Bill Text: MN HF1994 | 2011-2012 | 87th Legislature | Engrossed

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Bill Title: Health and human services policy provisions changed; provisions modified relating to continuing care, telephone equipment program, chemical and mental health, and health care; comprehensive assessment and case management services reformed; and technical changes made.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2012-04-16 - HF indefinitely postponed [HF1994 Detail]

Download: Minnesota-2011-HF1994-Engrossed.html

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A bill for an act

relating to state government; making changes to health and human services
policy provisions; modifying provisions related to continuing care, the telephone
equipment program, chemical and mental health, and health care; reforming
comprehensive assessment and case management services; making technical
changes; requiring reports;amending Minnesota Statutes 2010, sections
144A.071, subdivision 5a; 237.50; 237.51; 237.52; 237.53; 237.54; 237.55;
237.56; 245.461, by adding a subdivision; 245.462, subdivision 20; 245.487,
by adding a subdivision; 245.4871, subdivision 15; 245.4932, subdivision 1;
245A.11, subdivisions 2a, 8; 246.53, by adding a subdivision; 252.32, subdivision
1a; 252A.21, subdivision 2; 256.476, subdivision 11; 256.9657, subdivision 1;
256B.04, subdivision 14; 256B.056, subdivision 3c; 256B.0595, subdivision 2;
256B.0625, subdivisions 13, 13d, 19c, 42; 256B.0659, subdivisions 1, 2, 3, 3a, 4,
9, 13, 14, 19, 21, 30; 256B.0911, subdivisions 1, 2b, 2c, 3, 3b, 4c, 6; 256B.0913,
subdivisions 7, 8; 256B.0915, subdivisions 1a, 1b, 3c, 6; 256B.0916, subdivision
7; 256B.092, subdivisions 1, 1a, 1b, 1e, 1g, 2, 3, 5, 7, 8, 8a, 9, 11; 256B.096,
subdivision 5; 256B.15, subdivisions 1c, 1f; 256B.19, subdivision 1c; 256B.441,
subdivisions 13, 31, 53; 256B.49, subdivisions 13, 21; 256B.69, subdivision
5; 256F.13, subdivision 1; 256G.02, subdivision 6; 256L.05, subdivision 3;
514.982, subdivision 1; Minnesota Statutes 2011 Supplement, sections 125A.21,
subdivision 7; 144A.071, subdivisions 3, 4a; 245A.03, subdivision 7; 254B.04,
subdivision 2a; 256B.056, subdivision 3; 256B.057, subdivision 9; 256B.0625,
subdivisions 13e, 13h, 14, 56; 256B.0631, subdivisions 1, 2; 256B.0659,
subdivision 11; 256B.0911, subdivisions 1a, 3a, 4a; 256B.0915, subdivision
10; 256B.49, subdivisions 14, 15; 256B.69, subdivisions 5a, 28; 256L.12,
subdivision 9; 256L.15, subdivision 1; 626.557, subdivision 9; Laws 2009,
chapter 79, article 8, section 81, as amended; proposing coding for new law in
Minnesota Statutes, chapter 252; repealing Minnesota Statutes 2010, sections
256.01, subdivision 18b; 256B.431, subdivisions 2c, 2g, 2i, 2j, 2k, 2l, 2o, 3c,
11, 14, 17b, 17f, 19, 20, 25, 27, 29; 256B.434, subdivisions 4a, 4b, 4c, 4d, 4e,
4g, 4h, 7, 8; 256B.435; 256B.436; Minnesota Statutes 2011 Supplement, section
256B.431, subdivision 26; Minnesota Rules, part 9555.7700.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

