Bill Text: MN SF2754 | 2013-2014 | 88th Legislature | Engrossed

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Bill Title: Home and community-based services, health care, Northstar care for children, community first services and supports (CFSS), continuing care, and payment rate modifications

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2014-04-01 - Author added Sheran [SF2754 Detail]

Download: Minnesota-2013-SF2754-Engrossed.html

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A bill for an act

relating to the operation of state government; making changes to provisions
relating to the Department of Health, Northstar Care for Children program,
continuing care, community first services and supports, health care, and
chemical dependency; modifying the hospital payment system; modifying
provisions governing background studies and home and community-based
services standards; setting fees; providing rate increases;amending Minnesota
Statutes 2012, sections 13.46, subdivision 4; 245C.03, by adding a subdivision;
245C.04, by adding a subdivision; 245C.05, subdivision 5; 245C.10, by adding
a subdivision; 245C.33, subdivisions 1, 4; 252.451, subdivision 2; 254B.12;
256.01, by adding a subdivision; 256.9685, subdivisions 1, 1a; 256.9686,
subdivision 2; 256.969, subdivisions 1, 2, 2b, 2c, 3a, 3b, 6a, 9, 10, 14, 17, 30,
by adding subdivisions; 256B.0625, subdivision 30; 256B.199; 256B.5012, by
adding a subdivision; 256I.05, subdivision 2; 257.85, subdivision 11; 260C.212,
subdivision 1; 260C.515, subdivision 4; 260C.611; Minnesota Statutes 2013
Supplement, sections 245.8251; 245A.042, subdivision 3; 245A.16, subdivision
1; 245C.08, subdivision 1; 245D.02, subdivisions 3, 4b, 8b, 11, 15b, 29, 34, 34a,
by adding a subdivision; 245D.03, subdivisions 1, 2, 3, by adding a subdivision;
245D.04, subdivision 3; 245D.05, subdivisions 1, 1a, 1b, 2, 4, 5; 245D.051;
245D.06, subdivisions 1, 2, 4, 6, 7, 8; 245D.071, subdivisions 3, 4, 5; 245D.081,
subdivision 2; 245D.09, subdivisions 3, 4a; 245D.091, subdivisions 2, 3, 4;
245D.10, subdivisions 3, 4; 245D.11, subdivision 2; 256B.04, subdivision 21;
256B.055, subdivision 1; 256B.439, subdivisions 1, 7; 256B.4912, subdivision
1; 256B.85, subdivisions 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18,
23, 24, by adding subdivisions; 256N.02, by adding a subdivision; 256N.21,
subdivision 2, by adding a subdivision; 256N.22, subdivisions 1, 2, 4, 6;
256N.23, subdivisions 1, 4; 256N.24, subdivisions 9, 10; 256N.25, subdivisions
2, 3; 256N.26, subdivision 1; 256N.27, subdivision 4; Laws 2013, chapter 108,
article 7, section 49; article 14, section 2, subdivision 6; proposing coding for
new law in Minnesota Statutes, chapter 144A; repealing Minnesota Statutes
2012, sections 245.825, subdivisions 1, 1b; 256.969, subdivisions 8b, 9a, 9b, 11,
13, 20, 21, 22, 25, 26, 27, 28; 256.9695, subdivisions 3, 4; Minnesota Statutes
2013 Supplement, sections 245D.02, subdivisions 2b, 2c, 5a, 23b; 245D.06,
subdivisions 5, 6, 7, 8; 245D.061, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9; 256N.26,
subdivision 7; Minnesota Rules, parts 9525.2700; 9525.2810.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

HEALTH DEPARTMENT

    Section 1. [144A.484] INTEGRATED LICENSURE; HOME AND
COMMUNITY-BASED SERVICES DESIGNATION.
    Subdivision 1. Integrated licensing established. (a) From January 1, 2014, to
June 30, 2015, the commissioner of health shall enforce the home and community-based
services standards under chapter 245D for those providers who also have a home care
license pursuant to chapter 144A as required under Laws 2013, chapter 108, article 11,
section 31, and article 8, section 60.
(b) Beginning July 1, 2015, a home care provider applicant or license holder may
apply to the commissioner of health for a home and community-based services designation
for the provision of basic home and community-based services identified under section
245D.03, subdivision 1, paragraph (b). The designation allows the license holder to
provide basic home and community-based services that would otherwise require licensure
under chapter 245D, under the license holder's home care license governed by sections
144A.43 to 144A.481.
    Subd. 2. Application for home and community-based services designation. An
application for a home and community-based services designation must be made on the
forms and in the manner prescribed by the commissioner. The commissioner shall provide
the applicant with instruction for completing the application and provide information
about the requirements of other state agencies that affect the applicant. Application for
the home and community-based services designation is subject to the requirements under
section 144A.473.
    Subd. 3. Home and community-based services designation fees. A home care
provider applicant or licensee applying for the home and community-based services
designation or renewal of a home and community-based services designation must submit
a fee in the amount specified in subdivision 8.
    Subd. 4. Applicability of home and community-based services requirements. A
home care provider with a home and community-based services designation must comply
with the requirements for home care services governed by this chapter. For the provision
of basic home and community-based services, the home care provider must also comply
with the following home and community-based services licensing requirements:
(1) person-centered planning requirements in section 245D.07;
(2) protection standards in section 245D.06;
(3) emergency use of manual restraints in section 245D.061; and
(4) service recipient rights in section 245D.04, subdivision 3, paragraph (a), clauses
(5), (7), (8), (12), and (13), and paragraph (b).
A home care provider with the integrated license-HCBS designation may utilize a bill of
rights which incorporates the service recipient rights in section 245D.04, subdivision 3,
paragraph (a), clauses (5), (7), (8), (12), and (13), and paragraph (b) with the home care
bill of rights in section 144A.44.
    Subd. 5. Monitoring and enforcement. (a) The commissioner shall monitor for
compliance with the home and community-based services requirements identified in
subdivision 5, in accordance with this section and any agreements by the commissioners
of health and human services.
(b) The commissioner shall enforce compliance with applicable home and
community-based services licensing requirements as follows:
(1) the commissioner may deny a home and community-based services designation
in accordance with section 144A.473 or 144A.475; and
(2) if the commissioner finds that the applicant or license holder has failed to comply
with the applicable home and community-based services designation requirements the
commissioner may issue:
(i) a correction order in accordance with section 144A.474;
(ii) an order of conditional license in accordance with section 144A.475;
(iii) a sanction in accordance with section 144A.475; or
(iv) any combination of clauses (i) to (iii).
    Subd. 6. Appeals. A home care provider applicant that has been denied a temporary
license will also be denied their application for the home and community-based services
designation. The applicant may request reconsideration in accordance with section
144A.473, subdivision 3. A licensed home care provider whose application for a home
and community-based services designation has been denied or whose designation has been
suspended or revoked may appeal the denial, suspension, revocation, or refusal to renew a
home and community-based services designation in accordance with section 144A.475.
A license holder may request reconsideration of a correction order in accordance with
section 144A.474, subdivision 12.
    Subd. 7. Agreements. The commissioners of health and human services shall enter
into any agreements necessary to implement this section.
    Subd. 8. Fees; home and community-based services designation. (a) The initial
fee for a basic home and community-based services designation is $155. A home care
provider who is seeking to renew the provider's home and community-based services
designation must pay an annual nonrefundable fee with the annual home care license
fee according to the following schedule and based on revenues from the home and
community-based services:

	Provider Annual Revenue from HCBS	HCBS Designation
	greater than $1,500,000	$320
	greater than $1,275,000 and no more than $1,500,000	$300
	greater than $1,100,000 and no more than $1,275,000	$280
	greater than $950,000 and no more than $1,100,000	$260
	greater than $850,000 and no more than $950,000	$240
	greater than $750,000 and no more than $850,000	$220
	greater than $650,000 and no more than $750,000	$200
	greater than $550,000 and no more than $650,000	$180
	greater than $450,000 and no more than $550,000	$160
	greater than $350,000 and no more than $450,000	$140
	greater than $250,000 and no more than $350,000	$120
	greater than $100,000 and no more than $250,000	$100
	greater than $50,000 and no more than $100,000	$80
	greater than $25,000 and no more than $50,000	$60
	no more than $25,000	$40

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

    Sec. 2. Minnesota Statutes 2013 Supplement, section 256B.04, subdivision 21, is
amended to read:
    Subd. 21. Provider enrollment. (a) If the commissioner or the Centers for
Medicare and Medicaid Services determines that a provider is designated "high-risk," the
commissioner may withhold payment from providers within that category upon initial
enrollment for a 90-day period. The withholding for each provider must begin on the date
of the first submission of a claim.
(b) An enrolled provider that is also licensed by the commissioner under chapter
245A or that is licensed by the Department of Health under chapter 144A and has a
HCBS designation on the home care license must designate an individual as the entity's
compliance officer. The compliance officer must:
(1) develop policies and procedures to assure adherence to medical assistance laws
and regulations and to prevent inappropriate claims submissions;
(2) train the employees of the provider entity, and any agents or subcontractors of
the provider entity including billers, on the policies and procedures under clause (1);
(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;
(4) use evaluation techniques to monitor compliance with medical assistance laws
and regulations;
(5) promptly report to the commissioner any identified violations of medical
assistance laws or regulations; and
    (6) within 60 days of discovery by the provider of a medical assistance
reimbursement overpayment, report the overpayment to the commissioner and make
arrangements with the commissioner for the commissioner's recovery of the overpayment.
The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.
(c) The commissioner may revoke the enrollment of an ordering or rendering
provider for a period of not more than one year, if the provider fails to maintain and, upon
request from the commissioner, provide access to documentation relating to written orders
or requests for payment for durable medical equipment, certifications for home health
services, or referrals for other items or services written or ordered by such provider, when
the commissioner has identified a pattern of a lack of documentation. A pattern means a
failure to maintain documentation or provide access to documentation on more than one
occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
provider under the provisions of section 256B.064.
(d) The commissioner shall terminate or deny the enrollment of any individual or
entity if the individual or entity has been terminated from participation in Medicare or
under the Medicaid program or Children's Health Insurance Program of any other state.
(e) As a condition of enrollment in medical assistance, the commissioner shall
require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
and Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.
(f) As a condition of enrollment in medical assistance, the commissioner shall
require that a high-risk provider, or a person with a direct or indirect ownership interest in
the provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is
designated high-risk for fraud, waste, or abuse.
(g)(1) Upon initial enrollment, reenrollment, and revalidation, all durable medical
equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers operating in
Minnesota and receiving Medicaid funds must purchase a surety bond that is annually
renewed and designates the Minnesota Department of Human Services as the obligee, and
must be submitted in a form approved by the commissioner.
(2) At the time of initial enrollment or reenrollment, the provider agency must
purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
in the previous calendar year is up to and including $300,000, the provider agency must
purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
in the previous calendar year is over $300,000, the provider agency must purchase a
performance bond of $100,000. The performance bond must allow for recovery of costs
and fees in pursuing a claim on the bond.
(h) The Department of Human Services may require a provider to purchase a
performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
department determines there is significant evidence of or potential for fraud and abuse by
the provider, or (3) the provider or category of providers is designated high-risk pursuant
to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450. The
performance bond must be in an amount of $100,000 or ten percent of the provider's
payments from Medicaid during the immediately preceding 12 months, whichever is
greater. The performance bond must name the Department of Human Services as an
obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.

ARTICLE 2

HEALTH CARE

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

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

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

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

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

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

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

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

    Sec. 9. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
to read:
    Subd. 2d. Budget neutrality factor. For the rebased period effective September 1,
2014, when rebasing rates under subdivisions 2b and 2c, the commissioner must apply a
budget neutrality factor (BNF) to a hospital's conversion factor to ensure that total DRG
payments to hospitals do not exceed total DRG payments that would have been made to
hospitals if the relative rates and weights had not been recalibrated. For the purposes of
this section, BNF equals the percentage change from total aggregate payments calculated
under a new payment system to total aggregate payments calculated under the old system.

    Sec. 10. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695 , in addition to third-party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. This payment limitation
shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991. Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and may
merge the payment rates while maintaining separate provider numbers. The operating and
property base rates per admission or per day shall be derived from the best Medicare and
claims data available when rates are established. The commissioner shall determine the
best Medicare and claims data, taking into consideration variables of recency of the data,
audit disposition, settlement status, and the ability to set rates in a timely manner. The
commissioner shall notify hospitals of payment rates by December 1 of the year preceding
the rate year 30 days prior to implementation. The rate setting data must reflect the
admissions data used to establish relative values. Base year changes from 1981 to the base
year established for the rate year beginning January 1, 1991, and for subsequent rate years,
shall not be limited to the limits ending June 30, 1987, on the maximum rate of increase
under subdivision 1. The commissioner may adjust base year cost, relative value, and case
mix index data to exclude the costs of services that have been discontinued by the October
1 of the year preceding the rate year or that are paid separately from inpatient services.
Inpatient stays that encompass portions of two or more rate years shall have payments
established based on payment rates in effect at the time of admission unless the date of
admission preceded the rate year in effect by six months or more. In this case, operating
payment rates for services rendered during the rate year in effect and established based on
the date of admission shall be adjusted to the rate year in effect by the hospital cost index.
    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.
    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, and
facilities defined under subdivision 16 are excluded from this paragraph.
    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent
from the current statutory rates. Mental health services within diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
assistance does not include general assistance medical care. Payments made to managed
care plans shall be reduced for services provided on or after January 1, 2006, to reflect
this reduction.
    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
1.9 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.79 percent
from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Payments made to managed care plans shall be reduced for services provided on or after
July 1, 2011, to reflect this reduction.
(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
payment for fee-for-service admissions occurring on or after July 1, 2009, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
one percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.
(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
payment for fee-for-service admissions occurring on or after July 1, 2011, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
1.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after January 1, 2011, to reflect this reduction.

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

    Sec. 12. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
to read:
    Subd. 4b. Medical assistance cost reports for services. (a) A hospital that meets
one of the following criteria must annually file medical assistance cost reports within six
months of the end of the hospital's fiscal year:
(1) a hospital designated as a critical access hospital that receives medical assistance
payments; or
(2) a Minnesota hospital or out-of-state hospital located within a Minnesota local
trade area that receives a disproportionate population adjustment under subdivision 9.
For purposes of this subdivision, local trade area has the meaning given in
subdivision 17.
(b) The Department of Human Services must suspend payments to any hospital that
fails to file a report required under this subdivision. Payments must remain suspended
until the report has been filed with and accepted by the Department of Human Services
inpatient rates unit.

    Sec. 13. Minnesota Statutes 2012, section 256.969, subdivision 6a, is amended to read:
    Subd. 6a. Special considerations. In determining the payment rates, the
commissioner shall consider whether the circumstances in subdivisions 7 8 to 14 exist.

    Sec. 14. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
to read:
    Subd. 8c. Hospital residents. Payments for hospital residents shall be made
as follows:
(1) payments for the first 180 days of inpatient care shall be the APR-DRG payment
plus any appropriate outliers; and
(2) payment for all medically necessary patient care subsequent to 180 days shall
be reimbursed at a rate computed by multiplying the statewide average cost-to-charge
ratio by the usual and customary charges.

