis facility to hydrolyze the body;
572.23(3) the name, address, telephone number, relationship to the deceased, and signature
572.24of the person or persons with legal right to control final disposition or a legal designee;
572.25(4) directions for the disposition of any nonhydrolyzed materials or items recovered
572.26from the alkaline hydrolysis vessel;
572.27(5) acknowledgment that the hydrolyzed remains will be dried and mechanically
572.28reduced to a granulated appearance and placed in an appropriate container and
572.29authorization to place any hydrolyzed remains that a selected urn or container will not
572.30accommodate into a temporary container;
572.31(6) acknowledgment that, even with the exercise of reasonable care, it is not possible
572.32to recover all particles of the hydrolyzed remains and that some particles may inadvertently
572.33become commingled with particles of other hydrolyzed remains that remain in the alkaline
572.34hydrolysis vessel or other mechanical devices used to process the hydrolyzed remains;
572.35(7) directions for the ultimate disposition of the hydrolyzed remains; and
573.1(8) a statement that includes, but is not limited to, the following information:
573.2"During the alkaline hydrolysis process, chemical dissolution using heat, water, and an
573.3alkaline solution is used to chemically break down the human tissue and the hydrolyzable
573.4alkaline hydrolysis container. After the process is complete, the liquid effluent solution
573.5contains the chemical by-products of the alkaline hydrolysis process except for the
573.6deceased's bone fragments. The solution is cooled and released according to local
573.7environmental regulations. A water rinse is applied to the hydrolyzed remains which are
573.8then dried and processed to facilitate inurnment or scattering."
573.9    Subd. 13. Limitation of liability. A licensed alkaline hydrolysis facility acting in
573.10good faith, with reasonable reliance upon an authorization to hydrolyze, pursuant to an
573.11authorization to hydrolyze and in an otherwise lawful manner, shall be held harmless from
573.12civil liability and criminal prosecution for any actions taken by the alkaline hydrolysis
573.13facility.
573.14    Subd. 14. Acceptance of delivery of body. (a) No dead human body shall be
573.15accepted for final disposition by alkaline hydrolysis unless:
573.16(1) encased in an appropriate alkaline hydrolysis container;
573.17(2) accompanied by a disposition permit issued pursuant to section 149A.93,
573.18subdivision 3, including a photocopy of the completed death record or a signed release
573.19authorizing alkaline hydrolysis of the body received from the coroner or medical
573.20examiner; and
573.21(3) accompanied by an alkaline hydrolysis authorization that complies with
573.22subdivision 12.
573.23    (b) An alkaline hydrolysis facility shall refuse to accept delivery of an alkaline
573.24hydrolysis container where there is:
573.25(1) evidence of leakage of fluids from the alkaline hydrolysis container;
573.26(2) a known dispute concerning hydrolysis of the body delivered;
573.27(3) a reasonable basis for questioning any of the representations made on the written
573.28authorization to hydrolyze; or
573.29(4) any other lawful reason.
573.30    Subd. 15. Bodies awaiting hydrolysis. A dead human body must be hydrolyzed
573.31within 24 hours of the alkaline hydrolysis facility accepting legal and physical custody of
573.32the body.
573.33    Subd. 16. Handling of alkaline hydrolysis containers for dead human bodies.
573.34All alkaline hydrolysis facility employees handling alkaline hydrolysis containers for
573.35dead human bodies shall use universal precautions and otherwise exercise all reasonable
574.1precautions to minimize the risk of transmitting any communicable disease from the body.
574.2No dead human body shall be removed from the container in which it is delivered.
574.3    Subd. 17. Identification of body. All licensed alkaline hydrolysis facilities shall
574.4develop, implement, and maintain an identification procedure whereby dead human
574.5bodies can be identified from the time the alkaline hydrolysis facility accepts delivery
574.6of the remains until the hydrolyzed remains are released to an authorized party. After
574.7hydrolyzation, an identifying disk, tab, or other permanent label shall be placed within the
574.8hydrolyzed remains container before the hydrolyzed remains are released from the alkaline
574.9hydrolysis facility. Each identification disk, tab, or label shall have a number that shall
574.10be recorded on all paperwork regarding the decedent. This procedure shall be designed
574.11to reasonably ensure that the proper body is hydrolyzed and that the hydrolyzed remains
574.12are returned to the appropriate party. Loss of all or part of the hydrolyzed remains or the
574.13inability to individually identify the hydrolyzed remains is a violation of this subdivision.
574.14    Subd. 18. Alkaline hydrolysis vessel for human remains. A licensed alkaline
574.15hydrolysis facility shall knowingly hydrolyze only dead human bodies or human remains
574.16in an alkaline hydrolysis vessel, along with the alkaline hydrolysis container used for
574.17infectious disease control.
574.18    Subd. 19. Alkaline hydrolysis procedures; privacy. The final disposition of
574.19dead human bodies by alkaline hydrolysis shall be done in privacy. Unless there is
574.20written authorization from the person with the legal right to control the disposition,
574.21only authorized alkaline hydrolysis facility personnel shall be permitted in the alkaline
574.22hydrolysis area while any dead human body is in the alkaline hydrolysis area awaiting
574.23alkaline hydrolysis, in the alkaline hydrolysis vessel, being removed from the alkaline
574.24hydrolysis vessel, or being processed and placed in a hydrolyzed remains container.
574.25    Subd. 20. Alkaline hydrolysis procedures; commingling of hydrolyzed remains
574.26prohibited. Except with the express written permission of the person with the legal right
574.27to control the disposition, no alkaline hydrolysis facility shall hydrolyze more than one
574.28dead human body at the same time and in the same alkaline hydrolysis vessel, or introduce
574.29a second dead human body into an alkaline hydrolysis vessel until reasonable efforts have
574.30been employed to remove all fragments of the preceding hydrolyzed remains, or hydrolyze
574.31a dead human body and other human remains at the same time and in the same alkaline
574.32hydrolysis vessel. This section does not apply where commingling of human remains
574.33during alkaline hydrolysis is otherwise provided by law. The fact that there is incidental
574.34and unavoidable residue in the alkaline hydrolysis vessel used in a prior hydrolyzation is
574.35not a violation of this subdivision.
575.1    Subd. 21. Alkaline hydrolysis procedures; removal from alkaline hydrolysis
575.2vessel. Upon completion of the alkaline hydrolysis process, reasonable efforts shall be
575.3made to remove from the alkaline hydrolysis vessel all of the recoverable hydrolyzed
575.4remains and nonhydrolyzed materials or items. Further, all reasonable efforts shall be
575.5made to separate and recover the nonhydrolyzed materials or items from the hydrolyzed
575.6human remains and dispose of these materials in a lawful manner, by the alkaline
575.7hydrolysis facility. The hydrolyzed human remains shall be placed in an appropriate
575.8container to be transported to the processing area.
575.9    Subd. 22. Drying device or mechanical processor procedures; commingling of
575.10hydrolyzed remains prohibited. Except with the express written permission of the
575.11person with the legal right to control the final disposition or otherwise provided by
575.12law, no alkaline hydrolysis facility shall dry or mechanically process the hydrolyzed
575.13human remains of more than one body at a time in the same drying device or mechanical
575.14processor, or introduce the hydrolyzed human remains of a second body into a drying
575.15device or mechanical processor until processing of any preceding hydrolyzed human
575.16remains has been terminated and reasonable efforts have been employed to remove all
575.17fragments of the preceding hydrolyzed remains. The fact that there is incidental and
575.18unavoidable residue in the drying device, the mechanical processor, or any container used
575.19in a prior alkaline hydrolysis process, is not a violation of this provision.
575.20    Subd. 23. Alkaline hydrolysis procedures; processing hydrolyzed remains. The
575.21hydrolyzed human remains shall be dried and then reduced by a motorized mechanical
575.22device to a granulated appearance appropriate for final disposition and placed in an
575.23alkaline hydrolysis remains container along with the appropriate identifying disk, tab,
575.24or permanent label. Processing must take place within the licensed alkaline hydrolysis
575.25facility. Dental gold, silver or amalgam, jewelry, or mementos, to the extent that they
575.26can be identified, may be removed prior to processing the hydrolyzed remains, only by
575.27staff licensed or registered by the commissioner of health; however, any dental gold and
575.28silver, jewelry, or mementos that are removed shall be returned to the hydrolyzed remains
575.29container unless otherwise directed by the person or persons having the right to control the
575.30final disposition. Every person who removes or possesses dental gold or silver, jewelry,
575.31or mementos from any hydrolyzed remains without specific written permission of the
575.32person or persons having the right to control those remains is guilty of a misdemeanor.
575.33The fact that residue and any unavoidable dental gold or dental silver, or other precious
575.34metals remain in the alkaline hydrolysis vessel or other equipment or any container used
575.35in a prior hydrolysis is not a violation of this section.
576.1    Subd. 24. Alkaline hydrolysis procedures; container of insufficient capacity.
576.2If a hydrolyzed remains container is of insufficient capacity to accommodate all
576.3hydrolyzed remains of a given dead human body, subject to directives provided in the
576.4written authorization to hydrolyze, the alkaline hydrolysis facility shall place the excess
576.5hydrolyzed remains in a secondary alkaline hydrolysis remains container and attach the
576.6second container, in a manner so as not to be easily detached through incidental contact, to
576.7the primary alkaline hydrolysis remains container. The secondary container shall contain a
576.8duplicate of the identification disk, tab, or permanent label that was placed in the primary
576.9container and all paperwork regarding the given body shall include a notation that the
576.10hydrolyzed remains were placed in two containers. Keepsake jewelry or similar miniature
576.11hydrolyzed remains containers are not subject to the requirements of this subdivision.
576.12    Subd. 25. Disposition procedures; commingling of hydrolyzed remains
576.13prohibited. No hydrolyzed remains shall be disposed of or scattered in a manner or in
576.14a location where the hydrolyzed remains are commingled with those of another person
576.15without the express written permission of the person with the legal right to control
576.16disposition or as otherwise provided by law. This subdivision does not apply to the
576.17scattering or burial of hydrolyzed remains at sea or in a body of water from individual
576.18containers, to the scattering or burial of hydrolyzed remains in a dedicated cemetery, to
576.19the disposal in a dedicated cemetery of accumulated residue removed from an alkaline
576.20hydrolysis vessel or other alkaline hydrolysis equipment, to the inurnment of members
576.21of the same family in a common container designed for the hydrolyzed remains of more
576.22than one body, or to the inurnment in a container or interment in a space that has been
576.23previously designated, at the time of sale or purchase, as being intended for the inurnment
576.24or interment of the hydrolyzed remains of more than one person.
576.25    Subd. 26. Alkaline hydrolysis procedures; disposition of accumulated residue.
576.26Every alkaline hydrolysis facility shall provide for the removal and disposition in a
576.27dedicated cemetery of any accumulated residue from any alkaline hydrolysis vessel,
576.28drying device, mechanical processor, container, or other equipment used in alkaline
576.29hydrolysis. Disposition of accumulated residue shall be according to the regulations of the
576.30dedicated cemetery and any applicable local ordinances.
576.31    Subd. 27. Alkaline hydrolysis procedures; release of hydrolyzed remains.
576.32Following completion of the hydrolyzation, the inurned hydrolyzed remains shall be
576.33released according to the instructions given on the written authorization to hydrolyze. If
576.34the hydrolyzed remains are to be shipped, they must be securely packaged and transported
576.35by a method which has an internal tracing system available and which provides for a
576.36receipt signed by the person accepting delivery. Where there is a dispute over release
577.1or disposition of the hydrolyzed remains, an alkaline hydrolysis facility may deposit
577.2the hydrolyzed remains with a court of competent jurisdiction pending resolution of the
577.3dispute or retain the hydrolyzed remains until the person with the legal right to control
577.4disposition presents satisfactory indication that the dispute is resolved.
577.5    Subd. 28. Unclaimed hydrolyzed remains. If, after 30 calendar days following
577.6the inurnment, the hydrolyzed remains are not claimed or disposed of according to the
577.7written authorization to hydrolyze, the alkaline hydrolysis facility or funeral establishment
577.8may give written notice, by certified mail, to the person with the legal right to control
577.9the final disposition or a legal designee, that the hydrolyzed remains are unclaimed and
577.10requesting further release directions. Should the hydrolyzed remains be unclaimed 120
577.11calendar days following the mailing of the written notification, the alkaline hydrolysis
577.12facility or funeral establishment may dispose of the hydrolyzed remains in any lawful
577.13manner deemed appropriate.
577.14    Subd. 29. Required records. Every alkaline hydrolysis facility shall create and
577.15maintain on its premises or other business location in Minnesota an accurate record of
577.16every hydrolyzation provided. The record shall include all of the following information
577.17for each hydrolyzation:
577.18(1) the name of the person or funeral establishment delivering the body for alkaline
577.19hydrolysis;
577.20(2) the name of the deceased and the identification number assigned to the body;
577.21(3) the date of acceptance of delivery;
577.22(4) the names of the alkaline hydrolysis vessel, drying device, and mechanical
577.23processor operator;
577.24(5) the time and date that the body was placed in and removed from the alkaline
577.25hydrolysis vessel;
577.26(6) the time and date that processing and inurnment of the hydrolyzed remains
577.27was completed;
577.28(7) the time, date, and manner of release of the hydrolyzed remains;
577.29(8) the name and address of the person who signed the authorization to hydrolyze;
577.30(9) all supporting documentation, including any transit or disposition permits, a
577.31photocopy of the death record, and the authorization to hydrolyze; and
577.32(10) the type of alkaline hydrolysis container.
577.33    Subd. 30. Retention of records. Records required under subdivision 29 shall be
577.34maintained for a period of three calendar years after the release of the hydrolyzed remains.
577.35Following this period and subject to any other laws requiring retention of records, the
577.36alkaline hydrolysis facility may then place the records in storage or reduce them to
578.1microfilm, microfiche, laser disc, or any other method that can produce an accurate
578.2reproduction of the original record, for retention for a period of ten calendar years from
578.3the date of release of the hydrolyzed remains. At the end of this period and subject to any
578.4other laws requiring retention of records, the alkaline hydrolysis facility may destroy
578.5the records by shredding, incineration, or any other manner that protects the privacy of
578.6the individuals identified.

578.7    Sec. 96. Minnesota Statutes 2012, section 149A.96, subdivision 9, is amended to read:
578.8    Subd. 9. Hydrolyzed and cremated remains. Subject to section 149A.95,
578.9subdivision 16 , inurnment of the hydrolyzed or cremated remains and release to an
578.10appropriate party is considered final disposition and no further permits or authorizations
578.11are required for disinterment, transportation, or placement of the hydrolyzed or cremated
578.12remains.

578.13    Sec. 97. Minnesota Statutes 2012, section 257.75, subdivision 7, is amended to read:
578.14    Subd. 7. Hospital and Department of Health; recognition form. Hospitals that
578.15provide obstetric services and the state registrar of vital statistics shall distribute the
578.16educational materials and recognition of parentage forms prepared by the commissioner of
578.17human services to new parents, shall assist parents in understanding the recognition of
578.18parentage form, including following the provisions for notice under subdivision 5, shall
578.19provide notary services for parents who complete the recognition of parentage form, and
578.20shall timely file the completed recognition of parentage form with the Office of the State
578.21Registrar of Vital Statistics Records unless otherwise instructed by the Office of the State
578.22Registrar of Vital Statistics Records. On and after January 1, 1994, hospitals may not
578.23distribute the declaration of parentage forms.

578.24    Sec. 98. Minnesota Statutes 2012, section 260C.635, subdivision 1, is amended to read:
578.25    Subdivision 1. Legal effect. (a) Upon adoption, the adopted child becomes the legal
578.26child of the adopting parent and the adopting parent becomes the legal parent of the child
578.27with all the rights and duties between them of a birth parent and child.
578.28(b) The child shall inherit from the adoptive parent and the adoptive parent's
578.29relatives the same as though the child were the birth child of the parent, and in case of the
578.30child's death intestate, the adoptive parent and the adoptive parent's relatives shall inherit
578.31the child's estate as if the child had been the adoptive parent's birth child.
578.32(c) After a decree of adoption is entered, the birth parents or previous legal parents
578.33of the child shall be relieved of all parental responsibilities for the child except child
579.1support that has accrued to the date of the order for guardianship to the commissioner
579.2which continues to be due and owing. The child's birth or previous legal parent shall not
579.3exercise or have any rights over the adopted child or the adopted child's property, person,
579.4privacy, or reputation.
579.5(d) The adopted child shall not owe the birth parents or the birth parent's relatives
579.6any legal duty nor shall the adopted child inherit from the birth parents or kindred unless
579.7otherwise provided for in a will of the birth parent or kindred.
579.8    (e) Upon adoption, the court shall complete a certificate of adoption form and mail
579.9the form to the Office of the State Registrar Vital Records at the Minnesota Department
579.10of Health. Upon receiving the certificate of adoption, the state registrar shall register a
579.11replacement vital record in the new name of the adopted child as required under section
579.12144.218 .

579.13    Sec. 99. Minnesota Statutes 2012, section 517.001, is amended to read:
579.14517.001 DEFINITION.
579.15As used in this chapter, "local registrar" has the meaning given in section 144.212,
579.16subdivision 10 means an individual designated by the county board of commissioners to
579.17register marriages.

579.18    Sec. 100. Laws 2011, First Special Session chapter 9, article 2, section 27, is amended
579.19to read:
579.20    Sec. 27. MINNESOTA TASK FORCE ON PREMATURITY.
579.21    Subdivision 1. Establishment. The Minnesota Task Force on Prematurity is
579.22established to evaluate and make recommendations on methods for reducing prematurity
579.23and improving premature infant health care in the state.
579.24    Subd. 2. Membership; meetings; staff. (a) The task force shall be composed of at
579.25least the following members, who serve at the pleasure of their appointing authority:
579.26(1) 15 11 representatives of the Minnesota Prematurity Coalition including, but not
579.27limited to, health care providers who treat pregnant women or neonates, organizations
579.28focused on preterm births, early childhood education and development professionals, and
579.29families affected by prematurity;
579.30(2) one representative appointed by the commissioner of human services;
579.31(3) two representatives appointed by the commissioner of health;
579.32(4) one representative appointed by the commissioner of education;
579.33(5) two members of the house of representatives, one appointed by the speaker of
579.34the house and one appointed by the minority leader; and
580.1(6) two members of the senate, appointed according to the rules of the senate.
580.2(b) Members of the task force serve without compensation or payment of expenses.
580.3(c) The commissioner of health must convene the first meeting of the Minnesota
580.4Task Force on Prematurity by July 31, 2011. The task force must continue to meet at
580.5least quarterly. Staffing and technical assistance shall be provided by the Minnesota
580.6Perinatal Coalition.
580.7    Subd. 3. Duties. The task force must report the current state of prematurity in
580.8Minnesota and develop recommendations on strategies for reducing prematurity and
580.9improving premature infant health care in the state by considering the following:
580.10(1) promoting adherence to standards of care for premature infants born less than 37
580.11weeks gestational age, including recommendations to improve utilization of appropriate
580.12 hospital discharge and follow-up care procedures;
580.13(2) coordination of information among appropriate professional and advocacy
580.14organizations on measures to improve health care for infants born prematurely;
580.15(3) identification and centralization of available resources to improve access and
580.16awareness for caregivers of premature infants; and
580.17(4) development and dissemination of evidence-based practices through networking
580.18and educational opportunities;
580.19(5) a review of relevant evidence-based research regarding the causes and effects of
580.20premature births in Minnesota;
580.21(6) a review of relevant evidence-based research regarding premature infant health
580.22care, including methods for improving quality of and access to care for premature infants;
580.23(7) (4) a review of the potential improvements in health status related to the use of
580.24health care homes to provide and coordinate pregnancy-related services; and.
580.25(8) identification of gaps in public reporting measures and possible effects of these
580.26measures on prematurity rates.
580.27    Subd. 4. Report; expiration. (a) By November 30, 2011 January 15, 2015, the
580.28task force must submit a final report to the chairs and ranking minority members of
580.29the legislative policy committees on health and human services on the current state of
580.30prematurity in Minnesota to the chairs of the legislative policy committees on health and
580.31human services, including any recommendations to reduce premature births and improve
580.32premature infant health in the state.
580.33(b) By January 15, 2013, the task force must report its final recommendations,
580.34including any draft legislation necessary for implementation, to the chairs of the legislative
580.35policy committees on health and human services.
581.1(c) (b) This task force expires on January 31, 2013 2015, or upon submission of the
581.2final report required in paragraph (b) (a), whichever is earlier.

581.3    Sec. 101. FUNERAL ESTABLISHMENTS; BRANCH LOCATIONS.
581.4    The commissioner of health shall review the statutory requirements for preparation
581.5and embalming rooms and develop legislation with input from stakeholders that provides
581.6appropriate health and safety protection for funeral home locations where deceased bodies
581.7are present, but are branch locations associated through a majority ownership of a licensed
581.8funeral establishment that meets the requirements of Minnesota Statutes, sections 149A.50
581.9and 149A.92, subdivisions 2 to 10. The review shall include consideration of distance
581.10between the main location and branch, and other health and safety issues.

581.11    Sec. 102. HEALTH EQUITY REPORT.
581.12By February 1, 2014, the commissioner of health, in consultation with local public
581.13health, health care, and community partners, must submit a report to the chairs and ranking
581.14minority members of the committees with jurisdiction over health policy and finance, on a
581.15plan for advancing health equity in Minnesota. The report must include the following:
581.16(1) assessment of health disparities that exist in the state and how these disparities
581.17relate to health equity;
581.18(2) identification of policies, processes, and systems that contribute to health
581.19inequity in the state;
581.20(3) recommendations for changes to policies, processes and systems within the
581.21Department of Health that would increase the department's leadership in addressing health
581.22inequities;
581.23(4) identification of best practices for local public health, health care, and community
581.24partners to provide culturally responsive services and advance health equity; and
581.25(5) recommendations for strategies for the use of data to document and monitor
581.26existing health inequities and to evaluate effectiveness of policies, processes, systems,
581.27and environmental changes that will advance health equity.

581.28    Sec. 103. GUARANTEED RENEWABILITY STUDY.
581.29The commissioner of commerce, in consultation with the commissioner of health,
581.30and representatives of health carriers and consumer advocates, shall study guaranteed
581.31renewability of health plans in the individual market and assess the need for statutory
581.32provisions related to permitting the discontinuance or modification of health plan
581.33coverage in the individual market by a health carrier. The commissioner shall submit
582.1recommendations and draft legislation, if needed, to the chairs and ranking minority
582.2members of the legislative committees with jurisdiction over health insurance policy
582.3issues by February 1, 2014.

582.4    Sec. 104. CAPITAL RESERVES LIMITS STUDY.
582.5By February 1, 2014, the commissioner of health, in consultation with the
582.6commissioners of human services and commerce, shall study methodologies for
582.7determining appropriate levels for capital reserves of health maintenance organizations
582.8and requirements for reducing capital reserves to any recommended maximum levels.
582.9In conducting the study, the commissioner shall consult with health maintenance
582.10organizations, stakeholders, consumers, and other states' insurance regulators. The
582.11commissioner shall make recommendations on the need for a level of capital reserves, and
582.12framework for implementing any recommended levels. The commissioner shall submit
582.13a report to the chairs and ranking minority members of the legislative committees with
582.14jurisdiction over health and human services.

582.15    Sec. 105. STUDY AND RECOMMENDATIONS REGARDING MINNESOTA
582.16COMPREHENSIVE HEALTH ASSOCIATION.
582.17By August 15, 2013, the Department of Commerce shall study and report to the
582.18legislature on reasonable and efficient options for coverage for high-quality, medically
582.19necessary, evidence-based treatment of autism spectrum disorders up to age 18, including
582.20whether the Minnesota Comprehensive Health Association could provide coverage
582.21options through January 1, 2016, under Minnesota Statutes, chapter 62E.

582.22    Sec. 106. ESSENTIAL HEALTH BENEFITS.
582.23By December 31, 2014, the Department of Commerce shall request that the United
582.24States Department of Human Services include autism services in Minnesota's Essential
582.25Health Benefits when the next benefit set is selected in 2016. These services should
582.26include but not be limited to the services listed in Minnesota Statutes, section 62A.3094,
582.27subdivision 2, paragraph (a).

582.28    Sec. 107. ATTORNEY GENERAL LEGAL OPINION REQUIRED.
582.29Pursuant to the requirements of Minnesota Statutes, section 8.05, and no later than
582.30October 1, 2013, the attorney general shall give a written legal opinion on whether a
582.31health plan, as defined by Minnesota Statutes, section 62Q.01, subdivision 3, is required
582.32to provide coverage of treatment for mental health and mental health-related illnesses,
583.1including autism spectrum disorders and any other mental health condition as determined
583.2by criteria set forth in the most recent edition of the Diagnostic and Statistical Manual of
583.3Mental Disorders of the American Psychiatric Association. The attorney general shall
583.4provide copies of this legal opinion to the commissioners of commerce and human
583.5services, the board of directors of the Minnesota Insurance Marketplace, and the legislative
583.6chairs with jurisdiction over commerce and health policy.

583.7    Sec. 108. REVISOR'S INSTRUCTION.
583.8The revisor shall substitute the term "vertical heat exchangers" or "vertical
583.9heat exchanger" with "bored geothermal heat exchangers" or "bored geothermal heat
583.10exchanger" wherever it appears in Minnesota Statutes, sections 103I.005, subdivisions
583.112 and 12; 103I.101, subdivisions 2 and 5; 103I.105; 103I.205, subdivision 4; 103I.208,
583.12subdivision 2; 103I.501; 103I.531, subdivision 5; and 103I.641, subdivisions 1, 2, and 3.

583.13    Sec. 109. REPEALER.
583.14(a) Minnesota Statutes 2012, sections 62J.693; 103I.005, subdivision 20; 149A.025;
583.15149A.20, subdivision 8; 149A.30, subdivision 2; 149A.40, subdivision 8; 149A.45,
583.16subdivision 6; 149A.50, subdivision 6; 149A.51, subdivision 7; 149A.52, subdivision 5a;
583.17149A.53, subdivision 9; and 485.14, are repealed.
583.18(b) Minnesota Statutes 2012, section 144.123, subdivision 2, is repealed effective
583.19July 1, 2014.


583.23    Section 1. Minnesota Statutes 2012, section 252.41, subdivision 3, is amended to read:
583.24    Subd. 3. Day training and habilitation services for adults with developmental
583.25disabilities. "Day training and habilitation services for adults with developmental
583.26disabilities" means services that:
583.27(1) include supervision, training, assistance, and supported employment,
583.28work-related activities, or other community-integrated activities designed and
583.29implemented in accordance with the individual service and individual habilitation plans
583.30required under Minnesota Rules, parts 9525.0015 to 9525.0165, to help an adult reach
583.31and maintain the highest possible level of independence, productivity, and integration
583.32into the community; and
584.1(2) are provided under contract with the county where the services are delivered
584.2 by a vendor licensed under sections 245A.01 to 245A.16 and 252.28, subdivision 2, to
584.3provide day training and habilitation services.
584.4Day training and habilitation services reimbursable under this section do not include
584.5special education and related services as defined in the Education of the Individuals with
584.6Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and
584.7(17), or vocational services funded under section 110 of the Rehabilitation Act of 1973,
584.8United States Code, title 29, section 720, as amended.
584.9EFFECTIVE DATE.This section is effective January 1, 2014.

584.10    Sec. 2. Minnesota Statutes 2012, section 252.42, is amended to read:
584.11252.42 SERVICE PRINCIPLES.
584.12The design and delivery of services eligible for reimbursement under the rates
584.13established in section 252.46 should reflect the following principles:
584.14(1) services must suit a person's chronological age and be provided in the least
584.15restrictive environment possible, consistent with the needs identified in the person's
584.16individual service and individual habilitation plans under Minnesota Rules, parts
584.179525.0015 to 9525.0165;
584.18(2) a person with a developmental disability whose individual service and individual
584.19habilitation plans authorize employment or employment-related activities shall be given
584.20the opportunity to participate in employment and employment-related activities in which
584.21nondisabled persons participate;
584.22(3) a person with a developmental disability participating in work shall be paid
584.23wages commensurate with the rate for comparable work and productivity except as
584.24regional centers are governed by section 246.151;
584.25(4) a person with a developmental disability shall receive services which include
584.26services offered in settings used by the general public and designed to increase the person's
584.27active participation in ordinary community activities;
584.28(5) a person with a developmental disability shall participate in the patterns,
584.29conditions, and rhythms of everyday living and working that are consistent with the norms
584.30of the mainstream of society.
584.31EFFECTIVE DATE.This section is effective January 1, 2014.

584.32    Sec. 3. Minnesota Statutes 2012, section 252.43, is amended to read:
584.33252.43 COMMISSIONER'S DUTIES.
585.1The commissioner shall supervise county boards' provision of day training and
585.2habilitation services to adults with developmental disabilities. The commissioner shall:
585.3(1) determine the need for day training and habilitation services under section 252.28;
585.4(2) approve establish payment rates established by a county under section 252.46,
585.5subdivision 1 as provided under section 256B.4914;
585.6(3) adopt rules for the administration and provision of day training and habilitation
585.7services under sections 252.40 252.41 to 252.46 and sections 245A.01 to 245A.16 and
585.8252.28, subdivision 2 ;
585.9(4) enter into interagency agreements necessary to ensure effective coordination and
585.10provision of day training and habilitation services;
585.11(5) monitor and evaluate the costs and effectiveness of day training and habilitation
585.12services; and
585.13(6) provide information and technical help to county boards and vendors in their
585.14administration and provision of day training and habilitation services.
585.15EFFECTIVE DATE.This section is effective January 1, 2014.

585.16    Sec. 4. Minnesota Statutes 2012, section 252.44, is amended to read:
585.17252.44 COUNTY BOARD RESPONSIBILITIES.
585.18(a) When the need for day training and habilitation services in a county has been
585.19determined under section 252.28, the board of commissioners for that county shall:
585.20(1) authorize the delivery of services according to the individual service and
585.21habilitation plans required as part of the county's provision of case management services
585.22under Minnesota Rules, parts 9525.0015 to 9525.0165. For calendar years for which
585.23section 252.46, subdivisions 2 to 10, apply, the county board shall not authorize a change
585.24in service days from the number of days authorized for the previous calendar year unless
585.25there is documentation for the change in the individual service plan. An increase in service
585.26days must also be supported by documentation that the goals and objectives assigned to the
585.27vendor cannot be met more economically and effectively by other available community
585.28services and that without the additional days of service the individual service plan could
585.29not be implemented in a manner consistent with the service principles in section 252.42;
585.30(2) contract with licensed vendors, as specified in paragraph (b), under sections
585.31256E.12 and 256B.092 and rules adopted under those sections;
585.32(3) (2) ensure that transportation is provided or arranged by the vendor in the most
585.33efficient and reasonable way possible; and
585.34(4) set payment rates under section 252.46;
586.1(5) (3) monitor and evaluate the cost and effectiveness of the services; and.
586.2(6) reimburse vendors for the provision of authorized services according to the rates,
586.3procedures, and regulations governing reimbursement.
586.4(b) With all vendors except regional centers, the contract must include the approved
586.5payment rates, the projected budget for the contract period, and any actual expenditures
586.6of previous and current contract periods. With all vendors, including regional centers,
586.7the contract must also include the amount, availability, and components of day training
586.8and habilitation services to be provided, the performance standards governing service
586.9provision and evaluation, and the time period in which the contract is effective.
586.10EFFECTIVE DATE.This section is effective January 1, 2014.