CONTINUING CARE

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

    Sec. 2. Minnesota Statutes 2011 Supplement, section 144A.071, subdivision 4a,
is amended to read:
    Subd. 4a. Exceptions for replacement beds. It is in the best interest of the state
to ensure that nursing homes and boarding care homes continue to meet the physical
plant licensing and certification requirements by permitting certain construction projects.
Facilities should be maintained in condition to satisfy the physical and emotional needs
of residents while allowing the state to maintain control over nursing home expenditure
growth.
    The commissioner of health in coordination with the commissioner of human
services, may approve the renovation, replacement, upgrading, or relocation of a nursing
home or boarding care home, under the following conditions:
    (a) to license or certify beds in a new facility constructed to replace a facility or to
make repairs in an existing facility that was destroyed or damaged after June 30, 1987, by
fire, lightning, or other hazard provided:
    (i) destruction was not caused by the intentional act of or at the direction of a
controlling person of the facility;
    (ii) at the time the facility was destroyed or damaged the controlling persons of the
facility maintained insurance coverage for the type of hazard that occurred in an amount
that a reasonable person would conclude was adequate;
    (iii) the net proceeds from an insurance settlement for the damages caused by the
hazard are applied to the cost of the new facility or repairs;
    (iv) the number of licensed and certified beds in the new facility does not exceed the
number of licensed and certified beds in the destroyed facility; and
    (v) the commissioner determines that the replacement beds are needed to prevent an
inadequate supply of beds.
Project construction costs incurred for repairs authorized under this clause shall not be
considered in the dollar threshold amount defined in subdivision 2;
    (b) to license or certify beds that are moved from one location to another within a
nursing home facility, provided the total costs of remodeling performed in conjunction
with the relocation of beds does not exceed $1,000,000;
    (c) to license or certify beds in a project recommended for approval under section
144A.073 ;
    (d) to license or certify beds that are moved from an existing state nursing home to
a different state facility, provided there is no net increase in the number of state nursing
home beds;
    (e) to certify and license as nursing home beds boarding care beds in a certified
boarding care facility if the beds meet the standards for nursing home licensure, or in a
facility that was granted an exception to the moratorium under section 144A.073, and if
the cost of any remodeling of the facility does not exceed $1,000,000. If boarding care
beds are licensed as nursing home beds, the number of boarding care beds in the facility
must not increase beyond the number remaining at the time of the upgrade in licensure.
The provisions contained in section 144A.073 regarding the upgrading of the facilities
do not apply to facilities that satisfy these requirements;
    (f) to license and certify up to 40 beds transferred from an existing facility owned and
operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
same location as the existing facility that will serve persons with Alzheimer's disease and
other related disorders. The transfer of beds may occur gradually or in stages, provided
the total number of beds transferred does not exceed 40. At the time of licensure and
certification of a bed or beds in the new unit, the commissioner of health shall delicense
and decertify the same number of beds in the existing facility. As a condition of receiving
a license or certification under this clause, the facility must make a written commitment
to the commissioner of human services that it will not seek to receive an increase in its
property-related payment rate as a result of the transfers allowed under this paragraph;
    (g) to license and certify nursing home beds to replace currently licensed and certified
boarding care beds which may be located either in a remodeled or renovated boarding care
or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
nursing home facility within the identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located, provided that the number of
boarding care beds in the facility or complex are decreased by the number to be licensed
as nursing home beds and further provided that, if the total costs of new construction,
replacement, remodeling, or renovation exceed ten percent of the appraised value of
the facility or $200,000, whichever is less, the facility makes a written commitment to
the commissioner of human services that it will not seek to receive an increase in its
property-related payment rate by reason of the new construction, replacement, remodeling,
or renovation. The provisions contained in section 144A.073 regarding the upgrading of
facilities do not apply to facilities that satisfy these requirements;
    (h) to license as a nursing home and certify as a nursing facility a facility that is
licensed as a boarding care facility but not certified under the medical assistance program,
but only if the commissioner of human services certifies to the commissioner of health that
licensing the facility as a nursing home and certifying the facility as a nursing facility will
result in a net annual savings to the state general fund of $200,000 or more;
    (i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing
home beds in a facility that was licensed and in operation prior to January 1, 1992;
    (j) to license and certify new nursing home beds to replace beds in a facility acquired
by the Minneapolis Community Development Agency as part of redevelopment activities
in a city of the first class, provided the new facility is located within three miles of the site
of the old facility. Operating and property costs for the new facility must be determined
and allowed under section 256B.431 or 256B.434;
    (k) to license and certify up to 20 new nursing home beds in a community-operated
hospital and attached convalescent and nursing care facility with 40 beds on April 21,
1991, that suspended operation of the hospital in April 1986. The commissioner of human
services shall provide the facility with the same per diem property-related payment rate
for each additional licensed and certified bed as it will receive for its existing 40 beds;
    (l) to license or certify beds in renovation, replacement, or upgrading projects as
defined in section 144A.073, subdivision 1, so long as the cumulative total costs of the
facility's remodeling projects do not exceed $1,000,000;
    (m) to license and certify beds that are moved from one location to another for the
purposes of converting up to five four-bed wards to single or double occupancy rooms
in a nursing home that, as of January 1, 1993, was county-owned and had a licensed
capacity of 115 beds;
    (n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified
nursing facility located in Minneapolis to layaway all of its licensed and certified nursing
home beds. These beds may be relicensed and recertified in a newly constructed teaching
nursing home facility affiliated with a teaching hospital upon approval by the legislature.
The proposal must be developed in consultation with the interagency committee on
long-term care planning. The beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds, except that beds on layaway status remain
subject to the surcharge in section 256.9657. This layaway provision expires July 1, 1998;
    (o) to allow a project which will be completed in conjunction with an approved
moratorium exception project for a nursing home in southern Cass County and which is
directly related to that portion of the facility that must be repaired, renovated, or replaced,
to correct an emergency plumbing problem for which a state correction order has been
issued and which must be corrected by August 31, 1993;
    (p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified
nursing facility located in Minneapolis to layaway, upon 30 days prior written notice to
the commissioner, up to 30 of the facility's licensed and certified beds by converting
three-bed wards to single or double occupancy. Beds on layaway status shall have the
same status as voluntarily delicensed and decertified beds except that beds on layaway
status remain subject to the surcharge in section 256.9657, remain subject to the license
application and renewal fees under section 144A.07 and shall be subject to a $100 per bed
reactivation fee. In addition, at any time within three years of the effective date of the
layaway, the beds on layaway status may be:
    (1) relicensed and recertified upon relocation and reactivation of some or all of
the beds to an existing licensed and certified facility or facilities located in Pine River,
Brainerd, or International Falls; provided that the total project construction costs related to
the relocation of beds from layaway status for any facility receiving relocated beds may
not exceed the dollar threshold provided in subdivision 2 unless the construction project
has been approved through the moratorium exception process under section 144A.073;
    (2) relicensed and recertified, upon reactivation of some or all of the beds within the
facility which placed the beds in layaway status, if the commissioner has determined a
need for the reactivation of the beds on layaway status.
    The property-related payment rate of a facility placing beds on layaway status
must be adjusted by the incremental change in its rental per diem after recalculating the
rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The
property-related payment rate for a facility relicensing and recertifying beds from layaway
status must be adjusted by the incremental change in its rental per diem after recalculating
its rental per diem using the number of beds after the relicensing to establish the facility's
capacity day divisor, which shall be effective the first day of the month following the
month in which the relicensing and recertification became effective. Any beds remaining
on layaway status more than three years after the date the layaway status became effective
must be removed from layaway status and immediately delicensed and decertified;
    (q) to license and certify beds in a renovation and remodeling project to convert 12
four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
home that, as of January 1, 1994, met the following conditions: the nursing home was
located in Ramsey County; had a licensed capacity of 154 beds; and had been ranked
among the top 15 applicants by the 1993 moratorium exceptions advisory review panel.
The total project construction cost estimate for this project must not exceed the cost
estimate submitted in connection with the 1993 moratorium exception process;
    (r) to license and certify up to 117 beds that are relocated from a licensed and
certified 138-bed nursing facility located in St. Paul to a hospital with 130 licensed
hospital beds located in South St. Paul, provided that the nursing facility and hospital are
owned by the same or a related organization and that prior to the date the relocation is
completed the hospital ceases operation of its inpatient hospital services at that hospital.
After relocation, the nursing facility's status under section 256B.431, subdivision 2j, shall
be the same as it was prior to relocation. The nursing facility's property-related payment
rate resulting from the project authorized in this paragraph shall become effective no
earlier than April 1, 1996. For purposes of calculating the incremental change in the
facility's rental per diem resulting from this project, the allowable appraised value of
the nursing facility portion of the existing health care facility physical plant prior to the
renovation and relocation may not exceed $2,490,000;
    (s) to license and certify two beds in a facility to replace beds that were voluntarily
delicensed and decertified on June 28, 1991;
    (t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed
nursing home and 21-bed boarding care home facility in Minneapolis, notwithstanding
the licensure and certification after July 1, 1995, of the Minneapolis facility as a 147-bed
nursing home facility after completion of a construction project approved in 1993 under
section 144A.073, to be laid away upon 30 days' prior written notice to the commissioner.
Beds on layaway status shall have the same status as voluntarily delicensed or decertified
beds except that they shall remain subject to the surcharge in section 256.9657. The
16 beds on layaway status may be relicensed as nursing home beds and recertified at
any time within five years of the effective date of the layaway upon relocation of some
or all of the beds to a licensed and certified facility located in Watertown, provided that
the total project construction costs related to the relocation of beds from layaway status
for the Watertown facility may not exceed the dollar threshold provided in subdivision
2 unless the construction project has been approved through the moratorium exception
process under section 144A.073.
    The property-related payment rate of the facility placing beds on layaway status
must be adjusted by the incremental change in its rental per diem after recalculating the
rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The
property-related payment rate for the facility relicensing and recertifying beds from
layaway status must be adjusted by the incremental change in its rental per diem after
recalculating its rental per diem using the number of beds after the relicensing to establish
the facility's capacity day divisor, which shall be effective the first day of the month
following the month in which the relicensing and recertification became effective. Any
beds remaining on layaway status more than five years after the date the layaway status
became effective must be removed from layaway status and immediately delicensed
and decertified;
    (u) to license and certify beds that are moved within an existing area of a facility or
to a newly constructed addition which is built for the purpose of eliminating three- and
four-bed rooms and adding space for dining, lounge areas, bathing rooms, and ancillary
service areas in a nursing home that, as of January 1, 1995, was located in Fridley and had
a licensed capacity of 129 beds;
    (v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County
to a 160-bed facility in Crow Wing County, provided all the affected beds are under
common ownership;
    (w) to license and certify a total replacement project of up to 49 beds located in
Norman County that are relocated from a nursing home destroyed by flood and whose
residents were relocated to other nursing homes. The operating cost payment rates for
the new nursing facility shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until
the second rate year after the settle-up cost report is filed. Property-related reimbursement
rates shall be determined under section 256B.431, taking into account any federal or state
flood-related loans or grants provided to the facility;
    (x) to license and certify a total replacement project of up to 129 beds located
in Polk County that are relocated from a nursing home destroyed by flood and whose
residents were relocated to other nursing homes. The operating cost payment rates for
the new nursing facility shall be determined based on the interim and settle-up payment
provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until
the second rate year after the settle-up cost report is filed. Property-related reimbursement
rates shall be determined under section 256B.431, taking into account any federal or state
flood-related loans or grants provided to the facility;
    (y) to license and certify beds in a renovation and remodeling project to convert 13
three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and
add improvements in a nursing home that, as of January 1, 1994, met the following
conditions: the nursing home was located in Ramsey County, was not owned by a hospital
corporation, had a licensed capacity of 64 beds, and had been ranked among the top 15
applicants by the 1993 moratorium exceptions advisory review panel. The total project
construction cost estimate for this project must not exceed the cost estimate submitted in
connection with the 1993 moratorium exception process;
    (z) to license and certify up to 150 nursing home beds to replace an existing 285
bed nursing facility located in St. Paul. The replacement project shall include both the
renovation of existing buildings and the construction of new facilities at the existing
site. The reduction in the licensed capacity of the existing facility shall occur during the
construction project as beds are taken out of service due to the construction process. Prior
to the start of the construction process, the facility shall provide written information to the
commissioner of health describing the process for bed reduction, plans for the relocation
of residents, and the estimated construction schedule. The relocation of residents shall be
in accordance with the provisions of law and rule;
    (aa) to allow the commissioner of human services to license an additional 36 beds
to provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
the total number of licensed and certified beds at the facility does not increase;
    (bb) to license and certify a new facility in St. Louis County with 44 beds
constructed to replace an existing facility in St. Louis County with 31 beds, which has
resident rooms on two separate floors and an antiquated elevator that creates safety
concerns for residents and prevents nonambulatory residents from residing on the second
floor. The project shall include the elimination of three- and four-bed rooms;
    (cc) to license and certify four beds in a 16-bed certified boarding care home in
Minneapolis to replace beds that were voluntarily delicensed and decertified on or
before March 31, 1992. The licensure and certification is conditional upon the facility
periodically assessing and adjusting its resident mix and other factors which may
contribute to a potential institution for mental disease declaration. The commissioner of
human services shall retain the authority to audit the facility at any time and shall require
the facility to comply with any requirements necessary to prevent an institution for mental
disease declaration, including delicensure and decertification of beds, if necessary;
    (dd) to license and certify 72 beds in an existing facility in Mille Lacs County with
80 beds as part of a renovation project. The renovation must include construction of
an addition to accommodate ten residents with beginning and midstage dementia in a
self-contained living unit; creation of three resident households where dining, activities,
and support spaces are located near resident living quarters; designation of four beds
for rehabilitation in a self-contained area; designation of 30 private rooms; and other
improvements;
    (ee) to license and certify beds in a facility that has undergone replacement or
remodeling as part of a planned closure under section 256B.437;
    (ff) to license and certify a total replacement project of up to 124 beds located
in Wilkin County that are in need of relocation from a nursing home significantly
damaged by flood. The operating cost payment rates for the new nursing facility shall
be determined based on the interim and settle-up payment provisions of Minnesota
Rules, part 9549.0057, and the reimbursement provisions of section 256B.431, except
that section 256B.431, subdivision 26, paragraphs (a) and (b), shall not apply until the
second rate year after the settle-up cost report is filed. Property-related reimbursement
rates shall be determined under section 256B.431, taking into account any federal or state
flood-related loans or grants provided to the facility;
    (gg) to allow the commissioner of human services to license an additional nine beds
to provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
total number of licensed and certified beds at the facility does not increase;
    (hh) to license and certify up to 120 new nursing facility beds to replace beds in a
facility in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the
new facility is located within four miles of the existing facility and is in Anoka County.
Operating and property rates shall be determined and allowed under section 256B.431
and Minnesota Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 256B.435.
The provisions of section 256B.431, subdivision 26, paragraphs (a) and (b), do not apply
until the second rate year following settle-up 256B.441; or
    (ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County
that, as of March 25, 2001, is in the active process of closing, to a 122-licensed bed
nonprofit nursing facility located in the city of Columbia Heights or its affiliate. The
transfer is effective when the receiving facility notifies the commissioner in writing of the
number of beds accepted. The commissioner shall place all transferred beds on layaway
status held in the name of the receiving facility. The layaway adjustment provisions of
section 256B.431, subdivision 30, do not apply to this layaway. The receiving facility
may only remove the beds from layaway for recertification and relicensure at the receiving
facility's current site, or at a newly constructed facility located in Anoka County. The
receiving facility must receive statutory authorization before removing these beds from
layaway status, or may remove these beds from layaway status if removal from layaway
status is part of a moratorium exception project approved by the commissioner under
section 144A.073.