    Sec. 15. Minnesota Statutes 2012, section 256.969, subdivision 9, is amended to read:
    Subd. 9. Disproportionate numbers of low-income patients served. (a) For
admissions occurring on or after October 1, 1992, through December 31, 1992, the
medical assistance disproportionate population adjustment shall comply with federal law
and shall be paid to a hospital, excluding regional treatment centers and facilities of the
federal Indian Health Service, with a medical assistance inpatient utilization rate in excess
of the arithmetic mean. The adjustment must be determined as follows:
    (1) for a hospital with a medical assistance inpatient utilization rate above the
arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
federal Indian Health Service but less than or equal to one standard deviation above the
mean, the adjustment must be determined by multiplying the total of the operating and
property payment rates by the difference between the hospital's actual medical assistance
inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
treatment centers and facilities of the federal Indian Health Service; and
    (2) for a hospital with a medical assistance inpatient utilization rate above one
standard deviation above the mean, the adjustment must be determined by multiplying
the adjustment that would be determined under clause (1) for that hospital by 1.1. If
federal matching funds are not available for all adjustments under this subdivision, the
commissioner shall reduce payments on a pro rata basis so that all adjustments qualify for
federal match. The commissioner may establish a separate disproportionate population
operating payment rate adjustment under the general assistance medical care program.
For purposes of this subdivision medical assistance does not include general assistance
medical care. The commissioner shall report annually on the number of hospitals likely to
receive the adjustment authorized by this paragraph. The commissioner shall specifically
report on the adjustments received by public hospitals and public hospital corporations
located in cities of the first class.
    (b) For admissions occurring on or after July 1, 1993, the medical assistance
disproportionate population adjustment shall comply with federal law and shall be paid to
a hospital, excluding regional treatment centers, critical access hospitals, and facilities of
the federal Indian Health Service, with a medical assistance inpatient utilization rate in
excess of the arithmetic mean. The adjustment must be determined as follows:
    (1) for a hospital with a medical assistance inpatient utilization rate above the
arithmetic mean for all hospitals excluding regional treatment centers, critical access
hospitals, and facilities of the federal Indian Health Service but less than or equal to one
standard deviation above the mean, the adjustment must be determined by multiplying the
total of the operating and property payment rates by the difference between the hospital's
actual medical assistance inpatient utilization rate and the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the federal Indian Health Service; and
    (2) for a hospital with a medical assistance inpatient utilization rate above one
standard deviation above the mean, the adjustment must be determined by multiplying
the adjustment that would be determined under clause (1) for that hospital by 1.1. The
commissioner may establish a separate disproportionate population operating payment
rate adjustment under the general assistance medical care program. For purposes of this
subdivision, medical assistance does not include general assistance medical care. The
commissioner shall report annually on the number of hospitals likely to receive the
adjustment authorized by this paragraph. The commissioner shall specifically report on
the adjustments received by public hospitals and public hospital corporations located in
cities of the first class;.
    (3) for a hospital that had medical assistance fee-for-service payment volume during
calendar year 1991 in excess of 13 percent of total medical assistance fee-for-service
payment volume, a medical assistance disproportionate population adjustment shall be
paid in addition to any other disproportionate payment due under this subdivision as
follows: $1,515,000 due on the 15th of each month after noon, beginning July 15, 1995.
For a hospital that had medical assistance fee-for-service payment volume during calendar
year 1991 in excess of eight percent of total medical assistance fee-for-service payment
volume and was the primary hospital affiliated with the University of Minnesota, a
medical assistance disproportionate population adjustment shall be paid in addition to any
other disproportionate payment due under this subdivision as follows: $505,000 due on
the 15th of each month after noon, beginning July 15, 1995; and
    (4) effective August 1, 2005, the payments in paragraph (b), clause (3), shall be
reduced to zero.
    (c) The commissioner shall adjust rates paid to a health maintenance organization
under contract with the commissioner to reflect rate increases provided in paragraph (b),
clauses (1) and (2), on a nondiscounted hospital-specific basis but shall not adjust those
rates to reflect payments provided in clause (3).
    (d) If federal matching funds are not available for all adjustments under paragraph
(b), the commissioner shall reduce payments under paragraph (b), clauses (1) and (2), on a
pro rata basis so that all adjustments under paragraph (b) qualify for federal match.
    (e) For purposes of this subdivision, medical assistance does not include general
assistance medical care.
    (f) For hospital services occurring on or after July 1, 2005, to June 30, 2007:
    (1) general assistance medical care expenditures for fee-for-service inpatient and
outpatient hospital payments made by the department shall be considered Medicaid
disproportionate share hospital payments, except as limited below:
     (i) only the portion of Minnesota's disproportionate share hospital allotment under
section 1923(f) of the Social Security Act that is not spent on the disproportionate
population adjustments in paragraph (b), clauses (1) and (2), may be used for general
assistance medical care expenditures;
     (ii) only those general assistance medical care expenditures made to hospitals that
qualify for disproportionate share payments under section 1923 of the Social Security Act
and the Medicaid state plan may be considered disproportionate share hospital payments;
     (iii) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and
     (iv) general assistance medical care expenditures may be considered only to the
extent of Minnesota's aggregate allotment under section 1923 of the Social Security Act.
All hospitals and prepaid health plans participating in general assistance medical care
must provide any necessary expenditure, cost, and revenue information required by the
commissioner as necessary for purposes of obtaining federal Medicaid matching funds for
general assistance medical care expenditures; and
    (2) (c) Certified public expenditures made by Hennepin County Medical Center shall
be considered Medicaid disproportionate share hospital payments. Hennepin County
and Hennepin County Medical Center shall report by June 15, 2007, on payments made
beginning July 1, 2005, or another date specified by the commissioner, that may qualify
for reimbursement under federal law. Based on these reports, the commissioner shall
apply for federal matching funds.
    (g) (d) Upon federal approval of the related state plan amendment, paragraph (f) (c)
is effective retroactively from July 1, 2005, or the earliest effective date approved by the
Centers for Medicare and Medicaid Services.

    Sec. 16. Minnesota Statutes 2012, section 256.969, subdivision 10, is amended to read:
    Subd. 10. Separate billing by certified registered nurse anesthetists. Hospitals
may must exclude certified registered nurse anesthetist costs from the operating payment
rate as allowed by section 256B.0625, subdivision 11. To be eligible, a hospital must
notify the commissioner in writing by October 1 of even-numbered years to exclude
certified registered nurse anesthetist costs. The hospital must agree that all hospital
claims for the cost and charges of certified registered nurse anesthetist services will not
be included as part of the rates for inpatient services provided during the rate year. In
this case, the operating payment rate shall be adjusted to exclude the cost of certified
registered nurse anesthetist services.
For admissions occurring on or after July 1, 1991, and until the expiration date of
section 256.9695, subdivision 3, services of certified registered nurse anesthetists provided
on an inpatient basis may be paid as allowed by section 256B.0625, subdivision 11, when
the hospital's base year did not include the cost of these services. To be eligible, a hospital
must notify the commissioner in writing by July 1, 1991, of the request and must comply
with all other requirements of this subdivision.

    Sec. 17. Minnesota Statutes 2012, section 256.969, subdivision 14, is amended to read:
    Subd. 14. Transfers. Except as provided in subdivisions 11 and 13, Operating
and property payment rates for admissions that result in transfers and transfers shall be
established on a per day payment system. The per day payment rate shall be the sum of
the adjusted operating and property payment rates determined under this subdivision and
subdivisions 2, 2b, 2c, 3a, 4a, 5a, and 7 8 to 12, divided by the arithmetic mean length
of stay for the diagnostic category. Each admission that results in a transfer and each
transfer is considered a separate admission to each hospital, and the total of the admission
and transfer payments to each hospital must not exceed the total per admission payment
that would otherwise be made to each hospital under this subdivision and subdivisions
2, 2b, 2c, 3a, 4a, 5a, and 7 to 13 8 to 12.

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

    Sec. 19. Minnesota Statutes 2012, section 256.969, subdivision 30, is amended to read:
    Subd. 30. Payment rates for births. (a) For admissions occurring on or after
October 1, 2009 September 1, 2014, the total operating and property payment rate,
excluding disproportionate population adjustment, for the following diagnosis-related
groups, as they fall within the diagnostic APR-DRG categories: (1) 371 cesarean section
without complicating diagnosis 5601, 5602, 5603, 5604 vaginal delivery; and (2) 372
vaginal delivery with complicating diagnosis; and (3) 373 vaginal delivery without
complicating diagnosis 5401, 5402, 5403, 5404 cesarean section, shall be no greater
than $3,528.
(b) The rates described in this subdivision do not include newborn care.
(c) Payments to managed care and county-based purchasing plans under section
256B.69 , 256B.692, or 256L.12 shall be reduced for services provided on or after October
1, 2009, to reflect the adjustments in paragraph (a).
(d) Prior authorization shall not be required before reimbursement is paid for a
cesarean section delivery.

    Sec. 20. Minnesota Statutes 2012, section 256B.0625, subdivision 30, is amended to
read:
    Subd. 30. Other clinic services. (a) Medical assistance covers rural health clinic
services, federally qualified health center services, nonprofit community health clinic
services, and public health clinic services. Rural health clinic services and federally
qualified health center services mean services defined in United States Code, title 42,
section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified
health center services shall be made according to applicable federal law and regulation.
(b) A federally qualified health center that is beginning initial operation shall submit
an estimate of budgeted costs and visits for the initial reporting period in the form and
detail required by the commissioner. A federally qualified health center that is already in
operation shall submit an initial report using actual costs and visits for the initial reporting
period. Within 90 days of the end of its reporting period, a federally qualified health
center shall submit, in the form and detail required by the commissioner, a report of
its operations, including allowable costs actually incurred for the period and the actual
number of visits for services furnished during the period, and other information required
by the commissioner. Federally qualified health centers that file Medicare cost reports
shall provide the commissioner with a copy of the most recent Medicare cost report filed
with the Medicare program intermediary for the reporting year which support the costs
claimed on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), a federally qualified health center or rural health clinic
must apply for designation as an essential community provider within six months of final
adoption of rules by the Department of Health according to section 62Q.19, subdivision
7 . For those federally qualified health centers and rural health clinics that have applied
for essential community provider status within the six-month time prescribed, medical
assistance payments will continue to be made according to paragraphs (a) and (b) for the
first three years after application. For federally qualified health centers and rural health
clinics that either do not apply within the time specified above or who have had essential
community provider status for three years, medical assistance payments for health services
provided by these entities shall be according to the same rates and conditions applicable
to the same service provided by health care providers that are not federally qualified
health centers or rural health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally
qualified health center or a rural health clinic to make application for an essential
community provider designation in order to have cost-based payments made according
to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b)
shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, each federally qualified health center and rural health
clinic may elect to be paid either under the prospective payment system established
in United States Code, title 42, section 1396a(aa), or under an alternative payment
methodology consistent with the requirements of United States Code, title 42, section
1396a(aa), and approved by the Centers for Medicare and Medicaid Services. The
alternative payment methodology shall be 100 percent of cost as determined according to
Medicare cost principles.
(g) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups,
uninsured, high-risk and special needs populations, underserved and other special needs
populations;
(4) employs professional staff at least one-half of which are familiar with the
cultural background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or
public assistance status and provides no-cost care as needed.
(h) By July 1 of each year, the commissioner shall notify federally qualified health
centers and rural health clinics enrolled in medical assistance of the commissioner's intent
to close out payment rates and claims processing for services provided during the calendar
year two years prior to the year in which notification is provided. If the commissioner
and federally qualified health center or rural health clinic do not mutually agree to close
out these rates and claims processing within 90 days following the commissioner's
notification, the matter shall be submitted to an arbiter to determine whether to extend the
closeout deadline.

    Sec. 21. Minnesota Statutes 2012, section 256B.199, is amended to read:
256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
    (a) Effective July 1, 2007, The commissioner shall apply for federal matching
funds for the expenditures in paragraphs (b) and (c). Effective September 1, 2011, the
commissioner shall apply for matching funds for expenditures in paragraph (e).
    (b) The commissioner shall apply for federal matching funds for certified public
expenditures as follows:.
    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions
Hospital, the University of Minnesota, and Fairview-University Medical Center shall
report quarterly to the commissioner beginning June 1, 2007, payments made during the
second previous quarter that may qualify for reimbursement under federal law;
     (2) based on these reports, the commissioner shall apply for federal matching
funds. These funds are appropriated to the commissioner for the payments under section
256.969, subdivision 27; and
    (3) By May 1 of each year, beginning May 1, 2007, the commissioner shall inform
the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
hospital payment money expected to be available in the current federal fiscal year.
    (c) The commissioner shall apply for federal matching funds for general assistance
medical care expenditures as follows:
    (1) for hospital services occurring on or after July 1, 2007, general assistance medical
care expenditures for fee-for-service inpatient and outpatient hospital payments made by
the department shall be used to apply for federal matching funds, except as limited below:
    (i) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and
    (ii) general assistance medical care expenditures may be considered only to the extent
of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
    (2) all hospitals must provide any necessary expenditure, cost, and revenue
information required by the commissioner as necessary for purposes of obtaining federal
Medicaid matching funds for general assistance medical care expenditures.
(d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the American Recovery and Reinvestment Act of 2009. These funds shall
be made available as the state share of payments under section 256.969, subdivision 28.
The entities required to report certified public expenditures under paragraph (b), clause
(1), shall report additional certified public expenditures as necessary under this paragraph.
(e) (c) For services provided on or after September 1, 2011, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the MinnesotaCare program according to the requirements and conditions
of paragraph (c). A hospital may elect on an annual basis to not be a disproportionate
share hospital for purposes of this paragraph, if the hospital does not qualify for a payment
under section 256.969, subdivision 9, paragraph (b).

    Sec. 22. REPEALER.
Minnesota Statutes 2012, sections 256.969, subdivisions 8b, 9a, 9b, 11, 13, 20, 21,
22, 25, 26, 27, and 28; and 256.9695, subdivisions 3 and 4, are repealed.

ARTICLE 3

NORTHSTAR CARE FOR CHILDREN

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

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

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

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

    Sec. 5. Minnesota Statutes 2013 Supplement, section 256B.055, subdivision 1, is
amended to read:
    Subdivision 1. Children eligible for subsidized adoption assistance. Medical
assistance may be paid for a child eligible for or receiving adoption assistance payments
under title IV-E of the Social Security Act, United States Code, title 42, sections 670 to
676, and to any child who is not title IV-E eligible but who was determined eligible for
adoption assistance under chapter 256N or section 259A.10, subdivision 2, and has a
special need for medical or rehabilitative care.

    Sec. 6. Minnesota Statutes 2013 Supplement, section 256N.02, is amended by adding a
subdivision to read:
    Subd. 14a. Licensed child foster parent. "Licensed child foster parent" means a
person who is licensed for child foster care under Minnesota Rules, parts 2960.3000 to
2960.3340, or licensed by a Minnesota tribe in accordance with tribal standards.