586.11    Sec. 5. Minnesota Statutes 2012, section 252.45, is amended to read:
586.12252.45 VENDOR'S DUTIES.
586.13A vendor's responsibility vendor enrolled with the commissioner is responsible for
586.14items under clauses (1), (2), and (3), and extends only to the provision of services that are
586.15reimbursable under state and federal law. A vendor under contract with a county board to
586.16provide providing day training and habilitation services shall:
586.17(1) provide the amount and type of services authorized in the individual service plan
586.18under Minnesota Rules, parts 9525.0015 to 9525.0165;
586.19(2) design the services to achieve the outcomes assigned to the vendor in the
586.20individual service plan;
586.21(3) provide or arrange for transportation of persons receiving services to and from
586.22service sites;
586.23(4) enter into agreements with community-based intermediate care facilities for
586.24persons with developmental disabilities to ensure compliance with applicable federal
586.25regulations; and
586.26(5) comply with state and federal law.
586.27EFFECTIVE DATE.This section is effective January 1, 2014.

586.28    Sec. 6. Minnesota Statutes 2012, section 252.46, subdivision 1a, is amended to read:
586.29    Subd. 1a. Day training and habilitation rates. The commissioner shall establish
586.30a statewide rate-setting methodology for all day training and habilitation services as
586.31provided under section 256B.4914. The rate-setting methodology must abide by the
586.32principles of transparency and equitability across the state. The methodology must involve
587.1a uniform process of structuring rates for each service and must promote quality and
587.2participant choice.
587.3EFFECTIVE DATE.This section is effective January 1, 2014.

587.4    Sec. 7. Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to read:
587.5    Subd. 2. Payment methodologies. (a) The commissioner shall establish, as defined
587.6under section 256B.4914, statewide payment methodologies that meet federal waiver
587.7requirements for home and community-based waiver services for individuals with
587.8disabilities. The payment methodologies must abide by the principles of transparency
587.9and equitability across the state. The methodologies must involve a uniform process of
587.10structuring rates for each service and must promote quality and participant choice.
587.11    (b) As of January 1, 2012, counties shall not implement changes to established
587.12processes for rate-setting methodologies for individuals using components of or data
587.13from research rates.

587.14    Sec. 8. Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:
587.15    Subd. 3. Payment requirements. The payment methodologies established under
587.16this section shall accommodate:
587.17(1) supervision costs;
587.18(2) staffing patterns staff compensation;
587.19(3) staffing and supervisory patterns;
587.20(3) (4) program-related expenses;
587.21(4) (5) general and administrative expenses; and
587.22(5) (6) consideration of recipient intensity.

587.23    Sec. 9. Minnesota Statutes 2012, section 256B.4913, is amended by adding a
587.24subdivision to read:
587.25    Subd. 4a. Rate stabilization adjustment. (a) For purposes of this subdivision,
587.26"implementation period" shall mean the period beginning January 1, 2014, and ending
587.27on the last day of the month in which the rate management system is populated with the
587.28data necessary to calculate rates for substantially all individuals receiving home and
587.29community-based services.
587.30(b) For purposes of this subdivision, the banding value for all service recipients
587.31shall mean the individual reimbursement rate for a recipient in effect on December 1,
587.322013, except that:
588.1(1)(i) for day training and habilitation pilot program service recipients, the banding
588.2value shall be the authorized rate for the provider in the county of service effective
588.3December 1, 2013, if the recipient: was not authorized to receive these waiver services
588.4prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
588.5changed providers on or after January 1, 2014; and
588.6(ii) for all other unit or day service recipients, the banding value shall be the
588.7weighted average authorized rate for each provider number in the county of service
588.8effective December 1, 2013, if the recipient: was not authorized to receive these waiver
588.9services prior to January 1, 2014; added a new service or services on or after January 1,
588.102014; or changed providers on or after January 1, 2014; and
588.11(2) for residential service recipients who change providers on or after January 1,
588.122014, the banding value shall be set by each lead agency within their county aggregate
588.13budget using their respective methodology for residential services effective December 1,
588.142013, for determining the provider rate for a similarly situated recipient being served by
588.15that provider.
588.16(c) The commissioner shall adjust individual reimbursement rates determined under
588.17this section so that the unit rate is no higher or lower than:
588.18(1) 0.5 percent from the banding value for the implementation period;
588.19(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period
588.20immediately following the time period of clause (1);
588.21(3) 1.0 percent from the rate in effect in clause (2), for the 12-month period
588.22immediately following the time period of clause (2);
588.23(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period
588.24immediately following the time period of clause (3); and
588.25(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period
588.26immediately following the time period of clause (4).
588.27(d) This subdivision shall not apply to rates for recipients served by providers new
588.28to a given county after January 1, 2014.

588.29    Sec. 10. Minnesota Statutes 2012, section 256B.4913, subdivision 5, is amended to read:
588.30    Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
588.31on regular intervals with the existing stakeholder group established as part of the
588.32rate-setting methodology process and others, to gather input, concerns, and data, and
588.33exchange ideas for the legislative proposals for to assist in the full implementation of
588.34 the new rate payment system and to make pertinent information available to the public
588.35through the department's Web site.

589.1    Sec. 11. Minnesota Statutes 2012, section 256B.4913, subdivision 6, is amended to read:
589.2    Subd. 6. Implementation. (a) The commissioner may shall implement changes
589.3no sooner than on January 1, 2014, to payment rates for individuals receiving home and
589.4community-based waivered services after the enactment of legislation that establishes
589.5specific payment methodology frameworks, processes for rate calculations, and specific
589.6values to populate the payment methodology frameworks disability waiver rates system.
589.7(b) On January 1, 2014, all new service authorizations must use the disability waiver
589.8rates system. Beginning January 1, 2014, all renewing individual service plans must use the
589.9disability waiver rates system as reassessment and reauthorization occurs. By December
589.1031, 2014, data for all recipients must be entered into the disability waiver rates system.

589.11    Sec. 12. [256B.4914] HOME AND COMMUNITY-BASED SERVICES
589.12WAIVERS; RATE SETTING.
589.13    Subdivision 1. Application. The payment methodologies in this section apply to
589.14home and community-based services waivers under sections 256B.092 and 256B.49. This
589.15section does not change existing waiver policies and procedures.
589.16    Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
589.17meanings given them, unless the context clearly indicates otherwise.
589.18(b) "Commissioner" means the commissioner of human services.
589.19(c) "Component value" means underlying factors that are part of the cost of providing
589.20services that are built into the waiver rates methodology to calculate service rates.
589.21(d) "Customized living tool" means a methodology for setting service rates that
589.22delineates and documents the amount of each component service included in a recipient's
589.23customized living service plan.
589.24(e) "Disability waiver rates system" means a statewide system that establishes rates
589.25that are based on uniform processes and captures the individualized nature of waiver
589.26services and recipient needs.
589.27(f) "Lead agency" means a county, partnership of counties, or tribal agency charged
589.28with administering waivered services under sections 256B.092 and 256B.49.
589.29(g) "Median" means the amount that divides distribution into two equal groups,
589.30one-half above the median and one-half below the median.
589.31(h) "Payment or rate" means reimbursement to an eligible provider for services
589.32provided to a qualified individual based on an approved service authorization.
589.33(i) "Rates management system" means a Web-based software application that uses
589.34a framework and component values, as determined by the commissioner, to establish
589.35service rates.
590.1(j) "Recipient" means a person receiving home and community-based services
590.2funded under any of the disability waivers.
590.3    Subd. 3. Applicable services. Applicable services are those authorized under
590.4the state's home and community-based services waivers under sections 256B.092 and
590.5256B.49, including the following, as defined in the federally approved home and
590.6community-based services plan:
590.7(1) 24 hour customized living;
590.8(2) adult day care;
590.9(3) adult day care bath;
590.10(4) behavioral programming;
590.11(5) companion services;
590.12(6) customized living;
590.13(7) day training and habilitation;
590.14(8) housing access coordination;
590.15(9) independent living skills;
590.16(10) in-home family support;
590.17(11) night supervision;
590.18(12) personal support;
590.19(13) prevocational services;
590.20(14) residential care services;
590.21(15) residential support services;
590.22(16) respite services;
590.23(17) structured day services;
590.24(18) supported employment services;
590.25(19) supported living services;
590.26(20) transportation services; and
590.27(21) other services as approved by the federal government in the state home and
590.28community-based services plan.
590.29    Subd. 4. Data collection for rate determination. (a) Rates for applicable home
590.30and community-based waivered services, including rate exceptions under subdivision 12,
590.31are set by the rates management system.
590.32(b) Data for services under section 256B.4913, subdivision 4a, shall be collected in a
590.33manner prescribed by the commissioner.
590.34(c) Data and information in the rates management system may be used to calculate
590.35an individual's rate.
591.1(d) Service providers, with information from the community support plan and
591.2oversight by lead agencies, shall provide values and information needed to calculate an
591.3individual's rate into the rates management system. These values and information include:
591.4(1) shared staffing hours;
591.5(2) individual staffing hours;
591.6(3) direct RN hours;
591.7(4) direct LPN hours;
591.8(5) staffing ratios;
591.9(6) information to document variable levels of service qualification for variable
591.10levels of reimbursement in each framework;
591.11(7) shared or individualized arrangements for unit-based services, including the
591.12staffing ratio;
591.13(8) number of trips and miles for transportation services; and
591.14(9) service hours provided through monitoring technology.
591.15(e) Updates to individual data shall include:
591.16(1) data for each individual that is updated annually when renewing service plans; and
591.17(2) requests by individuals or lead agencies to update a rate whenever there is a
591.18change in an individual's service needs, with accompanying documentation.
591.19(f) Lead agencies shall review and approve values to calculate the final payment rate
591.20for each individual. Lead agencies must notify the individual and the service provider
591.21of the final agreed-upon values and rate. If a value used was mistakenly or erroneously
591.22entered and used to calculate a rate, a provider may petition lead agencies to correct it.
591.23Lead agencies must respond to these requests.
591.24    Subd. 5. Base wage index and standard component values. (a) The base wage
591.25index is established to determine staffing costs associated with providing services to
591.26individuals receiving home and community-based services. For purposes of developing
591.27and calculating the proposed base wage, Minnesota-specific wages taken from job
591.28descriptions and standard occupational classification (SOC) codes from the Bureau of
591.29Labor Statistics as defined in the most recent edition of the Occupational Handbook shall
591.30be used. The base wage index shall be calculated as follows:
591.31(1) for residential direct care staff, the sum of:
591.32(i) 15 percent of the subtotal of 50 percent of the median wage for personal and
591.33home health aide (SOC code 39-9021); 30 percent of the median wage for nursing aide
591.34(SOC code 31-1012); and 20 percent of the median wage for social and human services
591.35aide (SOC code 21-1093); and
592.1(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
592.2(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
592.3(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
592.420 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
592.5percent of the median wage for social and human services aide (SOC code 21-1093);
592.6(2) for day services, 20 percent of the median wage for nursing aide (SOC code
592.731-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
592.8and 60 percent of the median wage for social and human services aide (SOC code 21-1093);
592.9(3) for residential asleep-overnight staff, the wage will be $7.66 per hour, except in
592.10a family foster care setting, the wage is $2.80 per hour;
592.11(4) for behavior program analyst staff, 100 percent of the median wage for mental
592.12health counselors (SOC code 21-1014);
592.13(5) for behavior program professional staff, 100 percent of the median wage for
592.14clinical counseling and school psychologist (SOC code 19-3031);
592.15(6) for behavior program specialist staff, 100 percent of the median wage for
592.16psychiatric technicians (SOC code 29-2053);
592.17(7) for supportive living services staff, 20 percent of the median wage for nursing
592.18aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
592.19code 29-2053); and 60 percent of the median wage for social and human services aide
592.20(SOC code 21-1093);
592.21(8) for housing access coordination staff, 50 percent of the median wage for
592.22community and social services specialist (SOC code 21-1099); and 50 percent of the
592.23median wage for social and human services aide (SOC code 21-1093);
592.24(9) for in-home family support staff, 20 percent of the median wage for nursing
592.25aide (SOC code 31-1012); 30 percent of the median wage for community social service
592.26specialist (SOC code 21-1099); 40 percent of the median wage for social and human
592.27services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
592.28technician (SOC code 29-2053);
592.29(10) for independent living skills staff, 40 percent of the median wage for community
592.30social service specialist (SOC code 21-1099); 50 percent of the median wage for social
592.31and human services aide (SOC code 21-1093); and ten percent of the median wage for
592.32psychiatric technician (SOC code 29-2053);
592.33(11) for supported employment staff, 20 percent of the median wage for nursing aide
592.34(SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
592.35code 29-2053); and 60 percent of the median wage for social and human services aide
592.36(SOC code 21-1093);
593.1(12) for adult companion staff, 50 percent of the median wage for personal and home
593.2care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
593.3orderlies, and attendants (SOC code 31-1012);
593.4(13) for night supervision staff, 20 percent of the median wage for home health aide
593.5(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
593.6(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
593.720 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
593.8percent of the median wage for social and human services aide (SOC code 21-1093);
593.9(14) for respite staff, 50 percent of the median wage for personal and home care aide
593.10(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
593.11attendants (SOC code 31-1012);
593.12(15) for personal support staff, 50 percent of the median wage for personal and home
593.13care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
593.14orderlies, and attendants (SOC code 31-1012);
593.15(16) for supervisory staff, the basic wage is $17.43 per hour with exception of the
593.16supervisor of behavior analyst and behavior specialists, which shall be $30.75 per hour;
593.17(17) for RN, the basic wage is $30.82 per hour; and
593.18(18) for LPN, the basic wage is $18.64 per hour.
593.19(b) Component values for residential support services are:
593.20(1) supervisory span of control ratio: 11 percent;
593.21(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
593.22(3) employee-related cost ratio: 23.6 percent;
593.23(4) general administrative support ratio: 13.25 percent;
593.24(5) program-related expense ratio: 1.3 percent; and
593.25(6) absence and utilization factor ratio: 3.9 percent.
593.26(c) Component values for family foster care are:
593.27(1) supervisory span of control ratio: 11 percent;
593.28(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
593.29(3) employee-related cost ratio: 23.6 percent;
593.30(4) general administrative support ratio: 3.3 percent;
593.31(5) program-related expense ratio: 1.3 percent; and
593.32(6) absence factor: 1.7 percent.
593.33(d) Component values for day services for all services are:
593.34(1) supervisory span of control ratio: 11 percent;
593.35(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
593.36(3) employee-related cost ratio: 23.6 percent;
594.1(4) program plan support ratio: 5.6 percent;
594.2(5) client programming and support ratio: ten percent;
594.3(6) general administrative support ratio: 13.25 percent;
594.4(7) program-related expense ratio: 1.8 percent; and
594.5(8) absence and utilization factor ratio: 3.9 percent.
594.6(e) Component values for unit-based services with programming are:
594.7(1) supervisory span of control ratio: 11 percent;
594.8(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
594.9(3) employee-related cost ratio: 23.6 percent;
594.10(4) program plan supports ratio: 3.1 percent;
594.11(5) client programming and supports ratio: 8.6 percent;
594.12(6) general administrative support ratio: 13.25 percent;
594.13(7) program-related expense ratio: 6.1 percent; and
594.14(8) absence and utilization factor ratio: 3.9 percent.
594.15(f) Component values for unit-based services without programming except respite
594.16are:
594.17(1) supervisory span of control ratio: 11 percent;
594.18(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
594.19(3) employee-related cost ratio: 23.6 percent;
594.20(4) program plan support ratio: 3.1 percent;
594.21(5) client programming and support ratio: 8.6 percent;
594.22(6) general administrative support ratio: 13.25 percent;
594.23(7) program-related expense ratio: 6.1 percent; and
594.24(8) absence and utilization factor ratio: 3.9 percent.
594.25(g) Component values for unit-based services without programming for respite are:
594.26(1) supervisory span of control ratio: 11 percent;
594.27(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
594.28(3) employee-related cost ratio: 23.6 percent;
594.29(4) general administrative support ratio: 13.25 percent;
594.30(5) program-related expense ratio: 6.1 percent; and
594.31(6) absence and utilization factor ratio: 3.9 percent.
594.32(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
594.33(b) based on the wage data by standard occupational code (SOC) from the Bureau of
594.34Labor Statistics available on December 31, 2016. The commissioner shall publish these
594.35updated values and load them into the rate management system. This adjustment occurs
595.1every five years. For adjustments in 2021 and beyond, the commissioner shall use the data
595.2available on December 31 of the calendar year five years prior.
595.3(i) On July 1, 2017, the commissioner shall update the framework components in
595.4paragraph (c) for changes in the Consumer Price Index. The commissioner will adjust
595.5these values higher or lower by the percentage change in the Consumer Price Index-All
595.6Items, United States city average (CPI-U) from January 1, 2014, to January 1, 2017. The
595.7commissioner shall publish these updated values and load them into the rate management
595.8system. This adjustment occurs every five years. For adjustments in 2021 and beyond, the
595.9commissioner shall use the data available on January 1 of the calendar year four years
595.10prior and January 1 of the current calendar year.
595.11    Subd. 6. Payments for residential support services. (a) Payments for residential
595.12support services, as defined in sections 256B.092, subdivision 11, and 256B.49,
595.13subdivision 22, must be calculated as follows:
595.14(1) determine the number of shared and individual direct staff hours to meet a
595.15recipient's needs provided on-site or through monitoring technology;
595.16(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
595.17Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
595.185. This is defined as the direct-care rate;
595.19(3) for a recipient requiring customization for deaf and hard-of-hearing language
595.20accessibility under subdivision 12, add the customization rate provided in subdivision 12
595.21to the result of clause (2). This is defined as the customized direct-care rate;
595.22(4) multiply the number of shared and individual direct staff hours provided on-site
595.23or through monitoring technology and direct nursing hours by the appropriate staff wages
595.24in subdivision 5, paragraph (a), or the customized direct-care rate;
595.25(5) multiply the number of shared and individual direct staff hours provided
595.26on-site or through monitoring technology and direct nursing hours by the product of
595.27the supervision span of control ratio in subdivision 5, paragraph (b), clause (1), and the
595.28appropriate supervision wage in subdivision 5, paragraph (a), clause (16);
595.29(6) combine the results of clauses (4) and (5), excluding any shared and individual
595.30direct staff hours provided through monitoring technology, and multiply the result by one
595.31plus the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph
595.32(b), clause (2). This is defined as the direct staffing cost;
595.33(7) for employee-related expenses, multiply the direct staffing cost, excluding any
595.34shared and individual direct staff hours provided through monitoring technology, by one
595.35plus the employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
595.36(8) for client programming and supports, the commissioner shall add $2,179; and
596.1(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
596.2customized for adapted transport, per year.
596.3(b) The total rate shall be calculated using the following steps:
596.4(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any
596.5shared and individual direct staff hours provided through monitoring technology that
596.6was excluded in clause (7);
596.7(2) sum the standard general and administrative rate, the program-related expense
596.8ratio, and the absence and utilization ratio;
596.9(3) divide the result of clause (1) by one minus the result of clause (2). This is
596.10the total payment amount; and
596.11(4) adjust the result of clause (3) by a factor to be determined by the commissioner
596.12to adjust for regional differences in the cost of providing services.
596.13(c) The payment methodology for customized living, 24-hour customized living, and
596.14residential care services shall be the customized living tool. Revisions to the customized
596.15living tool shall be made to reflect the services and activities unique to disability-related
596.16recipient needs.
596.17(d) The commissioner shall establish a Monitoring Technology Review Panel to
596.18annually review and approve the plans, safeguards, and rates that include residential
596.19direct care provided remotely through monitoring technology. Lead agencies shall submit
596.20individual service plans that include supervision using monitoring technology to the
596.21Monitoring Technology Review Panel for approval. Individual service plans that include
596.22supervision using monitoring technology as of December 31, 2013, shall be submitted to
596.23the Monitoring Technology Review Panel, but the plans are not subject to approval.
596.24    Subd. 7. Payments for day programs. Payments for services with day programs
596.25including adult day care, day treatment and habilitation, prevocational services, and
596.26structured day services must be calculated as follows:
596.27(1) determine the number of units of service to meet a recipient's needs;
596.28(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
596.29Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
596.30(3) for a recipient requiring customization for deaf and hard-of-hearing language
596.31accessibility under subdivision 12, add the customization rate provided in subdivision 12
596.32to the result of clause (2). This is defined as the customized direct-care rate;
596.33(4) multiply the number of day program direct staff hours and direct nursing hours
596.34by the appropriate staff wage in subdivision 5, paragraph (a), or the customized direct-care
596.35rate;
597.1(5) multiply the number of day direct staff hours by the product of the supervision
597.2span of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate
597.3supervision wage in subdivision 5, paragraph (a), clause (16);
597.4(6) combine the results of clauses (4) and (5), and multiply the result by one plus
597.5the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
597.6clause (2). This is defined as the direct staffing rate;
597.7(7) for program plan support, multiply the result of clause (6) by one plus the
597.8program plan support ratio in subdivision 5, paragraph (d), clause (4);
597.9(8) for employee-related expenses, multiply the result of clause (7) by one plus the
597.10employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
597.11(9) for client programming and supports, multiply the result of clause (8) by one plus
597.12the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
597.13(10) for program facility costs, add $19.30 per week with consideration of staffing
597.14ratios to meet individual needs;
597.15(11) for adult day bath services, add $7.01 per 15 minute unit;
597.16(12) this is the subtotal rate;
597.17(13) sum the standard general and administrative rate, the program-related expense
597.18ratio, and the absence and utilization factor ratio;
597.19(14) divide the result of clause (12) by one minus the result of clause (13). This is
597.20the total payment amount;
597.21(15) adjust the result of clause (14) by a factor to be determined by the commissioner
597.22to adjust for regional differences in the cost of providing services;
597.23(16) for transportation provided as part of day training and habilitation for an
597.24individual who does not require a lift, add:
597.25(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle
597.26without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared
597.27ride in a vehicle with a lift;
597.28(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle
597.29without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared
597.30ride in a vehicle with a lift;
597.31(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle
597.32without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared
597.33ride in a vehicle with a lift; or
597.34(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a
597.35lift, $16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a
597.36vehicle with a lift;
598.1(17) for transportation provide as part of day training and habilitation for an
598.2individual who does require a lift, add:
598.3(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with
598.4a lift, and $15.05 for a shared ride in a vehicle with a lift;
598.5(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
598.6lift, and $28.16 for a shared ride in a vehicle with a lift;
598.7(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with
598.8a lift, and $58.76 for a shared ride in a vehicle with a lift; or
598.9(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a
598.10lift, and $80.93 for a shared ride in a vehicle with a lift.
598.11    Subd. 8. Payments for unit-based services with programming. Payments for
598.12unit-based with program services, including behavior programming, housing access
598.13coordination, in-home family support, independent living skills training, hourly supported
598.14living services, and supported employment provided to an individual outside of any day or
598.15residential service plan must be calculated as follows, unless the services are authorized
598.16separately under subdivision 6 or 7:
598.17(1) determine the number of units of service to meet a recipient's needs;
598.18(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
598.19Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
598.20(3) for a recipient requiring customization for deaf and hard-of-hearing language
598.21accessibility under subdivision 12, add the customization rate provided in subdivision 12
598.22to the result of clause (2). This is defined as the customized direct-care rate;
598.23(4) multiply the number of direct staff hours by the appropriate staff wage in
598.24subdivision 5, paragraph (a), or the customized direct care rate;
598.25(5) multiply the number of direct staff hours by the product of the supervision span
598.26of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
598.27wage in subdivision 5, paragraph (a), clause (16);
598.28(6) combine the results of clauses (4) and (5), and multiply the result by one plus
598.29the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
598.30clause (2). This is defined as the direct staffing rate;
598.31(7) for program plan support, multiply the result of clause (6) by one plus the
598.32program plan supports ratio in subdivision 5, paragraph (e), clause (4);
598.33(8) for employee-related expenses, multiply the result of clause (7) by one plus the
598.34employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
598.35(9) for client programming and supports, multiply the result of clause (8) by one plus
598.36the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
599.1(10) this is the subtotal rate;
599.2(11) sum the standard general and administrative rate, the program-related expense
599.3ratio, and the absence and utilization factor ratio;
599.4(12) divide the result of clause (10) by one minus the result of clause (11). This is
599.5the total payment amount;
599.6(13) for supported employment provided in a shared manner, divide the total
599.7payment amount in clause (12) by the number of service recipients, not to exceed three.
599.8For independent living skills training provided in a shared manner, divide the total
599.9payment amount in clause (12) by the number of service recipients, not to exceed two; and
599.10(14) adjust the result of clause (13) by a factor to be determined by the commissioner
599.11to adjust for regional differences in the cost of providing services.
599.12    Subd. 9. Payments for unit-based services without programming. Payments
599.13for unit-based without program services, including night supervision, personal support,
599.14respite, and companion care provided to an individual outside of any day or residential
599.15service plan must be calculated as follows unless the services are authorized separately
599.16under subdivision 6 or 7:
599.17(1) for all services except respite, determine the number of units of service to meet
599.18a recipient's needs;
599.19(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
599.20Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
599.21(3) for a recipient requiring customization for deaf and hard-of-hearing language
599.22accessibility under subdivision 12, add the customization rate provided in subdivision 12
599.23to the result of clause (2). This is defined as the customized direct care rate;
599.24(4) multiply the number of direct staff hours by the appropriate staff wage in
599.25subdivision 5 or the customized direct care rate;
599.26(5) multiply the number of direct staff hours by the product of the supervision span
599.27of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
599.28wage in subdivision 5, paragraph (a), clause (16);
599.29(6) combine the results of clauses (4) and (5), and multiply the result by one plus
599.30the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f),
599.31clause (2). This is defined as the direct staffing rate;
599.32(7) for program plan support, multiply the result of clause (6) by one plus the
599.33program plan support ratio in subdivision 5, paragraph (f), clause (4);
599.34(8) for employee-related expenses, multiply the result of clause (7) by one plus the
599.35employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
600.1(9) for client programming and supports, multiply the result of clause (8) by one plus
600.2the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
600.3(10) this is the subtotal rate;
600.4(11) sum the standard general and administrative rate, the program-related expense
600.5ratio, and the absence and utilization factor ratio;
600.6(12) divide the result of clause (10) by one minus the result of clause (11). This is
600.7the total payment amount;
600.8(13) for respite services, determine the number of daily units of service to meet an
600.9individual's needs;
600.10(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
600.11Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
600.12(15) for a recipient requiring deaf and hard-of-hearing customization under
600.13subdivision 12, add the customization rate provided in subdivision 12 to the result of
600.14clause (14). This is defined as the customized direct care rate;
600.15(16) multiply the number of direct staff hours by the appropriate staff wage in
600.16subdivision 5, paragraph (a);
600.17(17) multiply the number of direct staff hours by the product of the supervisory span
600.18of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
600.19wage in subdivision 5, paragraph (a), clause (16);
600.20(18) combine the results of clauses (16) and (17), and multiply the result by one plus
600.21the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
600.22clause (2). This is defined as the direct staffing rate;
600.23(19) for employee-related expenses, multiply the result of clause (18) by one plus
600.24the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
600.25(20) this is the subtotal rate;
600.26(21) sum the standard general and administrative rate, the program-related expense
600.27ratio, and the absence and utilization factor ratio;
600.28(22) divide the result of clause (20) by one minus the result of clause (21). This is
600.29the total payment amount; and
600.30(23) adjust the result of clauses (12) and (22) by a factor to be determined by the
600.31commissioner to adjust for regional differences in the cost of providing services.
600.32    Subd. 10. Updating payment values and additional information. (a) From
600.33January 1, 2014, through December 31, 2017, the commissioner shall develop and
600.34implement uniform procedures to refine terms and adjust values used to calculate payment
600.35rates in this section.
601.1(b) The commissioner shall, within available resources, conduct research and
601.2gather data and information from existing state systems or other outside sources on the
601.3following items:
601.4(1) differences in the underlying cost to provide services and care across the state; and
601.5(2) mileage and utilization of transportation for all day and unit-based services.
601.6(c) Using a statistically valid set of rates management system data, the commissioner,
601.7in consultation with stakeholders, shall analyze for each service the average difference in
601.8the rate on December 31, 2013, and the framework rate at the individual, provider, lead
601.9agency, and state levels.
601.10(d) The commissioner, in consultation with stakeholders, shall review and evaluate
601.11the following values already in subdivisions 6 to 9, or issues that impact all services,
601.12including, but not limited to:
601.13(1) values for transportation rates for day services;
601.14(2) values for transportation rates in residential services;
601.15(3) values for services where monitoring technology replaces staff time;
601.16(4) values for indirect services;
601.17(5) values for nursing;
601.18(6) component values for independent living skills;
601.19(7) component values for family foster care that reflect licensing requirements;
601.20(8) adjustments to other components to replace the budget neutrality factor;
601.21(9) remote monitoring technology for nonresidential services;
601.22(10) values for basic and intensive services in residential services;
601.23(11) values for the facility use rate in day services;
601.24(12) values for workers compensation as part of employee-related expenses;
601.25(13) values for unemployment insurance as part of employee-related expenses;
601.26(14) a component value to reflect costs for individuals with rates previously adjusted
601.27for the inclusion of group residential housing rate 3 costs, only for any individual enrolled
601.28as of December 31, 2013; and
601.29(15) any changes in state or federal law with an impact on the underlying cost of
601.30providing home and community-based services.
601.31(e) The commissioner shall report to the chairs and the ranking minority members of
601.32the legislative committees and divisions with jurisdiction over health and human services
601.33policy and finance with the information and data gathered under paragraphs (b) to (d)
601.34on the following dates:
601.35(1) January 15, 2015, with preliminary results and data;
602.1(2) January 15, 2016, with a status implementation update, and additional data
602.2and summary information;
602.3(3) January 15, 2017, with the full report; and
602.4(4) January 15, 2019, with another full report, and a full report once every four
602.5years thereafter.
602.6(f) Based on the commissioner's evaluation of the information and data collected in
602.7paragraphs (b) to (d), the commissioner may make recommendations to the legislature
602.8to address any potential issues.
602.9(g) The commissioner shall implement a regional adjustment factor to all rate
602.10calculations in subdivisions 6 to 9, effective no later than January 1, 2015. Prior to
602.11implementation, the commissioner shall consult with stakeholders on the methodology to
602.12calculate the adjustment.
602.13(h) The commissioner shall provide a public notice via LISTSERV in October of
602.14each year beginning October 1, 2014, containing information detailing legislatively
602.15approved changes in:
602.16(1) calculation values including derived wage rates and related employee and
602.17administrative factors;
602.18(2) service utilization;
602.19(3) county and tribal allocation changes; and
602.20(4) information on adjustments made to calculation values and the timing of those
602.21adjustments.
602.22The information in this notice shall be effective January 1 of the following year.
602.23    Subd. 11. Payment implementation. Upon implementation of the payment
602.24methodologies under this section, those payment rates supersede rates established in county
602.25contracts for recipients receiving waiver services under section 256B.092 or 256B.49.
602.26    Subd. 12. Customization of rates for individuals. (a) For persons determined to
602.27have higher needs based on being deaf or hard-of-hearing, the direct-care costs must be
602.28increased by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8,
602.29and 9. The customization rate with respect to deaf or hard-of-hearing persons shall be
602.30$2.50 per hour for waiver recipients who meet the respective criteria as determined by
602.31the commissioner.
602.32(b) For the purposes of this section, "deaf and hard-of-hearing" means:
602.33(1) the person has a developmental disability and an assessment score which
602.34indicates a hearing impairment that is severe or that the person has no useful hearing;
602.35(2) the person has a developmental disability and an expressive communications
602.36score that indicates the person uses single signs or gestures, uses an augmentative
603.1communication aid, or does not have functional communication, or the person's expressive
603.2communications is unknown; and
603.3(3) the person has a developmental disability and a communication score which
603.4indicates the person comprehends signs, gestures and modeling prompts or does not
603.5comprehend verbal, visual or gestural communication or that the person's receptive
603.6communication score is unknown; or
603.7(4) the person receives long-term care services and has an assessment score that
603.8indicates they hear only very loud sounds, have no useful hearing, or a determination
603.9cannot be made; and the person receives long-term care services and has an assessment
603.10that indicates the person communicates needs with sign language, symbol board, written
603.11messages, gestures or an interpreter; communicates with inappropriate content, makes
603.12garbled sounds or displays echolalia, or does not communicate needs.
603.13    Subd. 13. Transportation. The commissioner shall require that the purchase
603.14of transportation services be cost-effective and be limited to market rates where the
603.15transportation mode is generally available and accessible.
603.16    Subd. 14. Exceptions. (a) In a format prescribed by the commissioner, lead
603.17agencies must identify individuals with exceptional needs that cannot be met under the
603.18disability waiver rate system. The commissioner shall use that information to evaluate
603.19and, if necessary, approve an alternative payment rate for those individuals.
603.20(b) Lead agencies must submit exception requests to the state.
603.21(c) An application for a rate exception may be submitted for the following criteria:
603.22(1) an individual has service needs that cannot be met through additional units
603.23of service; or
603.24(2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
603.25individual being discharged.
603.26(d) Exception requests must include the following information:
603.27(1) the service needs required by each individual that are not accounted for in
603.28subdivisions 6, 7, 8, and 9;
603.29(2) the service rate requested and the difference from the rate determined in
603.30subdivisions 6, 7, 8, and 9;
603.31(3) a basis for the underlying costs used for the rate exception and any accompanying
603.32documentation;
603.33(4) the duration of the rate exception; and
603.34(5) any contingencies for approval.
603.35(e) Approved rate exceptions shall be managed within lead agency allocations under
603.36sections 256B.092 and 256B.49.
604.1(f) Individual disability waiver recipients may request that a lead agency submit an
604.2exception request. A lead agency that denies such a request shall notify the individual
604.3waiver recipient of its decision and the reasons for denying the request in writing no later
604.4than 30 days after the individual's request has been made.
604.5(g) The commissioner shall determine whether to approve or deny an exception
604.6request no more than 30 days after receiving the request. If the commissioner denies the
604.7request, the commissioner shall notify the lead agency and the individual disability waiver
604.8recipient in writing of the reasons for the denial.
604.9(h) The individual disability waiver recipient may appeal any denial of an exception
604.10request by either the lead agency or the commissioner, pursuant to sections 256.045 and
604.11256.0451. When the denial of an exception request results in the proposed demission of a
604.12waiver recipient from a residential or day habilitation program, the commissioner shall
604.13issue a temporary stay of demission, when requested by the disability waiver recipient,
604.14consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c).
604.15The temporary stay shall remain in effect until the lead agency can provide an informed
604.16choice of appropriate, alternative services to the disability waiver.
604.17(i) Providers may petition lead agencies to update values that were entered
604.18incorrectly or erroneously into the rate management system, based on past service level
604.19discussions and determination in subdivision 4, without applying for a rate exception.
604.20    Subd. 15. County or tribal allocations. (a) Upon implementation of the disability
604.21waiver rates management system on January 1, 2014, the commissioner shall establish
604.22a method of tracking and reporting the fiscal impact of the disability waiver rates
604.23management system on individual lead agencies.
604.24(b) Beginning January 1, 2014, the commissioner shall make annual adjustments to
604.25lead agencies' home and community-based waivered service budget allocations to adjust
604.26for rate differences and the resulting impact on county allocations upon implementation of
604.27the disability waiver rates system.
604.28    Subd. 16. Budget neutrality adjustments. (a) The commissioner shall use the
604.29following adjustments to the rate generated by the framework to assure budget neutrality
604.30until the rate information is available to implement paragraph (b). The rate generated by
604.31the framework shall be multiplied by the appropriate factor, as designated below:
604.32(1) for residential services: 1.003;
604.33(2) for day services: 1.000;
604.34(3) for unit-based services with programming: 0.941; and
604.35(4) for unit-based services without programming: 0.796.
605.1(b) Within 12 months of January 1, 2014, the commissioner shall compare estimated
605.2spending for all home and community-based waiver services under the new payment rates
605.3defined in subdivisions 6 to 9 with estimated spending for the same recipients and services
605.4under the rates in effect on July 1, 2013. This comparison must distinguish spending under
605.5each of subdivisions 6, 7, 8, and 9. The comparison must be based on actual recipients
605.6and services for one or more service months after the new rates have gone into effect.
605.7The commissioner shall consult with the commissioner of management and budget on
605.8this analysis to ensure budget neutrality. If estimated spending under the new rates for
605.9services under one or more subdivisions differs in this comparison by 0.3 percent or
605.10more, the commissioner shall assure aggregate budget neutrality across all service areas
605.11by adjusting the budget neutrality factor in paragraph (a) in each subdivision so that total
605.12estimated spending for each subdivision under the new rates matches estimated spending
605.13under the rates in effect on July 1, 2013.