    Sec. 3. Minnesota Statutes 2011 Supplement, section 245A.03, subdivision 7, is
amended to read:
    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
9555.6265, under this chapter for a physical location that will not be the primary residence
of the license holder for the entire period of licensure. If a license is issued during this
moratorium, and the license holder changes the license holder's primary residence away
from the physical location of the foster care license, the commissioner shall revoke the
license according to section 245A.07. Exceptions to the moratorium include:
    (1) foster care settings that are required to be registered under chapter 144D;
    (2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
and determined to be needed by the commissioner under paragraph (b);
    (3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or
restructuring of state-operated services that limits the capacity of state-operated facilities;
    (4) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for persons requiring hospital level care; or
    (5) new foster care licenses determined to be needed by the commissioner for the
transition of people from personal care assistance to the home and community-based
services.
    (b) The commissioner shall determine the need for newly licensed foster care homes
as defined under this subdivision. As part of the determination, the commissioner shall
consider the availability of foster care capacity in the area in which the licensee seeks to
operate, and the recommendation of the local county board. The determination by the
commissioner must be final. A determination of need is not required for a change in
ownership at the same address.
    (c) Residential settings that would otherwise be subject to the moratorium established
in paragraph (a), that are in the process of receiving an adult or child foster care license as
of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
or child foster care license. For this paragraph, all of the following conditions must be met
to be considered in the process of receiving an adult or child foster care license:
    (1) participants have made decisions to move into the residential setting, including
documentation in each participant's care plan;
    (2) the provider has purchased housing or has made a financial investment in the
property;
    (3) the lead agency has approved the plans, including costs for the residential setting
for each individual;
    (4) the completion of the licensing process, including all necessary inspections, is
the only remaining component prior to being able to provide services; and
    (5) the needs of the individuals cannot be met within the existing capacity in that
county.
To qualify for the process under this paragraph, the lead agency must submit
documentation to the commissioner by August 1, 2009, that all of the above criteria are
met.
    (d) (c) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011. This study shall
include, but is not limited to the following:
    (1) the overall capacity and utilization of foster care beds where the physical location
is not the primary residence of the license holder prior to and after implementation
of the moratorium;
    (2) the overall capacity and utilization of foster care beds where the physical
location is the primary residence of the license holder prior to and after implementation
of the moratorium; and
    (3) the number of licensed and occupied ICF/MR beds prior to and after
implementation of the moratorium.
    (e) (d) When a foster care recipient moves out of a foster home that is not the
primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), the county shall immediately inform the Department of Human Services
Licensing Division, and the department shall immediately decrease the licensed capacity
for the home. A decreased licensed capacity according to this paragraph is not subject to
appeal under this chapter.
    (e) At the time of application and reapplication for licensure, the applicant and the
license holder that are subject to the moratorium or an exclusion established in paragraph
(a) are required to inform the commissioner whether the physical location where the foster
care will be provided is or will be the primary residence of the license holder for the entire
period of licensure. If the primary residence of the applicant or license holder changes, the
applicant or license holder must notify the commissioner immediately. The commissioner
shall print on the foster care license certificate whether or not the physical location is the
primary residence of the license holder.
    (f) License holders of foster care homes identified under paragraph (e) that are not
the primary residence of the license holder and that also provide services in the foster care
home that are covered by a federally approved home and community-based services
waiver, as authorized under section 256B.0915, 256B.092, or 256B.49 must inform the
human services licensing division that the license holder provides or intends to provide
these waiver-funded services. These license holders must be considered registered under
section 256B.092, subdivision 11, paragraph (c), and this registration status must be
identified on their license certificates.

    Sec. 4. Minnesota Statutes 2010, section 245A.11, subdivision 2a, is amended to read:
    Subd. 2a. Adult foster care license capacity. (a) The commissioner shall issue
adult foster care licenses with a maximum licensed capacity of four beds, including
nonstaff roomers and boarders, except that the commissioner may issue a license with a
capacity of five beds, including roomers and boarders, according to paragraphs (b) to (f).
(b) An adult foster care license holder may have a maximum license capacity of five
if all persons in care are age 55 or over and do not have a serious and persistent mental
illness or a developmental disability.
(c) The commissioner may grant variances to paragraph (b) to allow a foster care
provider with a licensed capacity of five persons to admit an individual under the age of 55
if the variance complies with section 245A.04, subdivision 9, and approval of the variance
is recommended by the county in which the licensed foster care provider is located.
(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
bed for emergency crisis services for a person with serious and persistent mental illness
or a developmental disability, regardless of age, if the variance complies with section
245A.04, subdivision 9 , and approval of the variance is recommended by the county in
which the licensed foster care provider is located.
(e) If the 2009 legislature adopts a rate reduction that impacts providers of adult
foster care services, the commissioner may issue an adult foster care license with a
capacity of five adults if the fifth bed does not increase the overall statewide capacity of
licensed adult foster care beds in homes that are not the primary residence of the license
holder, over the licensed capacity in such homes on July 1, 2009, as identified in a plan
submitted to the commissioner by the county, when the capacity is recommended by
the county licensing agency of the county in which the facility is located and if the
recommendation verifies that:
(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;
(2) the five-bed living arrangement is specified for each resident in the resident's:
(i) individualized plan of care;
(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;
(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice to
living in the home and that the resident's refusal to consent would not have resulted in
service termination; and
(4) the facility was licensed for adult foster care before March 1, 2009.
(f) The commissioner shall not issue a new adult foster care license under paragraph
(e) after June 30, 2011 2014. The commissioner shall allow a facility with an adult foster
care license issued under paragraph (e) before June 30, 2011 2014, to continue with a
capacity of five adults if the license holder continues to comply with the requirements in
paragraph (e).

    Sec. 5. Minnesota Statutes 2010, section 245A.11, subdivision 8, is amended to read:
    Subd. 8. Community residential setting license. (a) The commissioner shall
establish provider standards for residential support services that integrate service standards
and the residential setting under one license. The commissioner shall propose statutory
language and an implementation plan for licensing requirements for residential support
services to the legislature by January 15, 2011 2012, as a component of the quality outcome
standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
for services in settings licensed as adult foster care under Minnesota Rules, parts
9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to
2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph
(b), must be required to obtain a community residential setting license.

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

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

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

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

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

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

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

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

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

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

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

    Sec. 17. Minnesota Statutes 2010, section 256B.0659, subdivision 14, is amended to
read:
    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal
care assistants must be supervised by a qualified professional.
    (b) Through direct training, observation, return demonstrations, and consultation
with the staff and the recipient, the qualified professional must ensure and document
that the personal care assistant is:
    (1) capable of providing the required personal care assistance services;
    (2) knowledgeable about the plan of personal care assistance services before services
are performed; and
    (3) able to identify conditions that should be immediately brought to the attention of
the qualified professional.
    (c) The qualified professional shall evaluate the personal care assistant within the
first 14 days of starting to provide regularly scheduled services for a recipient, or sooner as
determined by the qualified professional, except for the personal care assistance choice
option under subdivision 19, paragraph (a), clause (4). For the initial evaluation, the
qualified professional shall evaluate the personal care assistance services for a recipient
through direct observation of a personal care assistant's work. The qualified professional
may conduct additional training and evaluation visits, based upon the needs of the
recipient and the personal care assistant's ability to meet those needs. Subsequent visits to
evaluate the personal care assistance services provided to a recipient do not require direct
observation of each personal care assistant's work and shall occur:
    (1) at least every 90 days thereafter for the first year of a recipient's services;
    (2) every 120 days after the first year of a recipient's service or whenever needed for
response to a recipient's request for increased supervision of the personal care assistance
staff; and
    (3) after the first 180 days of a recipient's service, supervisory visits may alternate
between unscheduled phone or Internet technology and in-person visits, unless the
in-person visits are needed according to the care plan.
    (d) Communication with the recipient is a part of the evaluation process of the
personal care assistance staff.
    (e) At each supervisory visit, the qualified professional shall evaluate personal care
assistance services including the following information:
    (1) satisfaction level of the recipient with personal care assistance services;
    (2) review of the month-to-month plan for use of personal care assistance services;
    (3) review of documentation of personal care assistance services provided;
    (4) whether the personal care assistance services are meeting the goals of the service
as stated in the personal care assistance care plan and service plan;
    (5) a written record of the results of the evaluation and actions taken to correct any
deficiencies in the work of a personal care assistant; and
    (6) revision of the personal care assistance care plan as necessary in consultation
with the recipient or responsible party, to meet the needs of the recipient.
    (f) The qualified professional shall complete the required documentation in the
agency recipient and employee files and the recipient's home, including the following
documentation:
    (1) the personal care assistance care plan based on the service plan and individualized
needs of the recipient;
    (2) a month-to-month plan for use of personal care assistance services;
    (3) changes in need of the recipient requiring a change to the level of service and the
personal care assistance care plan;
    (4) evaluation results of supervision visits and identified issues with personal care
assistance staff with actions taken;
    (5) all communication with the recipient and personal care assistance staff; and
    (6) hands-on training or individualized training for the care of the recipient.
    (g) The documentation in paragraph (f) must be done on agency forms templates.
    (h) The services that are not eligible for payment as qualified professional services
include:
    (1) direct professional nursing tasks that could be assessed and authorized as skilled
nursing tasks;
    (2) supervision of personal care assistance completed by telephone;
    (3) (2) agency administrative activities;
    (4) (3) training other than the individualized training required to provide care for a
recipient; and
    (5) (4) any other activity that is not described in this section.