    Sec. 7. Minnesota Statutes 2013 Supplement, section 256N.21, subdivision 2, is
amended to read:
    Subd. 2. Placement in foster care. To be eligible for foster care benefits under this
section, the child must be in placement away from the child's legal parent or, guardian, or
Indian custodian as defined in section 260.755, subdivision 10, and all of the following
criteria must be met must meet one of the criteria in clause (1) and either clause (2) or (3):
(1) the legally responsible agency must have placement authority and care
responsibility, including for a child 18 years old or older and under age 21, who maintains
eligibility for foster care consistent with section 260C.451;
(2) (1) the legally responsible agency must have placement authority to place the
child with: (i) a voluntary placement agreement or a court order, consistent with sections
260B.198 , 260C.001, and 260D.01, or continued eligibility consistent with section
260C.451 for a child 18 years old or older and under age 21 who maintains eligibility for
foster care; or (ii) a voluntary placement agreement or court order by a Minnesota tribe
that is consistent with United States Code, title 42, section 672(a)(2); and
(3) (2) the child must be is placed in an emergency relative placement under section
245A.035, with a licensed foster family setting, foster residence setting, or treatment
foster care setting licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, a
family foster home licensed or approved by a tribal agency or, for a child 18 years old or
older and under age 21, child foster parent; or
(3) the child is placed in one of the following unlicensed child foster care settings:
(i) an emergency relative placement under tribal licensing regulations or section
245A.035, with the legally responsible agency ensuring the relative completes the required
child foster care application process;
(ii) a licensed adult foster home with an approved age variance under section
245A.16 for no more than six months;
(iii) for a child 18 years old or older and under age 21 who is eligible for extended
foster care under section 260C.451, an unlicensed supervised independent living setting
approved by the agency responsible for the youth's child's care.; or
(iv) a preadoptive placement in a home specified in section 245A.03, subdivision
2, paragraph (a), clause (9), with an approved adoption home study and signed adoption
placement agreement.

    Sec. 8. Minnesota Statutes 2013 Supplement, section 256N.21, is amended by adding a
subdivision to read:
    Subd. 7. Background study. (a) A county or private agency conducting a
background study for purposes of child foster care licensing or approval must conduct
the study in accordance with chapter 245C and must meet the requirements in United
States Code, title 42, section 671(a)(20).
(b) A Minnesota tribe conducting a background study for purposes of child foster
care licensing or approval must conduct the study in accordance with the requirements in
United States Code, title 42, section 671(a)(20), when applicable.

    Sec. 9. Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 1, is
amended to read:
    Subdivision 1. General eligibility requirements. (a) To be eligible for guardianship
assistance under this section, there must be a judicial determination under section
260C.515, subdivision 4 , that a transfer of permanent legal and physical custody to a
relative is in the child's best interest. For a child under jurisdiction of a tribal court, a
judicial determination under a similar provision in tribal code indicating that a relative
will assume the duty and authority to provide care, control, and protection of a child who
is residing in foster care, and to make decisions regarding the child's education, health
care, and general welfare until adulthood, and that this is in the child's best interest is
considered equivalent. Additionally, a child must:
(1) have been removed from the child's home pursuant to a voluntary placement
agreement or court order;
(2)(i) have resided in with the prospective relative custodian who has been a
licensed child foster care parent for at least six consecutive months in the home of the
prospective relative custodian; or
(ii) have received from the commissioner an exemption from the requirement in item
(i) from the court that the prospective relative custodian has been a licensed child foster
parent for at least six consecutive months, based on a determination that:
(A) an expedited move to permanency is in the child's best interest;
(B) expedited permanency cannot be completed without provision of guardianship
assistance; and
(C) the prospective relative custodian is uniquely qualified to meet the child's needs,
as defined in section 260C.212, subdivision 2, on a permanent basis;
(D) the child and prospective relative custodian meet the eligibility requirements
of this section; and
(E) efforts were made by the legally responsible agency to place the child with the
prospective relative custodian as a licensed child foster parent for six consecutive months
before permanency, or an explanation why these efforts were not in the child's best interests;
(3) meet the agency determinations regarding permanency requirements in
subdivision 2;
(4) meet the applicable citizenship and immigration requirements in subdivision 3;
(5) have been consulted regarding the proposed transfer of permanent legal and
physical custody to a relative, if the child is at least 14 years of age or is expected to attain
14 years of age prior to the transfer of permanent legal and physical custody; and
(6) have a written, binding agreement under section 256N.25 among the caregiver or
caregivers, the financially responsible agency, and the commissioner established prior to
transfer of permanent legal and physical custody.
(b) In addition to the requirements in paragraph (a), the child's prospective relative
custodian or custodians must meet the applicable background study requirements in
subdivision 4.
(c) To be eligible for title IV-E guardianship assistance, a child must also meet any
additional criteria in section 473(d) of the Social Security Act. The sibling of a child
who meets the criteria for title IV-E guardianship assistance in section 473(d) of the
Social Security Act is eligible for title IV-E guardianship assistance if the child and
sibling are placed with the same prospective relative custodian or custodians, and the
legally responsible agency, relatives, and commissioner agree on the appropriateness of
the arrangement for the sibling. A child who meets all eligibility criteria except those
specific to title IV-E guardianship assistance is entitled to guardianship assistance paid
through funds other than title IV-E.

    Sec. 10. Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 2, is
amended to read:
    Subd. 2. Agency determinations regarding permanency. (a) To be eligible for
guardianship assistance, the legally responsible agency must complete the following
determinations regarding permanency for the child prior to the transfer of permanent
legal and physical custody:
(1) a determination that reunification and adoption are not appropriate permanency
options for the child; and
(2) a determination that the child demonstrates a strong attachment to the prospective
relative custodian and the prospective relative custodian has a strong commitment to
caring permanently for the child.
(b) The legally responsible agency shall document the determinations in paragraph
(a) and the eligibility requirements in this section that comply with United States Code,
title 42, sections 673(d) and 675(1)(F). These determinations must be documented in a
kinship placement agreement, which must be in the format prescribed by the commissioner
and must be signed by the prospective relative custodian and the legally responsible
agency. In the case of a Minnesota tribe, the determinations and eligibility requirements
in this section may be provided in an alternative format approved by the commissioner.
Supporting information for completing each determination must be documented in the
legally responsible agency's case file and make them available for review as requested
by the financially responsible agency and the commissioner during the guardianship
assistance eligibility determination process.

    Sec. 11. Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 4, is
amended to read:
    Subd. 4. Background study. (a) A background study under section 245C.33 must be
completed on each prospective relative custodian and any other adult residing in the home
of the prospective relative custodian. The background study must meet the requirements of
United States Code, title 42, section 671(a)(20). A study completed under section 245C.33
meets this requirement. A background study on the prospective relative custodian or adult
residing in the household previously completed under section 245C.04 chapter 245C for the
purposes of child foster care licensure may under chapter 245A or licensure by a Minnesota
tribe, shall be used for the purposes of this section, provided that the background study is
current meets the requirements of this subdivision and the prospective relative custodian is
a licensed child foster parent at the time of the application for guardianship assistance.
(b) If the background study reveals:
(1) a felony conviction at any time for:
(i) child abuse or neglect;
(ii) spousal abuse;
(iii) a crime against a child, including child pornography; or
(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
including other physical assault or battery; or
(2) a felony conviction within the past five years for:
(i) physical assault;
(ii) battery; or
(iii) a drug-related offense;
the prospective relative custodian is prohibited from receiving guardianship assistance
on behalf of an otherwise eligible child.

    Sec. 12. Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 6, is
amended to read:
    Subd. 6. Exclusions. (a) A child with a guardianship assistance agreement under
Northstar Care for Children is not eligible for the Minnesota family investment program
child-only grant under chapter 256J.
(b) The commissioner shall not enter into a guardianship assistance agreement with:
(1) a child's biological parent or stepparent;
(2) an individual assuming permanent legal and physical custody of a child or the
equivalent under tribal code without involvement of the child welfare system; or
(3) an individual assuming permanent legal and physical custody of a child who was
placed in Minnesota by another state or a tribe outside of Minnesota.

    Sec. 13. Minnesota Statutes 2013 Supplement, section 256N.23, subdivision 1, is
amended to read:
    Subdivision 1. General eligibility requirements. (a) To be eligible for Northstar
adoption assistance under this section, a child must:
(1) be determined to be a child with special needs under subdivision 2;
(2) meet the applicable citizenship and immigration requirements in subdivision 3;
(3)(i) meet the criteria in section 473 of the Social Security Act; or
(ii) have had foster care payments paid on the child's behalf while in out-of-home
placement through the county social service agency or tribe and be either under the
tribal social service agency prior to the issuance of a court order transferring the child's
guardianship of to the commissioner or under the jurisdiction of a Minnesota tribe and
adoption, according to tribal law, is in the child's documented permanency plan making
the child a ward of the tribe; and
(4) have a written, binding agreement under section 256N.25 among the adoptive
parent, the financially responsible agency, or, if there is no financially responsible agency,
the agency designated by the commissioner, and the commissioner established prior to
finalization of the adoption.
(b) In addition to the requirements in paragraph (a), an eligible child's adoptive parent
or parents must meet the applicable background study requirements in subdivision 4.
(c) A child who meets all eligibility criteria except those specific to title IV-E adoption
assistance shall receive adoption assistance paid through funds other than title IV-E.
(d) A child receiving Northstar kinship assistance payments under section 256N.22
is eligible for Northstar adoption assistance when the criteria in paragraph (a) are met and
the child's legal custodian is adopting the child.

    Sec. 14. Minnesota Statutes 2013 Supplement, section 256N.23, subdivision 4, is
amended to read:
    Subd. 4. Background study. (a) A background study under section 259.41 must be
completed on each prospective adoptive parent. and all other adults residing in the home.
A background study must meet the requirements of United States Code, title 42, section
671(a)(20). A study completed under section 245C.33 meets this requirement. If the
prospective adoptive parent is a licensed child foster parent licensed under chapter 245A
or by a Minnesota tribe, the background study previously completed for the purposes of
child foster care licensure shall be used for the purpose of this section, provided that the
background study meets all other requirements of this subdivision and the prospective
adoptive parent is a licensed child foster parent at the time of the application for adoption
assistance.
(b) If the background study reveals:
(1) a felony conviction at any time for:
(i) child abuse or neglect;
(ii) spousal abuse;
(iii) a crime against a child, including child pornography; or
(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
including other physical assault or battery; or
(2) a felony conviction within the past five years for:
(i) physical assault;
(ii) battery; or
(iii) a drug-related offense;
the adoptive parent is prohibited from receiving adoption assistance on behalf of an
otherwise eligible child.

    Sec. 15. Minnesota Statutes 2013 Supplement, section 256N.24, subdivision 9, is
amended to read:
    Subd. 9. Timing of and requests for reassessments. Reassessments for an eligible
child must be completed within 30 days of any of the following events:
(1) for a child in continuous foster care, when six months have elapsed since
completion of the last assessment the initial assessment, and annually thereafter;
(2) for a child in continuous foster care, change of placement location;
(3) for a child in foster care, at the request of the financially responsible agency or
legally responsible agency;
(4) at the request of the commissioner; or
(5) at the request of the caregiver under subdivision 9 10.

    Sec. 16. Minnesota Statutes 2013 Supplement, section 256N.24, subdivision 10,
is amended to read:
    Subd. 10. Caregiver requests for reassessments. (a) A caregiver may initiate
a reassessment request for an eligible child in writing to the financially responsible
agency or, if there is no financially responsible agency, the agency designated by the
commissioner. The written request must include the reason for the request and the
name, address, and contact information of the caregivers. For an eligible child with a
guardianship assistance or adoption assistance agreement, The caregiver may request a
reassessment if at least six months have elapsed since any previously requested review
previous assessment or reassessment. For an eligible foster child, a foster parent may
request reassessment in less than six months with written documentation that there have
been significant changes in the child's needs that necessitate an earlier reassessment.
(b) A caregiver may request a reassessment of an at-risk child for whom a
guardianship assistance or an adoption assistance agreement has been executed if the
caregiver has satisfied the commissioner with written documentation from a qualified
expert that the potential disability upon which eligibility for the agreement was based has
manifested itself, consistent with section 256N.25, subdivision 3, paragraph (b).
(c) If the reassessment cannot be completed within 30 days of the caregiver's request,
the agency responsible for reassessment must notify the caregiver of the reason for the
delay and a reasonable estimate of when the reassessment can be completed.
(d) Notwithstanding any provision to the contrary in paragraph (a) or subdivision 9,
when a Northstar kinship assistance agreement or adoption assistance agreement under
section 256N.25 has been signed by all parties, no reassessment may be requested or
conducted until the court finalizes the transfer of permanent legal and physical custody or
finalizes the adoption, or the assistance agreement expires according to section 256N.25,
subdivision 1.

    Sec. 17. Minnesota Statutes 2013 Supplement, section 256N.25, subdivision 2, is
amended to read:
    Subd. 2. Negotiation of agreement. (a) When a child is determined to be eligible
for guardianship assistance or adoption assistance, the financially responsible agency, or,
if there is no financially responsible agency, the agency designated by the commissioner,
must negotiate with the caregiver to develop an agreement under subdivision 1. If and when
the caregiver and agency reach concurrence as to the terms of the agreement, both parties
shall sign the agreement. The agency must submit the agreement, along with the eligibility
determination outlined in sections 256N.22, subdivision 7, and 256N.23, subdivision 7, to
the commissioner for final review, approval, and signature according to subdivision 1.
(b) A monthly payment is provided as part of the adoption assistance or guardianship
assistance agreement to support the care of children unless the child is eligible for adoption
assistance and determined to be an at-risk child, in which case the special at-risk monthly
payment under section 256N.26, subdivision 7, must no payment will be made unless and
until the caregiver obtains written documentation from a qualified expert that the potential
disability upon which eligibility for the agreement was based has manifested itself.
(1) The amount of the payment made on behalf of a child eligible for guardianship
assistance or adoption assistance is determined through agreement between the prospective
relative custodian or the adoptive parent and the financially responsible agency, or, if there
is no financially responsible agency, the agency designated by the commissioner, using
the assessment tool established by the commissioner in section 256N.24, subdivision 2,
and the associated benefit and payments outlined in section 256N.26. Except as provided
under section 256N.24, subdivision 1, paragraph (c), the assessment tool establishes
the monthly benefit level for a child under foster care. The monthly payment under a
guardianship assistance agreement or adoption assistance agreement may be negotiated up
to the monthly benefit level under foster care. In no case may the amount of the payment
under a guardianship assistance agreement or adoption assistance agreement exceed the
foster care maintenance payment which would have been paid during the month if the
child with respect to whom the guardianship assistance or adoption assistance payment is
made had been in a foster family home in the state.
(2) The rate schedule for the agreement is determined based on the age of the
child on the date that the prospective adoptive parent or parents or relative custodian or
custodians sign the agreement.
(3) The income of the relative custodian or custodians or adoptive parent or parents
must not be taken into consideration when determining eligibility for guardianship
assistance or adoption assistance or the amount of the payments under section 256N.26.
(4) With the concurrence of the relative custodian or adoptive parent, the amount of
the payment may be adjusted periodically using the assessment tool established by the
commissioner in section 256N.24, subdivision 2, and the agreement renegotiated under
subdivision 3 when there is a change in the child's needs or the family's circumstances.
(5) The guardianship assistance or adoption assistance agreement of a child who is
identified as at-risk receives the special at-risk monthly payment under section 256N.26,
subdivision 7, unless and until the potential disability manifests itself, as documented by
an appropriate professional, and the commissioner authorizes commencement of payment
by modifying the agreement accordingly. A relative custodian or An adoptive parent
of an at-risk child with a guardianship assistance or an adoption assistance agreement
may request a reassessment of the child under section 256N.24, subdivision 9 10, and
renegotiation of the guardianship assistance or adoption assistance agreement under
subdivision 3 to include a monthly payment, if the caregiver has written documentation
from a qualified expert that the potential disability upon which eligibility for the agreement
was based has manifested itself. Documentation of the disability must be limited to
evidence deemed appropriate by the commissioner.
(c) For guardianship assistance agreements:
(1) the initial amount of the monthly guardianship assistance payment must be
equivalent to the foster care rate in effect at the time that the agreement is signed less any
offsets under section 256N.26, subdivision 11, or a lesser negotiated amount if agreed to
by the prospective relative custodian and specified in that agreement, unless the child is
identified as at-risk or the guardianship assistance agreement is entered into when a child
is under the age of six; and
(2) an at-risk child must be assigned level A as outlined in section 256N.26 and
receive the special at-risk monthly payment under section 256N.26, subdivision 7, unless
and until the potential disability manifests itself, as documented by a qualified expert, and
the commissioner authorizes commencement of payment by modifying the agreement
accordingly; and
(3) (2) the amount of the monthly payment for a guardianship assistance agreement
for a child, other than an at-risk child, who is under the age of six must be as specified in
section 256N.26, subdivision 5.
(d) For adoption assistance agreements:
(1) for a child in foster care with the prospective adoptive parent immediately prior
to adoptive placement, the initial amount of the monthly adoption assistance payment
must be equivalent to the foster care rate in effect at the time that the agreement is signed
less any offsets in section 256N.26, subdivision 11, or a lesser negotiated amount if agreed
to by the prospective adoptive parents and specified in that agreement, unless the child is
identified as at-risk or the adoption assistance agreement is entered into when a child is
under the age of six;
(2) for an at-risk child who must be assigned level A as outlined in section
256N.26 and receive the special at-risk monthly payment under section 256N.26,
subdivision 7, no payment will be made unless and until the potential disability manifests
itself, as documented by an appropriate professional, and the commissioner authorizes
commencement of payment by modifying the agreement accordingly;
(3) the amount of the monthly payment for an adoption assistance agreement for
a child under the age of six, other than an at-risk child, must be as specified in section
256N.26, subdivision 5 ;
(4) for a child who is in the guardianship assistance program immediately prior
to adoptive placement, the initial amount of the adoption assistance payment must be
equivalent to the guardianship assistance payment in effect at the time that the adoption
assistance agreement is signed or a lesser amount if agreed to by the prospective adoptive
parent and specified in that agreement, unless the child is identified as an at-risk child; and
(5) for a child who is not in foster care placement or the guardianship assistance
program immediately prior to adoptive placement or negotiation of the adoption assistance
agreement, the initial amount of the adoption assistance agreement must be determined
using the assessment tool and process in this section and the corresponding payment
amount outlined in section 256N.26.