605.14    Sec. 13. FEDERAL APPROVAL.
605.15During the transition to a new disability waivers payment methodology system, the
605.16commissioner of human services has the authority to manage the disability home and
605.17community-based service waiver programs within federally required parameters. The
605.18commissioner may negotiate an agreement with the Centers for Medicare and Medicaid
605.19Services for the implementation of the disability waivers payment methodology system
605.20in order to prevent federal action that would withhold or disallow federal funding for
605.21current waiver recipients, or new waiver recipients as authorized by the legislature. The
605.22commissioner must provide for public notice and comment, as required by state and
605.23federal law, to changes related to federal approval of the disability waivers payment
605.24methodology system. If the Centers for Medicare and Medicaid Services requires
605.25changes to the disability waivers payment rate methodology implementation plan, the
605.26commissioner shall implement the changes in accordance with Minnesota Statutes, section
605.27256B.4914, subdivision 16, and upon:
605.28(1) public notice;
605.29(2) federal approval;
605.30(3) Legislative Advisory Commission review and recommendation, in a manner
605.31described under Minnesota Statutes, section 3.3005, subdivision 4; and
605.32(4) recommendation of necessary legislation to the chairs and ranking minority
605.33members of the legislative committees with jurisdiction over health and human services
605.34policy and finance by January 15, 2014. The changed implementation plan must provide
605.35for a transition from the historical to the new rate setting methodology.

606.1    Sec. 14. REPEALER.
606.2(a) Minnesota Statutes 2012, sections 252.40; 252.46, subdivisions 1, 2, 3, 4, 5, 6,
606.37, 8, 9, 10, 11, 16, 17, 18, 19, 20, and 21; 256B.4913, subdivisions 1, 2, 3, and 4; and
606.4256B.501, subdivision 8, are repealed effective January 1, 2014.
606.5(b) Minnesota Rules, part 9525.1860, subparts 3, items B and C and 4, item D, are
606.6repealed effective January 1, 2014.

606.9

Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

606.10The sums shown in the columns marked "Appropriations" are appropriated to the
606.11agencies and for the purposes specified in this article. The appropriations are from the
606.12general fund, or another named fund, and are available for the fiscal years indicated
606.13for each purpose. The figures "2014" and "2015" used in this article mean that the
606.14appropriations listed under them are available for the fiscal year ending June 30, 2014, or
606.15June 30, 2015, respectively. "The first year" is fiscal year 2014. "The second year" is fiscal
606.16year 2015. "The biennium" is fiscal years 2014 and 2015.

606.17				APPROPRIATIONS
606.18				Available for the Year
606.19				Ending June 30
606.20					2014		2015

606.21 606.22

Sec. 2. COMMISSIONER OF HUMAN SERVICES

606.23

Subdivision 1.Total Appropriation

$

6,438,485,000

$

6,457,117,000

606.24	Appropriations by Fund
606.25		2014	2015
606.26	General	5,654,765,000	5,677,458,000
606.27 606.28	State Government Special Revenue	4,099,000	4,510,000
606.29	Health Care Access	519,816,000	518,446,000
606.30	Federal TANF	257,915,000	254,813,000
606.31	Lottery Prize Fund	1,890,000	1,890,000

606.32Receipts for Systems Projects.
606.33Appropriations and federal receipts for
606.34information systems projects for MAXIS,
606.35PRISM, MMIS, and SSIS must be deposited
606.36in the state system account authorized
607.1in Minnesota Statutes, section 256.014.
607.2Money appropriated for computer projects
607.3approved by the commissioner of Minnesota
607.4information technology services, funded
607.5by the legislature, and approved by the
607.6commissioner of management and budget,
607.7may be transferred from one project to
607.8another and from development to operations
607.9as the commissioner of human services
607.10considers necessary. Any unexpended
607.11balance in the appropriation for these
607.12projects does not cancel but is available for
607.13ongoing development and operations.
607.14Nonfederal Share Transfers. The
607.15nonfederal share of activities for which
607.16federal administrative reimbursement is
607.17appropriated to the commissioner may be
607.18transferred to the special revenue fund.
607.19ARRA Supplemental Nutrition Assistance
607.20Benefit Increases. The funds provided for
607.21food support benefit increases under the
607.22Supplemental Nutrition Assistance Program
607.23provisions of the American Recovery and
607.24Reinvestment Act (ARRA) of 2009 must be
607.25used for benefit increases beginning July 1,
607.262009.
607.27Supplemental Nutrition Assistance
607.28Program Employment and Training.
607.29(1) Notwithstanding Minnesota Statutes,
607.30sections 256D.051, subdivisions 1a, 6b,
607.31and 6c, and 256J.626, federal Supplemental
607.32Nutrition Assistance employment and
607.33training funds received as reimbursement of
607.34MFIP consolidated fund grant expenditures
607.35for diversionary work program participants
608.1and child care assistance program
608.2expenditures must be deposited in the general
608.3fund. The amount of funds must be limited to
608.4$4,900,000 per year in fiscal years 2014 and
608.52015, and to $4,400,000 per year in fiscal
608.6years 2016 and 2017, contingent on approval
608.7by the federal Food and Nutrition Service.
608.8(2) Consistent with the receipt of the federal
608.9funds, the commissioner may adjust the
608.10level of working family credit expenditures
608.11claimed as TANF maintenance of effort.
608.12Notwithstanding any contrary provision in
608.13this article, this rider expires June 30, 2017.
608.14TANF Maintenance of Effort. (a) In order
608.15to meet the basic maintenance of effort
608.16(MOE) requirements of the TANF block grant
608.17specified under Code of Federal Regulations,
608.18title 45, section 263.1, the commissioner may
608.19only report nonfederal money expended for
608.20allowable activities listed in the following
608.21clauses as TANF/MOE expenditures:
608.22(1) MFIP cash, diversionary work program,
608.23and food assistance benefits under Minnesota
608.24Statutes, chapter 256J;
608.25(2) the child care assistance programs
608.26under Minnesota Statutes, sections 119B.03
608.27and 119B.05, and county child care
608.28administrative costs under Minnesota
608.29Statutes, section 119B.15;
608.30(3) state and county MFIP administrative
608.31costs under Minnesota Statutes, chapters
608.32256J and 256K;
608.33(4) state, county, and tribal MFIP
608.34employment services under Minnesota
608.35Statutes, chapters 256J and 256K;
609.1(5) expenditures made on behalf of legal
609.2noncitizen MFIP recipients who qualify for
609.3the MinnesotaCare program under Minnesota
609.4Statutes, chapter 256L;
609.5(6) qualifying working family credit
609.6expenditures under Minnesota Statutes,
609.7section 290.0671;
609.8(7) qualifying Minnesota education credit
609.9expenditures under Minnesota Statutes,
609.10section 290.0674; and
609.11(8) qualifying Head Start expenditures under
609.12Minnesota Statutes, section 119A.50.
609.13(b) The commissioner shall ensure that
609.14sufficient qualified nonfederal expenditures
609.15are made each year to meet the state's
609.16TANF/MOE requirements. For the activities
609.17listed in paragraph (a), clauses (2) to
609.18(8), the commissioner may only report
609.19expenditures that are excluded from the
609.20definition of assistance under Code of
609.21Federal Regulations, title 45, section 260.31.
609.22(c) For fiscal years beginning with state fiscal
609.23year 2003, the commissioner shall ensure
609.24that the maintenance of effort used by the
609.25commissioner of management and budget
609.26for the February and November forecasts
609.27required under Minnesota Statutes, section
609.2816A.103, contains expenditures under
609.29paragraph (a), clause (1), equal to at least 16
609.30percent of the total required under Code of
609.31Federal Regulations, title 45, section 263.1.
609.32(d) The requirement in Minnesota Statutes,
609.33section 256.011, subdivision 3, that federal
609.34grants or aids secured or obtained under that
609.35subdivision be used to reduce any direct
610.1appropriations provided by law, do not apply
610.2if the grants or aids are federal TANF funds.
610.3(e) For the federal fiscal years beginning on
610.4or after October 1, 2007, the commissioner
610.5may not claim an amount of TANF/MOE in
610.6excess of the 75 percent standard in Code
610.7of Federal Regulations, title 45, section
610.8263.1(a)(2), except:
610.9(1) to the extent necessary to meet the 80
610.10percent standard under Code of Federal
610.11Regulations, title 45, section 263.1(a)(1),
610.12if it is determined by the commissioner
610.13that the state will not meet the TANF work
610.14participation target rate for the current year;
610.15(2) to provide any additional amounts
610.16under Code of Federal Regulations, title 45,
610.17section 264.5, that relate to replacement of
610.18TANF funds due to the operation of TANF
610.19penalties; and
610.20(3) to provide any additional amounts that
610.21may contribute to avoiding or reducing
610.22TANF work participation penalties through
610.23the operation of the excess MOE provisions
610.24of Code of Federal Regulations, title 45,
610.25section 261.43(a)(2).
610.26For the purposes of clauses (1) to (3),
610.27the commissioner may supplement the
610.28MOE claim with working family credit
610.29expenditures or other qualified expenditures
610.30to the extent such expenditures are otherwise
610.31available after considering the expenditures
610.32allowed in this subdivision and subdivisions
610.332 and 3.
611.1(f) Notwithstanding any contrary provision
611.2in this article, paragraphs (a) to (e) expire
611.3June 30, 2017.
611.4Working Family Credit Expenditures
611.5as TANF/MOE. The commissioner may
611.6claim as TANF maintenance of effort up to
611.7$6,707,000 per year of working family credit
611.8expenditures in each fiscal year.

611.9 611.10

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

611.11The commissioner may count the following
611.12amounts of working family credit
611.13expenditures as TANF/MOE:
611.14(1) fiscal year 2014, $50,272,000;
611.15(2) fiscal year 2015, $34,894,000;
611.16(3) fiscal year 2016, $0; and
611.17(4) fiscal year 2017, $1,283,000.

611.18 611.19

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

611.20(a) The following TANF fund amounts
611.21are appropriated to the commissioner for
611.22purposes of MFIP/transition year child care
611.23assistance under Minnesota Statutes, section
611.24119B.05:
611.25(1) fiscal year 2014; $14,020,000; and
611.26(2) fiscal year 2015, $14,020,000.
611.27(b) The commissioner shall authorize the
611.28transfer of sufficient TANF funds to the
611.29federal child care and development fund to
611.30meet this appropriation and shall ensure that
611.31all transferred funds are expended according
611.32to federal child care and development fund
611.33regulations.

611.34

Subd. 4.Central Office

612.1The amounts that may be spent from this
612.2appropriation for each purpose are as follows:

612.3

(a) Operations

612.4	Appropriations by Fund
612.5	General	101,979,000	96,858,000
612.6 612.7	State Government Special Revenue	3,974,000	4,385,000
612.8	Health Care Access	13,177,000	13,004,000
612.9	Federal TANF	100,000	100,000

612.10DHS Receipt Center Accounting. The
612.11commissioner is authorized to transfer
612.12appropriations to, and account for DHS
612.13receipt center operations in, the special
612.14revenue fund.
612.15Administrative Recovery; Set-Aside. The
612.16commissioner may invoice local entities
612.17through the SWIFT accounting system as an
612.18alternative means to recover the actual cost
612.19of administering the following provisions:
612.20(1) Minnesota Statutes, section 125A.744,
612.21subdivision 3;
612.22(2) Minnesota Statutes, section 245.495,
612.23paragraph (b);
612.24(3) Minnesota Statutes, section 256B.0625,
612.25subdivision 20, paragraph (k);
612.26(4) Minnesota Statutes, section 256B.0924,
612.27subdivision 6, paragraph (g);
612.28(5) Minnesota Statutes, section 256B.0945,
612.29subdivision 4, paragraph (d); and
612.30(6) Minnesota Statutes, section 256F.10,
612.31subdivision 6, paragraph (b).
612.32Systems Modernization. The following
612.33amounts are appropriated for transfer to
613.1the state systems account authorized in
613.2Minnesota Statutes, section 256.014:
613.3(1) $1,825,000 in fiscal year 2014 and
613.4$2,502,000 in fiscal year 2015 is for the
613.5state share of Medicaid-allocated costs of
613.6the health insurance exchange information
613.7technology and operational structure. The
613.8funding base is $3,222,000 in fiscal year 2016
613.9and $3,037,000 in fiscal year 2017 but shall
613.10not be included in the base thereafter; and
613.11(2) $9,344,000 in fiscal year 2014 and
613.12$3,660,000 in fiscal year 2015 are for the
613.13modernization and streamlining of agency
613.14eligibility and child support systems. The
613.15funding base is $5,921,000 in fiscal year
613.162016 and $1,792,000 in fiscal year 2017 but
613.17shall not be included in the base thereafter.
613.18The unexpended balance of the $9,344,000
613.19appropriation in fiscal year 2014 and the
613.20$3,660,000 appropriation in fiscal year 2015
613.21must be transferred from the Department of
613.22Human Services state systems account to
613.23the Office of Enterprise Technology when
613.24the Office of Enterprise Technology has
613.25negotiated a federally approved internal
613.26service fund rates and billing process with
613.27sufficient internal accounting controls to
613.28properly maximize federal reimbursement
613.29to Minnesota for human services system
613.30modernization projects, but not later than
613.31June 30, 2015.
613.32If contingent funding is fully or partially
613.33disbursed under article 15, section 3, and
613.34transferred to the state systems account, the
613.35unexpended balance of that appropriation
614.1must be transferred to the Office of Enterprise
614.2Technology in accordance with this clause.
614.3Contingent funding must not exceed
614.4$11,598,000 for the biennium.
614.5Base Adjustment. The general fund base
614.6is increased by $2,868,000 in fiscal year
614.72016 and decreased by $1,206,000 in fiscal
614.8year 2017. The health access fund base is
614.9decreased by $551,000 in fiscal years 2016
614.10and 2017. The state government special
614.11revenue fund base is increased by $4,000 in
614.12fiscal year 2016 and decreased by $236,000
614.13in fiscal year 2017.

614.14

(b) Children and Families

614.15	Appropriations by Fund
614.16	General	8,023,000	8,015,000
614.17	Federal TANF	2,282,000	2,282,000

614.18Financial Institution Data Match and
614.19Payment of Fees. The commissioner is
614.20authorized to allocate up to $310,000 each
614.21year in fiscal years 2014 and 2015 from the
614.22PRISM special revenue account to make
614.23payments to financial institutions in exchange
614.24for performing data matches between account
614.25information held by financial institutions
614.26and the public authority's database of child
614.27support obligors as authorized by Minnesota
614.28Statutes, section 13B.06, subdivision 7.
614.29Base Adjustment. The general fund base is
614.30decreased by $300,000 in fiscal years 2016
614.31and 2017. The TANF fund base is increased
614.32by $300,000 in fiscal years 2016 and 2017.

614.33

(c) Health Care

615.1	Appropriations by Fund
615.2	General	14,028,000	13,826,000
615.3	Health Care Access	28,442,000	31,137,000

615.4Base Adjustment. The general fund base
615.5is decreased by $86,000 in fiscal year 2016
615.6and by $86,000 in fiscal year 2017. The
615.7health care access fund base is increased
615.8by $6,954,000 in fiscal year 2016 and by
615.9$5,489,000 in fiscal year 2017.

615.10

(d) Continuing Care

615.11	Appropriations by Fund
615.12	General	20,993,000	22,359,000
615.13 615.14	State Government Special Revenue	125,000	125,000

615.15Base Adjustment. The general fund base is
615.16increased by $1,690,000 in fiscal year 2016
615.17and by $798,000 in fiscal year 2017.

615.18

(e) Chemical and Mental Health

615.19	Appropriations by Fund
615.20	General	4,639,000	4,490,000
615.21	Lottery Prize Fund	157,000	157,000

615.22

Subd. 5.Forecasted Programs

615.23The amounts that may be spent from this
615.24appropriation for each purpose are as follows:

615.25

(a) MFIP/DWP

615.26	Appropriations by Fund
615.27	General	72,583,000	76,927,000
615.28	Federal TANF	80,342,000	76,851,000

615.29

(b) MFIP Child Care Assistance

61,701,000

69,294,000

615.30

(c) General Assistance

54,787,000

56,068,000

615.31General Assistance Standard. The
615.32commissioner shall set the monthly standard
615.33of assistance for general assistance units
615.34consisting of an adult recipient who is
616.1childless and unmarried or living apart
616.2from parents or a legal guardian at $203.
616.3The commissioner may reduce this amount
616.4according to Laws 1997, chapter 85, article
616.53, section 54.
616.6Emergency General Assistance. The
616.7amount appropriated for emergency general
616.8assistance funds is limited to no more
616.9than $6,729,812 in fiscal year 2014 and
616.10$6,729,812 in fiscal year 2015. Funds
616.11to counties shall be allocated by the
616.12commissioner using the allocation method in
616.13Minnesota Statutes, section 256D.06.

616.14

(d) MN Supplemental Assistance

38,646,000

39,821,000

616.15

(e) Group Residential Housing

141,138,000

150,988,000

616.16

(f) MinnesotaCare

297,707,000

247,284,000

616.17This appropriation is from the health care
616.18access fund.

616.19

(g) Medical Assistance

616.20	Appropriations by Fund
616.21	General	4,443,768,000	4,431,612,000
616.22	Health Care Access	179,550,000	226,081,000

616.23Spending to be apportioned. The
616.24commissioner shall apportion expenditures
616.25under this paragraph consistent with the
616.26requirements of section 12.
616.27Support Services for Deaf and
616.28Hard-of-Hearing. $121,000 in fiscal
616.29year 2014 and $141,000 in fiscal year 2015;
616.30and $10,000 in fiscal year 2014 and $13,000
616.31in fiscal year 2015 are from the health care
616.32access fund for the hospital reimbursement
616.33increase in Minnesota Statutes, section
616.34256.969, subdivision 29, paragraph (b).
617.1Disproportionate Share Payments.
617.2 Effective for services provided on or after
617.3July 1, 2011, through June 30, 2015, the
617.4commissioner of human services shall
617.5deposit, in the health care access fund,
617.6additional federal matching funds received
617.7under Minnesota Statutes, section 256B.199,
617.8paragraph (e), as disproportionate share
617.9hospital payments for inpatient hospital
617.10services provided under MinnesotaCare to
617.11lawfully present noncitizens who are not
617.12eligible for MinnesotaCare with federal
617.13financial participation due to immigration
617.14status. The amount deposited shall not exceed
617.15$2,200,000 for the time period specified.
617.16Funding for Services Provided to EMA
617.17Recipients. $2,200,000 in fiscal year 2014 is
617.18from the health care access fund to provide
617.19services to emergency medical assistance
617.20recipients under Minnesota Statutes, section
617.21256B.06, subdivision 4, paragraph (l). This
617.22is a onetime appropriation and is available in
617.23either year of the biennium.

617.24

(h) Alternative Care

50,776,000

54,922,000

617.25Alternative Care Transfer. Any money
617.26allocated to the alternative care program that
617.27is not spent for the purposes indicated does
617.28not cancel but shall be transferred to the
617.29medical assistance account.

617.30

(i) CD Treatment Fund

81,440,000

74,875,000

617.31Balance Transfer. The commissioner must
617.32transfer $18,188,000 from the consolidated
617.33chemical dependency treatment fund to the
617.34general fund by September 30, 2013.

618.1

Subd. 6.Grant Programs

618.2The amounts that may be spent from this
618.3appropriation for each purpose are as follows:

618.4

(a) Support Services Grants

618.5	Appropriations by Fund
618.6	General	8,915,000	13,333,000
618.7	Federal TANF	94,611,000	94,611,000

618.8Paid Work Experience. $2,168,000
618.9each year in fiscal years 2015 and 2016
618.10is from the general fund for paid work
618.11experience for long-term MFIP recipients.
618.12Paid work includes full and partial wage
618.13subsidies and other related services such as
618.14job development, marketing, preworksite
618.15training, job coaching, and postplacement
618.16services. These are onetime appropriations.
618.17Unexpended funds for fiscal year 2015 do not
618.18cancel, but are available to the commissioner
618.19for this purpose in fiscal year 2016.
618.20Work Study Funding for MFIP
618.21Participants. $250,000 each year in fiscal
618.22years 2015 and 2016 is from the general fund
618.23to pilot work study jobs for MFIP recipients
618.24in approved postsecondary education
618.25programs. This is a onetime appropriation.
618.26Unexpended funds for fiscal year 2015 do
618.27not cancel, but are available for this purpose
618.28in fiscal year 2016.
618.29Local Strategies to Reduce Disparities.
618.30 $2,000,000 each year in fiscal years 2015
618.31and 2016 is from the general fund for
618.32local projects that focus on services for
618.33subgroups within the MFIP caseload
618.34who are experiencing poor employment
618.35outcomes. These are onetime appropriations.
619.1Unexpended funds for fiscal year 2015 do not
619.2cancel, but are available to the commissioner
619.3for this purpose in fiscal year 2016.
619.4Home Visiting Collaborations for MFIP
619.5Teen Parents. $200,000 per year in fiscal
619.6years 2014 and 2015 is from the general fund
619.7and $200,000 in fiscal year 2016 is from the
619.8federal TANF fund for technical assistance
619.9and training to support local collaborations
619.10that provide home visiting services for
619.11MFIP teen parents. The general fund
619.12appropriation is onetime. The federal TANF
619.13fund appropriation is added to the base.
619.14Performance Bonus Funds for Counties.
619.15 The TANF fund base is increased by
619.16$1,500,000 each year in fiscal years 2016
619.17and 2017. The commissioner must allocate
619.18this amount each year to counties that exceed
619.19their expected range of performance on the
619.20annualized three-year self-support index
619.21as defined in Minnesota Statutes, section
619.22256J.751, subdivision 2, clause (6). This is a
619.23permanent base adjustment. Notwithstanding
619.24any contrary provisions in this article, this
619.25provision expires June 30, 2016.
619.26Base Adjustment. The general fund base is
619.27decreased by $200,000 in fiscal year 2016
619.28and $4,618,000 in fiscal year 2017. The
619.29TANF fund base is increased by $1,700,000
619.30in fiscal years 2016 and 2017.

619.31 619.32

(b) Basic Sliding Fee Child Care Assistance Grants

36,836,000

42,318,000

619.33Base Adjustment. The general fund base is
619.34increased by $3,778,000 in fiscal year 2016
619.35and by $3,849,000 in fiscal year 2017.

620.1

(c) Child Care Development Grants

1,612,000

1,737,000

620.2

(d) Child Support Enforcement Grants

50,000

50,000

620.3Federal Child Support Demonstration
620.4Grants. Federal administrative
620.5reimbursement resulting from the federal
620.6child support grant expenditures authorized
620.7under United States Code, title 42, section
620.81315, is appropriated to the commissioner
620.9for this activity.

620.10

(e) Children's Services Grants

620.11	Appropriations by Fund
620.12	General	49,760,000	52,961,000
620.13	Federal TANF	140,000	140,000

620.14Adoption Assistance and Relative Custody
620.15Assistance. $37,453,000 in fiscal year 2014
620.16and $37,453,000 in fiscal year 2015 is for
620.17the adoption assistance and relative custody
620.18assistance programs. The commissioner
620.19shall determine with the commissioner of
620.20Minnesota Management and Budget the
620.21appropriation for Northstar Care for Children
620.22effective January 1, 2015. The commissioner
620.23may transfer appropriations for adoption
620.24assistance, relative custody assistance, and
620.25Northstar Care for Children between fiscal
620.26years and among programs to adjust for
620.27transfers across the programs.
620.28Title IV-E Adoption Assistance. Additional
620.29federal reimbursements to the state as a result
620.30of the Fostering Connections to Success
620.31and Increasing Adoptions Act's expanded
620.32eligibility for Title IV-E adoption assistance
620.33are appropriated for postadoption services,
620.34including a parent-to-parent support network.
621.1Privatized Adoption Grants. Federal
621.2reimbursement for privatized adoption grant
621.3and foster care recruitment grant expenditures
621.4is appropriated to the commissioner for
621.5adoption grants and foster care and adoption
621.6administrative purposes.
621.7Adoption Assistance Incentive Grants.
621.8 Federal funds available during fiscal years
621.92014 and 2015 for adoption incentive grants
621.10are appropriated for postadoption services,
621.11including a parent-to-parent support network.
621.12Base Adjustment. The general fund base is
621.13increased by $5,913,000 in fiscal year 2016
621.14and by $10,297,000 in fiscal year 2017.

621.15

(f) Child and Community Service Grants

53,301,000

53,301,000

621.16

(g) Child and Economic Support Grants

21,047,000

20,848,000

621.17Minnesota Food Assistance Program.
621.18Unexpended funds for the Minnesota food
621.19assistance program for fiscal year 2014 do
621.20not cancel but are available for this purpose
621.21in fiscal year 2015.
621.22Transitional Housing. $250,000 each year
621.23is for the transitional housing programs under
621.24Minnesota Statutes, section 256E.33.
621.25Emergency Services. $250,000 each year
621.26is for emergency services grants under
621.27Minnesota Statutes, section 256E.36.
621.28Family Assets for Independence. $250,000
621.29each year is for the Family Assets for
621.30Independence Minnesota program. This
621.31appropriation is available in either year of the
621.32biennium and may be transferred between
621.33fiscal years.
622.1Food Shelf Programs. $375,000 in fiscal
622.2year 2014 and $375,000 in fiscal year
622.32015 are for food shelf programs under
622.4Minnesota Statutes, section 256E.34. If the
622.5appropriation for either year is insufficient,
622.6the appropriation for the other year is
622.7available for it. Notwithstanding Minnesota
622.8Statutes, section 256E.34, subdivision 4, no
622.9portion of this appropriation may be used
622.10by Hunger Solutions for its administrative
622.11expenses, including but not limited to rent
622.12and salaries.
622.13Homeless Youth Act. $2,000,000 in fiscal
622.14year 2014 and $2,000,000 in fiscal year 2015
622.15is for purposes of Minnesota Statutes, section
622.16256K.45.
622.17Safe Harbor Shelter and Housing.
622.18$500,000 in fiscal year 2014 and $500,000 in
622.19fiscal year 2015 is for a safe harbor shelter
622.20and housing fund for housing and supportive
622.21services for youth who are sexually exploited.

622.22

(h) Health Care Grants

622.23	Appropriations by Fund
622.24	General	190,000	190,000
622.25	Health Care Access	190,000	190,000

622.26Emergency Medical Assistance Referral
622.27and Assistance Grants. (a) The
622.28commissioner of human services shall
622.29award grants to nonprofit programs that
622.30provide immigration legal services based
622.31on indigency to provide legal services for
622.32immigration assistance to individuals with
622.33emergency medical conditions or complex
622.34and chronic health conditions who are not
622.35currently eligible for medical assistance
623.1or other public health care programs, but
623.2who may meet eligibility requirements with
623.3immigration assistance.
623.4(b) The grantees, in collaboration with
623.5hospitals and safety net providers, shall
623.6provide referral assistance to connect
623.7individuals identified in paragraph (a) with
623.8alternative resources and services to assist in
623.9meeting their health care needs. $100,000
623.10is appropriated in fiscal year 2014 and
623.11$100,000 in fiscal year 2015. This is a
623.12onetime appropriation.
623.13Base Adjustment. The general fund is
623.14decreased by $100,000 in fiscal year 2016
623.15and $100,000 in fiscal year 2017.

623.16

(i) Aging and Adult Services Grants

14,827,000

15,010,000

623.17Base Adjustment. The general fund is
623.18increased by $1,150,000 in fiscal year 2016
623.19and $1,151,000 in fiscal year 2017.
623.20Community Service Development
623.21Grants and Community Services Grants.
623.22 Community service development grants and
623.23community services grants are reduced by
623.24$1,150,000 each year. This is a onetime
623.25reduction.