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

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

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

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

    Sec. 22. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to
read:
    Subd. 11. Residential support services. (a) Upon federal approval, there is
established a new service called residential support that is available on the community
alternative care, community alternatives for disabled individuals, developmental
disabilities, and traumatic brain injury waivers. Existing waiver service descriptions
must be modified to the extent necessary to ensure there is no duplication between
other services. Residential support services must be provided by vendors licensed as a
community residential setting as defined in section 245A.11, subdivision 8.
    (b) Residential support services must meet the following criteria:
    (1) providers of residential support services must own or control the residential site;
    (2) the residential site must not be the primary residence of the license holder;
    (3) the residential site must have a designated program supervisor responsible for
program oversight, development, and implementation of policies and procedures;
    (4) the provider of residential support services must provide supervision, training,
and assistance as described in the person's community support plan; and
    (5) the provider of residential support services must meet the requirements of
licensure and additional requirements of the person's community support plan.
    (c) Providers of residential support services that meet the definition in paragraph
(a) must be registered using a process determined by the commissioner beginning July
1, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
2960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
9555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
7, paragraph (e), are considered registered under this section.

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

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

    Sec. 25. Minnesota Statutes 2010, section 256B.441, subdivision 31, is amended to
read:
    Subd. 31. Prior system operating cost payment rate. "Prior system operating
cost payment rate" means the operating cost payment rate in effect on September 30,
2008, under Minnesota Rules and Minnesota Statutes, not including planned closure rate
adjustments under section 256B.436 or 256B.437, or single bed room incentives under
section 256B.431, subdivision 42.

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

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

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

    Sec. 29. Laws 2009, chapter 79, article 8, section 81, as amended by Laws 2010,
chapter 352, article 1, section 24, is amended to read:
    Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.
(a) The commissioner of human services shall consult with disability service
providers, advocates, counties, and consumer families to develop a single set of standards,
to be referred to as "quality outcome standards," governing services for people with
disabilities receiving services under the home and community-based waiver services
program, with the exception of customized living services because the service license
is under the jurisdiction of the Department of Health, to replace all or portions of
existing laws and rules including, but not limited to, data practices, licensure of facilities
and providers, background studies, reporting of maltreatment of minors, reporting of
maltreatment of vulnerable adults, and the psychotropic medication checklist. The
standards must:
(1) enable optimum consumer choice;
(2) be consumer driven;
(3) link services to individual needs and life goals;
(4) be based on quality assurance and individual outcomes;
(5) utilize the people closest to the recipient, who may include family, friends, and
health and service providers, in conjunction with the recipient's risk management plan to
assist the recipient or the recipient's guardian in making decisions that meet the recipient's
needs in a cost-effective manner and assure the recipient's health and safety;
(6) utilize person-centered planning; and
(7) maximize federal financial participation.
(b) The commissioner may consult with existing stakeholder groups convened under
the commissioner's authority, including the home and community-based expert services
panel established by the commissioner in 2008, to meet all or some of the requirements
of this section.
(c) The commissioner shall provide the reports and plans required by this section to
the legislative committees and budget divisions with jurisdiction over health and human
services policy and finance by January 15, 2012.

    Sec. 30. DISABILITY HOME AND COMMUNITY-BASED WAIVER
REQUEST.
By December 1, 2012, the commissioner shall request all federal approvals and
waiver amendments to the disability home and community-based waivers to allow properly
licensed adult foster care homes to provide residential services for up to five individuals.
EFFECTIVE DATE.This section is effective July 1, 2012.

    Sec. 31. HOURLY NURSING DETERMINATION MATRIX.
A service provider applying for medical assistance payments for private duty nursing
services under Minnesota Statutes, section 256B.0654, must complete and submit to the
commissioner of human services an hourly nursing determination matrix for each recipient
of private duty nursing services. The commissioner of human services will collect and
analyze data from the hourly nursing determination matrix.

    Sec. 32. REPEALER.
(a) Minnesota Statutes 2010, sections 256B.431, subdivisions 2c, 2g, 2i, 2j, 2k, 2l,
2o, 3c, 11, 14, 17b, 17f, 19, 20, 25, 27, and 29; 256B.434, subdivisions 4a, 4b, 4c, 4d, 4e,
4g, 4h, 7, and 8; 256B.435; and 256B.436, are repealed.
(b) Minnesota Statutes 2011 Supplement, section 256B.431, subdivision 26, is
repealed.
(c) Minnesota Rules, part 9555.7700, is repealed.

ARTICLE 2

TELEPHONE EQUIPMENT PROGRAM

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

    Sec. 2. Minnesota Statutes 2010, section 237.51, is amended to read:
237.51 TELECOMMUNICATIONS ACCESS MINNESOTA PROGRAM
ADMINISTRATION.
    Subdivision 1. Creation. The commissioner of commerce shall:
(1) administer through interagency agreement with the commissioner of human
services a program to distribute communication telecommunications devices to eligible
communication-impaired persons who have communication disabilities; and
(2) contract with a one or more qualified vendor vendors that serves
communication-impaired serve persons who have communication disabilities to create
and maintain a telecommunication provide telecommunications relay service services.
For purposes of sections 237.51 to 237.56, the Department of Commerce and any
organization with which it contracts pursuant to this section or section 237.54, subdivision
2 , are not telephone companies or telecommunications carriers as defined in section
237.01 .
    Subd. 5. Commissioner of commerce duties. In addition to any duties specified
elsewhere in sections 237.51 to 237.56, the commissioner of commerce shall:
(1) prepare the reports required by section 237.55;
(2) administer the fund created in section 237.52; and
(3) adopt rules under chapter 14 to implement the provisions of sections 237.50
to 237.56.
    Subd. 5a. Department Commissioner of human services duties. (a) In addition to
any duties specified elsewhere in sections 237.51 to 237.56, the commissioner of human
services shall:
(1) define economic hardship, special needs, and household criteria so as to
determine the priority of eligible applicants for initial distribution of devices and to
determine circumstances necessitating provision of more than one communication
telecommunications device per household;
(2) establish a method to verify eligibility requirements;
(3) establish specifications for communication telecommunications devices to be
purchased provided under section 237.53, subdivision 3; and
(4) inform the public and specifically the community of communication-impaired
persons who have communication disabilities of the program.; and
(5) provide devices based on the assessed need of eligible applicants.
(b) The commissioner may establish an advisory board to advise the department
in carrying out the duties specified in this section and to advise the commissioner of
commerce in carrying out duties under section 237.54. If so established, the advisory
board must include, at a minimum, the following communication-impaired persons:
(1) at least one member who is deaf;
(2) at least one member who is has a speech impaired disability;
(3) at least one member who is mobility impaired has a physical disability that
makes it difficult or impossible for the person to access telecommunications services; and
(4) at least one member who is hard-of-hearing.
The membership terms, compensation, and removal of members and the filling of
membership vacancies are governed by section 15.059. Advisory board meetings shall be
held at the discretion of the commissioner.