    Sec. 18. Minnesota Statutes 2013 Supplement, section 256N.25, subdivision 3, is
amended to read:
    Subd. 3. Renegotiation of agreement. (a) A relative custodian or adoptive
parent of a child with a guardianship assistance or adoption assistance agreement may
request renegotiation of the agreement when there is a change in the needs of the child
or in the family's circumstances. When a relative custodian or adoptive parent requests
renegotiation of the agreement, a reassessment of the child must be completed consistent
with section 256N.24, subdivisions 9 and 10. If the reassessment indicates that the
child's level has changed, the financially responsible agency or, if there is no financially
responsible agency, the agency designated by the commissioner or the commissioner's
designee, and the caregiver must renegotiate the agreement to include a payment with
the level determined through the reassessment process. The agreement must not be
renegotiated unless the commissioner, the financially responsible agency, and the caregiver
mutually agree to the changes. The effective date of any renegotiated agreement must be
determined by the commissioner.
(b) A relative custodian or An adoptive parent of an at-risk child with a guardianship
assistance or an adoption assistance agreement may request renegotiation of the agreement
to include a monthly payment higher than the special at-risk monthly payment under
section 256N.26, subdivision 7, if the caregiver has written documentation from a
qualified expert that the potential disability upon which eligibility for the agreement
was based has manifested itself. Documentation of the disability must be limited to
evidence deemed appropriate by the commissioner. Prior to renegotiating the agreement, a
reassessment of the child must be conducted as outlined in section 256N.24, subdivision
9 . The reassessment must be used to renegotiate the agreement to include an appropriate
monthly payment. The agreement must not be renegotiated unless the commissioner, the
financially responsible agency, and the caregiver mutually agree to the changes. The
effective date of any renegotiated agreement must be determined by the commissioner.
(c) Renegotiation of a guardianship assistance or adoption assistance agreement is
required when one of the circumstances outlined in section 256N.26, subdivision 13,
occurs.

    Sec. 19. Minnesota Statutes 2013 Supplement, section 256N.26, subdivision 1, is
amended to read:
    Subdivision 1. Benefits. (a) There are three benefits under Northstar Care for
Children: medical assistance, basic payment, and supplemental difficulty of care payment.
(b) A child is eligible for medical assistance under subdivision 2.
(c) A child is eligible for the basic payment under subdivision 3, except for a child
assigned level A under section 256N.24, subdivision 1, because the child is determined to
be an at-risk child receiving guardianship assistance or adoption assistance.
(d) A child, including a foster child age 18 to 21, is eligible for an additional
supplemental difficulty of care payment under subdivision 4, as determined by the
assessment under section 256N.24.
(e) An eligible child entering guardianship assistance or adoption assistance under
the age of six receives a basic payment and supplemental difficulty of care payment as
specified in subdivision 5.
(f) A child transitioning in from a pre-Northstar Care for Children program under
section 256N.28, subdivision 7, shall receive basic and difficulty of care supplemental
payments according to those provisions.

    Sec. 20. Minnesota Statutes 2013 Supplement, section 256N.27, subdivision 4, is
amended to read:
    Subd. 4. Nonfederal share. (a) The commissioner shall establish a percentage share
of the maintenance payments, reduced by federal reimbursements under title IV-E of the
Social Security Act, to be paid by the state and to be paid by the financially responsible
agency.
(b) These state and local shares must initially be calculated based on the ratio of the
average appropriate expenditures made by the state and all financially responsible agencies
during calendar years 2011, 2012, 2013, and 2014. For purposes of this calculation,
appropriate expenditures for the financially responsible agencies must include basic and
difficulty of care payments for foster care reduced by federal reimbursements, but not
including any initial clothing allowance, administrative payments to child care agencies
specified in section 317A.907, child care, or other support or ancillary expenditures. For
purposes of this calculation, appropriate expenditures for the state shall include adoption
assistance and relative custody assistance, reduced by federal reimbursements.
(c) For each of the periods January 1, 2015, to June 30, 2016, and fiscal years 2017,
2018, and 2019, the commissioner shall adjust this initial percentage of state and local
shares to reflect the relative expenditure trends during calendar years 2011, 2012, 2013, and
2014, taking into account appropriations for Northstar Care for Children and the turnover
rates of the components. In making these adjustments, the commissioner's goal shall be to
make these state and local expenditures other than the appropriations for Northstar Care
for Children to be the same as they would have been had Northstar Care for Children not
been implemented, or if that is not possible, proportionally higher or lower, as appropriate.
Except for adjustments so that the costs of the phase-in are borne by the state, the state and
local share percentages for fiscal year 2019 must be used for all subsequent years.

    Sec. 21. Minnesota Statutes 2012, section 257.85, subdivision 11, is amended to read:
    Subd. 11. Financial considerations. (a) Payment of relative custody assistance
under a relative custody assistance agreement is subject to the availability of state funds
and payments may be reduced or suspended on order of the commissioner if insufficient
funds are available.
(b) Upon receipt from a local agency of a claim for reimbursement, the commissioner
shall reimburse the local agency in an amount equal to 100 percent of the relative custody
assistance payments provided to relative custodians. The A local agency may not seek and
the commissioner shall not provide reimbursement for the administrative costs associated
with performing the duties described in subdivision 4.
(c) For the purposes of determining eligibility or payment amounts under MFIP,
relative custody assistance payments shall be excluded in determining the family's
available income.
(d) For expenditures made on or before December 31, 2014, upon receipt from a
local agency of a claim for reimbursement, the commissioner shall reimburse the local
agency in an amount equal to 100 percent of the relative custody assistance payments
provided to relative custodians.
(e) For expenditures made on or after January 1, 2015, upon receipt from a local
agency of a claim for reimbursement, the commissioner shall reimburse the local agency as
part of the Northstar Care for Children fiscal reconciliation process under section 256N.27.

    Sec. 22. Minnesota Statutes 2012, section 260C.212, subdivision 1, is amended to read:
    Subdivision 1. Out-of-home placement; plan. (a) An out-of-home placement plan
shall be prepared within 30 days after any child is placed in foster care by court order or a
voluntary placement agreement between the responsible social services agency and the
child's parent pursuant to section 260C.227 or chapter 260D.
    (b) An out-of-home placement plan means a written document which is prepared
by the responsible social services agency jointly with the parent or parents or guardian
of the child and in consultation with the child's guardian ad litem, the child's tribe, if the
child is an Indian child, the child's foster parent or representative of the foster care facility,
and, where appropriate, the child. For a child in voluntary foster care for treatment under
chapter 260D, preparation of the out-of-home placement plan shall additionally include
the child's mental health treatment provider. As appropriate, the plan shall be:
    (1) submitted to the court for approval under section 260C.178, subdivision 7;
    (2) ordered by the court, either as presented or modified after hearing, under section
260C.178 , subdivision 7, or 260C.201, subdivision 6; and
    (3) signed by the parent or parents or guardian of the child, the child's guardian ad
litem, a representative of the child's tribe, the responsible social services agency, and, if
possible, the child.
    (c) The out-of-home placement plan shall be explained to all persons involved in its
implementation, including the child who has signed the plan, and shall set forth:
    (1) a description of the foster care home or facility selected, including how the
out-of-home placement plan is designed to achieve a safe placement for the child in the
least restrictive, most family-like, setting available which is in close proximity to the home
of the parent or parents or guardian of the child when the case plan goal is reunification,
and how the placement is consistent with the best interests and special needs of the child
according to the factors under subdivision 2, paragraph (b);
    (2) the specific reasons for the placement of the child in foster care, and when
reunification is the plan, a description of the problems or conditions in the home of the
parent or parents which necessitated removal of the child from home and the changes the
parent or parents must make in order for the child to safely return home;
    (3) a description of the services offered and provided to prevent removal of the child
from the home and to reunify the family including:
    (i) the specific actions to be taken by the parent or parents of the child to eliminate
or correct the problems or conditions identified in clause (2), and the time period during
which the actions are to be taken; and
    (ii) the reasonable efforts, or in the case of an Indian child, active efforts to be made
to achieve a safe and stable home for the child including social and other supportive
services to be provided or offered to the parent or parents or guardian of the child, the
child, and the residential facility during the period the child is in the residential facility;
    (4) a description of any services or resources that were requested by the child or the
child's parent, guardian, foster parent, or custodian since the date of the child's placement
in the residential facility, and whether those services or resources were provided and if
not, the basis for the denial of the services or resources;
    (5) the visitation plan for the parent or parents or guardian, other relatives as defined
in section 260C.007, subdivision 27, and siblings of the child if the siblings are not placed
together in foster care, and whether visitation is consistent with the best interest of the
child, during the period the child is in foster care;
    (6) when a child cannot return to or be in the care of either parent, documentation of
steps to finalize the permanency plan for the child, including:
    (i) reasonable efforts to place the child for adoption or legal guardianship of the child
if the court has issued an order terminating the rights of both parents of the child or of the
only known, living parent of the child. At a minimum, the documentation must include
consideration of whether adoption is in the best interests of the child, child-specific
recruitment efforts such as relative search and the use of state, regional, and national
adoption exchanges to facilitate orderly and timely placements in and outside of the state.
A copy of this documentation shall be provided to the court in the review required under
section 260C.317, subdivision 3, paragraph (b); and
    (ii) documentation necessary to support the requirements of the kinship placement
agreement under section 256N.22 when adoption is determined not to be in the child's
best interest;
    (7) efforts to ensure the child's educational stability while in foster care, including:
(i) efforts to ensure that the child remains in the same school in which the child was
enrolled prior to placement or upon the child's move from one placement to another,
including efforts to work with the local education authorities to ensure the child's
educational stability; or
(ii) if it is not in the child's best interest to remain in the same school that the child
was enrolled in prior to placement or move from one placement to another, efforts to
ensure immediate and appropriate enrollment for the child in a new school;
(8) the educational records of the child including the most recent information
available regarding:
    (i) the names and addresses of the child's educational providers;
    (ii) the child's grade level performance;
    (iii) the child's school record;
    (iv) a statement about how the child's placement in foster care takes into account
proximity to the school in which the child is enrolled at the time of placement; and
(v) any other relevant educational information;
    (9) the efforts by the local agency to ensure the oversight and continuity of health
care services for the foster child, including:
(i) the plan to schedule the child's initial health screens;
(ii) how the child's known medical problems and identified needs from the screens,
including any known communicable diseases, as defined in section 144.4172, subdivision
2, will be monitored and treated while the child is in foster care;
(iii) how the child's medical information will be updated and shared, including
the child's immunizations;
(iv) who is responsible to coordinate and respond to the child's health care needs,
including the role of the parent, the agency, and the foster parent;
(v) who is responsible for oversight of the child's prescription medications;
(vi) how physicians or other appropriate medical and nonmedical professionals
will be consulted and involved in assessing the health and well-being of the child and
determine the appropriate medical treatment for the child; and
(vii) the responsibility to ensure that the child has access to medical care through
either medical insurance or medical assistance;
(10) the health records of the child including information available regarding:
(i) the names and addresses of the child's health care and dental care providers;
(ii) a record of the child's immunizations;
(iii) the child's known medical problems, including any known communicable
diseases as defined in section 144.4172, subdivision 2;
(iv) the child's medications; and
(v) any other relevant health care information such as the child's eligibility for
medical insurance or medical assistance;
(11) an independent living plan for a child age 16 or older. The plan should include,
but not be limited to, the following objectives:
    (i) educational, vocational, or employment planning;
    (ii) health care planning and medical coverage;
    (iii) transportation including, where appropriate, assisting the child in obtaining a
driver's license;
    (iv) money management, including the responsibility of the agency to ensure that
the youth annually receives, at no cost to the youth, a consumer report as defined under
section 13C.001 and assistance in interpreting and resolving any inaccuracies in the report;
    (v) planning for housing;
    (vi) social and recreational skills; and
    (vii) establishing and maintaining connections with the child's family and
community; and
    (12) for a child in voluntary foster care for treatment under chapter 260D, diagnostic
and assessment information, specific services relating to meeting the mental health care
needs of the child, and treatment outcomes.
    (d) The parent or parents or guardian and the child each shall have the right to legal
counsel in the preparation of the case plan and shall be informed of the right at the time
of placement of the child. The child shall also have the right to a guardian ad litem.
If unable to employ counsel from their own resources, the court shall appoint counsel
upon the request of the parent or parents or the child or the child's legal guardian. The
parent or parents may also receive assistance from any person or social services agency
in preparation of the case plan.
    After the plan has been agreed upon by the parties involved or approved or ordered
by the court, the foster parents shall be fully informed of the provisions of the case plan
and shall be provided a copy of the plan.
    Upon discharge from foster care, the parent, adoptive parent, or permanent legal and
physical custodian, as appropriate, and the child, if appropriate, must be provided with
a current copy of the child's health and education record.