623.26

(j) Deaf and Hard-of-Hearing Grants

1,771,000

1,785,000

623.27

(k) Disabilities Grants

18,605,000

18,823,000

623.28Advocating Change Together. $310,000 in
623.29fiscal year 2014 is for a grant to Advocating
623.30Change Together (ACT) to maintain and
623.31promote services for persons with intellectual
623.32and developmental disabilities throughout
623.33the state. This appropriation is onetime. Of
623.34this appropriation:
624.1(1) $120,000 is for direct costs associated
624.2with the delivery and evaluation of
624.3peer-to-peer training programs administered
624.4throughout the state, focusing on education,
624.5employment, housing, transportation, and
624.6voting;
624.7(2) $100,000 is for delivery of statewide
624.8conferences focusing on leadership and
624.9skill development within the disability
624.10community; and
624.11(3) $90,000 is for administrative and general
624.12operating costs associated with managing
624.13or maintaining facilities, program delivery,
624.14staff, and technology.
624.15Base Adjustment. The general fund base
624.16is increased by $535,000 in fiscal year 2016
624.17and by $709,000 in fiscal year 2017.

624.18

(l) Adult Mental Health Grants

624.19	Appropriations by Fund
624.20	General	71,199,000	69,530,000
624.21	Health Care Access	750,000	750,000
624.22	Lottery Prize	1,733,000	1,733,000

624.23Problem Gambling. $225,000 in fiscal year
624.242014 and $225,000 in fiscal year 2015 is
624.25appropriated from the lottery prize fund for a
624.26grant to the state affiliate recognized by the
624.27National Council on Problem Gambling. The
624.28affiliate must provide services to increase
624.29public awareness of problem gambling,
624.30education and training for individuals and
624.31organizations providing effective treatment
624.32services to problem gamblers and their
624.33families, and research relating to problem
624.34gambling.
625.1Funding Usage. Up to 75 percent of a fiscal
625.2year's appropriations for adult mental health
625.3grants may be used to fund allocations in that
625.4portion of the fiscal year ending December
625.531.
625.6Base Adjustment. The general fund base is
625.7decreased by $4,427,000 in fiscal years 2016
625.8and 2017.
625.9Mental Health Pilot Project. $230,000
625.10each year is for a grant to the Zumbro
625.11Valley Mental Health Center. The grant
625.12shall be used to implement a pilot project
625.13to test an integrated behavioral health care
625.14coordination model. The grant recipient must
625.15report measurable outcomes and savings
625.16to the commissioner of human services
625.17by January 15, 2016. This is a onetime
625.18appropriation.
625.19High-risk adults. $200,000 in fiscal
625.20year 2014 is for a grant to the nonprofit
625.21organization selected to administer the
625.22demonstration project for high-risk adults
625.23under Laws 2007, chapter 54, article 1,
625.24section 19, in order to complete the project.
625.25This is a onetime appropriation.

625.26

(m) Child Mental Health Grants

18,246,000

20,636,000

625.27Text Message Suicide Prevention
625.28Program. $625,000 in fiscal year 2014 and
625.29$625,000 in fiscal year 2015 is for a grant
625.30to a nonprofit organization to establish and
625.31implement a statewide text message suicide
625.32prevention program. The program shall
625.33implement a suicide prevention counseling
625.34text line designed to use text messaging to
625.35connect with crisis counselors and to obtain
626.1emergency information and referrals to
626.2local resources in the local community. The
626.3program shall include training within schools
626.4and communities to encourage the use of the
626.5program.
626.6Mental Health First Aid Training. $22,000
626.7in fiscal year 2014 and $23,000 in fiscal
626.8year 2015 is to train teachers, social service
626.9personnel, law enforcement, and others who
626.10come into contact with children with mental
626.11illnesses, in children and adolescents mental
626.12health first aid training.
626.13Funding Usage. Up to 75 percent of a fiscal
626.14year's appropriation for child mental health
626.15grants may be used to fund allocations in that
626.16portion of the fiscal year ending December
626.1731.

626.18

(n) CD Treatment Support Grants

1,816,000

1,816,000

626.19SBIRT Training. (1) $300,000 each year is
626.20for grants to train primary care clinicians to
626.21provide substance abuse brief intervention
626.22and referral to treatment (SBIRT). This is a
626.23onetime appropriation. The commissioner of
626.24human services shall apply to SAMHSA for
626.25an SBIRT professional training grant.
626.26(2) If the commissioner of human services
626.27receives a grant under clause (1) funds
626.28appropriated under this clause, equal to
626.29the grant amount, up to the available
626.30appropriation, shall be transferred to the
626.31Minnesota Organization on Fetal Alcohol
626.32Syndrome (MOFAS). MOFAS must use
626.33the funds for grants. Grant recipients must
626.34be selected from communities that are
626.35not currently served by federal Substance
627.1Abuse Prevention and Treatment Block
627.2Grant funds. Grant money must be used to
627.3reduce the rates of fetal alcohol syndrome
627.4and fetal alcohol effects, and the number of
627.5drug-exposed infants. Grant money may be
627.6used for prevention and intervention services
627.7and programs, including, but not limited to,
627.8community grants, professional eduction,
627.9public awareness, and diagnosis.
627.10Fetal Alcohol Syndrome Grant. $180,000
627.11each year from the general fund is for a
627.12grant to the Minnesota Organization on Fetal
627.13Alcohol Syndrome (MOFAS) to support
627.14nonprofit Fetal Alcohol Spectrum Disorders
627.15(FASD) outreach prevention programs
627.16in Olmsted County. This is a onetime
627.17appropriation.
627.18Base Adjustment. The general fund base is
627.19decreased by $480,000 in fiscal year 2016
627.20and $480,000 in fiscal year 2017.

627.21

Subd. 7.State-Operated Services

627.22Transfer Authority Related to
627.23State-Operated Services. Money
627.24appropriated for state-operated services
627.25may be transferred between fiscal years
627.26of the biennium with the approval of the
627.27commissioner of management and budget.
627.28The amounts that may be spent from the
627.29appropriation for each purpose are as follows:

627.30

(a) SOS Mental Health

115,738,000

115,738,000

627.31Dedicated Receipts Available. Of the
627.32revenue received under Minnesota Statutes,
627.33section 246.18, subdivision 8, paragraph
627.34(a), $1,000,000 each year is available for
628.1the purposes of paragraph (b), clause (1),
628.2of that subdivision, $1,000,000 each year
628.3is available to transfer to the adult mental
628.4health budget activity for the purposes of
628.5paragraph (b), clause (2), of that subdivision,
628.6and up to $2,713,000 each year is available
628.7for the purposes of paragraph (b), clause (3),
628.8of that subdivision.

628.9

(b) SOS MN Security Hospital

69,582,000

69,582,000

628.10

Subd. 8.Sex Offender Program

76,769,000

79,745,000

628.11Transfer Authority Related to Minnesota
628.12Sex Offender Program. Money
628.13appropriated for the Minnesota sex offender
628.14program may be transferred between fiscal
628.15years of the biennium with the approval of the
628.16commissioner of management and budget.

628.17

Subd. 9.Technical Activities

80,440,000

80,829,000

628.18This appropriation is from the federal TANF
628.19fund.
628.20Base Adjustment. The federal TANF fund
628.21base is increased by $278,000 in fiscal year
628.222016 and increased by $651,000 in fiscal
628.23year 2017.

628.24

Subd. 10.C.A.R.E.

628.25(a) Notwithstanding Minnesota Statutes,
628.26section 254B.06, subdivision 1, $2,200,000
628.27is transferred from the consolidated chemical
628.28dependency treatment fund administrative
628.29account in the special revenue fund and
628.30deposited into the enterprise fund for the
628.31Community Addiction Recovery Enterprise
628.32in fiscal year 2013.
628.33(b) Notwithstanding Minnesota Statutes,
628.34section 245.037, $1,000,000 must be
629.1transferred from the dedicated services
629.2- Lease Income Brainerd account in the
629.3special revenue fund and deposited into the
629.4enterprise fund for the Community Addiction
629.5Recovery Enterprise in fiscal year 2013.
629.6(c) Paragraphs (a) and (b) are effective the
629.7day following final enactment.

629.8

Sec. 3. COMMISSIONER OF HEALTH

629.9

Subdivision 1.Total Appropriation

$

169,326,000

$

165,531,000

629.10	Appropriations by Fund
629.11		2014	2015
629.12	General	79,476,000	74,256,000
629.13 629.14	State Government Special Revenue	48,094,000	50,119,000
629.15	Health Care Access	29,743,000	29,143,000
629.16	Federal TANF	11,713,000	11,713,000
629.17	Special Revenue	300,000	300,000

629.18The amounts that may be spent for each
629.19purpose are specified in the following
629.20subdivisions.

629.21

Subd. 2.Health Improvement

629.22	Appropriations by Fund
629.23	General	52,864,000	47,644,000
629.24 629.25	State Government Special Revenue	1,033,000	1,033,000
629.26	Health Care Access	17,500,000	17,500,000
629.27	Federal TANF	11,713,000	11,713,000

629.28Notwithstanding the cancellation requirement
629.29in Minnesota Statutes, section 256J.02,
629.30subdivision 6, TANF funds awarded under
629.31Minnesota Statutes, section 145.928, during
629.32fiscal year 2013 to grantees determined
629.33during the application process to have limited
629.34financial capacity, are available until June
629.3530, 2014.
630.1Statewide Health Improvement Program.
630.2$17,500,000 in fiscal year 2014 and
630.3$17,500,000 in fiscal year 2015 is from the
630.4health care access fund for the statewide
630.5health improvement program under
630.6Minnesota Statutes, section 145.986. Funds
630.7appropriated under this paragraph are
630.8available until expended. No more than 16
630.9percent of the SHIP budget may be used
630.10for administration, technical assistance,
630.11and state-level evaluation costs. The
630.12commissioner shall incorporate strategies
630.13for improving health outcomes and reducing
630.14health care costs in populations over age 60
630.15to the menu of statewide health improvement
630.16program strategies.
630.17Statewide Cancer Surveillance System. Of
630.18the general fund appropriation, $350,000 in
630.19fiscal year 2014 and $350,000 in fiscal year
630.202015 is to develop and implement a new
630.21cancer reporting system under Minnesota
630.22Statutes, sections 144.671 to 144.69. Any
630.23information technology development or
630.24support costs necessary for the cancer
630.25surveillance system must be incorporated
630.26into the agency's service level agreement and
630.27paid to the Office of Enterprise Technology.
630.28Minnesota Poison Information Center.
630.29 $500,000 in fiscal year 2014 and $500,000
630.30in fiscal year 2015 from the general fund
630.31is for regional poison information centers
630.32according to Minnesota Statutes, section
630.33145.93.
630.34Support Services for Deaf and
630.35Hard-of-Hearing. (a) $365,000 in fiscal
631.1year 2014 and $349,000 in fiscal year 2015
631.2are for providing support services to families
631.3as required under Minnesota Statutes, section
631.4144.966, subdivision 3a.
631.5(b) $164,000 in fiscal year 2014 and $156,000
631.6in fiscal year 2015 are for home-based
631.7education in American Sign Language for
631.8families with children who are deaf or have
631.9hearing loss, as required under Minnesota
631.10Statutes, section 144.966, subdivision 3a.
631.11Reproductive Health Strategic Plan to
631.12Reduce Health Disparities for Somali
631.13Women. To the extent funds are available
631.14for fiscal years 2014 and 2015 for grants
631.15provided pursuant to Minnesota Statutes,
631.16section 145.928, the commissioner
631.17shall provide a grant to a Somali-based
631.18organization located in the metropolitan area
631.19to develop a reproductive health strategic
631.20plan to eliminate reproductive health
631.21disparities for Somali women. The plan shall
631.22develop initiatives to provide educational
631.23and information resources to health care
631.24providers, community organizations, and
631.25Somali women to ensure effective interaction
631.26with Somali culture and western medicine
631.27and the delivery of appropriate health care
631.28services, and the achievement of better health
631.29outcomes for Somali women. The plan must
631.30engage health care providers, the Somali
631.31community, and Somali health-centered
631.32organizations. The commissioner shall
631.33submit a report to the chairs and ranking
631.34minority members of the senate and house
631.35committees with jurisdiction over health
631.36policy on the strategic plan developed under
632.1this grant for eliminating reproductive health
632.2disparities for Somali women. The report
632.3must be submitted by February 15, 2014.
632.4Sexual Violence Prevention. Within
632.5available appropriations, by January 15,
632.62015, the commissioner must report to the
632.7legislature on its activities to prevent sexual
632.8violence, including activities to promote
632.9coordination of existing state programs and
632.10services to achieve maximum impact on
632.11addressing the root causes of sexual violence.
632.12Safe Harbor for Sexually Exploited
632.13Youth. (a) $375,000 in fiscal year 2014 and
632.14$375,000 in fiscal year 2015 are for grants
632.15to six regional navigators under Minnesota
632.16Statutes, section 145.4717.
632.17(b) $100,000 in fiscal year 2014 and $100,000
632.18in fiscal year 2015 are for the director of
632.19child sex trafficking prevention position.
632.20(c) $50,000 in fiscal year 2015 is for program
632.21evaluation required under Minnesota
632.22Statutes, section 145.4718.
632.23TANF Appropriations. (1) $1,156,000 of
632.24the TANF funds is appropriated each year of
632.25the biennium to the commissioner for family
632.26planning grants under Minnesota Statutes,
632.27section 145.925.
632.28(2) $3,579,000 of the TANF funds is
632.29appropriated each year of the biennium to
632.30the commissioner for home visiting and
632.31nutritional services listed under Minnesota
632.32Statutes, section 145.882, subdivision 7,
632.33clauses (6) and (7). Funds must be distributed
632.34to community health boards according to
633.1Minnesota Statutes, section 145A.131,
633.2subdivision 1.
633.3(3) $2,000,000 of the TANF funds is
633.4appropriated each year of the biennium to
633.5the commissioner for decreasing racial and
633.6ethnic disparities in infant mortality rates
633.7under Minnesota Statutes, section 145.928,
633.8subdivision 7.
633.9(4) $4,978,000 of the TANF funds is
633.10appropriated each year of the biennium to the
633.11commissioner for the family home visiting
633.12grant program according to Minnesota
633.13Statutes, section 145A.17. $4,000,000 of the
633.14funding must be distributed to community
633.15health boards according to Minnesota
633.16Statutes, section 145A.131, subdivision 1.
633.17$978,000 of the funding must be distributed
633.18to tribal governments based on Minnesota
633.19Statutes, section 145A.14, subdivision 2a.
633.20(5) The commissioner may use up to 6.23
633.21percent of the funds appropriated each fiscal
633.22year to conduct the ongoing evaluations
633.23required under Minnesota Statutes, section
633.24145A.17, subdivision 7, and training and
633.25technical assistance as required under
633.26Minnesota Statutes, section 145A.17,
633.27subdivisions 4 and 5.
633.28TANF Carryforward. Any unexpended
633.29balance of the TANF appropriation in the
633.30first year of the biennium does not cancel but
633.31is available for the second year.

633.32

Subd. 3.Policy Quality and Compliance

633.33	Appropriations by Fund
633.34	General	9,391,000	9,391,000
634.1 634.2	State Government Special Revenue	14,428,000	16,450,000
634.3	Health Care Access	12,243,000	11,643,000

634.4The health care access fund appropriation
634.5includes the base appropriation for health
634.6care homes activities.
634.7Base Level Adjustment. The health care
634.8access base shall be increased by $600,000
634.9in fiscal year 2016.
634.10Criminal Background Checks. The state
634.11government special revenue fund base for
634.12fiscal year 2017 includes $111,000 for the
634.13implementation of criminal background
634.14checks for occupational therapy practitioners,
634.15speech-language pathologists, audiologists,
634.16and hearing aid dispensers, if the Sunset
634.17Advisory Commission under Minnesota
634.18Statutes, section 3D.03, is repealed before
634.19June 30, 2014.

634.20

Subd. 4.Health Protection

634.21	Appropriations by Fund
634.22	General	9,201,000	9,201,000
634.23 634.24	State Government Special Revenue	32,633,000	32,636,000
634.25	Special Revenue	300,000	300,000

634.26Infectious Disease Laboratory. Of the
634.27general fund appropriation, $200,000 in
634.28fiscal year 2014 and $200,000 in fiscal year
634.292015 are to monitor infectious disease trends
634.30and investigate infectious disease outbreaks.
634.31Surveillance for Elevated Blood Lead
634.32Levels. Of the general fund appropriation,
634.33$100,000 in fiscal year 2014 and $100,000
634.34in fiscal year 2015 are for the blood lead
635.1surveillance system under Minnesota
635.2Statutes, section 144.9502.
635.3Base Level Adjustment. The state
635.4government special revenue base is increased
635.5by $6,000 in fiscal year 2016 and by $13,000
635.6in fiscal year 2017.

635.7

Subd. 5.Administrative Support Services

8,020,000

8,020,000

635.8The general fund appropriation includes the
635.9base appropriation for the Office of the State
635.10Epidemiologist.
635.11Regional Support for Local Public Health
635.12Departments. $350,000 in fiscal year
635.132014 and $350,000 in fiscal year 2015 is
635.14for regional staff who provide specialized
635.15expertise to local public health departments.

635.16

Sec. 4. HEALTH-RELATED BOARDS

635.17

Subdivision 1.Total Appropriation

$

20,040,000

$

18,446,000

635.18This appropriation is from the state
635.19government special revenue fund.
635.20The amounts that may be spent for each
635.21purpose are specified in the following
635.22subdivisions.

635.23

Subd. 2.Board of Chiropractic Examiners

508,000

490,000

635.24This appropriation includes $10,000
635.25for information technology hardware
635.26to streamline board operations. This
635.27is a onetime appropriation. $15,000 is
635.28for a LEAN evaluation. This is a onetime
635.29appropriation. $2,000 in fiscal years 2014 and
635.302015 is for rental of additional storage space.

635.31

Subd. 3.Board of Dentistry

2,059,000

2,056,000

636.1This appropriation includes $843,000 in fiscal
636.2year 2014 and $837,000 in fiscal year 2015
636.3for the health professional services program.
636.4$15,000 in fiscal year 2014 is for repairs,
636.5maintenance, furnishings, and ergonomic
636.6upgrades. This is a onetime appropriation.
636.7$35,000 in fiscal years 2014 and 2015 is for
636.8additional staff to implement new regulatory
636.9activity. $20,000 in fiscal years 2014 and
636.102015 is for database upgrades for regulatory
636.11and licensing activities. $10,000 in fiscal
636.12years 2014 and 2015 is for professional and
636.13technical contracts for expert consultants
636.14to review complex complaints, advise on
636.15specialty dentistry areas, and to serve as
636.16expert witnesses in contested case matters.

636.17 636.18

Subd. 4.Board of Dietetic and Nutrition Practice

111,000

111,000

636.19 636.20

Subd. 5.Board of Marriage and Family Therapy

254,000

226,000

636.21This appropriation includes $25,000 in fiscal
636.22year 2014 for rulemaking. This is a onetime
636.23appropriation. $31,000 in fiscal year 2014
636.24and $27,000 in fiscal year 2015 are for
636.25additional staff to improve licensing and
636.26licensing renewal activities. $30,000 in fiscal
636.27year 2014 and $31,000 in fiscal year 2015
636.28are to increase the executive director to a
636.29full-time position.
636.30The remaining balance of the state
636.31government special revenue fund
636.32appropriation in Laws 2011, First Special
636.33Session chapter 9, article 10, section 8,
636.34subdivision 5, for Board of Marriage and
636.35Family Therapy rulemaking, estimated to
637.1be $25,000, is canceled. This paragraph is
637.2effective the day following final enactment.

637.3

Subd. 6.Board of Medical Practice

3,867,000

3,867,000

637.4

Subd. 7.Board of Nursing

3,637,000

3,637,000

637.5 637.6

Subd. 8.Board of Nursing Home Administrators

3,742,000

2,252,000

637.7Administrative Services Unit - Operating
637.8Costs. Of this appropriation, $676,000
637.9in fiscal year 2014 and $626,000 in
637.10fiscal year 2015 are for operating costs
637.11of the administrative services unit. The
637.12administrative services unit may receive
637.13and expend reimbursements for services
637.14performed by other agencies.
637.15Administrative Services Unit - Volunteer
637.16Health Care Provider Program. Of this
637.17appropriation, $150,000 in fiscal year 2014
637.18and $150,000 in fiscal year 2015 are to pay
637.19for medical professional liability coverage
637.20required under Minnesota Statutes, section
637.21214.40.
637.22Administrative Services Unit - Contested
637.23Cases and Other Legal Proceedings. Of
637.24this appropriation, $200,000 in fiscal year
637.252014 and $200,000 in fiscal year 2015 are
637.26for costs of contested case hearings and other
637.27unanticipated costs of legal proceedings
637.28involving health-related boards funded
637.29under this section. Upon certification of a
637.30health-related board to the administrative
637.31services unit that the costs will be incurred
637.32and that there is insufficient money available
637.33to pay for the costs out of money currently
637.34available to that board, the administrative
637.35services unit is authorized to transfer money
638.1from this appropriation to the board for
638.2payment of those costs with the approval
638.3of the commissioner of management and
638.4budget.
638.5This appropriation includes $44,000 in
638.6fiscal year 2014 for rulemaking. This is
638.7a onetime appropriation. $1,441,000 in
638.8fiscal year 2014 and $420,000 in fiscal year
638.92015 are for the development of a shared
638.10disciplinary, regulatory, licensing, and
638.11information management system. $391,000
638.12in fiscal year 2014 is a onetime appropriation
638.13for retirement costs in the health-related
638.14boards. This funding may be transferred to
638.15the health boards incurring retirement costs.
638.16These funds are available either year of the
638.17biennium.
638.18This appropriation includes $16,000 in fiscal
638.19years 2014 and 2015 for evening security,
638.20$2,000 in fiscal years 2014 and 2015 for a
638.21state vehicle lease, and $18,000 in fiscal
638.22years 2014 and 2015 for shared office space
638.23and administrative support. $205,000 in
638.24fiscal year 2014 and $221,000 in fiscal year
638.252015 are for shared information technology
638.26services, equipment, and maintenance.
638.27The remaining balance of the state
638.28government special revenue fund
638.29appropriation in Laws 2011, First Special
638.30Session chapter 9, article 10, section 8,
638.31subdivision 8, for Board of Nursing Home
638.32Administrators rulemaking, estimated to
638.33be $44,000, is canceled, and the remaining
638.34balance of the state government special
638.35revenue fund appropriation in Laws 2011,
639.1First Special Session chapter 9, article 10,
639.2section 8, subdivision 8, for electronic
639.3licensing system adaptors, estimated to be
639.4$761,000, and for the development and
639.5implementation of a disciplinary, regulatory,
639.6licensing, and information management
639.7system, estimated to be $1,100,000, are
639.8canceled. This paragraph is effective the day
639.9following final enactment.
639.10Base Adjustment. The base is decreased by
639.11$370,000 in fiscal years 2016 and 2017.

639.12

Subd. 9.Board of Optometry

107,000

107,000

639.13

Subd. 10.Board of Pharmacy

2,555,000

2,555,000

639.14Prescription Electronic Reporting. Of
639.15this appropriation, $356,000 in fiscal year
639.162014 and $356,000 in fiscal year 2015 from
639.17the state government special revenue fund
639.18are to the board to operate the prescription
639.19monitoring program in Minnesota Statutes,
639.20section 152.126.

639.21

Subd. 11.Board of Physical Therapy

390,000

346,000

639.22This appropriation includes $44,000 in fiscal
639.23year 2014 for rulemaking. This is a onetime
639.24appropriation.
639.25The remaining balance of the state
639.26government special revenue fund
639.27appropriation in Laws 2011, First Special
639.28Session chapter 9, article 10, section 8,
639.29subdivision 11, for Board of Physical
639.30Therapy rulemaking, estimated to be
639.31$44,000, is canceled. This paragraph is
639.32effective the day following final enactment.

639.33

Subd. 12.Board of Podiatry

76,000

76,000

639.34

Subd. 13.Board of Psychology

892,000

892,000

640.1This appropriation includes $15,000 in
640.2fiscal years 2014 and 2015 for continuing
640.3educational programming. $5,000 in fiscal
640.4years 2014 and 2015 are for a public
640.5education program. $25,000 in fiscal years
640.62014 and 2015 are for development of
640.7educational materials. This is a onetime
640.8appropriation.
640.9Base Adjustment. The base is decreased by
640.10$45,000 in fiscal years 2016 and 2017.

640.11

Subd. 14.Board of Social Work

1,109,000

1,110,000

640.12This appropriation includes $55,000 in fiscal
640.13year 2014 and $56,000 in fiscal year 2015
640.14for additional staff to enhance the board's
640.15complaint resolution process.

640.16

Subd. 15.Board of Veterinary Medicine

262,000

256,000

640.17This appropriation includes $32,000 in fiscal
640.18year 2014 and $26,000 in fiscal year 2015
640.19for additional staff to improve the board's
640.20complaint resolution process.

640.21 640.22

Subd. 16.Board of Behavioral Health and Therapy

471,000

465,000

640.23This appropriation includes $56,000 in fiscal
640.24year 2014 and $50,000 in fiscal year 2015 for
640.25additional staff to enhance the licensing and
640.26complaint resolution processes of the board.

640.27 640.28

Sec. 5. EMERGENCY MEDICAL SERVICES REGULATORY BOARD

$

2,741,000

$

2,741,000

640.29Regional Grants. $585,000 in fiscal year
640.302014 and $585,000 in fiscal year 2015 are
640.31for regional emergency medical services
640.32programs, to be distributed equally to the
640.33eight emergency medical service regions.
641.1Cooper/Sams Volunteer Ambulance
641.2Program. $700,000 in fiscal year 2014 and
641.3$700,000 in fiscal year 2015 are for the
641.4Cooper/Sams volunteer ambulance program
641.5under Minnesota Statutes, section 144E.40.
641.6(a) Of this amount, $611,000 in fiscal year
641.72014 and $611,000 in fiscal year 2015
641.8are for the ambulance service personnel
641.9longevity award and incentive program under
641.10Minnesota Statutes, section 144E.40.
641.11(b) Of this amount, $89,000 in fiscal year
641.122014 and $89,000 in fiscal year 2015 are
641.13for the operations of the ambulance service
641.14personnel longevity award and incentive
641.15program under Minnesota Statutes, section
641.16144E.40.
641.17Ambulance Training Grant. $361,000 in
641.18fiscal year 2014 and $361,000 in fiscal year
641.192015 are for training grants.
641.20EMSRB Board Operations. $1,095,000 in
641.21fiscal year 2014 and $1,095,000 in fiscal year
641.222015 are for operations.

641.23

Sec. 6. COUNCIL ON DISABILITY

$

614,000

$

614,000

641.24 641.25 641.26

Sec. 7. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES

$

1,654,000

$

1,654,000

641.27

Sec. 8. OMBUDSPERSON FOR FAMILIES

$

333,000

$

334,000

641.28    Sec. 9. Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:
641.29    Subd. 34. Federal administrative reimbursement dedicated. Federal
641.30administrative reimbursement resulting from the following activities is appropriated to the
641.31commissioner for the designated purposes:
641.32(1) reimbursement for the Minnesota senior health options project; and
642.1(2) reimbursement related to prior authorization and inpatient admission certification
642.2by a professional review organization. A portion of these funds must be used for activities
642.3to decrease unnecessary pharmaceutical costs in medical assistance.; and
642.4(3) reimbursement resulting from the federal child support grant expenditures
642.5authorized under United States Code, title 42, section 1315.

642.6    Sec. 10. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
642.7to read:
642.8    Subd. 35. Federal reimbursement for privatized adoption grants. Federal
642.9reimbursement for privatized adoption grant and foster care recruitment grant expenditures
642.10is appropriated to the commissioner for adoption grants and foster care and adoption
642.11administrative purposes.

642.12    Sec. 11. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
642.13to read:
642.14    Subd. 36. DHS receipt center accounting. The commissioner may transfer
642.15appropriations to, and account for DHS receipt center operations in, the special revenue
642.16fund.

642.17    Sec. 12. APPROPRIATION ADJUSTMENTS.
642.18(a) The general fund appropriation in section 2, subdivision 5, paragraph (g),
642.19includes up to $53,391,000 in fiscal year 2014; $216,637,000 in fiscal year 2015;
642.20$261,660,000 in fiscal year 2016; and $279,984,000 in fiscal year 2017, for medical
642.21assistance eligibility and administration changes related to:
642.22(1) eligibility for children age two to 18 with income up to 275 percent of the federal
642.23poverty guidelines;
642.24(2) eligibility for pregnant women with income up to 275 percent of the federal
642.25poverty guidelines;
642.26(3) Affordable Care Act enrollment and renewal processes, including elimination
642.27of six-month renewals, ex parte eligibility reviews, preprinted renewal forms, changes
642.28in verification requirements, and other changes in the eligibility determination and
642.29enrollment and renewal process;
642.30(4) automatic eligibility for children who turn 18 in foster care until they reach age 26;
642.31(5) eligibility related to spousal impoverishment provisions for waiver recipients; and
642.32(6) presumptive eligibility determinations by hospitals.
643.1(b) The commissioner of human services shall determine the difference between the
643.2actual or forecasted costs to the medical assistance program attributable to the program
643.3changes in paragraph (a), clauses (1) to (6), and the costs of paragraph (a), clauses (1) to
643.4(6), that were estimated during the 2013 legislative session based on data from the 2013
643.5February forecast. The costs in this paragraph must be calculated between January 1,
643.62014, and June 30, 2017.
643.7(c) For each fiscal year from 2014 to 2017, the commissioner of human services
643.8shall certify the actual or forecasted cost differences to the medical assistance program
643.9determined under paragraph (b), and report the difference in costs to the commissioner of
643.10management and budget at least four weeks prior to a forecast under Minnesota Statutes,
643.11section 16A.103. No later than three weeks before the release of the forecast under
643.12Minnesota Statutes, section 16A.103, the commissioner of management and budget shall
643.13reduce the health care access fund appropriation in section 2, subdivision 5, paragraph (g),
643.14by the cumulative difference in costs determined in paragraph (b). If for any fiscal year,
643.15the amount of the cumulative cost differences determined under paragraph (b) is positive,
643.16no adjustment shall be made to the health care access fund appropriation. If for any fiscal
643.17year, the amount of the cumulative cost differences determined under paragraph (b) is less
643.18than the original appropriation, the appropriation for that fiscal year is zero.
643.19(d) This section expires on January 1, 2018.

643.20    Sec. 13. TRANSFERS.
643.21    Subdivision 1. Grants. The commissioner of human services, with the approval of
643.22the commissioner of management and budget, may transfer unencumbered appropriation
643.23balances for the biennium ending June 30, 2015, within fiscal years among the MFIP,
643.24general assistance, general assistance medical care under Minnesota Statutes 2009
643.25Supplement, section 256D.03, subdivision 3, medical assistance, MinnesotaCare, MFIP
643.26child care assistance under Minnesota Statutes, section 119B.05, Minnesota supplemental
643.27aid, group residential housing programs, the entitlement portion of the chemical
643.28dependency consolidated treatment fund, and between fiscal years of the biennium. The
643.29commissioner shall inform the chairs and ranking minority members of the senate Health
643.30and Human Services Finance Division and the house of representatives Health and Human
643.31Services Finance Committee quarterly about transfers made under this provision.
643.32    Subd. 2. Administration. Positions, salary money, and nonsalary administrative
643.33money may be transferred within the Departments of Human Services and Health as the
643.34commissioners consider necessary, with the advance approval of the commissioner of
643.35management and budget. The commissioner shall inform the chairs and ranking minority
644.1members of the senate Health and Human Services Finance Division and the house of
644.2representatives Health and Human Services Finance Committee quarterly about transfers
644.3made under this provision.