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

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

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

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

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

ARTICLE 3

COMPREHENSIVE ASSESSMENT AND CASE MANAGEMENT REFORM

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

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

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

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

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

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

    Sec. 7. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 1a,
is amended to read:
    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
    (a) Until additional requirements apply under paragraph (b), "long-term care
consultation services" means:
    (1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;
    (2) providing recommendations on for and referrals to cost-effective community
services that are available to the individual;
    (3) development of an individual's person-centered community support plan;
    (4) providing information regarding eligibility for Minnesota health care programs;
    (5) face-to-face long-term care consultation assessments, which may be completed
in a hospital, nursing facility, intermediate care facility for persons with developmental
disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
residence;
    (6) federally mandated preadmission screening to determine the need for an
institutional level of care under subdivision 4a activities described under subdivisions
4a and 4b;
    (7) determination of home and community-based waiver and other service eligibility
as required under sections 256B.0913, 256B.0915, and 256B.49, including level of
care determination for individuals who need an institutional level of care as determined
under section 256B.0911, subdivision 4a, paragraph (d), or 256B.092, service eligibility
including state plan home care services identified in sections 256B.0625, subdivisions 6,
7, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and community
support plan development with, appropriate referrals to obtain necessary diagnostic
information, and including the option an eligibility determination for consumer-directed
community supports;
    (8) providing recommendations for nursing facility institutional placement when
there are no cost-effective community services available; and
    (9) providing access to assistance to transition people back to community settings
after facility institutional admission.; and
(10) providing information about competitive employment, with or without supports,
for school-age youth and working-age adults and referrals to the Disability Linkage
Line and Disability Benefits 101 to ensure that an informed choice about competitive
employment can be made. For the purposes of this subdivision, "competitive employment"
means work in the competitive labor market that is performed on a full-time or part-time
basis in an integrated setting, and for which an individual is compensated at or above the
minimum wage, but not less than the customary wage and level of benefits paid by the
employer for the same or similar work performed by individuals without disabilities.
(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
2c, and 3a, "long-term care consultation services" also means:
(1) service eligibility determination for state plan home care services identified in:
(i) section 256B.0625, subdivisions 7, 19a, and 19c;
(ii) section 256B.0657; or
(iii) consumer support grants under section 256.476;
(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
determination of eligibility for case management services available under sections
256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part
9525.0016;
(3) determination of institutional level of care, home and community-based service
waiver, and other service eligibility as required under section 256B.092, determination
of eligibility for family support grants under section 252.32, semi-independent living
services under section 252.275, and day training and habilitation services under section
256B.092; and
(4) obtaining necessary diagnostic information to determine eligibility under clauses
(2) and (3).
    (b) (c) "Long-term care options counseling" means the services provided by the
linkage lines as mandated by sections 256.01 and 256.975, subdivision 7, and also
includes telephone assistance and follow up once a long-term care consultation assessment
has been completed.
    (c) (d) "Minnesota health care programs" means the medical assistance program
under chapter 256B and the alternative care program under section 256B.0913.
    (d) (e) "Lead agencies" means counties administering or a collaboration of counties,
tribes, and health plans administering under contract with the commissioner to administer
long-term care consultation assessment and support planning services.

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

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

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

    Sec. 11. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 3a,
is amended to read:
    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 15 20
calendar days after the date on which an assessment was requested or recommended.
After January 1, 2011, these requirements also apply to Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services, and private duty nursing, and home health
agency services, on timelines established in subdivision 5. The commissioner shall provide
at least a 90-day notice to lead agencies prior to the effective date of this requirement.
Face-to-face assessments must be conducted according to paragraphs (b) to (i).
    (b) The county lead agency may utilize a team of either the social worker or public
health nurse, or both. After January 1, 2011 Upon implementation of subdivisions 2b, 2c,
and 5, lead agencies shall use certified assessors to conduct the assessment in a face-to-face
interview assessment. The consultation team members must confer regarding the most
appropriate care for each individual screened or assessed. For a person with complex
health care needs, a public health or registered nurse from the team must be consulted.
    (c) The assessment must be comprehensive and include a person-centered assessment
of the health, psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a community support plan that
meets the consumers needs, using an assessment form provided by the commissioner.
    (d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, as required by legally executed
documents, and other individuals as requested by the person, who can provide information
on the needs, strengths, and preferences of the person necessary to develop a community
support plan that ensures the person's health and safety, but who is not a provider of
service or has any financial interest in the provision of services.
    (e) The person, or the person's legal representative, must be provided with written
recommendations for community-based services, including consumer-directed options,
or institutional care that include documentation that the most cost-effective alternatives
available were offered to the individual, and alternatives to residential settings, including,
but not limited to, foster care settings that are not the primary residence of the license
holder. For purposes of this requirement, "cost-effective alternatives" means community
services and living arrangements that cost the same as or less than institutional care.
    (f) (e) If the person chooses to use community-based services, the person or the
person's legal representative must be provided with a written community support plan
within 40 calendar days of the assessment visit, regardless of whether the individual
is eligible for Minnesota health care programs. The written community support plan
must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including all
available options for case management services and providers;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a,
paragraph (b), clause (1), the person or person's representative must also receive a copy of
the home care service plan developed by the certified assessor.
(f) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying
community support, the person must be transferred or referred to the long-term care
options counseling services available under sections 256.975, subdivision 7, and 256.01,
subdivision 24, for telephone assistance and follow up.
    (g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in subdivision 4a, paragraph (c).
    (h) The team lead agency must give the person receiving assessment or support
planning, or the person's legal representative, materials, and forms supplied by the
commissioner containing the following information:
    (1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to
the individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 256B.49, "cost effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening if the person selects nursing
facility placement;
    (2) (4) the role of the long-term care consultation assessment and support planning
in waiver and alternative care program eligibility determination for waiver and alternative
care programs, and state plan home care, case management, and other services as defined
in subdivision 1a, paragraphs (a), clause (7), and (b);
    (3) (5) information about Minnesota health care programs;
    (4) (6) the person's freedom to accept or reject the recommendations of the team;
    (5) (7) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;
    (6) (8) the long-term care consultant's certified assessor's decision regarding the
person's need for institutional level of care as determined under criteria established in
section 144.0724, subdivision 11, or 256B.092 256B.0911, subdivision 4a, paragraph (d),
and the certified assessor's decision regarding eligibility for all services and programs as
defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
    (7) (9) the person's right to appeal the certified assessor's decision regarding
eligibility for all services and programs as defined in subdivision 1a, paragraphs (a),
clause (7), and (b), and incorporating the decision regarding the need for nursing facility
institutional level of care or the county's lead agency's final decisions regarding public
programs eligibility according to section 256.045, subdivision 3.
    (i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and traumatic brain injury waiver programs under sections
256B.0913, 256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility
for no more than 60 calendar days after the date of assessment.
(j) The effective eligibility start date for these programs in paragraph (i) can never
be prior to the date of assessment. If an assessment was completed more than 60 days
before the effective waiver or alternative care program eligibility start date, assessment
and support plan information must be updated in a face-to-face visit and documented in
the department's Medicaid Management Information System (MMIS). Notwithstanding
retroactive medical assistance coverage of state plan services, the effective date of
program eligibility in this case for programs included in paragraph (i) cannot be prior to
the date the most recent updated assessment is completed.

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

    Sec. 13. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 4a,
is amended to read:
    Subd. 4a. Preadmission screening activities related to nursing facility
admissions. (a) All applicants to Medicaid certified nursing facilities, including certified
boarding care facilities, must be screened prior to admission regardless of income, assets,
or funding sources for nursing facility care, except as described in subdivision 4b. The
purpose of the screening is to determine the need for nursing facility level of care as
described in paragraph (d) and to complete activities required under federal law related to
mental illness and developmental disability as outlined in paragraph (b).
(b) A person who has a diagnosis or possible diagnosis of mental illness or
developmental disability must receive a preadmission screening before admission
regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need
for further evaluation and specialized services, unless the admission prior to screening is
authorized by the local mental health authority or the local developmental disabilities case
manager, or unless authorized by the county agency according to Public Law 101-508.
The following criteria apply to the preadmission screening:
(1) the county lead agency must use forms and criteria developed by the
commissioner to identify persons who require referral for further evaluation and
determination of the need for specialized services; and
(2) the evaluation and determination of the need for specialized services must be
done by:
(i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or
(ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a
qualified developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title 42, section
483.430.
(c) The local county mental health authority or the state developmental disability
authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
nursing facility if the individual does not meet the nursing facility level of care criteria or
needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
purposes of this section, "specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal Regulations, title
42, section 483.440 (a)(1).
(d) The determination of the need for nursing facility level of care must be made
according to criteria developed by the commissioner, and in section 256B.092, using
forms developed by the commissioner. Effective no sooner than on or after July 1, 2012,
for individuals age 21 and older, and on or after October 1, 2019, for individuals under
age 21, the determination of need for nursing facility level of care shall be based on
criteria in section 144.0724, subdivision 11. In assessing a person's needs, consultation
team members shall have a physician available for consultation and shall consider the
assessment of the individual's attending physician, if any. The individual's physician must
be included if the physician chooses to participate. Other personnel may be included on
the team as deemed appropriate by the county lead agency.