    Sec. 23. Minnesota Statutes 2012, section 260C.515, subdivision 4, is amended to read:
    Subd. 4. Custody to relative. The court may order permanent legal and physical
custody to a fit and willing relative in the best interests of the child according to the
following conditions requirements:
(1) an order for transfer of permanent legal and physical custody to a relative shall
only be made after the court has reviewed the suitability of the prospective legal and
physical custodian, including a review of the background study required under sections
245C.33 and 256N.22, subdivision 4;
(2) in transferring permanent legal and physical custody to a relative, the juvenile
court shall follow the standards applicable under this chapter and chapter 260, and the
procedures in the Minnesota Rules of Juvenile Protection Procedure;
(3) a transfer of legal and physical custody includes responsibility for the protection,
education, care, and control of the child and decision making on behalf of the child;
(4) a permanent legal and physical custodian may not return a child to the permanent
care of a parent from whom the court removed custody without the court's approval and
without notice to the responsible social services agency;
(5) the social services agency may file a petition naming a fit and willing relative as
a proposed permanent legal and physical custodian. A petition for transfer of permanent
legal and physical custody to a relative who is not a parent shall be accompanied by a
kinship placement agreement under section 256N.22, subdivision 2, between the agency
and proposed permanent legal and physical custodian;
(6) another party to the permanency proceeding regarding the child may file a
petition to transfer permanent legal and physical custody to a relative, but the. The petition
must include facts upon which the court can make the determination required under clause
(7) and must be filed not later than the date for the required admit-deny hearing under
section 260C.507; or if the agency's petition is filed under section 260C.503, subdivision
2 , the petition must be filed not later than 30 days prior to the trial required under section
260C.509 ; and
(7) where a petition is for transfer of permanent legal and physical custody to a
relative who is not a parent, the court must find that:
(i) transfer of permanent legal and physical custody and receipt of Northstar kinship
assistance under chapter 256N, when requested and the child is eligible, is in the child's
best interests;
(ii) adoption is not in the child's best interests based on the determinations in the
kinship placement agreement required under section 256N.22, subdivision 2;
(iii) the agency made efforts to discuss adoption with the child's parent or parents,
or the agency did not make efforts to discuss adoption and the reasons why efforts were
not made; and
(iv) there are reasons to separate siblings during placement, if applicable;
(8) the court may defer finalization of an order transferring permanent legal and
physical custody to a relative when deferring finalization is necessary to determine
eligibility for Northstar kinship assistance under chapter 256N; and
(7) (9) the juvenile court may maintain jurisdiction over the responsible social
services agency, the parents or guardian of the child, the child, and the permanent legal
and physical custodian for purposes of ensuring appropriate services are delivered to the
child and permanent legal custodian for the purpose of ensuring conditions ordered by the
court related to the care and custody of the child are met.

    Sec. 24. Minnesota Statutes 2012, section 260C.611, is amended to read:
260C.611 ADOPTION STUDY REQUIRED.
(a) An adoption study under section 259.41 approving placement of the child in the
home of the prospective adoptive parent shall be completed before placing any child under
the guardianship of the commissioner in a home for adoption. If a prospective adoptive
parent has a current child foster care license under chapter 245A and is seeking to adopt
a foster child who is placed in the prospective adoptive parent's home and is under the
guardianship of the commissioner according to section 260C.325, subdivision 1, the child
foster care home study meets the requirements of this section for an approved adoption
home study if:
(1) the written home study on which the foster care license was based is completed
in the commissioner's designated format, consistent with the requirements in sections
260C.215, subdivision 4, clause (5); and 259.41, subdivision 2; and Minnesota Rules,
part 2960.3060, subpart 4;
(2) the background studies on each prospective adoptive parent and all required
household members were completed according to section 245C.33;
(3) the commissioner has not issued, within the last three years, a sanction on the
license under section 245A.07 or an order of a conditional license under section 245A.06;
and
(4) the legally responsible agency determines that the individual needs of the child
are being met by the prospective adoptive parent through an assessment under section
256N.24, subdivision 2, or a documented placement decision consistent with section
260C.212, subdivision 2.
(b) If a prospective adoptive parent has previously held a foster care license or
adoptive home study, any update necessary to the foster care license, or updated or new
adoptive home study, if not completed by the licensing authority responsible for the
previous license or home study, shall include collateral information from the previous
licensing or approving agency, if available.

    Sec. 25. REVISOR'S INSTRUCTION.
The revisor of statutes shall change the term "guardianship assistance" to "Northstar
kinship assistance" wherever it appears in Minnesota Statutes and Minnesota Rules to
refer to the program components related to Northstar Care for Children under Minnesota
Statutes, chapter 256N.

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

ARTICLE 4

COMMUNITY FIRST SERVICES AND SUPPORTS

    Section 1. Minnesota Statutes 2012, section 245C.03, is amended by adding a
subdivision to read:
    Subd. 8. Community first services and supports organizations. The
commissioner shall conduct background studies on any individual required under section
256B.85 to have a background study completed under this chapter.

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

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

    Sec. 4. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 2, is
amended to read:
    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
this subdivision have the meanings given.
(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
dressing, bathing, mobility, positioning, and transferring.
(c) "Agency-provider model" means a method of CFSS under which a qualified
agency provides services and supports through the agency's own employees and policies.
The agency must allow the participant to have a significant role in the selection and
dismissal of support workers of their choice for the delivery of their specific services
and supports.
(d) "Behavior" means a description of a need for services and supports used to
determine the home care rating and additional service units. The presence of Level I
behavior is used to determine the home care rating. "Level I behavior" means physical
aggression towards self or others or destruction of property that requires the immediate
response of another person. If qualified for a home care rating as described in subdivision
8, additional service units can be added as described in subdivision 8, paragraph (f), for
the following behaviors:
(1) Level I behavior;
(2) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
(3) increased need for assistance for recipients participants who are verbally
aggressive or resistive to care so that time needed to perform activities of daily living is
increased.
(e) "Budget model" means a service delivery method of CFSS that allows the
use of a service budget and assistance from a vendor fiscal/employer agent financial
management services (FMS) contractor for a participant to directly employ support
workers and purchase supports and goods.
(e) (f) "Complex health-related needs" means an intervention listed in clauses (1)
to (8) that has been ordered by a physician, and is specified in a community support
plan, including:
(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.
(f) (g) "Community first services and supports" or "CFSS" means the assistance and
supports program under this section needed for accomplishing activities of daily living,
instrumental activities of daily living, and health-related tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task, or the
purchase of goods as defined in subdivision 7, paragraph (a), clause (3), that replace
the need for human assistance.
(g) (h) "Community first services and supports service delivery plan" or "service
delivery plan" means a written summary of document detailing the services and supports
chosen by the participant to meet assessed needs that is are within the approved CFSS
service authorization amount. Services and supports are based on the community support
plan identified in section 256B.0911 and coordinated services and support plan and budget
identified in section 256B.0915, subdivision 6, if applicable, that is determined by the
participant to meet the assessed needs, using a person-centered planning process.
(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that is under contract with the department and has the knowledge, skills,
and ability to assist CFSS participants in using either the agency-provider model under
subdivision 11 or the budget model under subdivision 13.
(h) (j) "Critical activities of daily living" means transferring, mobility, eating, and
toileting.
(i) (k) "Dependency" in activities of daily living means a person requires hands-on
assistance or constant supervision and cueing to accomplish one or more of the activities
of daily living every day or on the days during the week that the activity is performed;
however, 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 and the assistance needed is the assistance appropriate for
a typical child of the same age.
(j) (l) "Extended CFSS" means CFSS services and supports under the
agency-provider model included in a service plan through one of the home and
community-based services waivers and as approved and authorized under sections
256B.0915 ; 256B.092, subdivision 5; and 256B.49, which exceed the amount, duration,
and frequency of the state plan CFSS services for participants.
(k) (m) "Financial management services contractor or vendor" or "FMS contractor"
means a qualified organization having necessary to use the budget model under subdivision
13 that has a written contract with the department to provide vendor fiscal/employer agent
financial management services necessary to use the budget model under subdivision 13
that (FMS). Services include but are not limited to: participant education and technical
assistance; CFSS service delivery planning and budgeting; filing and payment of federal
and state payroll taxes on behalf of the participant; initiating criminal background
checks; billing, making payments, and for approved CFSS funds; monitoring of
spending expenditures; accounting and disbursing CFSS funds; providing assistance in
obtaining liability, workers' compensation, and unemployment coverage and filings; and
assisting participant instruction and technical assistance to the participant in fulfilling
employer-related requirements in accordance with Section 3504 of the Internal Revenue
Code and the Internal Revenue Service Revenue Procedure 70-6 related regulations and
interpretations, including Code of Federal Regulations, title 26, section 31.3504-1.
(l) "Budget model" means a service delivery method of CFSS that allows the use of
an individualized CFSS service delivery plan and service budget and provides assistance
from the financial management services contractor to facilitate participant employment of
support workers and the acquisition of supports and goods.
(m) (n) "Health-related procedures and tasks" means procedures and tasks related
to the specific needs of an individual that can be delegated taught or assigned by a
state-licensed healthcare or mental health professional and performed by a support worker.
(n) (o) "Instrumental activities of daily living" means activities related to
living independently in the community, including but not limited to: meal planning,
preparation, and cooking; shopping for food, clothing, or other essential items; laundry;
housecleaning; assistance with medications; managing finances; communicating needs
and preferences during activities; arranging supports; and assistance with traveling around
and participating in the community.
(o) (p) "Legal representative" means parent of a minor, a court-appointed guardian,
or another representative with legal authority to make decisions about services and
supports for the participant. Other representatives with legal authority to make decisions
include but are not limited to a health care agent or an attorney-in-fact authorized through
a health care directive or power of attorney.
(p) (q) "Medication assistance" means providing verbal or visual reminders to take
regularly scheduled medication, and includes any of the following supports listed in clauses
(1) to (3) and other types of assistance, except that a support worker may not determine
medication dose or time for medication or inject medications into veins, muscles, or skin:
(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
(2) organizing medications as directed by the participant or the participant's
representative; and
(3) providing verbal or visual reminders to perform regularly scheduled medications.
(q) (r) "Participant's representative" means a parent, family member, advocate,
or other adult authorized by the participant to serve as a representative in connection
with the provision of CFSS. This authorization must be in writing or by another method
that clearly indicates the participant's free choice. The participant's representative must
have no financial interest in the provision of any services included in the participant's
service delivery plan and must be capable of providing the support necessary to assist
the participant in the use of CFSS. If through the assessment process described in
subdivision 5 a participant is determined to be in need of a participant's representative, one
must be selected. If the participant is unable to assist in the selection of a participant's
representative, the legal representative shall appoint one. Two persons may be designated
as a participant's representative for reasons such as divided households and court-ordered
custodies. Duties of a participant's representatives may include:
(1) being available while care is services are provided in a method agreed upon by
the participant or the participant's legal representative and documented in the participant's
CFSS service delivery plan;
(2) monitoring CFSS services to ensure the participant's CFSS service delivery
plan is being followed; and
(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.
(r) (s) "Person-centered planning process" means a process that is directed by the
participant to plan for services and supports. The person-centered planning process must:
(1) include people chosen by the participant;
(2) provide necessary information and support to ensure that the participant directs
the process to the maximum extent possible, and is enabled to make informed choices
and decisions;
(3) be timely and occur at time and locations of convenience to the participant;
(4) reflect cultural considerations of the participant;
(5) include strategies for solving conflict or disagreement within the process,
including clear conflict-of-interest guidelines for all planning;
(6) provide the participant choices of the services and supports they receive and the
staff providing those services and supports;
(7) include a method for the participant to request updates to the plan; and
(8) record the alternative home and community-based settings that were considered
by the participant.
(s) (t) "Shared services" means the provision of CFSS services by the same CFSS
support worker to two or three participants who voluntarily enter into an agreement to
receive services at the same time and in the same setting by the same provider employer.
(t) "Support specialist" means a professional with the skills and ability to assist the
participant using either the agency-provider model under subdivision 11 or the flexible
spending model under subdivision 13, in services including but not limited to assistance
regarding:
(1) the development, implementation, and evaluation of the CFSS service delivery
plan under subdivision 6;
(2) recruitment, training, or supervision, including supervision of health-related tasks
or behavioral supports appropriately delegated or assigned by a health care professional,
and evaluation of support workers; and
(3) facilitating the use of informal and community supports, goods, or resources.
(u) "Support worker" means an a qualified and trained employee of the agency
provider agency-provider or of the participant employer under the budget model who
has direct contact with the participant and provides services as specified within the
participant's service delivery plan.
(v) "Wages and benefits" means the hourly 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, contributions to
employee retirement accounts, or other forms of employee compensation and benefits.
(w) "Worker training and development" means services for developing workers'
skills as required by the participant's individual CFSS delivery plan that are arranged for
or provided by the agency-provider or purchased by the participant employer. These
services include training, education, direct observation and supervision, and evaluation
and coaching of job skills and tasks, including supervision of health-related tasks or
behavioral supports.

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

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

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

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

    Sec. 9. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 8, is
amended to read:
    Subd. 8. Determination of CFSS service methodology. (a) All community first
services and supports must be authorized by the commissioner or the commissioner's
designee before services begin, except for the assessments established in section
256B.0911 . The authorization for CFSS must be completed as soon as possible following
an assessment but no later than 40 calendar days from the date of the assessment.
(b) The amount of CFSS authorized must be based on the recipient's participant's
home care rating described in paragraphs (d) and (e) and any additional service units for
which the person participant qualifies as described in paragraph (f).
(c) The home care rating shall be determined by the commissioner or the
commissioner's designee based on information submitted to the commissioner identifying
the following for a recipient participant:
(1) the total number of dependencies of activities of daily living as defined in
subdivision 2, paragraph (b);
(2) the presence of complex health-related needs as defined in subdivision 2,
paragraph (e); and
(3) the presence of Level I behavior as defined in subdivision 2, paragraph (d),
clause (1).
(d) The methodology to determine the total service units for CFSS for each home
care rating is based on the median paid units per day for each home care rating from
fiscal year 2007 data for the PCA program.
(e) Each home care rating is designated by the letters P through Z and EN and has
the following base number of service units assigned:
(1) P home care rating requires Level I behavior or one to three dependencies in
ADLs and qualifies one for five service units;
(2) Q home care rating requires Level I behavior and one to three dependencies in
ADLs and qualifies one for six service units;
(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies one for seven service units;
(4) S home care rating requires four to six dependencies in ADLs and qualifies
one for ten service units;
(5) T home care rating requires four to six dependencies in ADLs and Level I
behavior and qualifies one for 11 service units;
(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies one for 14 service units;
(7) V home care rating requires seven to eight dependencies in ADLs and qualifies
one for 17 service units;
(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies one for 20 service units;
(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies one for 30 service units; and
(10) EN home care rating includes ventilator dependency as defined in section
256B.0651, subdivision 1 , paragraph (g). Recipients Participants who meet the definition
of ventilator-dependent and the EN home care rating and utilize a combination of
CFSS and other home care services are limited to a total of 96 service units per day for
those services in combination. Additional units may be authorized when a recipient's
participant's assessment indicates a need for two staff to perform activities. Additional
time is limited to 16 service units per day.
(f) Additional service units are provided through the assessment and identification of
the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in subdivision 2, paragraph (h) (j);
(2) 30 additional minutes per day for each complex health-related function as
defined in subdivision 2, paragraph (e) (f); and
(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2,
paragraph (d).
(g) The service budget for budget model participants shall be based on:
(1) assessed units as determined by the home care rating; and
(2) an adjustment needed for administrative expenses.