644.4    Sec. 14. INDIRECT COSTS NOT TO FUND PROGRAMS.
644.5The commissioners of health and human services shall not use indirect cost
644.6allocations to pay for the operational costs of any program for which they are responsible.

644.7    Sec. 15. EXPIRATION OF UNCODIFIED LANGUAGE.
644.8All uncodified language contained in this article expires on June 30, 2015, unless a
644.9different expiration date is explicit.

644.10    Sec. 16. EFFECTIVE DATE.
644.11This article is effective July 1, 2013, unless a different effective date is specified.

644.14

Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

644.15The sums shown in the columns marked "Appropriations" are appropriated to the
644.16agencies and for the purposes specified in this article. The appropriations are from the
644.17general fund, or another named fund, and are available for the fiscal years indicated
644.18for each purpose. The figures "2014" and "2015" used in this article mean that the
644.19appropriations listed under them are available for the fiscal year ending June 30, 2014, or
644.20June 30, 2015, respectively. "The first year" is fiscal year 2014. "The second year" is fiscal
644.21year 2015. "The biennium" is fiscal years 2014 and 2015.

644.22				APPROPRIATIONS
644.23				Available for the Year
644.24				Ending June 30
644.25					2014		2015

644.26 644.27

Sec. 2. COMMISSIONER OF HUMAN SERVICES

644.28

Subdivision 1.Total Appropriation

$

2,144,000

$

214,000

644.29

Subd. 2.Central Office

644.30The amounts that may be spent from this
644.31appropriation for each purpose are as follows:

645.1

(a) Operations

2,909,000

8,957,000

645.2Base Adjustment. The general fund base is
645.3decreased by $8,916,000 in fiscal year 2016
645.4and $8,916,000 in fiscal year 2017.

645.5

(b) Children and Families

109,000

206,000

645.6

(c) Continuing Care

2,849,000

3,574,000

645.7Base Adjustment. The general fund base is
645.8decreased by $2,000 in fiscal year 2016 and
645.9by $27,000 in fiscal year 2017.

645.10

(d) Group Residential Housing

(1,166,000)

(8,602,000)

645.11

(e) Medical Assistance

(3,950,000)

(6,420,000)

645.12

(f) Alternative Care

(7,386,000)

(6,851,000)

645.13

(g) Child and Community Service Grants

3,000,000

3,000,000

645.14

(h) Aging and Adult Services Grants

5,365,000

5,936,000

645.15Gaps Analysis. In fiscal year 2014, and
645.16in each even-numbered year thereafter,
645.17$435,000 is appropriated to conduct an
645.18analysis of gaps in long-term care services
645.19under Minnesota Statutes, section 144A.351.
645.20This is a biennial appropriation. The base is
645.21increased by $435,000 in fiscal year 2016.
645.22Notwithstanding any contrary provisions in
645.23this article, this provision does not expire.
645.24Base Adjustment. The general fund base is
645.25increased by $498,000 in fiscal year 2016,
645.26and decreased by $124,000 in fiscal year
645.272017.

645.28

(i) Disabilities Grants

414,000

414,000

645.29    Sec. 3. FEDERAL APPROVAL.
645.30(a) The implementation of this article and article 2 is contingent on federal approval.
646.1(b) Upon full or partial approval of the waiver application, the commissioner of
646.2human services shall submit to the commissioner of management and budget a plan for
646.3implementing the provisions in this article that received federal approval as well as any
646.4provisions that do not require federal approval. The plan must:
646.5(1) include fiscal estimates that, with federal administrative reimbursement, do
646.6not increase the general fund appropriations to the commissioner of human services in
646.7fiscal years 2014 and 2015; and
646.8(2) include a fiscal estimate for the systems modernization appropriation, which
646.9cannot exceed $11,598,000 for the biennium ending June 30, 2015.
646.10(c) Upon approval by the commissioner of management and budget, the
646.11commissioner of human services may implement the plan.
646.12(d) The commissioner of management and budget must notify the chairs and ranking
646.13minority members of the legislative committees with jurisdiction over health and human
646.14services finance when the plan is approved. The plan must be made publicly available.

646.15    Sec. 4. IMPLEMENTATION OF REFORM 2020 CONTINGENT PROVISIONS
646.16AND ADJUSTMENTS TO APPROPRIATIONS AND PLANNING ESTIMATES.
646.17Upon approval of the plan in section 3, the commissioner of management and
646.18budget shall make necessary adjustments to the appropriations in this article to reflect the
646.19effective date of federal approval. The adjustments must include the nondedicated revenue
646.20attributable to the provisions of this article and the related planning estimates for fiscal
646.21years 2016 and 2017 must reflect the revised fiscal estimates attributable to the provisions
646.22in this article. The revised appropriations for fiscal years 2014 and 2015 shall be included
646.23in the forecast and must not increase the appropriations to the commissioner of human
646.24services for fiscal years 2014 and 2015. If the adjustments to the planning estimates for
646.25fiscal years 2016 and 2017 result in increased general fund expenditure estimates for
646.26the commissioner of human services attributable to the provisions in this article, when
646.27compared to the planning estimates attributable to the provision in this article made in the
646.28February 2013 forecast, none of the provisions in this article shall be implemented.

646.31 646.32

Section 1. COMMISSIONER OF HUMAN SERVICES

646.33

Subdivision 1.Total Appropriation

$

(161,031,000)

647.1	Appropriations by Fund
647.2		2013
647.3	General Fund	(158,668,000)
647.4	Health Care Access	(7,179,000)
647.5	TANF	4,816,000

647.6	Subd. 2.Forecasted Programs
647.7	(a) MFIP/DWP Grants

647.8	Appropriations by Fund
647.9	General Fund	(8,211,000)
647.10	TANF	4,399,000

647.11

(b) MFIP Child Care Assistance Grants

10,113,000

647.12

(c) General Assistance Grants

3,230,000

647.13

(d) Minnesota Supplemental Aid Grants

(1,008,000)

647.14

(e) Group Residential Housing Grants

(5,423,000)

647.15

(f) MinnesotaCare Grants

(7,179,000)

647.16This appropriation is from the health care
647.17access fund.

647.18

(g) Medical Assistance Grants

(159,733,000)

647.19

(h) Alternative Care Grants

-0-

647.20

(i) CD Entitlement Grants

2,364,000

647.21

Subd. 3.Technical Activities

417,000

647.22This appropriation is from the TANF fund.
647.23EFFECTIVE DATE.This section is effective the day following final enactment.


647.26    Section 1. Minnesota Statutes 2012, section 256.0112, is amended by adding a
647.27subdivision to read:
647.28    Subd. 10. Contracts for child foster care services. When local agencies negotiate
647.29lead county contracts or purchase of service contracts for child foster care services, the
647.30foster care maintenance payment made on behalf of the child shall follow the provisions of
647.31Northstar Care for Children, chapter 256N. Foster care maintenance payments as defined
648.1in section 256N.02, subdivision 15, represent costs for activities similar in nature to those
648.2expected of parents and do not cover services rendered by the licensed or tribally approved
648.3foster parent, facility, or administrative costs or fees. Payments made to foster parents
648.4must follow the requirements of section 256N.26, subdivision 15. The legally responsible
648.5agency must provide foster parents with the assessment and notice as specified in section
648.6256N.24. The financially responsible agency is permitted to make additional payments for
648.7specific services provided by the foster parents or facility, as permitted in section 256N.21,
648.8subdivision 5. These additional payments are not considered foster care maintenance.

648.9    Sec. 2. Minnesota Statutes 2012, section 256.82, subdivision 2, is amended to read:
648.10    Subd. 2. Foster care maintenance payments. Beginning January 1, 1986, For the
648.11purpose of foster care maintenance payments under title IV-E of the Social Security Act,
648.12United States Code, title 42, sections 670 to 676, the county paying the maintenance
648.13costs must be reimbursed for the costs from the federal money available for the purpose.
648.14Beginning July 1, 1997, for the purposes of determining a child's eligibility under title
648.15IV-E of the Social Security Act, the placing agency shall use AFDC requirements in
648.16effect on July 16, 1996.

648.17    Sec. 3. Minnesota Statutes 2012, section 256.82, subdivision 3, is amended to read:
648.18    Subd. 3. Setting foster care standard rates. (a) The commissioner shall annually
648.19establish minimum standard maintenance rates for foster care maintenance and including
648.20supplemental difficulty of care payments for all children in foster care eligible for
648.21Northstar Care for Children under chapter 256N.
648.22(b) All children entering foster care on or after January 1, 2015, are eligible for
648.23Northstar Care for Children under chapter 256N. Any increase in rates shall in no case
648.24exceed three percent per annum.
648.25(c) All children in foster care on December 31, 2014, must remain in the
648.26pre-Northstar Care for Children foster care program under sections 256N.21, subdivision
648.276, and 260C.4411, subdivision 1. The rates for the pre-Northstar Care for Children foster
648.28care program shall remain those in effect on January 1, 2013.

648.29    Sec. 4. [256N.001] CITATION.
648.30Sections 256N.001 to 256N.28 may be cited as the "Northstar Care for Children Act."
648.31Sections 256N.001 to 256N.28 establish Northstar Care for Children, which authorizes
648.32certain benefits to support a child in need who is served by the Minnesota child welfare
648.33system and who is the responsibility of the state, local county social service agencies, or
649.1tribal social service agencies authorized under section 256.01, subdivision 14b, or are
649.2otherwise eligible for federal adoption assistance. A child eligible under this chapter
649.3has experienced a child welfare intervention that has resulted in the child being placed
649.4away from the child's parents' care and is receiving foster care services consistent with
649.5chapter 260B, 260C, or 260D, or is in the permanent care of relatives through a transfer of
649.6permanent legal and physical custody, or in the permanent care of adoptive parents.

649.7    Sec. 5. [256N.01] PUBLIC POLICY.
649.8(a) The legislature declares that the public policy of this state is to keep children safe
649.9from harm and to ensure that when children suffer harmful or injurious experiences in
649.10their lives, appropriate services are immediately available to keep them safe.
649.11(b) Children do best in permanent, safe, nurturing homes where they can maintain
649.12lifelong relationships with adults. Whenever safely possible, children are best served
649.13when they can be nurtured and raised by their parents. Where services cannot be provided
649.14to allow a child to remain safely at home, an out-of-home placement may be required.
649.15When this occurs, reunification should be sought if it can be accomplished safely. When
649.16it is not possible for parents to provide safety and permanency for their children, an
649.17alternative permanent home must quickly be made available to the child, drawing from
649.18kinship sources whenever possible.
649.19(c) Minnesota understands the importance of having a comprehensive approach to
649.20temporary out-of-home care and to permanent homes for children who cannot be reunited
649.21with their families. It is critical that stable benefits be available to caregivers to ensure
649.22that the child's needs can be met whether the child's situation and best interests call for
649.23temporary foster care, transfer of permanent legal and physical custody to a relative, or
649.24adoption. Northstar Care for Children focuses on the child's needs and strengths, and
649.25the actual level of care provided by the caregiver, without consideration for the type of
649.26placement setting. In this way caregivers are not faced with the burden of making specific
649.27long-term decisions based upon competing financial incentives.

649.28    Sec. 6. [256N.02] DEFINITIONS.
649.29    Subdivision 1. Scope. For the purposes of sections 256N.001 to 256N.28, the terms
649.30defined in this section have the meanings given them.
649.31    Subd. 2. Adoption assistance. "Adoption assistance" means medical coverage as
649.32allowable under section 256B.055 and reimbursement of nonrecurring expenses associated
649.33with adoption and may include financial support provided under agreement with the
649.34financially responsible agency, the commissioner, and the parents of an adoptive child
650.1whose special needs would otherwise make it difficult to place the child for adoption to
650.2assist with the cost of caring for the child. Financial support may include a basic rate
650.3payment and a supplemental difficulty of care rate.
650.4    Subd. 3. Assessment. "Assessment" means the process under section 256N.24 that
650.5determines the benefits an eligible child may receive under section 256N.26.
650.6    Subd. 4. At-risk child. "At-risk child" means a child who does not have a
650.7documented disability but who is at risk of developing a physical, mental, emotional, or
650.8behavioral disability based on being related within the first or second degree to persons
650.9who have an inheritable physical, mental, emotional, or behavioral disabling condition,
650.10or from a background which has the potential to cause the child to develop a physical,
650.11mental, emotional, or behavioral disability that the child is at risk of developing. The
650.12disability must manifest during childhood.
650.13    Subd. 5. Basic rate. "Basic rate" means the maintenance payment made on behalf
650.14of a child to support the costs caregivers incur to provide for a child's needs consistent with
650.15the care parents customarily provide, including: food, clothing, shelter, daily supervision,
650.16school supplies, and a child's personal incidentals. It also supports typical travel to the
650.17child's home for visitation, and reasonable travel for the child to remain in the school in
650.18which the child is enrolled at the time of placement.
650.19    Subd. 6. Caregiver. "Caregiver" means the foster parent or parents of a child in
650.20foster care who meet the requirements of emergency relative placement, licensed foster
650.21parents under chapter 245A, or foster parents licensed or approved by a tribe; the relative
650.22custodian or custodians; or the adoptive parent or parents who have legally adopted a child.
650.23    Subd. 7. Commissioner. "Commissioner" means the commissioner of human
650.24services or any employee of the Department of Human Services to whom the
650.25commissioner has delegated appropriate authority.
650.26    Subd. 8. County board. "County board" means the board of county commissioners
650.27in each county.
650.28    Subd. 9. Disability. "Disability" means a physical, mental, emotional, or behavioral
650.29impairment that substantially limits one or more major life activities. Major life activities
650.30include, but are not limited to: thinking, walking, hearing, breathing, working, seeing,
650.31speaking, communicating, learning, developing and maintaining healthy relationships,
650.32safely caring for oneself, and performing manual tasks. The nature, duration, and severity
650.33of the impairment must be considered in determining if the limitation is substantial.
650.34    Subd. 10. Financially responsible agency. "Financially responsible agency" means
650.35the agency that is financially responsible for a child. These agencies include both local
650.36social service agencies under section 393.07 and tribal social service agencies authorized
651.1in section 256.01, subdivision 14b, as part of the American Indian Child Welfare Initiative,
651.2and Minnesota tribes who assume financial responsibility of children from other states.
651.3Under Northstar Care for Children, the agency that is financially responsible at the time of
651.4placement for foster care continues to be responsible under section 256N.27 for the local
651.5share of any maintenance payments, even after finalization of the adoption of transfer of
651.6permanent legal and physical custody of a child.
651.7    Subd. 11. Guardianship assistance. "Guardianship assistance" means medical
651.8coverage, as allowable under section 256B.055, and reimbursement of nonrecurring
651.9expenses associated with obtaining permanent legal and physical custody of a child, and
651.10may include financial support provided under agreement with the financially responsible
651.11agency, the commissioner, and the relative who has received a transfer of permanent legal
651.12and physical custody of a child. Financial support may include a basic rate payment and a
651.13supplemental difficulty of care rate to assist with the cost of caring for the child.
651.14    Subd. 12. Human services board. "Human services board" means a board
651.15established under section 402.02; Laws 1974, chapter 293; or Laws 1976, chapter 340.
651.16    Subd. 13. Initial assessment. "Initial assessment" means the assessment conducted
651.17within the first 30 days of a child's initial placement into foster care under section
651.18256N.24, subdivisions 4 and 5.
651.19    Subd. 14. Legally responsible agency. "Legally responsible agency" means the
651.20Minnesota agency that is assigned responsibility for placement, care, and supervision
651.21of the child through a court order, voluntary placement agreement, or voluntary
651.22relinquishment. These agencies include local social service agencies under section 393.07,
651.23tribal social service agencies authorized in section 256.01, subdivision 14b, and Minnesota
651.24tribes that assume court jurisdiction when legal responsibility is transferred to the tribal
651.25social service agency through a Minnesota district court order. A Minnesota local social
651.26service agency is otherwise financially responsible.
651.27    Subd. 15. Maintenance payments. "Maintenance payments" means the basic
651.28rate plus any supplemental difficulty of care rate under Northstar Care for Children. It
651.29specifically does not include the cost of initial clothing allowance, payment for social
651.30services, or administrative payments to a child-placing agency. Payments are paid
651.31consistent with section 256N.26.
651.32    Subd. 16. Permanent legal and physical custody. "Permanent legal and physical
651.33custody" means a transfer of permanent legal and physical custody to a relative ordered by
651.34a Minnesota juvenile court under section 260C.515, subdivision 4, or for a child under
651.35jurisdiction of a tribal court, a judicial determination under a similar provision in tribal
651.36code which means that a relative will assume the duty and authority to provide care,
652.1control, and protection of a child who is residing in foster care, and to make decisions
652.2regarding the child's education, health care, and general welfare until adulthood.
652.3    Subd. 17. Reassessment. "Reassessment" means an update of a previous assessment
652.4through the process under section 256N.24 for a child who has been continuously eligible
652.5for Northstar Care for Children, or when a child identified as an at-risk child (Level A)
652.6under guardianship or adoption assistance has manifested the disability upon which
652.7eligibility for the agreement was based according to section 256N.25, subdivision 3,
652.8paragraph (b). A reassessment may be used to update an initial assessment, a special
652.9assessment, or a previous reassessment.
652.10    Subd. 18. Relative. "Relative," as described in section 260C.007, subdivision 27,
652.11means a person related to the child by blood, marriage, or adoption, or an individual who
652.12is an important friend with whom the child has resided or had significant contact. For an
652.13Indian child, relative includes members of the extended family as defined by the law or
652.14custom of the Indian child's tribe or, in the absence of law or custom, nieces, nephews,
652.15or first or second cousins, as provided in the Indian Child Welfare Act of 1978, United
652.16States Code, title 25, section 1903.
652.17    Subd. 19. Relative custodian. "Relative custodian" means a person to whom
652.18permanent legal and physical custody of a child has been transferred under section
652.19260C.515, subdivision 4, or for a child under jurisdiction of a tribal court, a judicial
652.20determination under a similar provision in tribal code, which means that a relative will
652.21assume the duty and authority to provide care, control, and protection of a child who is
652.22residing in foster care, and to make decisions regarding the child's education, health
652.23care, and general welfare until adulthood.
652.24    Subd. 20. Special assessment. "Special assessment" means an assessment
652.25performed under section 256N.24 that determines the benefits that an eligible child may
652.26receive under section 256N.26 at the time when a special assessment is required. A
652.27special assessment is used when a child's status within Northstar Care is shifted from a
652.28pre-Northstar Care program into Northstar Care for Children and when the commissioner
652.29determines that a special assessment is appropriate instead of assigning the transition child
652.30to a level under section 256N.28.
652.31    Subd. 21. Supplemental difficulty of care rate. "Supplemental difficulty of care
652.32rate" means the supplemental payment under section 256N.26, if any, as determined by
652.33the financially responsible agency or the state, based upon an assessment under section
652.34256N.24. The rate must support activities consistent with the care a parent provides a child
652.35with special needs and not the equivalent of a purchased service. The rate must consider
652.36the capacity and intensity of the activities associated with parenting duties provided in
653.1the home to nurture the child, preserve the child's connections, and support the child's
653.2functioning in the home and community.

653.3    Sec. 7. [256N.20] NORTHSTAR CARE FOR CHILDREN; GENERALLY.
653.4    Subdivision 1. Eligibility. A child is eligible for Northstar Care for Children if
653.5the child is eligible for:
653.6(1) foster care under section 256N.21;
653.7(2) guardianship assistance under section 256N.22; or
653.8(3) adoption assistance under section 256N.23.
653.9    Subd. 2. Assessments. Except as otherwise specified, a child eligible for Northstar
653.10Care for Children shall receive an assessment under section 256N.24.
653.11    Subd. 3. Agreements. When a child is eligible for guardianship assistance or
653.12adoption assistance, negotiations with caregivers and the development of a written,
653.13binding agreement must be conducted under section 256N.25.
653.14    Subd. 4. Benefits and payments. A child eligible for Northstar Care for Children is
653.15entitled to benefits specified in section 256N.26, based primarily on assessments under
653.16section 256N.24, and, if appropriate, negotiations and agreements under section 256N.25.
653.17Although paid to the caregiver, these benefits must be considered benefits of the child
653.18rather than of the caregiver.
653.19    Subd. 5. Federal, state, and local shares. The cost of Northstar Care for Children
653.20must be shared among the federal government, state, counties of financial responsibility,
653.21and certain tribes as specified in section 256N.27.
653.22    Subd. 6. Administration and appeals. The commissioner and financially
653.23responsible agency, or other agency designated by the commissioner, shall administer
653.24Northstar Care for Children according to section 256N.28. The notification and fair
653.25hearing process applicable to this chapter is defined in section 256N.28.
653.26    Subd. 7. Transition. A child in foster care, relative custody assistance, or adoption
653.27assistance prior to January 1, 2015, who remains with the same caregivers continues
653.28to receive benefits under programs preceding Northstar Care for Children, unless the
653.29child moves to a new foster care placement, permanency is obtained for the child, or the
653.30commissioner initiates transition of a child receiving pre-Northstar Care for Children
653.31relative custody assistance, guardianship assistance, or adoption assistance under this
653.32chapter. Provisions for the transition to Northstar Care for Children for certain children in
653.33preceding programs are specified in section 256N.28, subdivisions 2 and 7. Additional
653.34provisions for children in: foster care are specified in section 256N.21, subdivision
653.356; relative custody assistance under section 257.85 are specified in section 256N.22,
654.1subdivision 12; and adoption assistance under chapter 259A are specified in section
654.2256N.23, subdivision 13.

654.3    Sec. 8. [256N.21] ELIGIBILITY FOR FOSTER CARE BENEFITS.
654.4    Subdivision 1. General eligibility requirements. (a) A child is eligible for foster
654.5care benefits under this section if the child meets the requirements of subdivision 2 on
654.6or after January 1, 2015.
654.7(b) The financially responsible agency shall make a title IV-E eligibility determination
654.8for all foster children meeting the requirements of subdivision 2, provided the agency has
654.9such authority under the state title IV-E plan. To be eligible for title IV-E foster care, a child
654.10must also meet any additional criteria specified in section 472 of the Social Security Act.
654.11(c) Except as provided under section 256N.26, subdivision 1 or 6, the foster care
654.12benefit to the child under this section must be determined under sections 256N.24 and
654.13256N.26 through an individual assessment. Information from this assessment must be
654.14used to determine a potential future benefit under guardianship assistance or adoption
654.15assistance, if needed.
654.16(d) When a child is eligible for additional services, subdivisions 3 and 4 govern
654.17the co-occurrence of program eligibility.
654.18    Subd. 2. Placement in foster care. To be eligible for foster care benefits under this
654.19section, the child must be in placement away from the child's legal parent or guardian and
654.20all of the following criteria must be met:
654.21(1) the legally responsible agency must have placement authority and care
654.22responsibility, including for a child 18 years old or older and under age 21, who maintains
654.23eligibility for foster care consistent with section 260C.451;
654.24(2) the legally responsible agency must have authority to place the child with a
654.25voluntary placement agreement or a court order, consistent with sections 260B.198,
654.26260C.001, 260D.01, or continued eligibility consistent with section 260C.451; and
654.27(3) the child must be placed in an emergency relative placement under section
654.28245A.035, a licensed foster family setting, foster residence setting, or treatment foster
654.29care setting licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, a family
654.30foster home licensed or approved by a tribal agency or, for a child 18 years old or older
654.31and under age 21, an unlicensed supervised independent living setting approved by the
654.32agency responsible for the youth's care.
654.33    Subd. 3. Minor parent. A child who is a minor parent in placement with the minor
654.34parent's child in the same home is eligible for foster care benefits under this section. The
655.1foster care benefit is limited to the minor parent, unless the legally responsible agency has
655.2separate legal authority for placement of the minor parent's child.
655.3    Subd. 4. Foster children ages 18 up to 21 placed in an unlicensed supervised
655.4independent living setting. A foster child 18 years old or older and under age 21 who
655.5maintains eligibility consistent with section 260C.451 and who is placed in an unlicensed
655.6supervised independent living setting shall receive the level of benefit under section
655.7256N.26.
655.8    Subd. 5. Excluded activities. The basic and supplemental difficulty of care
655.9payment represents costs for activities similar in nature to those expected of parents,
655.10and does not cover services rendered by the licensed or tribally approved foster parent,
655.11facility, or administrative costs or fees. The financially responsible agency may pay an
655.12additional fee for specific services provided by the licensed foster parent or facility. A
655.13foster parent or residence setting must distinguish such a service from the daily care of the
655.14child as assessed through the process under section 256N.24.
655.15    Subd. 6. Transition from pre-Northstar Care for Children program. (a) Section
655.16256.82 establishes the pre-Northstar Care for Children foster care program for all children
655.17residing in family foster care on December 31, 2014. Unless transitioned under paragraph
655.18(b), a child in foster care with the same caregiver receives benefits under this pre-Northstar
655.19Care for Children foster care program.
655.20(b) Transition from the pre-Northstar Care for Children foster care program to
655.21Northstar Care for Children takes place on or after January 1, 2015, when the child:
655.22(1) moves to a different foster home or unlicensed supervised independent living
655.23setting;
655.24(2) has permanent legal and physical custody transferred and, if applicable, meets
655.25eligibility requirements in section 256N.22;
655.26(3) is adopted and, if applicable, meets eligibility requirements in section 256N.23; or
655.27(4) re-enters foster care after reunification or a trial home visit.
655.28(c) Upon becoming eligible, a foster child must be assessed according to section
655.29256N.24 and then transitioned into Northstar Care for Children according to section
655.30256N.28.

655.31    Sec. 9. [256N.22] GUARDIANSHIP ASSISTANCE ELIGIBILITY.
655.32    Subdivision 1. General eligibility requirements. (a) To be eligible for guardianship
655.33assistance under this section, there must be a judicial determination under section
655.34260C.515, subdivision 4, that a transfer of permanent legal and physical custody to a
655.35relative is in the child's best interest. For a child under jurisdiction of a tribal court, a
656.1judicial determination under a similar provision in tribal code indicating that a relative
656.2will assume the duty and authority to provide care, control, and protection of a child who
656.3is residing in foster care, and to make decisions regarding the child's education, health
656.4care, and general welfare until adulthood, and that this is in the child's best interest is
656.5considered equivalent. Additionally, a child must:
656.6(1) have been removed from the child's home pursuant to a voluntary placement
656.7agreement or court order;
656.8(2)(i) have resided in foster care for at least six consecutive months in the home
656.9of the prospective relative custodian; or
656.10(ii) have received an exemption from the requirement in item (i) from the court
656.11based on a determination that:
656.12(A) an expedited move to permanency is in the child's best interest;
656.13(B) expedited permanency cannot be completed without provision of guardianship
656.14assistance; and
656.15(C) the prospective relative custodian is uniquely qualified to meet the child's needs
656.16on a permanent basis;
656.17(3) meet the agency determinations regarding permanency requirements in
656.18subdivision 2;
656.19(4) meet the applicable citizenship and immigration requirements in subdivision 3;
656.20(5) have been consulted regarding the proposed transfer of permanent legal and
656.21physical custody to a relative, if the child is at least 14 years of age or is expected to attain
656.2214 years of age prior to the transfer of permanent legal and physical custody; and
656.23(6) have a written, binding agreement under section 256N.25 among the caregiver or
656.24caregivers, the financially responsible agency, and the commissioner established prior to
656.25transfer of permanent legal and physical custody.
656.26(b) In addition to the requirements in paragraph (a), the child's prospective relative
656.27custodian or custodians must meet the applicable background study requirements in
656.28subdivision 4.
656.29(c) To be eligible for title IV-E guardianship assistance, a child must also meet any
656.30additional criteria in section 473(d) of the Social Security Act. The sibling of a child
656.31who meets the criteria for title IV-E guardianship assistance in section 473(d) of the
656.32Social Security Act is eligible for title IV-E guardianship assistance if the child and
656.33sibling are placed with the same prospective relative custodian or custodians, and the
656.34legally responsible agency, relatives, and commissioner agree on the appropriateness of
656.35the arrangement for the sibling. A child who meets all eligibility criteria except those
657.1specific to title IV-E guardianship assistance is entitled to guardianship assistance paid
657.2through funds other than title IV-E.
657.3    Subd. 2. Agency determinations regarding permanency. (a) To be eligible for
657.4guardianship assistance, the legally responsible agency must complete the following
657.5determinations regarding permanency for the child prior to the transfer of permanent
657.6legal and physical custody:
657.7(1) a determination that reunification and adoption are not appropriate permanency
657.8options for the child; and
657.9(2) a determination that the child demonstrates a strong attachment to the prospective
657.10relative custodian and the prospective relative custodian has a strong commitment to
657.11caring permanently for the child.
657.12(b) The legally responsible agency shall document the determinations in paragraph
657.13(a) and the supporting information for completing each determination in the case file and
657.14make them available for review as requested by the financially responsible agency and the
657.15commissioner during the guardianship assistance eligibility determination process.
657.16    Subd. 3. Citizenship and immigration status. A child must be a citizen of the
657.17United States or otherwise be eligible for federal public benefits according to the Personal
657.18Responsibility and Work Opportunity Reconciliation Act of 1996, as amended, in order
657.19to be eligible for guardianship assistance.
657.20    Subd. 4. Background study. (a) A background study under section 245C.33 must
657.21be completed on each prospective relative custodian and any other adult residing in the
657.22home of the prospective relative custodian. A background study on the prospective
657.23relative custodian or adult residing in the household previously completed under section
657.24245C.04 for the purposes of foster care licensure may be used for the purposes of this
657.25section, provided that the background study is current at the time of the application for
657.26guardianship assistance.
657.27(b) If the background study reveals:
657.28(1) a felony conviction at any time for:
657.29(i) child abuse or neglect;
657.30(ii) spousal abuse;
657.31(iii) a crime against a child, including child pornography; or
657.32(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
657.33including other physical assault or battery; or
657.34(2) a felony conviction within the past five years for:
657.35(i) physical assault;
657.36(ii) battery; or
658.1(iii) a drug-related offense;
658.2the prospective relative custodian is prohibited from receiving guardianship assistance
658.3on behalf of an otherwise eligible child.
658.4    Subd. 5. Responsibility for determining guardianship assistance eligibility. The
658.5commissioner shall determine eligibility for:
658.6(1) a child under the legal custody or responsibility of a Minnesota county social
658.7service agency who would otherwise remain in foster care;
658.8(2) a Minnesota child under tribal court jurisdiction who would otherwise remain
658.9in foster care; and
658.10(3) an Indian child being placed in Minnesota who meets title IV-E eligibility defined
658.11in section 473(d) of the Social Security Act. The agency or entity assuming responsibility
658.12for the child is responsible for the nonfederal share of the guardianship assistance payment.
658.13    Subd. 6. Exclusions. (a) A child with a guardianship assistance agreement under
658.14Northstar Care for Children is not eligible for the Minnesota family investment program
658.15child-only grant under chapter 256J.
658.16(b) The commissioner shall not enter into a guardianship assistance agreement with:
658.17(1) a child's biological parent;
658.18(2) an individual assuming permanent legal and physical custody of a child or the
658.19equivalent under tribal code without involvement of the child welfare system; or
658.20(3) an individual assuming permanent legal and physical custody of a child who was
658.21placed in Minnesota by another state or a tribe outside of Minnesota.
658.22    Subd. 7. Guardianship assistance eligibility determination. The financially
658.23responsible agency shall prepare a guardianship assistance eligibility determination
658.24for review and final approval by the commissioner. The eligibility determination must
658.25be completed according to requirements and procedures and on forms prescribed by
658.26the commissioner. Supporting documentation for the eligibility determination must be
658.27provided to the commissioner. The financially responsible agency and the commissioner
658.28must make every effort to establish a child's eligibility for title IV-E guardianship
658.29assistance. A child who is determined to be eligible for guardianship assistance must
658.30have a guardianship assistance agreement negotiated on the child's behalf according to
658.31section 256N.25.
658.32    Subd. 8. Termination of agreement. (a) A guardianship assistance agreement must
658.33be terminated in any of the following circumstances:
658.34(1) the child has attained the age of 18, or up to age 21 when the child meets a
658.35condition for extension in subdivision 11;
659.1(2) the child has not attained the age of 18 years of age, but the commissioner
659.2determines the relative custodian is no longer legally responsible for support of the child;
659.3(3) the commissioner determines the relative custodian is no longer providing
659.4financial support to the child up to age 21;
659.5(4) the death of the child; or
659.6(5) the relative custodian requests in writing termination of the guardianship
659.7assistance agreement.
659.8(b) A relative custodian is considered no longer legally responsible for support of
659.9the child in any of the following circumstances:
659.10(1) permanent legal and physical custody or guardianship of the child is transferred
659.11to another individual;
659.12(2) the death of the relative custodian under subdivision 9;
659.13(3) the child enlists in the military;
659.14(4) the child gets married; or
659.15(5) the child is determined an emancipated minor through legal action.
659.16    Subd. 9. Death of relative custodian or dissolution of custody. The guardianship
659.17assistance agreement ends upon death or dissolution of permanent legal and physical
659.18custody of both relative custodians in the case of assignment of custody to two individuals,
659.19or the sole relative custodian in the case of assignment of custody to one individual.
659.20Guardianship assistance eligibility may be continued according to subdivision 10.
659.21    Subd. 10. Assigning a child's guardianship assistance to a court-appointed
659.22guardian or custodian. (a) Guardianship assistance may be continued with the written
659.23consent of the commissioner to an individual who is a guardian or custodian appointed by
659.24a court for the child upon the death of both relative custodians in the case of assignment
659.25of custody to two individuals, or the sole relative custodian in the case of assignment
659.26of custody to one individual, unless the child is under the custody of a county, tribal,
659.27or child-placing agency.
659.28(b) Temporary assignment of guardianship assistance may be approved for a
659.29maximum of six consecutive months from the death of the relative custodian or custodians
659.30as provided in paragraph (a) and must adhere to the policies and procedures prescribed by
659.31the commissioner. If a court has not appointed a permanent legal guardian or custodian
659.32within six months, the guardianship assistance must terminate and must not be resumed.
659.33(c) Upon assignment of assistance payments under this subdivision, assistance must
659.34be provided from funds other than title IV-E.
659.35    Subd. 11. Extension of guardianship assistance after age 18. (a) Under the
659.36circumstances outlined in paragraph (e), a child may qualify for extension of the
660.1guardianship assistance agreement beyond the date the child attains age 18, up to the
660.2date the child attains the age of 21.
660.3(b) A request for extension of the guardianship assistance agreement must be
660.4completed in writing and submitted, including all supporting documentation, by the
660.5relative custodian to the commissioner at least 60 calendar days prior to the date that the
660.6current agreement will terminate.
660.7(c) A signed amendment to the current guardianship assistance agreement must be
660.8fully executed between the relative custodian and the commissioner at least ten business
660.9days prior to the termination of the current agreement. The request for extension and
660.10the fully executed amendment must be made according to requirements and procedures
660.11prescribed by the commissioner, including documentation of eligibility, and on forms
660.12prescribed by the commissioner.
660.13(d) If an agency is certifying a child for guardianship assistance and the child will
660.14attain the age of 18 within 60 calendar days of submission, the request for extension must
660.15be completed in writing and submitted, including all supporting documentation, with
660.16the guardianship assistance application.
660.17(e) A child who has attained the age of 16 prior to the effective date of the
660.18guardianship assistance agreement is eligible for extension of the agreement up to the
660.19date the child attains age 21 if the child:
660.20(1) is dependent on the relative custodian for care and financial support; and
660.21(2) meets at least one of the following conditions:
660.22(i) is completing a secondary education program or a program leading to an
660.23equivalent credential;
660.24(ii) is enrolled in an institution which provides postsecondary or vocational education;
660.25(iii) is participating in a program or activity designed to promote or remove barriers
660.26to employment;
660.27(iv) is employed for at least 80 hours per month; or
660.28(v) is incapable of doing any of the activities described in items (i) to (iv) due to
660.29a medical condition where incapability is supported by professional documentation
660.30according to the requirements and procedures prescribed by the commissioner.
660.31(f) A child who has not attained the age of 16 prior to the effective date of the
660.32guardianship assistance agreement is eligible for extension of the guardianship assistance
660.33agreement up to the date the child attains the age of 21 if the child is:
660.34(1) dependent on the relative custodian for care and financial support; and
661.1(2) possesses a physical or mental disability which impairs the capacity for
661.2independent living and warrants continuation of financial assistance, as determined by
661.3the commissioner.
661.4    Subd. 12. Beginning guardianship assistance component of Northstar Care for
661.5Children. Effective November 27, 2014, a child who meets the eligibility criteria for
661.6guardianship assistance in subdivision 1 may have a guardianship assistance agreement
661.7negotiated on the child's behalf according to section 256N.25. The effective date of the
661.8agreement must be January 1, 2015, or the date of the court order transferring permanent
661.9legal and physical custody, whichever is later. Except as provided under section 256N.26,
661.10subdivision 1, paragraph (c), the rate schedule for an agreement under this subdivision
661.11is determined under section 256N.26 based on the age of the child on the date that the
661.12prospective relative custodian signs the agreement.
661.13    Subd. 13. Transition to guardianship assistance under Northstar Care for
661.14Children. The commissioner may execute guardianship assistance agreements for a child
661.15with a relative custody agreement under section 257.85 executed on the child's behalf
661.16on or before November 26, 2014, in accordance with the priorities outlined in section
661.17256N.28, subdivision 7, paragraph (b). To facilitate transition into the guardianship
661.18assistance program, the commissioner may waive any guardianship assistance eligibility
661.19requirements for a child with a relative custody agreement under section 257.85 executed
661.20on the child's behalf on or before November 26, 2014. Agreements negotiated under
661.21this subdivision must be done according to the process outlined in section 256N.28,
661.22subdivision 7. The maximum rate used in the negotiation process for an agreement under
661.23this subdivision must be as outlined in section 256N.28, subdivision 7.