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

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

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

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

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

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

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

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

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

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

    Sec. 24. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to
read:
    Subd. 1a. Case management administration and services. (a) The administrative
functions of case management provided to or arranged for a person include: Each recipient
of a home and community-based waiver shall be provided case management services by
qualified vendors as described in the federally approved waiver application.
(1) review of eligibility for services;
(2) screening;
(3) intake;
(4) diagnosis;
(5) the review and authorization of services based upon an individualized service
plan; and
(6) responding to requests for conciliation conferences and appeals according to
section 256.045 made by the person, the person's legal guardian or conservator, or the
parent if the person is a minor.
(b) Case management service activities provided to or arranged for a person include:
(1) development of the individual service coordinated service and support plan
under subdivision 1b;
(2) informing the individual or the individual's legal guardian or conservator, or
parent if the person is a minor, of service options;
(3) consulting with relevant medical experts or service providers;
(4) assisting the person in the identification of potential providers;
(5) assisting the person to access services and assisting in appeals under section
256.045;
(6) coordination of services, if coordination is not provided by another service
provider;
(7) evaluation and monitoring of the services identified in the coordinated service
and support plan, which must incorporate at least one annual face-to-face visit by the case
manager with each person; and
(8) annual reviews of service plans and services provided reviewing coordinated
service and support plans and providing the lead agency with recommendations for service
authorization based upon the individual's needs identified in the coordinated service and
support plan.
(c) Case management administration and service activities that are provided to the
person with a developmental disability shall be provided directly by county agencies or
under contract. Case management services must be provided by a public or private agency
that is enrolled as a medical assistance provider determined by the commissioner to meet
all of the requirements in the approved federal waiver plans. Case management services
must not be provided to a recipient by a private agency that has a financial interest in the
provision of any other services included in the recipient's coordinated service and support
plan. For purposes of this section, "private agency" means any agency that is not identified
as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
(d) Case managers are responsible for the administrative duties and service
provisions listed in paragraphs (a) and (b). Case managers shall collaborate with
consumers, families, legal representatives, and relevant medical experts and service
providers in the development and annual review of the individualized service coordinated
service and support plan and habilitation plans plan.
(e) The Department of Human Services shall offer ongoing education in case
management to case managers. Case managers shall receive no less than ten hours of case
management education and disability-related training each year.

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

    Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to
read:
    Subd. 1e. Coordination, evaluation, and monitoring of services. (a) If the
individual service coordinated service and support plan identifies the need for individual
program plans for authorized services, the case manager shall assure that individual
program plans are developed by the providers according to clauses (2) to (5). The
providers shall assure that the individual program plans:
(1) are developed according to the respective state and federal licensing and
certification requirements;
(2) are designed to achieve the goals of the individual service coordinated service
and support plan;
(3) are consistent with other aspects of the individual service coordinated service
and support plan;
(4) assure the health and safety of the person; and
(5) are developed with consistent and coordinated approaches to services among the
various service providers.
(b) The case manager shall monitor the provision of services:
(1) to assure that the individual service coordinated service and support plan is
being followed according to paragraph (a);
(2) to identify any changes or modifications that might be needed in the individual
service coordinated service and support plan, including changes resulting from
recommendations of current service providers;
(3) to determine if the person's legal rights are protected, and if not, notify the
person's legal guardian or conservator, or the parent if the person is a minor, protection
services, or licensing agencies as appropriate; and
(4) to determine if the person, the person's legal guardian or conservator, or the
parent if the person is a minor, is satisfied with the services provided.
(c) If the provider fails to develop or carry out the individual program plan according
to paragraph (a), the case manager shall notify the person's legal guardian or conservator,
or the parent if the person is a minor, the provider, the respective licensing and certification
agencies, and the county board where the services are being provided. In addition, the
case manager shall identify other steps needed to assure the person receives the services
identified in the individual service coordinated service and support plan.

    Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to
read:
    Subd. 1g. Conditions not requiring development of individual service
coordinated service and support plan. Unless otherwise required by federal law, the
county agency is not required to complete an individual service a coordinated service and
support plan as defined in subdivision 1b for:
(1) persons whose families are requesting respite care for their family member who
resides with them, or whose families are requesting a family support grant and are not
requesting purchase or arrangement of habilitative services; and
(2) persons with developmental disabilities, living independently without authorized
services or receiving funding for services at a rehabilitation facility as defined in section
268A.01, subdivision 6 , and not in need of or requesting additional services.

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

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

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

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

    Sec. 32. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:
    Subd. 8. Screening team Additional certified assessor duties. In addition to the
responsibilities of certified assessors described in section 256B.0911, for persons with
developmental disabilities, the screening team certified assessor shall:
(1) review diagnostic data;
(2) review health, social, and developmental assessment data using a uniform
screening tool specified by the commissioner;
(3) identify the level of services appropriate to maintain the person in the most
normal and least restrictive setting that is consistent with the person's treatment needs;
(4) (1) identify other noninstitutional public assistance or social service that may
prevent or delay long-term residential placement;
(5) (2) assess whether a person is in need of long-term residential care;
(6) (3) make recommendations regarding placement and payment for:
(i) social service or public assistance support, or both, to maintain a person in the
person's own home or other place of residence;
(ii) training and habilitation service, vocational rehabilitation, and employment
training activities;
(iii) community residential service placement;
(iv) regional treatment center placement; or
(v) a home and community-based service alternative to community residential
placement service or regional treatment center placement including self-directed service
options;
(7) (4) evaluate the availability, location, and quality of the services listed in clause
(6) (3), including the impact of placement alternatives on the person's ability to maintain
or improve existing patterns of contact and involvement with parents and other family
members;
(8) (5) identify the cost implications of recommendations in clause (6) (3); and
(9) (6) make recommendations to a court as may be needed to assist the court in
making decisions regarding commitment of persons with developmental disabilities; and.
(10) inform the person and the person's legal guardian or conservator, or the parent if
the person is a minor, that appeal may be made to the commissioner pursuant to section
256.045.

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

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

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

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

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

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

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

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

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

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

ARTICLE 4

CHEMICAL AND MENTAL HEALTH

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

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

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

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

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

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

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

    Sec. 8. Minnesota Statutes 2010, section 256B.0625, subdivision 42, is amended to
read:
    Subd. 42. Mental health professional. Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional shall include a person
who is qualified as specified in section 245.462, subdivision 18, clauses (5) and (1) to (6);
or 245.4871, subdivision 27, clauses (5) and (1) to (6), for the purpose of this section and
Minnesota Rules, parts 9505.0170 to 9505.0475.

    Sec. 9. Minnesota Statutes 2010, section 256F.13, subdivision 1, is amended to read:
    Subdivision 1. Federal revenue enhancement. (a) The commissioner of human
services may enter into an agreement with one or more family services collaboratives
to enhance federal reimbursement under title IV-E of the Social Security Act and
federal administrative reimbursement under title XIX of the Social Security Act. The
commissioner may contract with the Department of Education for purposes of transferring
the federal reimbursement to the commissioner of education to be distributed to the
collaboratives according to clause (2). The commissioner shall have the following
authority and responsibilities regarding family services collaboratives:
(1) the commissioner shall submit amendments to state plans and seek waivers as
necessary to implement the provisions of this section;
(2) the commissioner shall pay the federal reimbursement earned under this
subdivision to each collaborative based on their earnings. Payments to collaboratives for
expenditures under this subdivision will only be made of federal earnings from services
provided by the collaborative;
(3) the commissioner shall review expenditures of family services collaboratives
using reports specified in the agreement with the collaborative to ensure that the base level
of expenditures is continued and new federal reimbursement is used to expand education,
social, health, or health-related services to young children and their families;
(4) the commissioner may reduce, suspend, or eliminate a family services
collaborative's obligations to continue the base level of expenditures or expansion of
services if the commissioner determines that one or more of the following conditions
apply:
(i) imposition of levy limits that significantly reduce available funds for social,
health, or health-related services to families and children;
(ii) reduction in the net tax capacity of the taxable property eligible to be taxed by
the lead county or subcontractor that significantly reduces available funds for education,
social, health, or health-related services to families and children;
(iii) reduction in the number of children under age 19 in the county, collaborative
service delivery area, subcontractor's district, or catchment area when compared to the
number in the base year using the most recent data provided by the State Demographer's
Office; or
(iv) termination of the federal revenue earned under the family services collaborative
agreement;
(5) (4) the commissioner shall not use the federal reimbursement earned under this
subdivision in determining the allocation or distribution of other funds to counties or
collaboratives;
(6) (5) the commissioner may suspend, reduce, or terminate the federal
reimbursement to a provider that does not meet the reporting or other requirements
of this subdivision;
(7) (6) the commissioner shall recover from the family services collaborative any
federal fiscal disallowances or sanctions for audit exceptions directly attributable to the
family services collaborative's actions in the integrated fund, or the proportional share if
federal fiscal disallowances or sanctions are based on a statewide random sample; and
(8) (7) the commissioner shall establish criteria for the family services collaborative
for the accounting and financial management system that will support claims for federal
reimbursement.
(b) The family services collaborative shall have the following authority and
responsibilities regarding federal revenue enhancement:
(1) the family services collaborative shall be the party with which the commissioner
contracts. A lead county shall be designated as the fiscal agency for reporting, claiming,
and receiving payments;
(2) the family services collaboratives may enter into subcontracts with other
counties, school districts, special education cooperatives, municipalities, and other public
and nonprofit entities for purposes of identifying and claiming eligible expenditures to
enhance federal reimbursement, or to expand education, social, health, or health-related
services to families and children;
(3) the family services collaborative must use all new federal reimbursement
resulting from federal revenue enhancement to expand expenditures for education, social,
health, or health-related services to families and children beyond the base level, except
as provided in paragraph (a), clause (4);
(4) the family services collaborative must ensure that expenditures submitted for
federal reimbursement are not made from federal funds or funds used to match other
federal funds. Notwithstanding section 256B.19, subdivision 1, for the purposes of family
services collaborative expenditures under agreement with the department, the nonfederal
share of costs shall be provided by the family services collaborative from sources other
than federal funds or funds used to match other federal funds;
(5) the family services collaborative must develop and maintain an accounting and
financial management system adequate to support all claims for federal reimbursement,
including a clear audit trail and any provisions specified in the agreement; and
(6) the family services collaborative shall submit an annual report to the
commissioner as specified in the agreement.