    Sec. 10. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 9, is
amended to read:
    Subd. 9. Noncovered services. (a) Services or supports that are not eligible for
payment under this section include those that:
(1) are not authorized by the certified assessor or included in the written service
delivery plan;
(2) are provided prior to the authorization of services and the approval of the written
CFSS service delivery plan;
(3) are duplicative of other paid services in the written service delivery plan;
(4) supplant natural unpaid supports that appropriately meet a need in the service
plan, are provided voluntarily to the participant, and are selected by the participant in lieu
of other services and supports;
(5) are not effective means to meet the participant's needs; and
(6) are available through other funding sources, including, but not limited to, funding
through title IV-E of the Social Security Act.
(b) Additional services, goods, or supports that are not covered include:
(1) those that are not for the direct benefit of the participant, except that services for
caregivers such as training to improve the ability to provide CFSS are considered to directly
benefit the participant if chosen by the participant and approved in the support plan;
(2) any fees incurred by the participant, such as Minnesota health care programs fees
and co-pays, legal fees, or costs related to advocate agencies;
(3) insurance, except for insurance costs related to employee coverage;
(4) room and board costs for the participant with the exception of allowable
transition costs in subdivision 7, clause (6);
(5) services, supports, or goods that are not related to the assessed needs;
(6) special education and related services provided under the Individuals with
Disabilities Education Act and vocational rehabilitation services provided under the
Rehabilitation Act of 1973;
(7) assistive technology devices and assistive technology services other than those
for back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;
(8) medical supplies and equipment listed as a covered benefit under medical
assistance;
(9) environmental modifications, except as specified in subdivision 7;
(10) expenses for travel, lodging, or meals related to training the participant, or the
participant's representative, or legal representative, or paid or unpaid caregivers that
exceed $500 in a 12-month period;
(11) experimental treatments;
(12) any service or good covered by other medical assistance state plan services,
including prescription and over-the-counter medications, compounds, and solutions and
related fees, including premiums and co-payments;
(13) membership dues or costs, except when the service is necessary and appropriate
to treat a physical health condition or to improve or maintain the participant's physical
health condition. The condition must be identified in the participant's CFSS plan and
monitored by a physician enrolled in a Minnesota health care program Minnesota health
care program enrolled physician;
(14) vacation expenses other than the cost of direct services;
(15) vehicle maintenance or modifications not related to the disability, health
condition, or physical need; and
(16) tickets and related costs to attend sporting or other recreational or entertainment
events.;
(17) 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 CFSS
services and the assessor has listed the need in the service plan;
(18) services provided and billed by a provider who is not an enrolled CFSS provider;
(19) CFSS provided by a participant's representative or paid legal guardian;
(20) services that are used solely as a child care or babysitting service;
(21) services that are the responsibility or in the daily rate of a residential or program
license holder under the terms of a service agreement and administrative rules;
(22) sterile procedures;
(23) giving of injections into veins, muscles, or skin;
(24) homemaker services that are not an integral part of the assessed CFSS service;
(25) home maintenance or chore services;
(26) home care services, including hospice services if elected by the participant,
covered by Medicare or any other insurance held by the participant;
(27) services to other members of the participant's household;
(28) services not specified as covered under medical assistance as CFSS;
(29) application of restraints or implementation of deprivation procedures;
(30) assessments by CFSS provider organizations or by independently enrolled
registered nurses;
(31) services provided in lieu of legally required staffing in a residential or child
care setting; and
(32) services provided by the residential or program license holder in a residence for
more than four persons.

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

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

    Sec. 13. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 12,
is amended to read:
    Subd. 12. Requirements for enrollment of CFSS provider agency-provider
agencies. (a) All CFSS provider agencies agency-providers must provide, at the time of
enrollment, reenrollment, and revalidation as a CFSS provider agency agency-provider in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:
(1) the CFSS provider agency's agency-provider's current contact information
including address, telephone number, and e-mail address;
(2) proof of surety bond coverage. Upon new enrollment, or if the provider agency's
agency-provider's Medicaid revenue in the previous calendar year is less than or equal
to $300,000, the provider agency agency-provider must purchase a performance bond of
$50,000. If the provider agency's agency-provider's Medicaid revenue in the previous
calendar year is greater than $300,000, the provider agency agency-provider must
purchase a performance bond of $100,000. The performance bond must be in a form
approved by the commissioner, must be renewed annually, and must allow for recovery of
costs and fees in pursuing a claim on the bond;
(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 CFSS provider agency's agency-provider's organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directors, and owners, or staff to other service providers;
(7) a copy of the CFSS provider agency's agency-provider'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 CFSS provider agency agency-provider uses in the
course of daily business including, but not limited to:
(i) a copy of the CFSS provider agency's agency-provider's time sheet if the time
sheet varies from the standard time sheet for CFSS services approved by the commissioner,
and a letter requesting approval of the CFSS provider agency's agency-provider's
nonstandard time sheet; and
(ii) the a copy of the participant's individual CFSS provider agency's template for the
CFSS care service delivery plan;
(9) a list of all training and classes that the CFSS provider agency agency-provider
requires of its staff providing CFSS services;
(10) documentation that the CFSS provider agency agency-provider and staff have
successfully completed all the training required by this section;
(11) documentation of the agency's agency-provider's marketing practices;
(12) disclosure of ownership, leasing, or management of all residential properties
that are used or could be used for providing home care services;
(13) documentation that the agency agency-provider will use at least the following
percentages of revenue generated from the medical assistance rate paid for CFSS services
for employee personal care assistant CFSS support worker wages and benefits: 72.5
percent of revenue from CFSS providers. The revenue generated by the support specialist
worker training and development services and the reasonable costs associated with the
support specialist worker training and development services shall not be used in making
this calculation; and
(14) documentation that the agency agency-provider does not burden recipients'
participants' free exercise of their right to choose service providers by requiring personal
care assistants CFSS support workers to sign an agreement not to work with any particular
CFSS recipient participant or for another CFSS provider agency agency-provider after
leaving the agency and that the agency is not taking action on any such agreements or
requirements regardless of the date signed.
(b) CFSS provider agencies agency-providers shall provide to the commissioner
the information specified in paragraph (a).
(c) All CFSS provider agencies agency-providers 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. 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 CFSS provider agency agency-provider 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. CFSS provider agency agency-provider
billing staff shall complete training about CFSS program financial management. 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. CFSS provider agencies certified for participation in Medicare as home health
agencies are exempt from the training required in this subdivision.
(d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:
(1) list the materials and information the agency-provider is required to submit;
(2) provide instructions on submitting information to the commissioner; and
(3) provide a due date by which the commissioner must receive the requested
information.
Agency-providers shall submit the required documentation for annual review within
30 days of notification from the commissioner. If no documentation is submitted, the
agency-provider enrollment number must be terminated or suspended.

    Sec. 14. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 13,
is amended to read:
    Subd. 13. Budget model. (a) Under the budget model participants can may exercise
more responsibility and control over the services and supports described and budgeted
within the CFSS service delivery plan. Participants must use services provided by an FMS
contractor as defined in subdivision 2, paragraph (m). Under this model, participants may
use their approved service budget allocation to:
(1) directly employ support workers, and pay wages, federal and state payroll taxes,
and premiums for workers' compensation, liability, and health insurance coverage; and
(2) obtain supports and goods as defined in subdivision 7; and.
(3) choose a range of support assistance services from the financial management
services (FMS) contractor related to:
(i) assistance in managing the budget to meet the service delivery plan needs,
consistent with federal and state laws and regulations;
(ii) the employment, training, supervision, and evaluation of workers by the
participant;
(iii) acquisition and payment for supports and goods; and
(iv) evaluation of individual service outcomes as needed for the scope of the
participant's degree of control and responsibility.
(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
may authorize a legal representative or participant's representative to do so on their behalf.
(c) The commissioner shall disenroll or exclude participants from the budget model
and transfer them to the agency-provider model under the following circumstances that
include but are not limited to:
(1) when a participant has been restricted by the Minnesota restricted recipient
program, in which case the participant may be excluded for a specified time period under
Minnesota Rules, parts 9505.2160 to 9505.2245;
(2) when a participant exits the budget model during the participant's service plan
year. Upon transfer, the participant shall not access the budget model for the remainder of
that service plan year; or
(3) when the department determines that the participant or participant's representative
or legal representative cannot manage participant responsibilities under the budget model.
The commissioner must develop policies for determining if a participant is unable to
manage responsibilities under the budget model.
(d) A participant may appeal in writing to the department under section 256.045,
subdivision 3, to contest the department's decision under paragraph (c), clause (3), to
disenroll or exclude the participant from the budget model.
(c) (e) The FMS contractor shall not provide CFSS services and supports under the
agency-provider service model.
(f) The FMS contractor shall provide service functions as determined by the
commissioner for budget model participants that include but are not limited to:
(1) information and consultation about CFSS;
(2) (1) assistance with the development of the detailed budget for expenditures
portion of the service delivery plan and budget model as requested by the consultation
services provider or participant;
(3) (2) billing and making payments for budget model expenditures;
(4) (3) assisting participants in fulfilling employer-related requirements according to
Internal Revenue Service Revenue Procedure 70-6, section 3504, Agency Employer Tax
Liability, regulation 137036-08 section 3504 of the Internal Revenue Code and related
regulations and interpretations, including Code of Federal Regulations, title 26, section
31.3504-1, which includes assistance with filing and paying payroll taxes, and obtaining
worker compensation coverage;
(5) (4) data recording and reporting of participant spending; and
(6) (5) other duties established in the contract with the department, including with
respect to providing assistance to the participant, participant's representative, or legal
representative in performing their employer responsibilities regarding support workers.
The support worker shall not be considered the employee of the financial management
services FMS contractor.; and
(6) billing, payment, and accounting of approved expenditures for goods for
agency-provider participants.
(d) A participant who requests to purchase goods and supports along with support
worker services under the agency-provider model must use the budget model with
a service delivery plan that specifies the amount of services to be authorized to the
agency-provider and the expenditures to be paid by the FMS contractor.
(e) (g) The FMS contractor shall:
(1) not limit or restrict the participant's choice of service or support providers or
service delivery models consistent with any applicable state and federal requirements;
(2) provide the participant, consultation services provider, and the targeted case
manager, if applicable, with a monthly written summary of the spending for services and
supports that were billed against the spending budget;
(3) be knowledgeable of state and federal employment regulations, including those
under the Fair Labor Standards Act of 1938, and comply with the requirements under the
Internal Revenue Service Revenue Procedure 70-6, Section 3504, section 3504 of the
Internal Revenue Code and related regulations and interpretations, including Code of
Federal Regulations, title 26, section 31.3504-1, regarding agency employer tax liability
for vendor or fiscal employer agent, and any requirements necessary to process employer
and employee deductions, provide appropriate and timely submission of employer tax
liabilities, and maintain documentation to support medical assistance claims;
(4) have current and adequate liability insurance and bonding and sufficient cash
flow as determined by the commissioner and have on staff or under contract a certified
public accountant or an individual with a baccalaureate degree in accounting;
(5) assume fiscal accountability for state funds designated for the program and be
held liable for any overpayments or violations of applicable statutes or rules, including
but not limited to the Minnesota False Claims Act; and
(6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support
workers. The documentation and time records must be maintained for a minimum of
five years from the claim date and be available for audit or review upon request by the
commissioner. Claims submitted by the FMS contractor to the commissioner for payment
must correspond with services, amounts, and time periods as authorized in the participant's
spending service budget and service plan and must contain specific identifying information
as determined by the commissioner.
(f) (h) The commissioner of human services shall:
(1) establish rates and payment methodology for the FMS contractor;
(2) identify a process to ensure quality and performance standards for the FMS
contractor and ensure statewide access to FMS contractors; and
(3) establish a uniform protocol for delivering and administering CFSS services
to be used by eligible FMS contractors.
(g) The commissioner of human services shall disenroll or exclude participants from
the budget model and transfer them to the agency-provider model under the following
circumstances that include but are not limited to:
(1) when a participant has been restricted by the Minnesota restricted recipient
program, the participant may be excluded for a specified time period under Minnesota
Rules, parts 9505.2160 to 9505.2245;
(2) when a participant exits the budget model during the participant's service plan
year. Upon transfer, the participant shall not access the budget model for the remainder of
that service plan year; or
(3) when the department determines that the participant or participant's representative
or legal representative cannot manage participant responsibilities under the budget model.
The commissioner must develop policies for determining if a participant is unable to
manage responsibilities under a budget model.
(h) A participant may appeal under section 256.045, subdivision 3, in writing to the
department to contest the department's decision under paragraph (c), clause (3), to remove
or exclude the participant from the budget model.

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

    Sec. 16. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 16,
is amended to read:
    Subd. 16. Support workers requirements. (a) Support workers shall:
(1) enroll with the department as a support worker after a background study under
chapter 245C has been completed and the support worker has received a notice from the
commissioner that:
(i) the support worker is not disqualified under section 245C.14; or
(ii) is disqualified, but the support worker has received a set-aside of the
disqualification under section 245C.22;
(2) have the ability to effectively communicate with the participant or the
participant's representative;
(3) have the skills and ability to provide the services and supports according to
the person's participant's CFSS service delivery plan and respond appropriately to the
participant's needs;
(4) not be a participant of CFSS, unless the support services provided by the support
worker differ from those provided to the support worker;
(5) complete the basic 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. Support worker
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 support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance
to participants;
(6) complete training and orientation on the participant's individual needs; and
(7) maintain the privacy and confidentiality of the participant, and not independently
determine the medication dose or time for medications for the participant.
(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
(1) lacks the skills, knowledge, or ability to adequately or safely perform the
required work;
(2) fails to provide the authorized services required by the participant employer;
(3) has been intoxicated by alcohol or drugs while providing authorized services to
the participant or while in the participant's home;
(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
(5) has been excluded as a provider by the commissioner of human services, or the
United States Department of Health and Human Services, Office of Inspector General,
from participation in Medicaid, Medicare, or any other federal health care program.
(c) A support worker may appeal in writing to the commissioner to contest the
decision to terminate the support worker's provider enrollment and provider number.
(d) A support worker must not provide or be paid for more than 275 hours of
CFSS per month, regardless of the number of participants the support worker serves or
the number of agency-providers or participant employers by which the support worker
is employed. The department shall not disallow the number of hours per day a support
worker works unless it violates other law.