661.24    Sec. 10. [256N.23] ADOPTION ASSISTANCE ELIGIBILITY.
661.25    Subdivision 1. General eligibility requirements. (a) To be eligible for adoption
661.26assistance under this section, a child must:
661.27(1) be determined to be a child with special needs under subdivision 2;
661.28(2) meet the applicable citizenship and immigration requirements in subdivision 3;
661.29(3)(i) meet the criteria in section 473 of the Social Security Act; or
661.30(ii) have had foster care payments paid on the child's behalf while in out-of-home
661.31placement through the county or tribe and be either under the guardianship of the
661.32commissioner or under the jurisdiction of a Minnesota tribe and adoption, according to
661.33tribal law, is in the child's documented permanency plan; and
661.34(4) have a written, binding agreement under section 256N.25 among the adoptive
661.35parent, the financially responsible agency, or if there is no financially responsible agency,
662.1the agency designated by the commissioner, and the commissioner established prior to
662.2finalization of the adoption.
662.3(b) In addition to the requirements in paragraph (a), an eligible child's adoptive parent
662.4or parents must meet the applicable background study requirements in subdivision 4.
662.5(c) A child who meets all eligibility criteria except those specific to title IV-E adoption
662.6assistance shall receive adoption assistance paid through funds other than title IV-E.
662.7    Subd. 2. Special needs determination. (a) A child is considered a child with
662.8special needs under this section if the requirements in paragraphs (b) to (g) are met.
662.9(b) There must be a determination that the child must not or should not be returned
662.10to the home of the child's parents as evidenced by:
662.11(1) a court-ordered termination of parental rights;
662.12(2) a petition to terminate parental rights;
662.13(3) consent of parent to adoption accepted by the court under chapter 260C;
662.14(4) in circumstances when tribal law permits the child to be adopted without a
662.15termination of parental rights, a judicial determination by a tribal court indicating the valid
662.16reason why the child cannot or should not return home;
662.17(5) a voluntary relinquishment under section 259.25 or 259.47 or, if relinquishment
662.18occurred in another state, the applicable laws in that state; or
662.19(6) the death of the legal parent or parents if the child has two legal parents.
662.20(c) There exists a specific factor or condition of which it is reasonable to conclude
662.21that the child cannot be placed with adoptive parents without providing adoption
662.22assistance as evidenced by:
662.23(1) a determination by the Social Security Administration that the child meets all
662.24medical or disability requirements of title XVI of the Social Security Act with respect to
662.25eligibility for Supplemental Security Income benefits;
662.26(2) a documented physical, mental, emotional, or behavioral disability not covered
662.27under clause (1);
662.28(3) a member of a sibling group being adopted at the same time by the same parent;
662.29(4) an adoptive placement in the home of a parent who previously adopted a sibling
662.30for whom they receive adoption assistance; or
662.31(5) documentation that the child is an at-risk child.
662.32(d) A reasonable but unsuccessful effort must have been made to place the child
662.33with adoptive parents without providing adoption assistance as evidenced by:
662.34(1) a documented search for an appropriate adoptive placement; or
662.35(2) a determination by the commissioner that a search under clause (1) is not in the
662.36best interests of the child.
663.1(e) The requirement for a documented search for an appropriate adoptive placement
663.2under paragraph (d), including the registration of the child with the state adoption
663.3exchange and other recruitment methods under paragraph (f), must be waived if:
663.4(1) the child is being adopted by a relative and it is determined by the child-placing
663.5agency that adoption by the relative is in the best interests of the child;
663.6(2) the child is being adopted by a foster parent with whom the child has developed
663.7significant emotional ties while in the foster parent's care as a foster child and it is
663.8determined by the child-placing agency that adoption by the foster parent is in the best
663.9interests of the child; or
663.10(3) the child is being adopted by a parent that previously adopted a sibling of the
663.11child, and it is determined by the child-placing agency that adoption by this parent is
663.12in the best interests of the child.
663.13For an Indian child covered by the Indian Child Welfare Act, a waiver must not be
663.14granted unless the child-placing agency has complied with the placement preferences
663.15required by the Indian Child Welfare Act, United States Code, title 25, section 1915(a).
663.16(f) To meet the requirement of a documented search for an appropriate adoptive
663.17placement under paragraph (d), clause (1), the child-placing agency minimally must:
663.18(1) conduct a relative search as required by section 260C.221 and give consideration
663.19to placement with a relative, as required by section 260C.212, subdivision 2;
663.20(2) comply with the placement preferences required by the Indian Child Welfare Act
663.21when the Indian Child Welfare Act, United States Code, title 25, section 1915(a), applies;
663.22(3) locate prospective adoptive families by registering the child on the state adoption
663.23exchange, as required under section 259.75; and
663.24(4) if registration with the state adoption exchange does not result in the identification
663.25of an appropriate adoptive placement, the agency must employ additional recruitment
663.26methods prescribed by the commissioner.
663.27(g) Once the legally responsible agency has determined that placement with an
663.28identified parent is in the child's best interests and made full written disclosure about the
663.29child's social and medical history, the agency must ask the prospective adoptive parent if
663.30the prospective adoptive parent is willing to adopt the child without receiving adoption
663.31assistance under this section. If the identified parent is either unwilling or unable to
663.32adopt the child without adoption assistance, the legally responsible agency must provide
663.33documentation as prescribed by the commissioner to fulfill the requirement to make a
663.34reasonable effort to place the child without adoption assistance. If the identified parent is
663.35willing to adopt the child without adoption assistance, the parent must provide a written
663.36statement to this effect to the legally responsible agency and the statement must be
664.1maintained in the permanent adoption record of the legally responsible agency. For children
664.2under guardianship of the commissioner, the legally responsible agency shall submit a copy
664.3of this statement to the commissioner to be maintained in the permanent adoption record.
664.4    Subd. 3. Citizenship and immigration status. (a) A child must be a citizen of the
664.5United States or otherwise eligible for federal public benefits according to the Personal
664.6Responsibility and Work Opportunity Reconciliation Act of 1996, as amended, in order to
664.7be eligible for the title IV-E adoption assistance program.
664.8(b) A child must be a citizen of the United States or meet the qualified alien
664.9requirements as defined in the Personal Responsibility and Work Opportunity
664.10Reconciliation Act of 1996, as amended, in order to be eligible for adoption assistance
664.11paid through funds other than title IV-E.
664.12    Subd. 4. Background study. A background study under section 259.41 must be
664.13completed on each prospective adoptive parent. If the background study reveals:
664.14(1) a felony conviction at any time for:
664.15(i) child abuse or neglect;
664.16(ii) spousal abuse;
664.17(iii) a crime against a child, including child pornography; or
664.18(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
664.19including other physical assault or battery; or
664.20(2) a felony conviction within the past five years for:
664.21(i) physical assault;
664.22(ii) battery; or
664.23(iii) a drug-related offense;
664.24the adoptive parent is prohibited from receiving adoption assistance on behalf of an
664.25otherwise eligible child.
664.26    Subd. 5. Responsibility for determining adoption assistance eligibility. The
664.27commissioner must determine eligibility for:
664.28(1) a child under the guardianship of the commissioner who would otherwise remain
664.29in foster care;
664.30(2) a child who is not under the guardianship of the commissioner who meets title
664.31IV-E eligibility defined in section 473 of the Social Security Act and no state agency has
664.32legal responsibility for placement and care of the child;
664.33(3) a Minnesota child under tribal jurisdiction who would otherwise remain in foster
664.34care; and
665.1(4) an Indian child being placed in Minnesota who meets title IV-E eligibility defined
665.2in section 473 of the Social Security Act. The agency or entity assuming responsibility for
665.3the child is responsible for the nonfederal share of the adoption assistance payment.
665.4    Subd. 6. Exclusions. The commissioner must not enter into an adoption assistance
665.5agreement with the following individuals:
665.6(1) a child's biological parent or stepparent;
665.7(2) a child's relative under section 260C.007, subdivision 27, with whom the child
665.8resided immediately prior to child welfare involvement unless:
665.9(i) the child was in the custody of a Minnesota county or tribal agency pursuant to
665.10an order under chapter 260C or equivalent provisions of tribal code and the agency had
665.11placement and care responsibility for permanency planning for the child; and
665.12(ii) the child is under guardianship of the commissioner of human services according
665.13to the requirements of section 260C.325, subdivision 1 or 3, or is a ward of a Minnesota
665.14tribal court after termination of parental rights, suspension of parental rights, or a finding
665.15by the tribal court that the child cannot safely return to the care of the parent;
665.16(3) an individual adopting a child who is the subject of a direct adoptive placement
665.17under section 259.47 or the equivalent in tribal code;
665.18(4) a child's legal custodian or guardian who is now adopting the child; or
665.19(5) an individual who is adopting a child who is not a citizen or resident of the
665.20United States and was either adopted in another country or brought to the United States
665.21for the purposes of adoption.
665.22    Subd. 7. Adoption assistance eligibility determination. (a) The financially
665.23responsible agency shall prepare an adoption assistance eligibility determination for
665.24review and final approval by the commissioner. When there is no financially responsible
665.25agency, the adoption assistance eligibility determination must be completed by the
665.26agency designated by the commissioner. The eligibility determination must be completed
665.27according to requirements and procedures and on forms prescribed by the commissioner.
665.28The financially responsible agency and the commissioner shall make every effort to
665.29establish a child's eligibility for title IV-E adoption assistance. Documentation from a
665.30qualified expert for the eligibility determination must be provided to the commissioner
665.31to verify that a child meets the special needs criteria in subdivision 2. A child who
665.32is determined to be eligible for adoption assistance must have an adoption assistance
665.33agreement negotiated on the child's behalf according to section 256N.25.
665.34(b) Documentation from a qualified expert of a disability is limited to evidence
665.35deemed appropriate by the commissioner and must be submitted to the commissioner with
665.36the eligibility determination. Examples of appropriate documentation include, but are not
666.1limited to, medical records, psychological assessments, educational or early childhood
666.2evaluations, court findings, and social and medical history.
666.3(c) Documentation that the child is at risk of developing physical, mental, emotional,
666.4or behavioral disabilities must be submitted according to policies and procedures
666.5prescribed by the commissioner.
666.6    Subd. 8. Termination of agreement. (a) An adoption assistance agreement must
666.7terminate in any of the following circumstances:
666.8(1) the child has attained the age of 18, or up to age 21 when the child meets a
666.9condition for extension in subdivision 12;
666.10(2) the child has not attained the age of 18, but the commissioner determines the
666.11adoptive parent is no longer legally responsible for support of the child;
666.12(3) the commissioner determines the adoptive parent is no longer providing financial
666.13support to the child up to age 21;
666.14(4) the death of the child; or
666.15(5) the adoptive parent requests in writing the termination of the adoption assistance
666.16agreement.
666.17(b) An adoptive parent is considered no longer legally responsible for support of the
666.18child in any of the following circumstances:
666.19(1) parental rights to the child are legally terminated or a court accepted the parent's
666.20consent to adoption under chapter 260C;
666.21(2) permanent legal and physical custody or guardianship of the child is transferred
666.22to another individual;
666.23(3) death of the adoptive parent under subdivision 9;
666.24(4) the child enlists in the military;
666.25(5) the child gets married; or
666.26(6) the child is determined an emancipated minor through legal action.
666.27    Subd. 9. Death of adoptive parent or adoption dissolution. The adoption
666.28assistance agreement ends upon death or termination of parental rights of both adoptive
666.29parents in the case of a two-parent adoption, or the sole adoptive parent in the case of
666.30a single-parent adoption. The child's adoption assistance eligibility may be continued
666.31according to subdivision 10.
666.32    Subd. 10. Continuing a child's title IV-E adoption assistance in a subsequent
666.33adoption. (a) The child maintains eligibility for title IV-E adoption assistance in a
666.34subsequent adoption if the following criteria are met:
666.35(1) the child is determined to be a child with special needs as outlined in subdivision
666.362; and
667.1(2) the subsequent adoptive parent resides in Minnesota.
667.2(b) If a child had a title IV-E adoption assistance agreement in effect prior to the
667.3death of the adoptive parent or dissolution of the adoption, and the subsequent adoptive
667.4parent resides outside of Minnesota, the commissioner is not responsible for determining
667.5whether the child meets the definition of special needs, entering into the adoption
667.6assistance agreement, and making any adoption assistance payments outlined in the new
667.7agreement unless a state agency in Minnesota has responsibility for placement and care of
667.8the child at the time of the subsequent adoption. If there is no state agency in Minnesota
667.9that has responsibility for placement and care of the child at the time of the subsequent
667.10adoption, the public child welfare agency in the subsequent adoptive parent's residence is
667.11responsible for determining whether the child meets the definition of special needs and
667.12entering into the adoption assistance agreement.
667.13    Subd. 11. Assigning a child's adoption assistance to a court-appointed guardian
667.14or custodian. (a) State-funded adoption assistance may be continued with the written
667.15consent of the commissioner to an individual who is a guardian appointed by a court for
667.16the child upon the death of both the adoptive parents in the case of a two-parent adoption,
667.17or the sole adoptive parent in the case of a single-parent adoption, unless the child is
667.18under the custody of a state agency.
667.19(b) Temporary assignment of adoption assistance may be approved by the
667.20commissioner for a maximum of six consecutive months from the death of the adoptive
667.21parent or parents under subdivision 9 and must adhere to the requirements and procedures
667.22prescribed by the commissioner. If, within six months, the child has not been adopted by a
667.23person agreed upon by the commissioner, or a court has not appointed a permanent legal
667.24guardian under section 260C.325, 525.5-313, or similar law of another jurisdiction, the
667.25adoption assistance must terminate.
667.26(c) Upon assignment of payments under this subdivision, assistance must be from
667.27funds other than title IV-E.
667.28    Subd. 12. Extension of adoption assistance agreement. (a) Under certain limited
667.29circumstances a child may qualify for extension of the adoption assistance agreement
667.30beyond the date the child attains age 18, up to the date the child attains the age of 21.
667.31(b) A request for extension of the adoption assistance agreement must be completed
667.32in writing and submitted, including all supporting documentation, by the adoptive parent
667.33to the commissioner at least 60 calendar days prior to the date that the current agreement
667.34will terminate.
667.35(c) A signed amendment to the current adoption assistance agreement must be
667.36fully executed between the adoptive parent and the commissioner at least ten business
668.1days prior to the termination of the current agreement. The request for extension and the
668.2fully executed amendment must be made according to the requirements and procedures
668.3prescribed by the commissioner, including documentation of eligibility, on forms
668.4prescribed by the commissioner.
668.5(d) If an agency is certifying a child for adoption assistance and the child will attain
668.6the age of 18 within 60 calendar days of submission, the request for extension must be
668.7completed in writing and submitted, including all supporting documentation, with the
668.8adoption assistance application.
668.9(e) A child who has attained the age of 16 prior to the finalization of the child's
668.10adoption is eligible for extension of the adoption assistance agreement up to the date the
668.11child attains age 21 if the child is:
668.12(1) dependent on the adoptive parent for care and financial support; and
668.13(2)(i) completing a secondary education program or a program leading to an
668.14equivalent credential;
668.15(ii) enrolled in an institution that provides postsecondary or vocational education;
668.16(iii) participating in a program or activity designed to promote or remove barriers to
668.17employment;
668.18(iv) employed for at least 80 hours per month; or
668.19(v) incapable of doing any of the activities described in items (i) to (iv) due to
668.20a medical condition where incapability is supported by documentation from an expert
668.21according to the requirements and procedures prescribed by the commissioner.
668.22(f) A child who has not attained the age of 16 prior to finalization of the child's
668.23adoption is eligible for extension of the adoption assistance agreement up to the date the
668.24child attains the age of 21 if the child is:
668.25(1) dependent on the adoptive parent for care and financial support; and
668.26(2)(i) enrolled in a secondary education program or a program leading to the
668.27equivalent; or
668.28(ii) possesses a physical or mental disability that impairs the capacity for independent
668.29living and warrants continuation of financial assistance as determined by the commissioner.
668.30    Subd. 13. Beginning adoption assistance under Northstar Care for Children.
668.31Effective November 27, 2014, a child who meets the eligibility criteria for adoption
668.32assistance in subdivision 1, may have an adoption assistance agreement negotiated on
668.33the child's behalf according to section 256N.25, and the effective date of the agreement
668.34must be January 1, 2015, or the date of the court order finalizing the adoption, whichever
668.35is later. Except as provided under section 256N.26, subdivision 1, paragraph (c), the
668.36maximum rate schedule for the agreement must be determined according to section
669.1256N.26 based on the age of the child on the date that the prospective adoptive parent or
669.2parents sign the agreement.
669.3    Subd. 14. Transition to adoption assistance under Northstar Care for Children.
669.4The commissioner may offer adoption assistance agreements under this chapter to a
669.5child with an adoption assistance agreement under chapter 259A executed on the child's
669.6behalf on or before November 26, 2014, according to the priorities outlined in section
669.7256N.28, subdivision 7, paragraph (b). To facilitate transition into the Northstar Care for
669.8Children adoption assistance program, the commissioner has the authority to waive any
669.9Northstar Care for Children adoption assistance eligibility requirements for a child with
669.10an adoption assistance agreement under chapter 259A executed on the child's behalf on
669.11or before November 26, 2014. Agreements negotiated under this subdivision must be in
669.12accordance with the process in section 256N.28, subdivision 7. The maximum rate used in
669.13the negotiation process for an agreement under this subdivision must be as outlined in
669.14section 256N.28, subdivision 7.

669.15    Sec. 11. [256N.24] ASSESSMENTS.
669.16    Subdivision 1. Assessment. (a) Each child eligible under sections 256N.21,
669.17256N.22, and 256N.23, must be assessed to determine the benefits the child may receive
669.18under section 256N.26, in accordance with the assessment tool, process, and requirements
669.19specified in subdivision 2.
669.20(b) If an agency applies the emergency foster care rate for initial placement under
669.21section 256N.26, the agency may wait up to 30 days to complete the initial assessment.
669.22(c) Unless otherwise specified in paragraph (d), a child must be assessed at the basic
669.23level, level B, or one of ten supplemental difficulty of care levels, levels C to L.
669.24(d) An assessment must not be completed for:
669.25(1) a child eligible for guardianship assistance under section 256N.22 or adoption
669.26assistance under section 256N.23 who is determined to be an at-risk child. A child under
669.27this clause must be assigned level A under section 256N.26, subdivision 1; and
669.28(2) a child transitioning into Northstar Care for Children under section 256N.28,
669.29subdivision 7, unless the commissioner determines an assessment is appropriate.
669.30    Subd. 2. Establishment of assessment tool, process, and requirements. Consistent
669.31with sections 256N.001 to 256N.28, the commissioner shall establish an assessment tool
669.32to determine the basic and supplemental difficulty of care, and shall establish the process
669.33to be followed and other requirements, including appropriate documentation, when
669.34conducting the initial assessment of a child entering Northstar Care for Children or when
669.35the special assessment and reassessments may be needed for children continuing in the
670.1program. The assessment tool must take into consideration the strengths and needs of the
670.2child and the extra parenting provided by the caregiver to meet the child's needs.
670.3    Subd. 3. Child care allowance portion of assessment. (a) The assessment tool
670.4established under subdivision 2 must include consideration of the caregiver's need for
670.5child care under this subdivision, with greater consideration for children of younger ages.
670.6(b) The child's assessment must include consideration of the caregiver's need for
670.7child care if the following criteria are met:
670.8(1) the child is under age 13;
670.9(2) all available adult caregivers are employed or attending educational or vocational
670.10training programs; and
670.11(3) the caregiver does not receive child care assistance for the child under chapter
670.12119B.
670.13(c) For children younger than seven years of age, the level determined by the
670.14non-child care portions of the assessment must be adjusted based on the average number
670.15of hours child care is needed each week due to employment or attending a training or
670.16educational program as follows:
670.17(1) fewer than ten hours or if the caregiver is participating in the child care assistance
670.18program under chapter 119B, no adjustment;
670.19(2) ten to 19 hours or if needed during school summer vacation or equivalent only,
670.20increase one level;
670.21(3) 20 to 29 hours, increase two levels;
670.22(4) 30 to 39 hours, increase three levels; and
670.23(5) 40 or more hours, increase four levels.
670.24(d) For children at least seven years of age but younger than 13, the level determined
670.25by the non-child care portions of the assessment must be adjusted based on the average
670.26number of hours child care is needed each week due to employment or attending a training
670.27or educational program as follows:
670.28(1) fewer than 20 hours, needed during school summer vacation or equivalent only,
670.29or if the caregiver is participating in the child care assistance program under chapter
670.30119B, no adjustment;
670.31(2) 20 to 39 hours, increase one level; and
670.32(3) 40 or more hours, increase two levels.
670.33(e) When the child attains the age of seven, the child care allowance must be reduced
670.34by reducing the level to that available under paragraph (d). For children in foster care,
670.35benefits under section 256N.26 must be automatically reduced when the child turns seven.
670.36For children who receive guardianship assistance or adoption assistance, agreements must
671.1include similar provisions to ensure that the benefit provided to these children does not
671.2exceed the benefit provided to children in foster care.
671.3(f) When the child attains the age of 13, the child care allowance must be eliminated
671.4by reducing the level to that available prior to any consideration of the caregiver's need
671.5for child care. For children in foster care, benefits under section 256N.26 must be
671.6automatically reduced when the child attains the age of 13. For children who receive
671.7guardianship assistance or adoption assistance, agreements must include similar provisions
671.8to ensure that the benefit provided to these children does not exceed the benefit provided
671.9to children in foster care.
671.10(g) The child care allowance under this subdivision is not available to caregivers
671.11who receive the child care assistance under chapter 119B. A caregiver receiving a child
671.12care allowance under this subdivision must notify the commissioner if the caregiver
671.13subsequently receives the child care assistance program under chapter 119B, and the
671.14level must be reduced to that available prior to any consideration of the caregiver's need
671.15for child care.
671.16(h) In establishing the assessment tool under subdivision 2, the commissioner must
671.17design the tool so that the levels applicable to the non-child care portions of the assessment
671.18at a given age accommodate the requirements of this subdivision.
671.19    Subd. 4. Extraordinary levels. (a) The assessment tool established under
671.20subdivision 2 must provide a mechanism through which up to five levels can be added
671.21to the supplemental difficulty of care for a particular child under section 256N.26,
671.22subdivision 4. In establishing the assessment tool, the commissioner must design the tool
671.23so that the levels applicable to the portions of the assessment other than the extraordinary
671.24levels can accommodate the requirements of this subdivision.
671.25(b) These extraordinary levels are available when all of the following circumstances
671.26apply:
671.27(1) the child has extraordinary needs as determined by the assessment tool provided
671.28for under subdivision 2, and the child meets other requirements established by the
671.29commissioner, such as a minimum score on the assessment tool;
671.30(2) the child's extraordinary needs require extraordinary care and intense supervision
671.31that is provided by the child's caregiver as part of the parental duties as described in the
671.32supplemental difficulty of care rate, section 256N.02, subdivision 21. This extraordinary
671.33care provided by the caregiver is required so that the child can be safely cared for in the
671.34home and community, and prevents residential placement;
672.1(3) the child is physically living in a foster family setting, as defined in Minnesota
672.2Rules, part 2960.3010, subpart 23, or physically living in the home with the adoptive
672.3parent or relative custodian; and
672.4(4) the child is receiving the services for which the child is eligible through medical
672.5assistance programs or other programs that provide necessary services for children with
672.6disabilities or other medical and behavioral conditions to live with the child's family, but
672.7the agency with caregiver's input has identified a specific support gap that cannot be met
672.8through home and community support waivers or other programs that are designed to
672.9provide support for children with special needs.
672.10(c) The agency completing an assessment, under subdivision 2, that suggests an
672.11extraordinary level must document as part of the assessment, the following:
672.12(1) the assessment tool that determined that the child's needs or disabilities require
672.13extraordinary care and intense supervision;
672.14(2) a summary of the extraordinary care and intense supervision that is provided by
672.15the caregiver as part of the parental duties as described in the supplemental difficulty of
672.16care rate, section 256N.02, subdivision 21;
672.17(3) confirmation that the child is currently physically residing in the foster family
672.18setting or in the home with the adoptive parent or relative custodian;
672.19(4) the efforts of the agency, caregiver, parents, and others to request support services
672.20in the home and community that would ease the degree of parental duties provided by the
672.21caregiver for the care and supervision of the child. This would include documentation of
672.22the services provided for the child's needs or disabilities, and the services that were denied
672.23or not available from the local social service agency, community agency, the local school
672.24district, local public health department, the parent or child's medical insurance provider;
672.25(5) the specific support gap identified that places the child's safety and well-being at
672.26risk in the home or community and is necessary to prevent residential placement; and
672.27(6) the extraordinary care and intense supervision provided by the foster, adoptive,
672.28or guardianship caregivers to maintain the child safely in the child's home and prevent
672.29residential placement that cannot be supported by medical assistance or other programs
672.30that provide services, necessary care for children with disabilities, or other medical or
672.31behavioral conditions in the home or community.
672.32(d) An agency completing an assessment under subdivision 2 that suggests
672.33an extraordinary level is appropriate must forward the assessment and required
672.34documentation to the commissioner. If the commissioner approves, the extraordinary
672.35levels must be retroactive to the date the assessment was forwarded.
673.1    Subd. 5. Timing of initial assessment. For a child entering Northstar Care for
673.2Children under section 256N.21, the initial assessment must be completed within 30
673.3days after the child is placed in foster care.
673.4    Subd. 6. Completion of initial assessment. (a) The assessment must be completed
673.5in consultation with the child's caregiver. Face-to-face contact with the caregiver is not
673.6required to complete the assessment.
673.7(b) Initial assessments are completed for foster children, eligible under section
673.8256N.21.
673.9(c) The initial assessment must be completed by the financially responsible agency,
673.10in consultation with the legally responsible agency if different, within 30 days of the
673.11child's placement in foster care.
673.12(d) If the foster parent is unable or unwilling to cooperate with the assessment process,
673.13the child shall be assigned the basic level, level B under section 256N.26, subdivision 3.
673.14(e) Notice to the foster parent shall be provided as specified in subdivision 12.
673.15    Subd. 7. Timing of special assessment. (a) A special assessment is required as part
673.16of the negotiation of the guardianship assistance agreement under section 256N.22 if:
673.17(1) the child was not placed in foster care with the prospective relative custodian
673.18or custodians prior to the negotiation of the guardianship assistance agreement under
673.19section 256N.25; or
673.20(2) any requirement for reassessment under subdivision 8 is met.
673.21(b) A special assessment is required as part of the negotiation of the adoption
673.22assistance agreement under section 256N.23 if:
673.23(1) the child was not placed in foster care with the prospective adoptive parent
673.24or parents prior to the negotiation of the adoption assistance agreement under section
673.25256N.25; or
673.26(2) any requirement for reassessment under subdivision 8 is met.
673.27(c) A special assessment is required when a child transitions from a pre-Northstar
673.28Care for Children program into Northstar Care for Children if the commissioner
673.29determines that a special assessment is appropriate instead of assigning the transition child
673.30to a level under section 256N.28.
673.31(d) The special assessment must be completed prior to the establishment of a
673.32guardianship assistance or adoption assistance agreement on behalf of the child.
673.33    Subd. 8. Completing the special assessment. (a) The special assessment must
673.34be completed in consultation with the child's caregiver. Face-to-face contact with the
673.35caregiver is not required to complete the special assessment.
674.1(b) If a new special assessment is required prior to the effective date of the
674.2guardianship assistance agreement, it must be completed by the financially responsible
674.3agency, in consultation with the legally responsible agency if different. If the prospective
674.4relative custodian is unable or unwilling to cooperate with the special assessment process,
674.5the child shall be assigned the basic level, level B under section 256N.26, subdivision 3,
674.6unless the child is known to be an at-risk child, in which case, the child shall be assigned
674.7level A under section 256N.26, subdivision 1.
674.8(c) If a special assessment is required prior to the effective date of the adoption
674.9assistance agreement, it must be completed by the financially responsible agency, in
674.10consultation with the legally responsible agency if different. If there is no financially
674.11responsible agency, the special assessment must be completed by the agency designated by
674.12the commissioner. If the prospective adoptive parent is unable or unwilling to cooperate
674.13with the special assessment process, the child must be assigned the basic level, level B
674.14under section 256N.26, subdivision 3, unless the child is known to be an at-risk child, in
674.15which case, the child shall be assigned level A under section 256N.26, subdivision 1.
674.16(d) Notice to the prospective relative custodians or prospective adoptive parents
674.17must be provided as specified in subdivision 12.
674.18    Subd. 9. Timing of and requests for reassessments. Reassessments for an eligible
674.19child must be completed within 30 days of any of the following events:
674.20(1) for a child in continuous foster care, when six months have elapsed since
674.21completion of the last assessment;
674.22(2) for a child in continuous foster care, change of placement location;
674.23(3) for a child in foster care, at the request of the financially responsible agency or
674.24legally responsible agency;
674.25(4) at the request of the commissioner; or
674.26(5) at the request of the caregiver under subdivision 9.
674.27    Subd. 10. Caregiver requests for reassessments. (a) A caregiver may initiate
674.28a reassessment request for an eligible child in writing to the financially responsible
674.29agency or, if there is no financially responsible agency, the agency designated by the
674.30commissioner. The written request must include the reason for the request and the
674.31name, address, and contact information of the caregivers. For an eligible child with a
674.32guardianship assistance or adoption assistance agreement, the caregiver may request a
674.33reassessment if at least six months have elapsed since any previously requested review.
674.34For an eligible foster child, a foster parent may request reassessment in less than six
674.35months with written documentation that there have been significant changes in the child's
674.36needs that necessitate an earlier reassessment.
675.1(b) A caregiver may request a reassessment of an at-risk child for whom a
675.2guardianship assistance or adoption assistance agreement has been executed if the
675.3caregiver has satisfied the commissioner with written documentation from a qualified
675.4expert that the potential disability upon which eligibility for the agreement was based has
675.5manifested itself, consistent with section 256N.25, subdivision 3, paragraph (b).
675.6(c) If the reassessment cannot be completed within 30 days of the caregiver's request,
675.7the agency responsible for reassessment must notify the caregiver of the reason for the
675.8delay and a reasonable estimate of when the reassessment can be completed.
675.9    Subd. 11. Completion of reassessment. (a) The reassessment must be completed
675.10in consultation with the child's caregiver. Face-to-face contact with the caregiver is not
675.11required to complete the reassessment.
675.12(b) For foster children eligible under section 256N.21, reassessments must be
675.13completed by the financially responsible agency, in consultation with the legally
675.14responsible agency if different.
675.15(c) If reassessment is required after the effective date of the guardianship assistance
675.16agreement, the reassessment must be completed by the financially responsible agency.
675.17(d) If a reassessment is required after the effective date of the adoption assistance
675.18agreement, it must be completed by the financially responsible agency or, if there is no
675.19financially responsible agency, the agency designated by the commissioner.
675.20(e) If the child's caregiver is unable or unwilling to cooperate with the reassessment,
675.21the child must be assessed at level B under section 256N.26, subdivision 3, unless the
675.22child has an adoption assistance or guardianship assistance agreement in place and is
675.23known to be an at-risk child, in which case the child must be assessed at level A under
675.24section 256N.26, subdivision 1.
675.25    Subd. 12. Approval of initial assessments, special assessments, and
675.26reassessments. (a) Any agency completing initial assessments, special assessments, or
675.27reassessments must designate one or more supervisors or other staff to examine and approve
675.28assessments completed by others in the agency under subdivision 2. The person approving
675.29an assessment must not be the case manager or staff member completing that assessment.
675.30(b) In cases where a special assessment or reassessment for guardian assistance
675.31and adoption assistance is required under subdivision 7 or 10, the commissioner shall
675.32review and approve the assessment as part of the eligibility determination process outlined
675.33in section 256N.22, subdivision 7, for guardianship assistance, or section 256N.23,
675.34subdivision 7, for adoption assistance. The assessment determines the maximum for the
675.35negotiated agreement amount under section 256N.25.
676.1(c) The new rate is effective the calendar month that the assessment is approved,
676.2or the effective date of the agreement, whichever is later.
676.3    Subd. 13. Notice for caregiver. (a) The agency as defined in subdivision 5 or 10
676.4that is responsible for completing the initial assessment or reassessment must provide the
676.5child's caregiver with written notice of the initial assessment or reassessment.
676.6(b) Initial assessment notices must be sent within 15 days of completion of the initial
676.7assessment and must minimally include the following:
676.8(1) a summary of the child's completed individual assessment used to determine the
676.9initial rating;
676.10(2) statement of rating and benefit level;
676.11(3) statement of the circumstances under which the agency must reassess the child;
676.12(4) procedure to seek reassessment;
676.13(5) notice that the caregiver has the right to a fair hearing review of the assessment
676.14and how to request a fair hearing, consistent with section 256.045, subdivision 3; and
676.15(6) the name, telephone number, and e-mail, if available, of a contact person at the
676.16agency completing the assessment.
676.17(c) Reassessment notices must be sent within 15 days after the completion of the
676.18reassessment and must minimally include the following:
676.19(1) a summary of the child's individual assessment used to determine the new rating;
676.20(2) any change in rating and its effective date;
676.21(3) procedure to seek reassessment;
676.22(4) notice that if a change in rating results in a reduction of benefits, the caregiver
676.23has the right to a fair hearing review of the assessment and how to request a fair hearing
676.24consistent with section 256.045, subdivision 3;
676.25(5) notice that a caregiver who requests a fair hearing of the reassessed rating within
676.26ten days may continue at the current rate pending the hearing, but the agency may recover
676.27any overpayment; and
676.28(6) name, telephone number, and e-mail, if available, of a contact person at the
676.29agency completing the reassessment.
676.30(d) Notice is not required for special assessments since the notice is part of the
676.31guardianship assistance or adoption assistance negotiated agreement completed according
676.32to section 256N.25.
676.33    Subd. 14. Assessment tool determines rate of benefits. The assessment tool
676.34established by the commissioner in subdivision 2 determines the monthly benefit level
676.35for children in foster care. The monthly payment for guardian assistance or adoption
677.1assistance may be negotiated up to the monthly benefit level under foster care for those
677.2children eligible for a payment under section 256N.26, subdivision 1.