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

ARTICLE 5

HEALTH CARE

    Section 1. Minnesota Statutes 2011 Supplement, section 125A.21, subdivision 7,
is amended to read:
    Subd. 7. District disclosure of information. A school district may disclose
information contained in a student's individualized education program, consistent with
section 13.32, subdivision 3, paragraph (a), and Code of Federal Regulations, title 34,
parts 99 and 300; including records of the student's diagnosis and treatment, to a health
plan company only with the signed and dated consent of the student's parent, or other
legally authorized individual, including consent that the parent or legal representative gave
as part of the application process for MinnesotaCare or medical assistance under section
256B.08, subdivision 1. The school district shall disclose only that information necessary
for the health plan company to decide matters of coverage and payment. A health plan
company may use the information only for making decisions regarding coverage and
payment, and for any other use permitted by law.

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

    Sec. 3. Minnesota Statutes 2011 Supplement, section 256B.056, subdivision 3, is
amended to read:
    Subd. 3. Asset limitations for individuals and families. (a) To be eligible for
medical assistance, a person must not individually own more than $3,000 in assets, or if a
member of a household with two family members, husband and wife, or parent and child,
the household must not own more than $6,000 in assets, plus $200 for each additional
legal dependent. In addition to these maximum amounts, an eligible individual or family
may accrue interest on these amounts, but they must be reduced to the maximum at the
time of an eligibility redetermination. The accumulation of the clothing and personal
needs allowance according to section 256B.35 must also be reduced to the maximum at
the time of the eligibility redetermination. The value of assets that are not considered in
determining eligibility for medical assistance is the value of those assets excluded under
the supplemental security income program for aged, blind, and disabled persons, with
the following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;
(3) motor vehicles are excluded to the same extent excluded by the supplemental
security income program;
(4) assets designated as burial expenses are excluded to the same extent excluded by
the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses; and
(5) for a person who no longer qualifies as an employed person with a disability due
to loss of earnings, assets allowed while eligible for medical assistance under section
256B.057, subdivision 9 , are not considered for 12 months, beginning with the first month
of ineligibility as an employed person with a disability, to the extent that the person's total
assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph
(d).; and
(6) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.
EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

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

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

    Sec. 6. Minnesota Statutes 2010, section 256B.0595, subdivision 2, is amended to read:
    Subd. 2. Period of ineligibility for long-term care services. (a) For any
uncompensated transfer occurring on or before August 10, 1993, the number of months
of ineligibility for long-term care services shall be the lesser of 30 months, or the
uncompensated transfer amount divided by the average medical assistance rate for nursing
facility services in the state in effect on the date of application. The amount used to
calculate the average medical assistance payment rate shall be adjusted each July 1 to
reflect payment rates for the previous calendar year. The period of ineligibility begins
with the month in which the assets were transferred. If the transfer was not reported to
the local agency at the time of application, and the applicant received long-term care
services during what would have been the period of ineligibility if the transfer had been
reported, a cause of action exists against the transferee for the cost of long-term care
services provided during the period of ineligibility, or for the uncompensated amount of
the transfer, whichever is less. The uncompensated transfer amount is the fair market
value of the asset at the time it was given away, sold, or disposed of, less the amount of
compensation received.
    (b) For uncompensated transfers made after August 10, 1993, the number of months
of ineligibility for long-term care services shall be the total uncompensated value of the
resources transferred divided by the average medical assistance rate for nursing facility
services in the state in effect on the date of application. The amount used to calculate
the average medical assistance payment rate shall be adjusted each July 1 to reflect
payment rates for the previous calendar year. The period of ineligibility begins with the
first day of the month after the month in which the assets were transferred except that
if one or more uncompensated transfers are made during a period of ineligibility, the
total assets transferred during the ineligibility period shall be combined and a penalty
period calculated to begin on the first day of the month after the month in which the first
uncompensated transfer was made. If the transfer was reported to the local agency after
the date that advance notice of a period of ineligibility that affects the next month could
be provided to the recipient and the recipient received medical assistance services or the
transfer was not reported to the local agency, and the applicant or recipient received
medical assistance services during what would have been the period of ineligibility if
the transfer had been reported, a cause of action exists against the transferee for that
portion of long-term care services provided during the period of ineligibility, or for the
uncompensated amount of the transfer, whichever is less. The uncompensated transfer
amount is the fair market value of the asset at the time it was given away, sold, or disposed
of, less the amount of compensation received. Effective for transfers made on or after
March 1, 1996, involving persons who apply for medical assistance on or after April 13,
1996, no cause of action exists for a transfer unless:
    (1) the transferee knew or should have known that the transfer was being made by a
person who was a resident of a long-term care facility or was receiving that level of care in
the community at the time of the transfer;
    (2) the transferee knew or should have known that the transfer was being made to
assist the person to qualify for or retain medical assistance eligibility; or
    (3) the transferee actively solicited the transfer with intent to assist the person to
qualify for or retain eligibility for medical assistance.
    (c) For uncompensated transfers made on or after February 8, 2006, the period
of ineligibility:
    (1) for uncompensated transfers by or on behalf of individuals receiving medical
assistance payment of long-term care services, begins the first day of the month following
advance notice of the period of ineligibility, but no later than the first day of the month
that follows three full calendar months from the date of the report or discovery of the
transfer; or
    (2) for uncompensated transfers by individuals requesting medical assistance
payment of long-term care services, begins the date on which the individual is eligible
for medical assistance under the Medicaid state plan and would otherwise be receiving
long-term care services based on an approved application for such care but for the period
of ineligibility resulting from the uncompensated transfer; and
    (3) cannot begin during any other period of ineligibility.
    (d) If a calculation of a period of ineligibility results in a partial month, payments for
long-term care services shall be reduced in an amount equal to the fraction.
    (e) In the case of multiple fractional transfers of assets in more than one month for
less than fair market value on or after February 8, 2006, the period of ineligibility is
calculated by treating the total, cumulative, uncompensated value of all assets transferred
during all months on or after February 8, 2006, as one transfer.
    (f) A period of ineligibility established under paragraph (c) may be eliminated if
all of the assets transferred for less than fair market value used to calculate the period of
ineligibility, or cash equal to the value of the assets at the time of the transfer, are returned
within 12 months after the date the period of ineligibility began. A period of ineligibility
must not be adjusted if less than the full amount of the transferred assets or the full cash
value of the transferred assets are returned.

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

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

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

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

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

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

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

    Sec. 14. Minnesota Statutes 2010, section 256B.19, subdivision 1c, is amended to read:
    Subd. 1c. Additional portion of nonfederal share. (a) Hennepin County shall
be responsible for a monthly transfer payment of $1,500,000, due before noon on the
15th of each month and the University of Minnesota shall be responsible for a monthly
transfer payment of $500,000 due before noon on the 15th of each month, beginning July
15, 1995. These sums shall be part of the designated governmental unit's portion of the
nonfederal share of medical assistance costs.
(b) Beginning July 1, 2001, Hennepin County's payment under paragraph (a) shall
be $2,066,000 each month.
(c) Beginning July 1, 2001, the commissioner shall increase annual capitation
payments to the metropolitan health plan a demonstration provider serving eligible
individuals in Hennepin County under section 256B.69 for the prepaid medical assistance
program by approximately $6,800,000 to recognize higher than average medical education
costs.
(d) Effective August 1, 2005, Hennepin County's payment under paragraphs (a)
and (b) shall be reduced to $566,000, and the University of Minnesota's payment under
paragraph (a) shall be reduced to zero. Effective October 1, 2008, to December 31, 2010,
Hennepin County's payment under paragraphs (a) and (b) shall be $434,688. Effective
January 1, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be
$566,000.
(e) Notwithstanding paragraph (d), upon federal enactment of an extension to June
30, 2011, of the enhanced federal medical assistance percentage (FMAP) originally
provided under Public Law 111-5, for the six-month period from January 1, 2011, to June
30, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be $434,688.