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

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

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

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

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

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

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

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

ARTICLE 5

CONTINUING CARE

    Section 1. Minnesota Statutes 2012, section 13.46, subdivision 4, is amended to read:
    Subd. 4. Licensing data. (a) As used in this subdivision:
    (1) "licensing data" are all data collected, maintained, used, or disseminated by the
welfare system pertaining to persons licensed or registered or who apply for licensure
or registration or who formerly were licensed or registered under the authority of the
commissioner of human services;
    (2) "client" means a person who is receiving services from a licensee or from an
applicant for licensure; and
    (3) "personal and personal financial data" are Social Security numbers, identity
of and letters of reference, insurance information, reports from the Bureau of Criminal
Apprehension, health examination reports, and social/home studies.
    (b)(1)(i) Except as provided in paragraph (c), the following data on applicants,
license holders, and former licensees are public: name, address, telephone number of
licensees, date of receipt of a completed application, dates of licensure, licensed capacity,
type of client preferred, variances granted, record of training and education in child care
and child development, type of dwelling, name and relationship of other family members,
previous license history, class of license, the existence and status of complaints, and the
number of serious injuries to or deaths of individuals in the licensed program as reported
to the commissioner of human services, the local social services agency, or any other
county welfare agency. For purposes of this clause, a serious injury is one that is treated
by a physician.
(ii) When a correction order, an order to forfeit a fine, an order of license suspension,
an order of temporary immediate suspension, an order of license revocation, an order
of license denial, or an order of conditional license has been issued, or a complaint is
resolved, the following data on current and former licensees and applicants are public: the
substance and investigative findings of the licensing or maltreatment complaint, licensing
violation, or substantiated maltreatment; the record of informal resolution of a licensing
violation; orders of hearing; findings of fact; conclusions of law; specifications of the final
correction order, fine, suspension, temporary immediate suspension, revocation, denial, or
conditional license contained in the record of licensing action; whether a fine has been
paid; and the status of any appeal of these actions.
(iii) When a license denial under section 245A.05 or a sanction under section
245A.07 is based on a determination that the license holder or applicant is responsible for
maltreatment under section 626.556 or 626.557, the identity of the applicant or license
holder as the individual responsible for maltreatment is public data at the time of the
issuance of the license denial or sanction.
(iv) When a license denial under section 245A.05 or a sanction under section
245A.07 is based on a determination that the license holder or applicant is disqualified
under chapter 245C, the identity of the license holder or applicant as the disqualified
individual and the reason for the disqualification are public data at the time of the
issuance of the licensing sanction or denial. If the applicant or license holder requests
reconsideration of the disqualification and the disqualification is affirmed, the reason for
the disqualification and the reason to not set aside the disqualification are public data.
    (2) Notwithstanding sections 626.556, subdivision 11, and 626.557, subdivision 12b,
when any person subject to disqualification under section 245C.14 in connection with a
license to provide family day care for children, child care center services, foster care for
children in the provider's home, or foster care or day care services for adults in the provider's
home is a substantiated perpetrator of maltreatment, and the substantiated maltreatment is
a reason for a licensing action, the identity of the substantiated perpetrator of maltreatment
is public data. For purposes of this clause, a person is a substantiated perpetrator if the
maltreatment determination has been upheld under section 256.045; 626.556, subdivision
10i ; 626.557, subdivision 9d; or chapter 14, or if an individual or facility has not timely
exercised appeal rights under these sections, except as provided under clause (1).
    (3) For applicants who withdraw their application prior to licensure or denial of a
license, the following data are public: the name of the applicant, the city and county in
which the applicant was seeking licensure, the dates of the commissioner's receipt of the
initial application and completed application, the type of license sought, and the date
of withdrawal of the application.
    (4) For applicants who are denied a license, the following data are public: the name
and address of the applicant, the city and county in which the applicant was seeking
licensure, the dates of the commissioner's receipt of the initial application and completed
application, the type of license sought, the date of denial of the application, the nature of
the basis for the denial, the record of informal resolution of a denial, orders of hearings,
findings of fact, conclusions of law, specifications of the final order of denial, and the
status of any appeal of the denial.
    (5) The following data on persons subject to disqualification under section 245C.14 in
connection with a license to provide family day care for children, child care center services,
foster care for children in the provider's home, or foster care or day care services for adults
in the provider's home, are public: the nature of any disqualification set aside under section
245C.22 , subdivisions 2 and 4, and the reasons for setting aside the disqualification; the
nature of any disqualification for which a variance was granted under sections 245A.04,
subdivision 9 ; and 245C.30, and the reasons for granting any variance under section
245A.04, subdivision 9 ; and, if applicable, the disclosure that any person subject to
a background study under section 245C.03, subdivision 1, has successfully passed a
background study. If a licensing sanction under section 245A.07, or a license denial under
section 245A.05, is based on a determination that an individual subject to disqualification
under chapter 245C is disqualified, the disqualification as a basis for the licensing sanction
or denial is public data. As specified in clause (1), item (iv), if the disqualified individual
is the license holder or applicant, the identity of the license holder or applicant and the
reason for the disqualification are public data; and, if the license holder or applicant
requested reconsideration of the disqualification and the disqualification is affirmed, the
reason for the disqualification and the reason to not set aside the disqualification are
public data. If the disqualified individual is an individual other than the license holder or
applicant, the identity of the disqualified individual shall remain private data.
    (6) When maltreatment is substantiated under section 626.556 or 626.557 and the
victim and the substantiated perpetrator are affiliated with a program licensed under
chapter 245A, the commissioner of human services, local social services agency, or
county welfare agency may inform the license holder where the maltreatment occurred of
the identity of the substantiated perpetrator and the victim.
    (7) Notwithstanding clause (1), for child foster care, only the name of the license
holder and the status of the license are public if the county attorney has requested that data
otherwise classified as public data under clause (1) be considered private data based on the
best interests of a child in placement in a licensed program.
    (c) The following are private data on individuals under section 13.02, subdivision
12 , or nonpublic data under section 13.02, subdivision 9: personal and personal financial
data on family day care program and family foster care program applicants and licensees
and their family members who provide services under the license.
    (d) The following are private data on individuals: the identity of persons who have
made reports concerning licensees or applicants that appear in inactive investigative data,
and the records of clients or employees of the licensee or applicant for licensure whose
records are received by the licensing agency for purposes of review or in anticipation of a
contested matter. The names of reporters of complaints or alleged violations of licensing
standards under chapters 245A, 245B, 245C, and 245D, and applicable rules and alleged
maltreatment under sections 626.556 and 626.557, are confidential data and may be
disclosed only as provided in section 626.556, subdivision 11, or 626.557, subdivision 12b.
    (e) Data classified as private, confidential, nonpublic, or protected nonpublic under
this subdivision become public data if submitted to a court or administrative law judge as
part of a disciplinary proceeding in which there is a public hearing concerning a license
which has been suspended, immediately suspended, revoked, or denied.
    (f) Data generated in the course of licensing investigations that relate to an alleged
violation of law are investigative data under subdivision 3.
    (g) Data that are not public data collected, maintained, used, or disseminated under
this subdivision that relate to or are derived from a report as defined in section 626.556,
subdivision 2 , or 626.5572, subdivision 18, are subject to the destruction provisions of
sections 626.556, subdivision 11c, and 626.557, subdivision 12b.
    (h) Upon request, not public data collected, maintained, used, or disseminated under
this subdivision that relate to or are derived from a report of substantiated maltreatment as
defined in section 626.556 or 626.557 may be exchanged with the Department of Health
for purposes of completing background studies pursuant to section 144.057 and with
the Department of Corrections for purposes of completing background studies pursuant
to section 241.021.
    (i) Data on individuals collected according to licensing activities under chapters
245A and 245C, data on individuals collected by the commissioner of human services
according to investigations under chapters 245A, 245B, and 245C, and 245D, and
sections 626.556 and 626.557 may be shared with the Department of Human Rights, the
Department of Health, the Department of Corrections, the ombudsman for mental health
and developmental disabilities, and the individual's professional regulatory board when
there is reason to believe that laws or standards under the jurisdiction of those agencies may
have been violated or the information may otherwise be relevant to the board's regulatory
jurisdiction. Background study data on an individual who is the subject of a background
study under chapter 245C for a licensed service for which the commissioner of human
services is the license holder may be shared with the commissioner and the commissioner's
delegate by the licensing division. Unless otherwise specified in this chapter, the identity
of a reporter of alleged maltreatment or licensing violations may not be disclosed.
    (j) In addition to the notice of determinations required under section 626.556,
subdivision 10f , if the commissioner or the local social services agency has determined
that an individual is a substantiated perpetrator of maltreatment of a child based on sexual
abuse, as defined in section 626.556, subdivision 2, and the commissioner or local social
services agency knows that the individual is a person responsible for a child's care in
another facility, the commissioner or local social services agency shall notify the head
of that facility of this determination. The notification must include an explanation of the
individual's available appeal rights and the status of any appeal. If a notice is given under
this paragraph, the government entity making the notification shall provide a copy of the
notice to the individual who is the subject of the notice.
    (k) All not public data collected, maintained, used, or disseminated under this
subdivision and subdivision 3 may be exchanged between the Department of Human
Services, Licensing Division, and the Department of Corrections for purposes of
regulating services for which the Department of Human Services and the Department
of Corrections have regulatory authority.

    Sec. 2. Minnesota Statutes 2013 Supplement, section 245.8251, is amended to read:
245.8251 POSITIVE SUPPORT STRATEGIES AND EMERGENCY
MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
    Subdivision 1. Rules governing the use of positive support strategies and
restricting or prohibiting restrictive interventions. The commissioner of human
services shall, within 24 months of May 23, 2013 by August 31, 2015, adopt rules
governing the use of positive support strategies, safety interventions, and emergency use
of manual restraint, and restricting or prohibiting the use of restrictive interventions, in
all facilities and services licensed under chapter 245D. , and in all licensed facilities and
licensed services serving persons with a developmental disability or related condition.
For the purposes of this section, "developmental disability or related condition" has the
meaning given in Minnesota Rules, part 9525.0016, subpart 2, items A to E.
    Subd. 2. Data collection. (a) The commissioner shall, with stakeholder input,
develop identify data collection elements specific to incidents of emergency use of
manual restraint and positive support transition plans for persons receiving services from
providers governed licensed facilities and licensed services under chapter 245D and in
licensed facilities and licensed services serving persons with a developmental disability
or related condition as defined in Minnesota Rules, part 9525.0016, subpart 2, effective
January 1, 2014. Providers Licensed facilities and licensed services shall report the data in
a format and at a frequency determined by the commissioner of human services. Providers
shall submit the data to the commissioner and the Office of the Ombudsman for Mental
Health and Developmental Disabilities.
(b) Beginning July 1, 2013, providers licensed facilities and licensed services
regulated under Minnesota Rules, parts 9525.2700 to 9525.2810, shall submit data
regarding the use of all controlled procedures identified in Minnesota Rules, part
9525.2740, in a format and at a frequency determined by the commissioner. Providers
shall submit the data to the commissioner and the Office of the Ombudsman for Mental
Health and Developmental Disabilities.
    Subd. 3. External program review committee. Rules adopted according to this
section shall establish requirements for an external program review committee appointed
by the commissioner to monitor implementation of the rules and make recommendations
to the commissioner about any needed policy changes after adoption of the rules.
    Subd. 4. Interim review panel. (a) The commissioner shall establish an interim
review panel by August 15, 2014, for the purpose of reviewing requests for emergency
use of procedures that have been part of an approved positive support transition plan
when necessary to protect a person from imminent risk of serious injury as defined in
section 245.91, subdivision 6, due to self-injurious behavior. The panel must make
recommendations to the commissioner to approve or deny these requests based on criteria
to be established by the interim review panel. The interim review panel shall operate until
the external program review committee is established as required under subdivision 3.
(b) Members of the interim review panel shall be selected based on their expertise
and knowledge related to the use of positive support strategies as alternatives to the use
of restrictive interventions. The commissioner shall seek input and recommendations
from the Office of the Ombudsman for Mental Health and Developmental Disabilities in
establishing the interim review panel. Members of the interim review panel shall include
the following representatives:
(1) an expert in positive supports;
(2) a mental health professional, as defined in section 245.462;
(3) a licensed health professional as defined in section 245D.02, subdivision 14;
(4) a representative of the Department of Health; and
(5) a representative of the Minnesota Disability Law Center.

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

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

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

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

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

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

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

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

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

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

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

    Sec. 14. Minnesota Statutes 2013 Supplement, section 245D.03, subdivision 1, is
amended to read:
    Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of
home and community-based services to persons with disabilities and persons age 65 and
older pursuant to this chapter. The licensing standards in this chapter govern the provision
of basic support services and intensive support services.
(b) Basic support services provide the level of assistance, supervision, and care that
is necessary to ensure the health and safety of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of
the person. Basic support services include:
(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community
alternatives for disabled individuals, developmental disability, and elderly waiver plans,
excluding out-of-home respite care provided to children in a family child foster care home
licensed under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care
license holder complies with the requirements under section 245D.06, subdivisions 5, 6,
7, and 8, or successor provisions; and section 245D.061 or successor provisions, which
must be stipulated in the statement of intended use required under Minnesota Rules,
part 2960.3000, subpart 4;
(2) adult companion services as defined under the brain injury, community
alternatives for disabled individuals, and elderly waiver plans, excluding adult companion
services provided under the Corporation for National and Community Services Senior
Companion Program established under the Domestic Volunteer Service Act of 1973,
Public Law 98-288;
(3) personal support as defined under the developmental disability waiver plan;
(4) 24-hour emergency assistance, personal emergency response as defined under the
community alternatives for disabled individuals and developmental disability waiver plans;
(5) night supervision services as defined under the brain injury waiver plan; and
(6) homemaker services as defined under the community alternatives for disabled
individuals, brain injury, community alternative care, developmental disability, and elderly
waiver plans, excluding providers licensed by the Department of Health under chapter
144A and those providers providing cleaning services only.
(c) Intensive support services provide assistance, supervision, and care that is
necessary to ensure the health and safety of the person and services specifically directed
toward the training, habilitation, or rehabilitation of the person. Intensive support services
include:
(1) intervention services, including:
(i) behavioral support services as defined under the brain injury and community
alternatives for disabled individuals waiver plans;
(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and
(iii) specialist services as defined under the current developmental disability waiver
plan;
(2) in-home support services, including:
(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;
(ii) independent living services training as defined under the brain injury and
community alternatives for disabled individuals waiver plans; and
(iii) semi-independent living services;
(3) residential supports and services, including:
(i) supported living services as defined under the developmental disability waiver
plan provided in a family or corporate child foster care residence, a family adult foster
care residence, a community residential setting, or a supervised living facility;
(ii) foster care services as defined in the brain injury, community alternative care,
and community alternatives for disabled individuals waiver plans provided in a family or
corporate child foster care residence, a family adult foster care residence, or a community
residential setting; and
(iii) residential services provided to more than four persons with developmental
disabilities in a supervised living facility that is certified by the Department of Health as
an ICF/DD, including ICFs/DD;
(4) day services, including:
(i) structured day services as defined under the brain injury waiver plan;
(ii) day training and habilitation services under sections 252.40 to 252.46, and as
defined under the developmental disability waiver plan; and
(iii) prevocational services as defined under the brain injury and community
alternatives for disabled individuals waiver plans; and
(5) supported employment as defined under the brain injury, developmental
disability, and community alternatives for disabled individuals waiver plans.