677.3    Sec. 12. [256N.25] AGREEMENTS.
677.4    Subdivision 1. Agreement; guardianship assistance; adoption assistance. (a)
677.5In order to receive guardianship assistance or adoption assistance benefits on behalf of
677.6an eligible child, a written, binding agreement between the caregiver or caregivers, the
677.7financially responsible agency, or, if there is no financially responsible agency, the agency
677.8designated by the commissioner, and the commissioner must be established prior to
677.9finalization of the adoption or a transfer of permanent legal and physical custody. The
677.10agreement must be negotiated with the caregiver or caregivers under subdivision 2.
677.11(b) The agreement must be on a form approved by the commissioner and must
677.12specify the following:
677.13(1) duration of the agreement;
677.14(2) the nature and amount of any payment, services, and assistance to be provided
677.15under such agreement;
677.16(3) the child's eligibility for Medicaid services;
677.17(4) the terms of the payment, including any child care portion as specified in section
677.18256N.24, subdivision 3;
677.19(5) eligibility for reimbursement of nonrecurring expenses associated with adopting
677.20or obtaining permanent legal and physical custody of the child, to the extent that the
677.21total cost does not exceed $2,000 per child;
677.22(6) that the agreement must remain in effect regardless of the state of which the
677.23adoptive parents or relative custodians are residents at any given time;
677.24(7) provisions for modification of the terms of the agreement, including renegotiation
677.25of the agreement; and
677.26(8) the effective date of the agreement.
677.27(c) The caregivers, the commissioner, and the financially responsible agency, or, if
677.28there is no financially responsible agency, the agency designated by the commissioner, must
677.29sign the agreement. A copy of the signed agreement must be given to each party. Once
677.30signed by all parties, the commissioner shall maintain the official record of the agreement.
677.31(d) The effective date of the guardianship assistance agreement must be the date of the
677.32court order that transfers permanent legal and physical custody to the relative. The effective
677.33date of the adoption assistance agreement is the date of the finalized adoption decree.
677.34(e) Termination or disruption of the preadoptive placement or the foster care
677.35placement prior to assignment of custody makes the agreement with that caregiver void.
678.1    Subd. 2. Negotiation of agreement. (a) When a child is determined to be eligible
678.2for guardianship assistance or adoption assistance, the financially responsible agency, or,
678.3if there is no financially responsible agency, the agency designated by the commissioner,
678.4must negotiate with the caregiver to develop an agreement under subdivision 1. If and when
678.5the caregiver and agency reach concurrence as to the terms of the agreement, both parties
678.6shall sign the agreement. The agency must submit the agreement, along with the eligibility
678.7determination outlined in sections 256N.22, subdivision 7, and 256N.23, subdivision 7, to
678.8the commissioner for final review, approval, and signature according to subdivision 1.
678.9(b) A monthly payment is provided as part of the adoption assistance or guardianship
678.10assistance agreement to support the care of children unless the child is determined to be an
678.11at-risk child, in which case the special at-risk monthly payment under section 256N.26,
678.12subdivision 7, must be made until the caregiver obtains written documentation from a
678.13qualified expert that the potential disability upon which eligibility for the agreement
678.14was based has manifested itself.
678.15(1) The amount of the payment made on behalf of a child eligible for guardianship
678.16assistance or adoption assistance is determined through agreement between the prospective
678.17relative custodian or the adoptive parent and the financially responsible agency, or, if there
678.18is no financially responsible agency, the agency designated by the commissioner, using
678.19the assessment tool established by the commissioner in section 256N.24, subdivision 2,
678.20and the associated benefit and payments outlined in section 256N.26. Except as provided
678.21under section 256N.24, subdivision 1, paragraph (c), the assessment tool establishes
678.22the monthly benefit level for a child under foster care. The monthly payment under a
678.23guardianship assistance agreement or adoption assistance agreement may be negotiated up
678.24to the monthly benefit level under foster care. In no case may the amount of the payment
678.25under a guardianship assistance agreement or adoption assistance agreement exceed the
678.26foster care maintenance payment which would have been paid during the month if the
678.27child with respect to whom the guardianship assistance or adoption assistance payment is
678.28made had been in a foster family home in the state.
678.29(2) The rate schedule for the agreement is determined based on the age of the
678.30child on the date that the prospective adoptive parent or parents or relative custodian or
678.31custodians sign the agreement.
678.32(3) The income of the relative custodian or custodians or adoptive parent or parents
678.33must not be taken into consideration when determining eligibility for guardianship
678.34assistance or adoption assistance or the amount of the payments under section 256N.26.
678.35(4) With the concurrence of the relative custodian or adoptive parent, the amount of
678.36the payment may be adjusted periodically using the assessment tool established by the
679.1commissioner in section 256N.24, subdivision 2, and the agreement renegotiated under
679.2subdivision 3 when there is a change in the child's needs or the family's circumstances.
679.3(5) The guardianship assistance or adoption assistance agreement of a child who is
679.4identified as at-risk receives the special at-risk monthly payment under section 256N.26,
679.5subdivision 7, unless and until the potential disability manifests itself, as documented by
679.6an appropriate professional, and the commissioner authorizes commencement of payment
679.7by modifying the agreement accordingly. A relative custodian or adoptive parent of an
679.8at-risk child with a guardianship assistance or adoption assistance agreement may request
679.9a reassessment of the child under section 256N.24, subdivision 9, and renegotiation of
679.10the guardianship assistance or adoption assistance agreement under subdivision 3 to
679.11include a monthly payment, if the caregiver has written documentation from a qualified
679.12expert that the potential disability upon which eligibility for the agreement was based has
679.13manifested itself. Documentation of the disability must be limited to evidence deemed
679.14appropriate by the commissioner.
679.15(c) For guardianship assistance agreements:
679.16(1) the initial amount of the monthly guardianship assistance payment must be
679.17equivalent to the foster care rate in effect at the time that the agreement is signed less any
679.18offsets under section 256N.26, subdivision 11, or a lesser negotiated amount if agreed to
679.19by the prospective relative custodian and specified in that agreement, unless the child is
679.20identified as at-risk or the guardianship assistance agreement is entered into when a child
679.21is under the age of six;
679.22(2) an at-risk child must be assigned level A as outlined in section 256N.26 and
679.23receive the special at-risk monthly payment under section 256N.26, subdivision 7, unless
679.24and until the potential disability manifests itself, as documented by a qualified expert, and
679.25the commissioner authorizes commencement of payment by modifying the agreement
679.26accordingly; and
679.27(3) the amount of the monthly payment for a guardianship assistance agreement for
679.28a child, other than an at-risk child, who is under the age of six must be as specified in
679.29section 256N.26, subdivision 5.
679.30(d) For adoption assistance agreements:
679.31(1) for a child in foster care with the prospective adoptive parent immediately prior
679.32to adoptive placement, the initial amount of the monthly adoption assistance payment
679.33must be equivalent to the foster care rate in effect at the time that the agreement is signed
679.34less any offsets in section 256N.26, subdivision 11, or a lesser negotiated amount if agreed
679.35to by the prospective adoptive parents and specified in that agreement, unless the child is
680.1identified as at-risk or the adoption assistance agreement is entered into when a child is
680.2under the age of six;
680.3(2) an at-risk child must be assigned level A as outlined in section 256N.26 and
680.4receive the special at-risk monthly payment under section 256N.26, subdivision 7, unless
680.5and until the potential disability manifests itself, as documented by an appropriate
680.6professional, and the commissioner authorizes commencement of payment by modifying
680.7the agreement accordingly;
680.8(3) the amount of the monthly payment for an adoption assistance agreement for
680.9a child under the age of six, other than an at-risk child, must be as specified in section
680.10256N.26, subdivision 5;
680.11(4) for a child who is in the guardianship assistance program immediately prior
680.12to adoptive placement, the initial amount of the adoption assistance payment must be
680.13equivalent to the guardianship assistance payment in effect at the time that the adoption
680.14assistance agreement is signed or a lesser amount if agreed to by the prospective adoptive
680.15parent and specified in that agreement; and
680.16(5) for a child who is not in foster care placement or the guardianship assistance
680.17program immediately prior to adoptive placement or negotiation of the adoption assistance
680.18agreement, the initial amount of the adoption assistance agreement must be determined
680.19using the assessment tool and process in this section and the corresponding payment
680.20amount outlined in section 256N.26.
680.21    Subd. 3. Renegotiation of agreement. (a) A relative custodian or adoptive
680.22parent of a child with a guardianship assistance or adoption assistance agreement may
680.23request renegotiation of the agreement when there is a change in the needs of the child
680.24or in the family's circumstances. When a relative custodian or adoptive parent requests
680.25renegotiation of the agreement, a reassessment of the child must be completed consistent
680.26with section 256N.24, subdivisions 9 and 10. If the reassessment indicates that the
680.27child's level has changed, the financially responsible agency or, if there is no financially
680.28responsible agency, the agency designated by the commissioner or the commissioner's
680.29designee, and the caregiver must renegotiate the agreement to include a payment with
680.30the level determined through the reassessment process. The agreement must not be
680.31renegotiated unless the commissioner, the financially responsible agency, and the caregiver
680.32mutually agree to the changes. The effective date of any renegotiated agreement must be
680.33determined by the commissioner.
680.34(b) A relative custodian or adoptive parent of an at-risk child with a guardianship
680.35assistance or adoption assistance agreement may request renegotiation of the agreement to
680.36include a monthly payment higher than the special at-risk monthly payment under section
681.1256N.26, subdivision 7, if the caregiver has written documentation from a qualified
681.2expert that the potential disability upon which eligibility for the agreement was based has
681.3manifested itself. Documentation of the disability must be limited to evidence deemed
681.4appropriate by the commissioner. Prior to renegotiating the agreement, a reassessment
681.5of the child must be conducted as outlined in section 256N.24, subdivision 9. The
681.6reassessment must be used to renegotiate the agreement to include an appropriate monthly
681.7payment. The agreement must not be renegotiated unless the commissioner, the financially
681.8responsible agency, and the caregiver mutually agree to the changes. The effective date of
681.9any renegotiated agreement must be determined by the commissioner.
681.10(c) Renegotiation of a guardianship assistance or adoption assistance agreement is
681.11required when one of the circumstances outlined in section 256N.26, subdivision 13,
681.12occurs.

681.13    Sec. 13. [256N.26] BENEFITS AND PAYMENTS.
681.14    Subdivision 1. Benefits. (a) There are three benefits under Northstar Care for
681.15Children: medical assistance, basic payment, and supplemental difficulty of care payment.
681.16(b) A child is eligible for medical assistance under subdivision 2.
681.17(c) A child is eligible for the basic payment under subdivision 3, except for a child
681.18assigned level A under section 256N.24, subdivision 1, because the child is determined to
681.19be an at-risk child receiving guardianship assistance or adoption assistance.
681.20(d) A child, including a foster child age 18 to 21, is eligible for an additional
681.21supplemental difficulty of care payment under subdivision 4, as determined by the
681.22assessment under section 256N.24.
681.23(e) An eligible child entering guardianship assistance or adoption assistance under
681.24the age of six receives a basic payment and supplemental difficulty of care payment as
681.25specified in subdivision 5.
681.26(f) A child transitioning in from a pre-Northstar Care for Children program under
681.27section 256N.28, subdivision 7, shall receive basic and difficulty of care supplemental
681.28payments according to those provisions.
681.29    Subd. 2. Medical assistance. Eligibility for medical assistance under this chapter
681.30must be determined according to section 256B.055.
681.31    Subd. 3. Basic monthly rate. From January 1, 2015, to June 30, 2016, the basic
681.32monthly rate must be according to the following schedule:

681.33		Ages 0-5	$565 per month
681.34		Ages 6-12	$670 per month
681.35		Ages 13 and older	$790 per month

682.1    Subd. 4. Difficulty of care supplemental monthly rate. From January 1, 2015,
682.2to June 30, 2016, the supplemental difficulty of care monthly rate is determined by the
682.3following schedule:

682.4 682.5		Level A	none (special rate under subdivision 7 applies)
682.6		Level B	none (basic under subdivision 3 only)
682.7		Level C	$100 per month
682.8		Level D	$200 per month
682.9		Level E	$300 per month
682.10		Level F	$400 per month
682.11		Level G	$500 per month
682.12		Level H	$600 per month
682.13		Level I	$700 per month
682.14		Level J	$800 per month
682.15		Level K	$900 per month
682.16		Level L	$1,000 per month
682.17		Level M	$1,100 per month
682.18		Level N	$1,200 per month
682.19		Level O	$1,300 per month
682.20		Level P	$1,400 per month
682.21		Level Q	$1,500 per month

682.22A child assigned level A is not eligible for either the basic or supplemental difficulty
682.23of care payment, while a child assigned level B is not eligible for the supplemental
682.24difficulty of care payment but is eligible for the basic monthly rate under subdivision 3.
682.25    Subd. 5. Alternate rates for preschool entry and certain transitioned children.
682.26A child who entered the guardianship assistance or adoption assistance components
682.27of Northstar Care for Children while under the age of six shall receive 50 percent of
682.28the amount the child would otherwise be entitled to under subdivisions 3 and 4. The
682.29commissioner may also use the 50 percent rate for a child who was transitioned into those
682.30components through declaration of the commissioner under section 256N.28, subdivision 7.
682.31    Subd. 6. Emergency foster care rate for initial placement. (a) A child who enters
682.32foster care due to immediate custody by a police officer or court order, consistent with
682.33section 260C.175, subdivisions 1 and 2, or equivalent provision under tribal code, shall
682.34receive the emergency foster care rate for up to 30 days. The emergency foster care rate
682.35cannot be extended beyond 30 days of the child's placement.
682.36(b) For this payment rate to be applied, at least one of three conditions must apply:
682.37(1) the child's initial placement must be in foster care in Minnesota;
682.38(2) the child's previous placement was more than two years ago; or
683.1(3) the child's previous placement was for fewer than 30 days and an assessment
683.2under section 256N.24 was not completed by an agency under section 256N.24.
683.3(c) The emergency foster care rate consists of the appropriate basic monthly rate
683.4under subdivision 3 plus a difficulty of care supplemental monthly rate of level D under
683.5subdivision 4.
683.6(d) The emergency foster care rate ends under any of three conditions:
683.7(1) when an assessment under section 256N.24 is completed;
683.8(2) when the placement ends; or
683.9(3) after 30 days have elapsed.
683.10(e) The financially responsible agency, in consultation with the legally responsible
683.11agency, if different, may replace the emergency foster care rate at any time by completing
683.12an initial assessment on which a revised difficulty of care supplemental monthly rate
683.13would be based. Consistent with section 256N.24, subdivision 9, the caregiver may
683.14request a reassessment in writing for an initial assessment to replace the emergency foster
683.15care rate. This written request would initiate an initial assessment under section 256N.24,
683.16subdivision 5. If the revised difficulty of care supplemental level based on the initial
683.17assessment is higher than level D, then the revised higher rate shall apply retroactively to
683.18the beginning of the placement. If the revised level is lower, the lower rate shall apply on
683.19the date the initial assessment was completed.
683.20(f) If a child remains in foster care placement for more than 30 days, the emergency
683.21foster care rate ends after the 30th day of placement and an assessment under section
683.22256N.26 must be completed.
683.23    Subd. 7. Special at-risk monthly payment for at-risk children in guardianship
683.24assistance and adoption assistance. A child eligible for guardianship assistance under
683.25section 256N.22 or adoption assistance under section 256N.23 who is determined to be
683.26an at-risk child shall receive a special at-risk monthly payment of $1 per month basic,
683.27unless and until the potential disability manifests itself and the agreement is renegotiated
683.28to include reimbursement. Such an at-risk child shall receive neither a supplemental
683.29difficulty of care monthly rate under subdivision 4 nor home and vehicle modifications
683.30under subdivision 10, but must be considered for medical assistance under subdivision 2.
683.31    Subd. 8. Daily rates. (a) The commissioner shall establish prorated daily rates to
683.32the nearest cent for the monthly rates under subdivisions 3 to 7. Daily rates must be
683.33routinely used when a partial month is involved for foster care, guardianship assistance, or
683.34adoption assistance.
684.1(b) A full month payment is permitted if a foster child is temporarily absent from
684.2the foster home if the brief absence does not exceed 14 days and the child's placement
684.3continues with the same caregiver.
684.4    Subd. 9. Revision. By April 1, 2016, for fiscal year 2017, and by each succeeding
684.5April 1 for the subsequent fiscal year, the commissioner shall review and revise the rates
684.6under subdivisions 3 to 7 based on the United States Department of Agriculture, Estimates
684.7of the Cost of Raising a Child, published by the United States Department of Agriculture,
684.8Agricultural Resources Service, Publication 1411. The revision shall be the average
684.9percentage by which costs increase for the age ranges represented in the United States
684.10Department of Agriculture, Estimates of the Cost of Raising a Child, except that in no
684.11instance must the increase be more than three percent per annum. The monthly rates must
684.12be revised to the nearest dollar and the daily rates to the nearest cent.
684.13    Subd. 10. Home and vehicle modifications. (a) Except for a child assigned level A
684.14under section 256N.24, subdivision 1, paragraph (d), clause (1), a child who is eligible
684.15for an adoption assistance agreement may have reimbursement of home and vehicle
684.16modifications necessary to accommodate the child's special needs upon which eligibility
684.17for adoption assistance was based and included as part of the negotiation of the agreement
684.18under section 256N.25, subdivision 2. Reimbursement of home and vehicle modifications
684.19must not be available for a child who is assessed at level A under subdivision 1, unless
684.20and until the potential disability manifests itself and the agreement is renegotiated to
684.21include reimbursement.
684.22(b) Application for and reimbursement of modifications must be completed
684.23according to a process specified by the commissioner. The type and cost of each
684.24modification must be preapproved by the commissioner. The type of home and vehicle
684.25modifications must be limited to those specified by the commissioner.
684.26(c) Reimbursement for home modifications as outlined in this subdivision is limited
684.27to once every five years per child. Reimbursement for vehicle modifications as outlined in
684.28this subdivision is limited to once every five years per family.
684.29    Subd. 11. Child income or income attributable to the child. (a) A monthly
684.30guardianship assistance or adoption assistance payment must be considered as income
684.31and resources attributable to the child. Guardianship assistance and adoption assistance
684.32are exempt from garnishment, except as permissible under the laws of the state where the
684.33child resides.
684.34(b) When a child is placed into foster care, any income and resources attributable
684.35to the child are treated as provided in sections 252.27 and 260C.331, or 260B.331, as
684.36applicable to the child being placed.
685.1(c) Consideration of income and resources attributable to the child must be part of
685.2the negotiation process outlined in section 256N.25, subdivision 2. In some circumstances,
685.3the receipt of other income on behalf of the child may impact the amount of the monthly
685.4payment received by the relative custodian or adoptive parent on behalf of the child
685.5through Northstar Care for Children. Supplemental Security Income (SSI), retirement
685.6survivor's disability insurance (RSDI), veteran's benefits, railroad retirement benefits, and
685.7black lung benefits are considered income and resources attributable to the child.
685.8    Subd. 12. Treatment of Supplemental Security Income. If a child placed in foster
685.9care receives benefits through Supplemental Security Income (SSI) at the time of foster
685.10care placement or subsequent to placement in foster care, the financially responsible
685.11agency may apply to be the payee for the child for the duration of the child's placement in
685.12foster care. If a child continues to be eligible for SSI after finalization of the adoption or
685.13transfer of permanent legal and physical custody and is determined to be eligible for a
685.14payment under Northstar Care for Children, a permanent caregiver may choose to receive
685.15payment from both programs simultaneously. The permanent caregiver is responsible
685.16to report the amount of the payment to the Social Security Administration and the SSI
685.17payment will be reduced as required by the Social Security Administration.
685.18    Subd. 13. Treatment of retirement survivor's disability insurance, veteran's
685.19benefits, railroad retirement benefits, and black lung benefits. (a) If a child placed
685.20in foster care receives retirement survivor's disability insurance, veteran's benefits,
685.21railroad retirement benefits, or black lung benefits at the time of foster care placement or
685.22subsequent to placement in foster care, the financially responsible agency may apply to
685.23be the payee for the child for the duration of the child's placement in foster care. If it is
685.24anticipated that a child will be eligible to receive retirement survivor's disability insurance,
685.25veteran's benefits, railroad retirement benefits, or black lung benefits after finalization
685.26of the adoption or assignment of permanent legal and physical custody, the permanent
685.27caregiver shall apply to be the payee of those benefits on the child's behalf. The monthly
685.28amount of the other benefits must be considered an offset to the amount of the payment
685.29the child is determined eligible for under Northstar Care for Children.
685.30(b) If a child becomes eligible for retirement survivor's disability insurance, veteran's
685.31benefits, railroad retirement benefits, or black lung benefits, after the initial amount of the
685.32payment under Northstar Care for Children is finalized, the permanent caregiver shall
685.33contact the commissioner to redetermine the payment under Northstar Care for Children.
685.34The monthly amount of the other benefits must be considered an offset to the amount of
685.35the payment the child is determined eligible for under Northstar Care for Children.
686.1(c) If a child ceases to be eligible for retirement survivor's disability insurance,
686.2veteran's benefits, railroad retirement benefits, or black lung benefits after the initial amount
686.3of the payment under Northstar Care for Children is finalized, the permanent caregiver
686.4shall contact the commissioner to redetermine the payment under Northstar Care for
686.5Children. The monthly amount of the payment under Northstar Care for Children must be
686.6the amount the child was determined to be eligible for prior to consideration of any offset.
686.7(d) If the monthly payment received on behalf of the child under retirement survivor's
686.8disability insurance, veteran's benefits, railroad retirement benefits, or black lung benefits
686.9changes after the adoption assistance or guardianship assistance agreement is finalized,
686.10the permanent caregiver shall notify the commissioner as to the new monthly payment
686.11amount, regardless of the amount of the change in payment. If the monthly payment
686.12changes by $75 or more, even if the change occurs incrementally over the duration of
686.13the term of the adoption assistance or guardianship assistance agreement, the monthly
686.14payment under Northstar Care for Children must be adjusted without further consent
686.15to reflect the amount of the increase or decrease in the offset amount. Any subsequent
686.16change to the payment must be reported and handled in the same manner. A change of
686.17monthly payments of less than $75 is not a permissible reason to renegotiate the adoption
686.18assistance or guardianship assistance agreement under section 256N.25, subdivision 3.
686.19The commissioner shall review and revise the limit at which the adoption assistance or
686.20guardian assistance agreement must be renegotiated in accordance with subdivision 9.
686.21    Subd. 14. Treatment of child support and Minnesota family investment
686.22program. (a) If a child placed in foster care receives child support, the child support
686.23payment may be redirected to the financially responsible agency for the duration of the
686.24child's placement in foster care. In cases where the child qualifies for Northstar Care
686.25for Children by meeting the adoption assistance eligibility criteria or the guardianship
686.26assistance eligibility criteria, any court-ordered child support must not be considered
686.27income attributable to the child and must have no impact on the monthly payment.
686.28(b) Consistent with section 256J.24, a child eligible for Northstar Care for Children
686.29whose caregiver receives a payment on the child's behalf is excluded from a Minnesota
686.30family investment program assistance unit.
686.31    Subd. 15. Payments. (a) Payments to caregivers under Northstar Care for Children
686.32must be made monthly. Consistent with section 256N.24, subdivision 12, the financially
686.33responsible agency must send the caregiver the required written notice within 15 days of
686.34a completed assessment or reassessment.
686.35(b) Unless paragraph (c) or (d) applies, the financially responsible agency shall pay
686.36foster parents directly for eligible children in foster care.
687.1(c) When the legally responsible agency is different than the financially responsible
687.2agency, the legally responsible agency may make the payments to the caregiver, provided
687.3payments are made on a timely basis. The financially responsible agency must pay
687.4the legally responsible agency on a timely basis. Caregivers must have access to the
687.5financially and legally responsible agencies' records of the transaction, consistent with
687.6the retention schedule for the payments.
687.7(d) For eligible children in foster care, the financially responsible agency may pay
687.8the foster parent's payment for a licensed child-placing agency instead of paying the foster
687.9parents directly. The licensed child-placing agency must timely pay the foster parents
687.10and maintain records of the transaction. Caregivers must have access to the financially
687.11responsible agency's records of the transaction and the child-placing agency's records of
687.12the transaction, consistent with the retention schedule for the payments.
687.13    Subd. 16. Effect of benefit on other aid. Payments received under this section
687.14must not be considered as income for child care assistance under chapter 119B or any
687.15other financial benefit. Consistent with section 256J.24, a child receiving a maintenance
687.16payment under Northstar Care for Children is excluded from any Minnesota family
687.17investment program assistance unit.
687.18    Subd. 17. Home and community-based services waiver for persons with
687.19disabilities. A child in foster care may qualify for home and community-based waivered
687.20services, consistent with section 256B.092 for developmental disabilities, or section
687.21256B.49 for community alternative care, community alternatives for disabled individuals,
687.22or traumatic brain injury waivers. A waiver service must not be substituted for the foster
687.23care program. When the child is simultaneously eligible for waivered services and for
687.24benefits under Northstar Care for Children, the financially responsible agency must
687.25assess and provide basic and supplemental difficulty of care rates as determined by the
687.26assessment according to section 256N.24. If it is determined that additional services are
687.27needed to meet the child's needs in the home that is not or cannot be met by the foster care
687.28program, the need would be referred to the local waivered service program.
687.29    Subd. 18. Overpayments. The commissioner has the authority to collect any
687.30amount of foster care payment, adoption assistance, or guardianship assistance paid
687.31to a caregiver in excess of the payment due. Payments covered by this subdivision
687.32include basic maintenance needs payments, supplemental difficulty of care payments, and
687.33reimbursement of home and vehicle modifications under subdivision 10. Prior to any
687.34collection, the commissioner or the commissioner's designee shall notify the caregiver in
687.35writing, including:
687.36(1) the amount of the overpayment and an explanation of the cause of overpayment;
688.1(2) clarification of the corrected amount;
688.2(3) a statement of the legal authority for the decision;
688.3(4) information about how the caregiver can correct the overpayment;
688.4(5) if repayment is required, when the payment is due and a person to contact to
688.5review a repayment plan;
688.6(6) a statement that the caregiver has a right to a fair hearing review by the
688.7department; and
688.8(7) the procedure for seeking a fair hearing review by the department.
688.9    Subd. 19. Payee. For adoption assistance and guardianship assistance cases, the
688.10payment must only be made to the adoptive parent or relative custodian specified on the
688.11agreement. If there is more than one adoptive parent or relative custodian, both parties will
688.12be listed as the payee unless otherwise specified in writing according to policies outlined
688.13by the commissioner. In the event of divorce or separation of the caregivers, a change of
688.14payee must be made in writing according to policies outlined by the commissioner. If both
688.15caregivers are in agreement as to the change, it may be made according to a process outlined
688.16by the commissioner. If there is not agreement as to the change, a court order indicating
688.17the party who is to receive the payment is needed before a change can be processed. If the
688.18change of payee is disputed, the commissioner may withhold the payment until agreement
688.19is reached. A noncustodial caregiver may request notice in writing of review, modification,
688.20or termination of the adoption assistance or guardianship assistance agreement. In the
688.21event of the death of a payee, a change of payee consistent with sections 256N.22 and
688.22256N.23 may be made in writing according to policies outlined by the commissioner.
688.23    Subd. 20. Notification of change. (a) A caregiver who has an adoption assistance
688.24agreement or guardianship assistance agreement in place shall keep the agency
688.25administering the program informed of changes in status or circumstances which would
688.26make the child ineligible for the payments or eligible for payments in a different amount.
688.27(b) For the duration of the agreement, the caregiver agrees to notify the agency
688.28administering the program in writing within 30 days of any of the following:
688.29(1) a change in the child's or caregiver's legal name;
688.30(2) a change in the family's address;
688.31(3) a change in the child's legal custody status;
688.32(4) the child's completion of high school, if this occurs after the child attains age 18;
688.33(5) the end of the caregiver's legal responsibility to support the child based on
688.34termination of parental rights of the caregiver, transfer of guardianship to another person,
688.35or transfer of permanent legal and physical custody to another person;
688.36(6) the end of the caregiver's financial support of the child;
689.1(7) the death of the child;
689.2(8) the death of the caregiver;
689.3(9) the child enlists in the military;
689.4(10) the child gets married;
689.5(11) the child becomes an emancipated minor through legal action;
689.6(12) the caregiver separates or divorces; and
689.7(13) the child is residing outside the caregiver's home for a period of more than
689.830 consecutive days.
689.9    Subd. 21. Correct and true information. The caregiver must be investigated for
689.10fraud if the caregiver reports information the caregiver knows is untrue, the caregiver
689.11fails to notify the commissioner of changes that may affect eligibility, or the agency
689.12administering the program receives relevant information that the caregiver did not report.
689.13    Subd. 22. Termination notice for caregiver. The agency that issues the
689.14maintenance payment shall provide the child's caregiver with written notice of termination
689.15of payment. Termination notices must be sent at least 15 days before the final payment or,
689.16in the case of an unplanned termination, the notice is sent within three days of the end of
689.17the payment. The written notice must minimally include the following:
689.18(1) the date payment will end;
689.19(2) the reason payments will end and the event that is the basis to terminate payment;
689.20(3) a statement that the provider has a right to a fair hearing review by the department
689.21consistent with section 256.045, subdivision 3;
689.22(4) the procedure to request a fair hearing; and
689.23(5) the name, telephone number, and e-mail address of a contact person at the agency.