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

    Sec. 16. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 5a,
is amended to read:
    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
and section 256L.12 shall be entered into or renewed on a calendar year basis beginning
January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to
renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December
31, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may
issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
    (b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B and 256L is responsible for complying with the terms of its
contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B and 256L established after the effective date of a contract with the
commissioner take effect when the contract is next issued or renewed.
    (c) Effective for services rendered on or after January 1, 2003, the commissioner
shall withhold five percent of managed care plan payments under this section and
county-based purchasing plan payments under section 256B.692 for the prepaid medical
assistance program pending completion of performance targets. Each performance target
must be quantifiable, objective, measurable, and reasonably attainable, except in the case
of a performance target based on a federal or state law or rule. Criteria for assessment
of each performance target must be outlined in writing prior to the contract effective
date. Clinical or utilization performance targets and their related criteria must consider
evidence-based research and reasonable interventions when available or applicable to the
populations served, and must be developed with input from external clinical experts and
stakeholders, including managed care and county-based purchasing plans and providers.
The managed care plan must demonstrate, to the commissioner's satisfaction, that the data
submitted regarding attainment of the performance target is accurate. The commissioner
shall periodically change the administrative measures used as performance targets in
order to improve plan performance across a broader range of administrative services.
The performance targets must include measurement of plan efforts to contain spending
on health care services and administrative activities. The commissioner may adopt
plan-specific performance targets that take into account factors affecting only one plan,
including characteristics of the plan's enrollee population. The withheld funds must be
returned no sooner than July of the following year if performance targets in the contract
are achieved. The commissioner may exclude special demonstration projects under
subdivision 23.
    (d) Effective for services rendered on or after January 1, 2009, through December
31, 2009, the commissioner shall withhold three percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.
(e) Effective for services provided on or after January 1, 2010, the commissioner
shall require that managed care plans use the assessment and authorization processes,
forms, timelines, standards, documentation, and data reporting requirements, protocols,
billing processes, and policies consistent with medical assistance fee-for-service or the
Department of Human Services contract requirements consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for all
personal care assistance services under section 256B.0659.
(f) Effective for services rendered on or after January 1, 2010, through December
31, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.
(g) Effective for services rendered on or after January 1, 2011, through December
31, 2011, the commissioner shall include as part of the performance targets described
in paragraph (c) a reduction in the health plan's emergency room utilization rate for
state health care program enrollees by a measurable rate of five percent from the plan's
utilization rate for state health care program enrollees for the previous calendar year.
Effective for services rendered on or after January 1, 2012, the commissioner shall include
as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each year, the
managed care plan or county-based purchasing plan must achieve a qualifying reduction
of no less than ten percent of the plan's emergency department utilization rate for medical
assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs
described in subdivisions 23 and 28, compared to the previous calendar measurement
year until the final performance target is reached. When measuring performance, the
commissioner must consider the difference in health risk in a plan's membership in the
baseline year compared to the measurement year, and work with the managed care or
county-based purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
rate was achieved.
The withhold described in this paragraph shall continue for each consecutive
contract period until the plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the plan's emergency room utilization
rate for medical assistance and MinnesotaCare enrollees for calendar year 2011 2009.
Hospitals shall cooperate with the health plans in meeting this performance target and
shall accept payment withholds that may be returned to the hospitals if the performance
target is achieved.
(h) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction
in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than five percent of the plan's hospital admission rate for medical
assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs
described in subdivisions 23 and 28, compared to the previous calendar year until the final
performance target is reached. When measuring performance, the commissioner must
evaluate the difference in health risk in a plan's membership in the baseline year compared
to the measurement year, and work with the managed care or county-based purchasing
plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that this reduction in the
hospitalization rate was achieved.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in
calendar year 2011, as determined by the commissioner. The hospital admissions in this
performance target do not include the admissions applicable to the subsequent hospital
admission performance target under paragraph (i). Hospitals shall cooperate with the
plans in meeting this performance target and shall accept payment withholds that may be
returned to the hospitals if the performance target is achieved.
(i) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction in
the plan's hospitalization admission rates for subsequent hospitalizations within 30 days
of a previous hospitalization of a patient regardless of the reason, for medical assistance
and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of
the withhold each year, the managed care plan or county-based purchasing plan must
achieve a qualifying reduction of the subsequent hospitalization rate for medical assistance
and MinnesotaCare enrollees, excluding Medicare enrollees in programs described in
subdivisions 23 and 28, of no less than five percent compared to the previous calendar
year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31
of the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved.
The withhold described in this paragraph must continue for each consecutive
contract period until the plan's subsequent hospitalization rate for medical assistance
and MinnesotaCare enrollees, excluding Medicare enrollees in programs described in
subdivisions 23 and 28, is reduced by 25 percent of the plan's subsequent hospitalization
rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this
performance target and shall accept payment withholds that must be returned to the
hospitals if the performance target is achieved.
(j) Effective for services rendered on or after January 1, 2011, through December 31,
2011, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(k) Effective for services rendered on or after January 1, 2012, through December
31, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.
(l) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(m) Effective for services rendered on or after January 1, 2014, the commissioner
shall withhold three percent of managed care plan payments under this section and
county-based purchasing plan payments under section 256B.692 for the prepaid medical
assistance program. The withheld funds must be returned no sooner than July 1 and
no later than July 31 of the following year. The commissioner may exclude special
demonstration projects under subdivision 23.
(n) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.
(o) Contracts between the commissioner and a prepaid health plan are exempt from
the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
(a), and 7.
(p) The return of the withhold under paragraphs (d), (f), and (j) to (m) is not subject
to the requirements of paragraph (c).

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

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

    Sec. 19. Minnesota Statutes 2011 Supplement, section 256L.12, subdivision 9, is
amended to read:
    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective,
per capita, where possible. The commissioner may allow health plans to arrange for
inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
an independent actuary to determine appropriate rates.
    (b) For services rendered on or after January 1, 2004, the commissioner shall
withhold five percent of managed care plan payments and county-based purchasing
plan payments under this section pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions, when available or
applicable to the populations served, and must be developed with input from external
clinical experts and stakeholders, including managed care and county-based purchasing
plans and providers. The managed care plan must demonstrate, to the commissioner's
satisfaction, that the data submitted regarding attainment of the performance target is
accurate. The commissioner shall periodically change the administrative measures used
as performance targets in order to improve plan performance across a broader range of
administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, such as characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July 1 and no later than July 31 of the
following calendar year if performance targets in the contract are achieved.
(c) For services rendered on or after January 1, 2011, the commissioner shall
withhold an additional three percent of managed care plan or county-based purchasing
plan payments under this section. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following calendar year. The return of the withhold
under this paragraph is not subject to the requirements of paragraph (b).
(d) Effective for services rendered on or after January 1, 2011, through December
31, 2011, the commissioner shall include as part of the performance targets described in
paragraph (b) a reduction in the plan's emergency room utilization rate for state health
care program enrollees by a measurable rate of five percent from the plan's utilization
rate for the previous calendar year. Effective for services rendered on or after January
1, 2012, the commissioner shall include as part of the performance targets described in
paragraph (b) a reduction in the health plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, as determined by the commissioner. For
2012, the reduction shall be based on the health plan's utilization in 2009. To earn the
return of the withhold each year, the managed care plan or county-based purchasing plan
must achieve a qualifying reduction of no less than ten percent of the plan's utilization
rate for medical assistance and MinnesotaCare enrollees, excluding Medicare enrollees
in programs described in section 256B.69, subdivisions 23 and 28, compared to the
previous calendar measurement year, until the final performance target is reached. When
measuring performance, the commissioner must evaluate the difference in health risk in
a plan's membership in the baseline year compared to the measurement year, and work
with the managed care or county-based purchasing plan to account for differences that
they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
rate was achieved.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program
enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical
assistance and MinnesotaCare enrollees for calendar year 2011. Hospitals shall cooperate
with the health plans in meeting this performance target and shall accept payment
withholds that may be returned to the hospitals if the performance target is achieved.
(e) Effective for services rendered on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (b) a reduction
in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than five percent of the plan's hospital admission rate for medical
assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs
described in section 256B.69, subdivisions 23 and 28, compared to the previous calendar
year, until the final performance target is reached. When measuring performance, the
commissioner must evaluate the difference in health risk in a plan's membership in the
baseline year compared to the measurement year, and work with the managed care or
county-based purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that this reduction in the
hospitalization rate was achieved.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospitals admission rate compared to the hospital admission rate for
calendar year 2011 as determined by the commissioner. Hospitals shall cooperate with the
plans in meeting this performance target and shall accept payment withholds that may be
returned to the hospitals if the performance target is achieved. The hospital admissions
in this performance target do not include the admissions applicable to the subsequent
hospital admission performance target under paragraph (f).
(f) Effective for services provided on or after January 1, 2012, the commissioner
shall include as part of the performance targets described in paragraph (b) a reduction
in the plan's hospitalization rate for a subsequent hospitalization within 30 days of a
previous hospitalization of a patient regardless of the reason, for medical assistance and
MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the
withhold each year, the managed care plan or county-based purchasing plan must achieve
a qualifying reduction of the subsequent hospital admissions rate for medical assistance
and MinnesotaCare enrollees, excluding Medicare enrollees described in section 256B.69,
subdivisions 23 and 28, of no less than five percent compared to the previous calendar
year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31
of the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the subsequent
hospitalization rate was achieved.
The withhold described in this paragraph must continue for each consecutive
contract period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees is reduced by 25 percent of the plan's subsequent hospitalization
rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this
performance target and shall accept payment withholds that must be returned to the
hospitals if the performance target is achieved.
(g) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.

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

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

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

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

ARTICLE 6

TECHNICAL

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

    Sec. 2. REVISOR'S INSTRUCTION.
    (a) In Minnesota Statutes, sections 256B.038, 256B.0911, 256B.0918, 256B.092,
256B.097, 256B.49, and 256B.765, the revisor of statutes shall delete the word "traumatic"
when it comes before the word "brain."
    (b) In Minnesota Statutes, section 256B.093, subdivision 1, clauses (4) and (5), and
subdivision 3, clause (2), the revisor of statutes shall delete the word "traumatic" when it
comes before the word "brain."
    (c) In Minnesota Statutes, sections 144.0724 and 144G.05, the revisor of statutes
shall delete "TBI" and replace it with "BI."