689.24    Sec. 14. [256N.27] FEDERAL, STATE, AND LOCAL SHARES.
689.25    Subdivision 1. Federal share. For the purposes of determining a child's eligibility
689.26under title IV-E of the Social Security Act for a child in foster care, the financially
689.27responsible agency shall use the eligibility requirements outlined in section 472 of the
689.28Social Security Act. For a child who qualifies for guardianship assistance or adoption
689.29assistance, the financially responsible agency and the commissioner shall use the
689.30eligibility requirements outlined in section 473 of the Social Security Act. In each case,
689.31the agency paying the maintenance payments must be reimbursed for the costs from the
689.32federal money available for this purpose.
689.33    Subd. 2. State share. The commissioner shall pay the state share of the maintenance
689.34payments as determined under subdivision 4, and an identical share of the pre-Northstar
689.35Care foster care program under section 260C.4411, subdivision 1, the relative custody
690.1assistance program under section 257.85, and the pre-Northstar Care for Children adoption
690.2assistance program under chapter 259A. The commissioner may transfer funds into the
690.3account if a deficit occurs.
690.4    Subd. 3. Local share. (a) The financially responsible agency at the time of
690.5placement for foster care or finalization of the agreement for guardianship assistance or
690.6adoption assistance shall pay the local share of the maintenance payments as determined
690.7under subdivision 4, and an identical share of the pre-Northstar Care for Children foster
690.8care program under section 260C.4411, subdivision 1, the relative custody assistance
690.9program under section 257.85, and the pre-Northstar Care for Children adoption assistance
690.10program under chapter 259A.
690.11(b) The financially responsible agency shall pay the entire cost of any initial clothing
690.12allowance, administrative payments to child caring agencies specified in section 317A.907,
690.13or other support services it authorizes, except as provided under other provisions of law.
690.14(c) In cases of federally required adoption assistance where there is no financially
690.15responsible agency as provided in section 256N.24, subdivision 5, the commissioner
690.16shall pay the local share.
690.17(d) When an Indian child being placed in Minnesota meets title IV-E eligibility
690.18defined in section 473(d) of the Social Security Act and is receiving guardianship
690.19assistance or adoption assistance, the agency or entity assuming responsibility for the
690.20child is responsible for the nonfederal share of the payment.
690.21    Subd. 4. Nonfederal share. (a) The commissioner shall establish a percentage share
690.22of the maintenance payments, reduced by federal reimbursements under title IV-E of the
690.23Social Security Act, to be paid by the state and to be paid by the financially responsible
690.24agency.
690.25(b) These state and local shares must initially be calculated based on the ratio of the
690.26average appropriate expenditures made by the state and all financially responsible agencies
690.27during calendar years 2011, 2012, 2013, and 2014. For purposes of this calculation,
690.28appropriate expenditures for the financially responsible agencies must include basic and
690.29difficulty of care payments for foster care reduced by federal reimbursements, but not
690.30including any initial clothing allowance, administrative payments to child care agencies
690.31specified in section 317A.907, child care, or other support or ancillary expenditures. For
690.32purposes of this calculation, appropriate expenditures for the state shall include adoption
690.33assistance and relative custody assistance, reduced by federal reimbursements.
690.34(c) For each of the periods January 1, 2015, to June 30, 2016, and fiscal years 2017,
690.352018, and 2019, the commissioner shall adjust this initial percentage of state and local
690.36shares to reflect the relative expenditure trends during calendar years 2011, 2012, 2013, and
691.12014, taking into account appropriations for Northstar Care for Children and the turnover
691.2rates of the components. In making these adjustments, the commissioner's goal shall be to
691.3make these state and local expenditures other than the appropriations for Northstar Care for
691.4Children to be the same as they would have been had Northstar Care for Children not been
691.5implemented, or if that is not possible, proportionally higher or lower, as appropriate. The
691.6state and local share percentages for fiscal year 2019 must be used for all subsequent years.
691.7    Subd. 5. Adjustments for proportionate shares among financially responsible
691.8agencies. (a) The commissioner shall adjust the expenditures under subdivision 4 by each
691.9financially responsible agency so that its relative share is proportional to its foster care
691.10expenditures, with the goal of making the local share similar to what the county or tribe
691.11would have spent had Northstar Care for Children not been enacted.
691.12(b) For the period January 1, 2015, to June 30, 2016, the relative shares must be as
691.13determined under subdivision 4 for calendar years 2011, 2012, 2013, and 2014 compared
691.14with similar costs of all financially responsible agencies.
691.15(c) For subsequent fiscal years, the commissioner shall update the relative shares
691.16based on actual utilization of Northstar Care for Children by the financially responsible
691.17agencies during the previous period, so that those using relatively more than they did
691.18historically are adjusted upward and those using less are adjusted downward.
691.19(d) The commissioner must ensure that the adjustments are not unduly influenced by
691.20onetime events, anomalies, small changes that appear large compared to a narrow historic
691.21base, or fluctuations that are the results of the transfer of responsibilities to tribal social
691.22service agencies authorized in section 256.01, subdivision 14b, as part of the American
691.23Indian Child Welfare Initiative.

691.24    Sec. 15. [256N.28] ADMINISTRATION AND APPEALS.
691.25    Subdivision 1. Responsibilities. (a) The financially responsible agency shall
691.26determine the eligibility for Northstar Care for Children for children in foster care under
691.27section 256N.21, and for those children determined eligible, shall further determine each
691.28child's eligibility for title IV-E of the Social Security Act, provided the agency has such
691.29authority under the state title IV-E plan.
691.30(b) Subject to commissioner review and approval, the financially responsible agency
691.31shall prepare the eligibility determination for Northstar Care for Children for children in
691.32guardianship assistance under section 256N.22 and children in adoption assistance under
691.33section 256N.23. The AFDC relatedness determination, when necessary to determine a
691.34child's eligibility for title IV-E funding, shall be made only by an authorized agency
691.35according to policies and procedures prescribed by the commissioner.
692.1(c) The financially responsible agency is responsible for the administration of
692.2Northstar Care for Children for children in foster care. The agency designated by the
692.3commissioner is responsible for assisting the commissioner with the administration of
692.4Northstar Care for Children for children in guardianship assistance and adoption assistance
692.5by conducting assessments, reassessments, negotiations, and other activities as specified
692.6by the commissioner under subdivision 2.
692.7    Subd. 2. Procedures, requirements, and deadlines. The commissioner shall
692.8specify procedures, requirements, and deadlines for the administration of Northstar Care
692.9for Children in accordance with sections 256N.001 to 256N.28, including for children
692.10transitioning into Northstar Care for Children under subdivision 7. The commissioner
692.11shall periodically review all procedures, requirements, and deadlines, including the
692.12assessment tool and process under section 256N.24, in consultation with counties, tribes,
692.13and representatives of caregivers, and may alter them as needed.
692.14    Subd. 3. Administration of title IV-E programs. The title IV-E foster care,
692.15guardianship assistance, and adoption assistance programs must operate within the
692.16statutes, rules, and policies set forth by the federal government in the Social Security Act.
692.17    Subd. 4. Reporting. The commissioner shall specify required fiscal and statistical
692.18reports under section 256.01, subdivision 2, paragraph (q), and other reports as necessary.
692.19    Subd. 5. Promotion of programs. Families who adopt a child under the
692.20commissioner's guardianship must be informed as to the adoption tax credit. The
692.21commissioner shall actively seek ways to promote the guardianship assistance and
692.22adoption assistance programs, including informing prospective caregivers of eligible
692.23children of the availability of guardianship assistance and adoption assistance.
692.24    Subd. 6. Appeals and fair hearings. (a) A caregiver has the right to appeal to the
692.25commissioner under section 256.045 when eligibility for Northstar Care for Children is
692.26denied, and when payment or the agreement for an eligible child is modified or terminated.
692.27(b) A relative custodian or adoptive parent has additional rights to appeal to the
692.28commissioner pursuant to section 256.045. These rights include when the commissioner
692.29terminates or modifies the guardianship assistance or adoption assistance agreement or
692.30when the commissioner denies an application for guardianship assistance or adoption
692.31assistance. A prospective relative custodian or adoptive parent who disagrees with a
692.32decision by the commissioner before transfer of permanent legal and physical custody or
692.33finalization of the adoption may request review of the decision by the commissioner or
692.34may appeal the decision under section 256.045. A guardianship assistance or adoption
692.35assistance agreement must be signed and in effect before the court order that transfers
692.36permanent legal and physical custody or the adoption finalization; however, in some cases,
693.1there may be extenuating circumstances as to why an agreement was not entered into
693.2before finalization of permanency for the child. Caregivers who believe that extenuating
693.3circumstances exist in the case of their child may request a fair hearing. Caregivers have the
693.4responsibility of proving that extenuating circumstances exist. Caregivers must be required
693.5to provide written documentation of each eligibility criterion at the fair hearing. Examples
693.6of extenuating circumstances include: relevant facts regarding the child were known by
693.7the placing agency and not presented to the caregivers before transfer of permanent legal
693.8and physical custody or finalization of the adoption, or failure by the commissioner or a
693.9designee to advise potential caregivers about the availability of guardianship assistance or
693.10adoption assistance for children in the state foster care system. If an appeals judge finds
693.11through the fair hearing process that extenuating circumstances existed and that the child
693.12met all eligibility criteria at the time the transfer of permanent legal and physical custody
693.13was ordered or the adoption was finalized, the effective date and any associated federal
693.14financial participation shall be retroactive from the date of the request for a fair hearing.
693.15    Subd. 7. Transitions from pre-Northstar Care for Children programs. (a) A child
693.16in foster care who remains with the same caregiver shall continue to receive benefits under
693.17the pre-Northstar Care for Children foster care program under section 256.82. Transitions
693.18to Northstar Care for Children must occur as provided in section 256N.21, subdivision 6.
693.19(b) The commissioner may seek to transition into Northstar Care for Children a child
693.20who is in pre-Northstar Care for Children relative custody assistance under section 257.85
693.21or pre-Northstar Care for Children adoption assistance under chapter 259A, in accordance
693.22with these priorities, in order of priority:
693.23(1) financial and budgetary constraints;
693.24(2) complying with federal regulations;
693.25(3) converting pre-Northstar Care for Children relative custody assistance under
693.26section 257.85 to the guardianship assistance component of Northstar Care for Children;
693.27(4) improving permanency for a child or children;
693.28(5) maintaining permanency for a child or children;
693.29(6) accessing additional federal funds; and
693.30(7) administrative simplification.
693.31(c) Transitions shall be accomplished according to procedures, deadlines, and
693.32requirements specified by the commissioner under subdivision 2.
693.33(d) The commissioner may accomplish a transition of a child from pre-Northstar
693.34Care for Children relative custody assistance under section 257.85 to the guardianship
693.35assistance component of Northstar Care for Children by declaration and appropriate notice
693.36to the caregiver, provided that the benefit for a child under this paragraph is not reduced.
694.1(e) The commissioner may offer a transition of a child from pre-Northstar Care for
694.2Children adoption assistance under chapter 259A to the adoption assistance component
694.3of Northstar Care for Children by contacting the caregiver with an offer. The transition
694.4must be accomplished only when the caregiver agrees to the offer. The caregiver shall
694.5have a maximum of 90 days to review and accept the commissioner's offer. If the
694.6commissioner's offer is not accepted within 90 days, the pre-Northstar Care for Children
694.7adoption assistance agreement remains in effect until it terminates or a subsequent offer is
694.8made by the commissioner.
694.9(f) For a child transitioning into Northstar Care for Children, the commissioner shall
694.10assign an equivalent assessment level based on the most recently completed supplemental
694.11difficulty of care level assessment, unless the commissioner determines that arranging
694.12for a new assessment under section 256N.24 would be more appropriate based on the
694.13priorities specified in paragraph (b).
694.14(g) For a child transitioning into Northstar Care for Children, regardless of the age
694.15of the child, the commissioner shall use the rates under section 256N.26, subdivision 5,
694.16unless the rates under section 256N.26, subdivisions 3 and 4, are more appropriate based
694.17on the priorities specified in paragraph (b), as determined by the commissioner.
694.18    Subd. 8. Purchase of child-specific adoption services. The commissioner may
694.19reimburse the placing agency for appropriate adoption services for children eligible
694.20under section 259A.75.

694.21    Sec. 16. Minnesota Statutes 2012, section 257.85, subdivision 2, is amended to read:
694.22    Subd. 2. Scope. The provisions of this section apply to those situations in which
694.23the legal and physical custody of a child is established with a relative or important friend
694.24with whom the child has resided or had significant contact according to section 260C.515,
694.25subdivision 4, by a district court order issued on or after July 1, 1997, but on or before
694.26November 26, 2014, or a tribal court order issued on or after July 1, 2005, but on or
694.27before November 26, 2014, when the child has been removed from the care of the parent
694.28by previous district or tribal court order.

694.29    Sec. 17. Minnesota Statutes 2012, section 257.85, subdivision 5, is amended to read:
694.30    Subd. 5. Relative custody assistance agreement. (a) A relative custody assistance
694.31agreement will not be effective, unless it is signed by the local agency and the relative
694.32custodian no later than 30 days after the date of the order establishing permanent legal and
694.33physical custody, and on or before November 26, 2014, except that a local agency may
694.34enter into a relative custody assistance agreement with a relative custodian more than 30
695.1days after the date of the order if it certifies that the delay in entering the agreement was
695.2through no fault of the relative custodian and the agreement is signed and in effect on or
695.3before November 26, 2014. There must be a separate agreement for each child for whom
695.4the relative custodian is receiving relative custody assistance.
695.5(b) Regardless of when the relative custody assistance agreement is signed by the
695.6local agency and relative custodian, the effective date of the agreement shall be the date of
695.7the order establishing permanent legal and physical custody.
695.8(c) If MFIP is not the applicable program for a child at the time that a relative
695.9custody assistance agreement is entered on behalf of the child, when MFIP becomes
695.10the applicable program, if the relative custodian had been receiving custody assistance
695.11payments calculated based upon a different program, the amount of relative custody
695.12assistance payment under subdivision 7 shall be recalculated under the Minnesota family
695.13investment program.
695.14(d) The relative custody assistance agreement shall be in a form specified by the
695.15commissioner and shall include provisions relating to the following:
695.16(1) the responsibilities of all parties to the agreement;
695.17(2) the payment terms, including the financial circumstances of the relative
695.18custodian, the needs of the child, the amount and calculation of the relative custody
695.19assistance payments, and that the amount of the payments shall be reevaluated annually;
695.20(3) the effective date of the agreement, which shall also be the anniversary date for
695.21the purpose of submitting the annual affidavit under subdivision 8;
695.22(4) that failure to submit the affidavit as required by subdivision 8 will be grounds
695.23for terminating the agreement;
695.24(5) the agreement's expected duration, which shall not extend beyond the child's
695.25eighteenth birthday;
695.26(6) any specific known circumstances that could cause the agreement or payments
695.27to be modified, reduced, or terminated and the relative custodian's appeal rights under
695.28subdivision 9;
695.29(7) that the relative custodian must notify the local agency within 30 days of any of
695.30the following:
695.31(i) a change in the child's status;
695.32(ii) a change in the relationship between the relative custodian and the child;
695.33(iii) a change in composition or level of income of the relative custodian's family;
695.34(iv) a change in eligibility or receipt of benefits under MFIP, or other assistance
695.35program; and
696.1(v) any other change that could affect eligibility for or amount of relative custody
696.2assistance;
696.3(8) that failure to provide notice of a change as required by clause (7) will be
696.4grounds for terminating the agreement;
696.5(9) that the amount of relative custody assistance is subject to the availability of state
696.6funds to reimburse the local agency making the payments;
696.7(10) that the relative custodian may choose to temporarily stop receiving payments
696.8under the agreement at any time by providing 30 days' notice to the local agency and may
696.9choose to begin receiving payments again by providing the same notice but any payments
696.10the relative custodian chooses not to receive are forfeit; and
696.11(11) that the local agency will continue to be responsible for making relative custody
696.12assistance payments under the agreement regardless of the relative custodian's place of
696.13residence.

696.14    Sec. 18. Minnesota Statutes 2012, section 257.85, subdivision 6, is amended to read:
696.15    Subd. 6. Eligibility criteria. (a) A local agency shall enter into a relative custody
696.16assistance agreement under subdivision 5 if it certifies that the following criteria are met:
696.17(1) the juvenile court has determined or is expected to determine that the child,
696.18under the former or current custody of the local agency, cannot return to the home of
696.19the child's parents;
696.20(2) the court, upon determining that it is in the child's best interests, has issued
696.21or is expected to issue an order transferring permanent legal and physical custody of
696.22the child; and
696.23(3) the child either:
696.24(i) is a member of a sibling group to be placed together; or
696.25(ii) has a physical, mental, emotional, or behavioral disability that will require
696.26financial support.
696.27When the local agency bases its certification that the criteria in clause (1) or (2) are
696.28met upon the expectation that the juvenile court will take a certain action, the relative
696.29custody assistance agreement does not become effective until and unless the court acts as
696.30expected.
696.31(b) After November 26, 2014, new relative custody assistance agreements must not
696.32be executed. Agreements that were signed by all parties on or before November 26, 2014,
696.33and were not in effect because the proposed transfer of permanent legal and physical
696.34custody of the child did not occur on or before November 26, 2014, must be renegotiated
696.35under the terms of Northstar Care for Children in chapter 256N.

697.1    Sec. 19. [259A.12] NO NEW EXECUTION OF ADOPTION ASSISTANCE
697.2AGREEMENTS.
697.3After November 26, 2014, new adoption assistance agreements must not be executed
697.4under this section. Agreements that were signed on or before November 26, 2014, and
697.5were not in effect because the adoption finalization of the child did not occur on or before
697.6November 26, 2014, must be renegotiated according to the terms of Northstar Care for
697.7Children under chapter 256N. Agreements signed and in effect on or before November 26,
697.82014, must continue according to the terms of this section and applicable rules for the
697.9duration of the agreement, unless the commissioner and the adoptive parents choose to
697.10renegotiated the agreements under Northstar Care for Children consistent with section
697.11256N.28, subdivision 7. After November 26, 2014, this section and associated rules must
697.12be referred to as the pre-Northstar Care for Children adoption assistance program and
697.13shall apply to children whose adoption assistance agreements were in effect on or before
697.14November 26, 2014, and whose adoptive parents have not renegotiated their agreements
697.15according to the terms of Northstar Care for Children.

697.16    Sec. 20. [260C.4411] PRE-NORTHSTAR CARE FOR CHILDREN FOSTER
697.17CARE PROGRAM.
697.18    Subdivision 1. Pre-Northstar Care for Children foster care program. (a) For a
697.19child placed in family foster care on or before December 31, 2014, the county of financial
697.20responsibility under section 256G.02 or tribal agency authorized under section 256.01,
697.21subdivision 14b, shall pay the local share under section 256N.27, subdivision 3, for foster
697.22care maintenance including any difficulty of care as defined in Minnesota Rules, part
697.239560.0521, subparts 7 and 10. Family foster care includes:
697.24(1) emergency relative placement under section 245A.035;
697.25(2) licensed foster family settings, foster residence settings, or treatment foster care
697.26settings, licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, and served by
697.27a public or private child care agency authorized by Minnesota Rules, parts 9545.0755
697.28to 9545.0845;
697.29(3) family foster care homes approved by a tribal agency; and
697.30(4) unlicensed supervised settings for foster youth ages 18 to 21.
697.31(b) The county of financial responsibility under section 256G.02 or tribal social
697.32services agency authorized in section 256.01, subdivision 14b, shall pay the entire cost of
697.33any initial clothing allowance, administrative payments to child care agencies specified
697.34in section 317A.907, or any other support services it authorizes, except as otherwise
697.35provided by law.
698.1(c) The rates for the pre-Northstar Care for Children foster care program remain
698.2those in effect on January 1, 2013, continuing the preexisting rate structure for foster
698.3children who remain with the same caregivers and do not transition into Northstar Care for
698.4Children under section 256N.21, subdivision 6.
698.5(d) Difficulty of care payments must be maintained consistent with Minnesota Rules,
698.6parts 9560.0652 and 9560.0653, using the established reassessment tool in Minnesota
698.7Rules, part 9560.0654. The preexisting rate structure for the pre-Northstar Care for
698.8Children foster care program must be maintained, provided that when the number of
698.9foster children in the program is less than ten percent of the population in 2012, the
698.10commissioner may apply the same assessment tool to both the pre-Northstar Care for
698.11Children foster care program and Northstar Care for Children under the authority granted
698.12in section 256N.24, subdivision 2.
698.13(e) The county of financial responsibility under section 256G.02 or tribal agency
698.14authorized under section 256.01, subdivision 14b, shall document the determined
698.15pre-Northstar Care for Children foster care rate in the case record, including a description
698.16of each condition on which the difficulty of care assessment is based. The difficulty
698.17of care rate is reassessed:
698.18(1) every 12 months;
698.19(2) at the request of the foster parent; or
698.20(3) if the child's level of need changes in the current foster home.
698.21(f) The pre-Northstar Care for Children foster care program must maintain the
698.22following existing program features:
698.23(1) monthly payments must be made to the family foster home provider;
698.24(2) notice and appeal procedures must be consistent with Minnesota Rules, part
698.259560.0665; and
698.26(3) medical assistance eligibility for foster children must continue to be determined
698.27according to section 256B.055.
698.28(g) The county of financial responsibility under section 256G.02 or tribal agency
698.29authorized under section 256.01, subdivision 14b, may continue existing program features,
698.30including:
698.31(1) establishing a local fund of county money through which the agency may
698.32reimburse foster parents for the cost of repairing damage done to the home and contents by
698.33the foster child and the additional care insurance premium cost of a child who possesses a
698.34permit or license to drive a car; and
699.1(2) paying a fee for specific services provided by the foster parent, based on the
699.2parent's skills, experience, or training. This fee must not be considered foster care
699.3maintenance.
699.4(h) The following events end the child's enrollment in the pre-Northstar Care for
699.5Children foster care program:
699.6(1) reunification with parent or other relative;
699.7(2) adoption or transfer of permanent legal and physical custody;
699.8(3) removal from the current foster home to a different foster home;
699.9(4) another event that ends the current placement episode; or
699.10(5) attaining the age of 21.
699.11    Subd. 2. Consideration of other programs. (a) When a child in foster care
699.12is eligible to receive a grant of Retirement Survivors Disability Insurance (RSDI)
699.13or Supplemental Security Income for the aged, blind, and disabled, or a foster care
699.14maintenance payment under title IV-E of the Social Security Act, United States Code, title
699.1542, sections 670 to 676, the child's needs must be met through these programs. Every
699.16effort must be made to establish a child's eligibility for a title IV-E grant to reimburse the
699.17county or tribe from the federal funds available for this purpose.
699.18(b) When a child in foster care qualifies for home and community-based waivered
699.19services under section 256B.49 for community alternative care (CAC), community
699.20alternatives for disabled individuals (CADI), or traumatic brain injury (TBI) waivers,
699.21this service does not substitute for the child foster care program. When a foster child is
699.22receiving waivered services benefits, the county of financial responsibility under section
699.23256G.02 or tribal agency authorized under section 256.01, subdivision 14b, assesses and
699.24provides foster care maintenance including difficulty of care using the established tool in
699.25Minnesota Rules, part 9560.0654. If it is determined that additional services are needed to
699.26meet the child's needs in the home that are not or cannot be met by the foster care program,
699.27the needs must be referred to the waivered service program.

699.28    Sec. 21. [260C.4412] PAYMENT FOR RESIDENTIAL PLACEMENTS.
699.29When a child is placed in a foster care group residential setting under Minnesota
699.30Rules, parts 2960.0020 to 2960.0710, foster care maintenance payments must be made on
699.31behalf of the child to cover the cost of providing food, clothing, shelter, daily supervision,
699.32school supplies, child's personal incidentals and supports, reasonable travel for visitation,
699.33or other transportation needs associated with the items listed. Daily supervision in the
699.34group residential setting includes routine day-to-day direction and arrangements to
700.1ensure the well-being and safety of the child. It may also include reasonable costs of
700.2administration and operation of the facility.
700.3EFFECTIVE DATE.This section is effective January 1, 2015.

700.4    Sec. 22. [260C.4413] INITIAL CLOTHING ALLOWANCE.
700.5(a) An initial clothing allowance must be available to a child eligible for:
700.6(1) the pre-Northstar Care for Children foster care program under section 260C.4411,
700.7subdivision 1; and
700.8(2) the Northstar Care for Children benefits under section 256N.21.
700.9(b) An initial clothing allowance must also be available for a foster child in a group
700.10residential setting based on the child's individual needs during the first 60 days of the
700.11child's initial placement. The agency must consider the parent's ability to provide for a
700.12child's clothing needs and the residential facility contracts.
700.13(c) The county of financial responsibility under section 256G.02 or tribal agency
700.14authorized under section 256.01, subdivision 14b, shall approve an initial clothing
700.15allowance consistent with the child's needs. The amount of the initial clothing allowance
700.16must not exceed the monthly basic rate for the child's age group under section 256N.26,
700.17subdivision 3.
700.18EFFECTIVE DATE.This section is effective January 1, 2015.

700.19    Sec. 23. Minnesota Statutes 2012, section 260C.446, is amended to read:
700.20260C.446 DISTRIBUTION OF FUNDS RECOVERED FOR ASSISTANCE
700.21FURNISHED.
700.22When any amount shall be recovered from any source for assistance furnished
700.23under the provisions of sections 260C.001 to 260C.421 and 260C.441, there shall be paid
700.24into the treasury of the state or county in the proportion in which they have respectively
700.25contributed toward the total assistance paid.
700.26EFFECTIVE DATE.This section is effective January 1, 2015.

700.27    Sec. 24. REPEALER.
700.28(a) Minnesota Statutes 2012, sections 256.82, subdivision 4; and 260C.441, are
700.29repealed effective January 1, 2015.
700.30(b) Minnesota Rules, parts 9560.0650, subparts 1, 3, and 6; 9560.0651; and
700.319560.0655, are repealed effective January 1, 2015.