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

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

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

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

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

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

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

    Sec. 22. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 2, is
amended to read:
    Subd. 2. Medication administration. (a) If responsibility for medication
administration is assigned to the license holder in the coordinated service and support
plan or the coordinated service and support plan addendum, the license holder must
implement the following medication administration procedures to ensure a person takes
medications and treatments as prescribed For purposes of this subdivision, "medication
administration" means:
(1) checking the person's medication record;
(2) preparing the medication as necessary;
(3) administering the medication or treatment to the person;
(4) documenting the administration of the medication or treatment or the reason for
not administering the medication or treatment; and
(5) reporting to the prescriber or a nurse any concerns about the medication or
treatment, including side effects, effectiveness, or a pattern of the person refusing to
take the medication or treatment as prescribed. Adverse reactions must be immediately
reported to the prescriber or a nurse.
(b)(1) If responsibility for medication administration is assigned to the license holder
in the coordinated service and support plan or the coordinated service and support plan
addendum, the license holder must implement medication administration procedures
to ensure a person takes medications and treatments as prescribed. The license holder
must ensure that the requirements in clauses (2) to (4) and (3) have been met before
administering medication or treatment.
(2) The license holder must obtain written authorization from the person or the
person's legal representative to administer medication or treatment and must obtain
reauthorization annually as needed. This authorization shall remain in effect unless it is
withdrawn in writing and may be withdrawn at any time. If the person or the person's
legal representative refuses to authorize the license holder to administer medication, the
medication must not be administered. The refusal to authorize medication administration
must be reported to the prescriber as expediently as possible.
(3) The staff person responsible for administering the medication or treatment must
complete medication administration training according to section 245D.09, subdivision
4a, paragraphs (a) and (c), and, as applicable to the person, paragraph (d).
(4) (3) For a license holder providing intensive support services, the medication or
treatment must be administered according to the license holder's medication administration
policy and procedures as required under section 245D.11, subdivision 2, clause (3).
(c) The license holder must ensure the following information is documented in the
person's medication administration record:
(1) the information on the current prescription label or the prescriber's current
written or electronically recorded order or prescription that includes the person's name,
description of the medication or treatment to be provided, and the frequency and other
information needed to safely and correctly administer the medication or treatment to
ensure effectiveness;
(2) information on any risks or other side effects that are reasonable to expect, and
any contraindications to its use. This information must be readily available to all staff
administering the medication;
(3) the possible consequences if the medication or treatment is not taken or
administered as directed;
(4) instruction on when and to whom to report the following:
(i) if a dose of medication is not administered or treatment is not performed as
prescribed, whether by error by the staff or the person or by refusal by the person; and
(ii) the occurrence of possible adverse reactions to the medication or treatment;
(5) notation of any occurrence of a dose of medication not being administered or
treatment not performed as prescribed, whether by error by the staff or the person or by
refusal by the person, or of adverse reactions, and when and to whom the report was
made; and
(6) notation of when a medication or treatment is started, administered, changed, or
discontinued.

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

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

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

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

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

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

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

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

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

    Sec. 32. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 3,
is amended to read:
    Subd. 3. Assessment and initial service planning. (a) Within 15 days of service
initiation the license holder must complete a preliminary coordinated service and support
plan addendum based on the coordinated service and support plan.
(b) Within 45 days of service initiation the license holder must meet with the person,
the person's legal representative, the case manager, and other members of the support team
or expanded support team to assess and determine the following based on the person's
coordinated service and support plan and the requirements in subdivision 4 and section
245D.07, subdivision 1a:
(1) the scope of the services to be provided to support the person's daily needs
and activities;
(2) the person's desired outcomes and the supports necessary to accomplish the
person's desired outcomes;
(3) the person's preferences for how services and supports are provided;
(4) whether the current service setting is the most integrated setting available and
appropriate for the person; and
(5) how services must be coordinated across other providers licensed under this
chapter serving the same person to ensure continuity of care for the person.
(c) Within the scope of services, the license holder must, at a minimum, assess
the following areas:
(1) the person's ability to self-manage health and medical needs to maintain or
improve physical, mental, and emotional well-being, including, when applicable, allergies,
seizures, choking, special dietary needs, chronic medical conditions, self-administration
of medication or treatment orders, preventative screening, and medical and dental
appointments;
(2) the person's ability to self-manage personal safety to avoid injury or accident in
the service setting, including, when applicable, risk of falling, mobility, regulating water
temperature, community survival skills, water safety skills, and sensory disabilities; and
(3) the person's ability to self-manage symptoms or behavior that may otherwise
result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to
(7), suspension or termination of services by the license holder, or other symptoms
or behaviors that may jeopardize the health and safety of the person or others. The
assessments must produce information about the person that is descriptive of the person's
overall strengths, functional skills and abilities, and behaviors or symptoms.
(b) Within the scope of services, the license holder must, at a minimum, complete
assessments in the following areas before the 45-day planning meeting:
(1) the person's ability to self-manage health and medical needs to maintain or
improve physical, mental, and emotional well-being, including, when applicable, allergies,
seizures, choking, special dietary needs, chronic medical conditions, self-administration
of medication or treatment orders, preventative screening, and medical and dental
appointments;
(2) the person's ability to self-manage personal safety to avoid injury or accident in
the service setting, including, when applicable, risk of falling, mobility, regulating water
temperature, community survival skills, water safety skills, and sensory disabilities; and
(3) the person's ability to self-manage symptoms or behavior that may otherwise
result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7),
suspension or termination of services by the license holder, or other symptoms or
behaviors that may jeopardize the health and safety of the person or others.
Assessments must produce information about the person that describes the person's overall
strengths, functional skills and abilities, and behaviors or symptoms. Assessments must
be based on the person's status within the last 12 months at the time of service initiation.
Assessments based on older information must be documented and justified. Assessments
must be conducted annually at a minimum or within 30 days of a written request from the
person or the person's legal representative or case manager. The results must be reviewed
by the support team or expanded support team as part of a service plan review.
(c) Within 45 days of service initiation, the license holder must meet with the
person, the person's legal representative, the case manager, and other members of the
support team or expanded support team to determine the following based on information
obtained from the assessments identified in paragraph (b), the person's identified needs
in the coordinated service and support plan, and the requirements in subdivision 4 and
section 245D.07, subdivision 1a:
(1) the scope of the services to be provided to support the person's daily needs
and activities;
(2) the person's desired outcomes and the supports necessary to accomplish the
person's desired outcomes;
(3) the person's preferences for how services and supports are provided;
(4) whether the current service setting is the most integrated setting available and
appropriate for the person; and
(5) how services must be coordinated across other providers licensed under this
chapter serving the person and members of the support team or expanded support team to
ensure continuity of care and coordination of services for the person.

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

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

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

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

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

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

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

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

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

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

    Sec. 43. Minnesota Statutes 2013 Supplement, section 245D.11, subdivision 2, is
amended to read:
    Subd. 2. Health and safety. The license holder must establish policies and
procedures that promote health and safety by ensuring:
(1) use of universal precautions and sanitary practices in compliance with section
245D.06, subdivision 2 , clause (5);
(2) if the license holder operates a residential program, health service coordination
and care according to the requirements in section 245D.05, subdivision 1;
(3) safe medication assistance and administration according to the requirements
in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
doctor and require completion of medication administration training according to the
requirements in section 245D.09, subdivision 4a, paragraph (d). Medication assistance
and administration includes, but is not limited to:
(i) providing medication-related services for a person;
(ii) medication setup;
(iii) medication administration;
(iv) medication storage and security;
(v) medication documentation and charting;
(vi) verification and monitoring of effectiveness of systems to ensure safe medication
handling and administration;
(vii) coordination of medication refills;
(viii) handling changes to prescriptions and implementation of those changes;
(ix) communicating with the pharmacy; and
(x) coordination and communication with prescriber;
(4) safe transportation, when the license holder is responsible for transportation of
persons, with provisions for handling emergency situations according to the requirements
in section 245D.06, subdivision 2, clauses (2) to (4);
(5) a plan for ensuring the safety of persons served by the program in emergencies as
defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
to the license holder. A license holder with a community residential setting or a day service
facility license must ensure the policy and procedures comply with the requirements in
section 245D.22, subdivision 4;
(6) a plan for responding to all incidents as defined in section 245D.02, subdivision
11; and reporting all incidents required to be reported according to section 245D.06,
subdivision 1. The plan must:
(i) provide the contact information of a source of emergency medical care and
transportation; and
(ii) require staff to first call 911 when the staff believes a medical emergency may
be life threatening, or to call the mental health crisis intervention team or similar mental
health response team or service when such a team is available and appropriate when the
person is experiencing a mental health crisis; and
(7) a procedure for the review of incidents and emergencies to identify trends or
patterns, and corrective action if needed. The license holder must establish and maintain
a record-keeping system for the incident and emergency reports. Each incident and
emergency report file must contain a written summary of the incident. The license holder
must conduct a review of incident reports for identification of incident patterns, and
implementation of corrective action as necessary to reduce occurrences. Each incident
report must include:
(i) the name of the person or persons involved in the incident. It is not necessary
to identify all persons affected by or involved in an emergency unless the emergency
resulted in an incident;
(ii) the date, time, and location of the incident or emergency;
(iii) a description of the incident or emergency;
(iv) a description of the response to the incident or emergency and whether a person's
coordinated service and support plan addendum or program policies and procedures were
implemented as applicable;
(v) the name of the staff person or persons who responded to the incident or
emergency; and
(vi) the determination of whether corrective action is necessary based on the results
of the review.

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

    Sec. 45. Minnesota Statutes 2013 Supplement, section 256B.439, subdivision 1,
is amended to read:
    Subdivision 1. Development and implementation of quality profiles. (a) The
commissioner of human services, in cooperation with the commissioner of health, shall
develop and implement quality profiles for nursing facilities and, beginning not later than
July 1, 2014, for home and community-based services providers, except when the quality
profile system would duplicate requirements under section 256B.5011, 256B.5012, or
256B.5013 . For purposes of this section, home and community-based services providers
are defined as providers of home and community-based services under sections 256B.0625,
subdivisions 6a, 7, and 19a; 256B.0913 ,; 256B.0915,; 256B.092, and; 256B.49,; and
256B.85, and intermediate care facilities for persons with developmental disabilities
providers under section 256B.5013. To the extent possible, quality profiles must be
developed for providers of services to older adults and people with disabilities, regardless
of payor source, for the purposes of providing information to consumers. The quality
profiles must be developed using existing data sets maintained by the commissioners of
health and human services to the extent possible. The profiles must incorporate or be
coordinated with information on quality maintained by area agencies on aging, long-term
care trade associations, the ombudsman offices, counties, tribes, health plans, and other
entities and the long-term care database maintained under section 256.975, subdivision 7.
The profiles must be designed to provide information on quality to:
(1) consumers and their families to facilitate informed choices of service providers;
(2) providers to enable them to measure the results of their quality improvement
efforts and compare quality achievements with other service providers; and
(3) public and private purchasers of long-term care services to enable them to
purchase high-quality care.
(b) The profiles must be developed in consultation with the long-term care task
force, area agencies on aging, and representatives of consumers, providers, and labor
unions. Within the limits of available appropriations, the commissioners may employ
consultants to assist with this project.
EFFECTIVE DATE.This section is effective retroactively from February 1, 2014.

    Sec. 46. Minnesota Statutes 2013 Supplement, section 256B.439, subdivision 7,
is amended to read:
    Subd. 7. Calculation of home and community-based services quality add-on.
Effective On July 1, 2015, the commissioner shall determine the quality add-on rate
change and adjust payment rates for participating all home and community-based services
providers for services rendered on or after that date. The adjustment to a provider payment
rate determined under this subdivision shall become part of the ongoing rate paid to that
provider. The payment rate for the quality add-on shall be a variable amount based on
each provider's quality score as determined in subdivisions 1 and 2a. All home and
community-based services providers shall receive a minimum rate increase under this
subdivision. In addition to a minimum rate increase, a home and community-based
services provider shall receive a quality add-on payment. The commissioner shall limit
the types of home and community-based services providers that may receive the quality
add-on and based on availability of quality measures and outcome data. The commissioner
shall limit the amount of the minimum rate increase and quality add-on payments to
operate the quality add-on within funds appropriated for this purpose and based on the
availability of the quality measures the equivalent of a one percent rate increase for all
home and community-based services providers.

    Sec. 47. Minnesota Statutes 2013 Supplement, section 256B.4912, subdivision 1,
is amended to read:
    Subdivision 1. Provider qualifications. (a) For the home and community-based
waivers providing services to seniors and individuals with disabilities under sections
256B.0913 , 256B.0915, 256B.092, and 256B.49, the commissioner shall establish:
(1) agreements with enrolled waiver service providers to ensure providers meet
Minnesota health care program requirements;
(2) regular reviews of provider qualifications, and including requests of proof of
documentation; and
(3) processes to gather the necessary information to determine provider qualifications.
    (b) Beginning July 1, 2012, staff that provide direct contact, as defined in section
245C.02, subdivision 11 , for services specified in the federally approved waiver plans
must meet the requirements of chapter 245C prior to providing waiver services and as
part of ongoing enrollment. Upon federal approval, this requirement must also apply to
consumer-directed community supports.
    (c) Beginning January 1, 2014, service owners and managerial officials overseeing
the management or policies of services that provide direct contact as specified in the
federally approved waiver plans must meet the requirements of chapter 245C prior to
reenrollment or revalidation or, for new providers, prior to initial enrollment if they have
not already done so as a part of service licensure requirements.

    Sec. 48. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
subdivision to read:
    Subd. 16. ICF/DD rate increases effective July 1, 2014. (a) For each facility
reimbursed under this section, for the rate period beginning July 1, 2014, the commissioner
shall increase operating payments equal to four percent of the operating payment rates in
effect on July 1, 2014. For each facility, the commissioner shall apply the rate increase
based on occupied beds, using the percentage specified in this subdivision multiplied by
the total payment rate, including the variable rate but excluding the property-related
payment rate in effect on the preceding date.
(b) To receive the rate increase under paragraph (a), each facility reimbursed under
this section must submit to the commissioner documentation that identifies a quality
improvement project the facility will implement by June 30, 2015. Documentation must
be provided in a format specified by the commissioner. Projects must:
(1) improve the quality of life of intermediate care facility residents in a meaningful
way;
(2) improve the quality of services in a measurable way; or
(3) deliver good quality service more efficiently.
(c) For a facility that fails to submit the documentation described in paragraph (b)
by a date or in a format specified by the commissioner, the commissioner shall reduce
the facility's rate by one percent effective January 1, 2015.
(d) Facilities that receive a rate increase under this subdivision shall use 75 percent
of the rate increase to increase compensation-related costs for employees directly
employed by the facility on or after the effective date of the rate adjustments, except:
(1) persons employed in the central office of a corporation or entity that has an
ownership interest in the facility or exercises control over the facility; and
(2) persons paid by the facility under a management contract.
This requirement is subject to audit by the commissioner.
(e) Compensation-related costs include:
(1) wages and salaries;
(2) the employer's share of FICA taxes, Medicare taxes, state and federal
unemployment taxes, workers' compensation, and mileage reimbursement;
(3) the employer's share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and
(4) other benefits provided and workforce needs, including the recruiting and
training of employees as specified in the distribution plan required under paragraph (f).
(f) A facility that receives a rate adjustment under paragraph (a) that is subject to
paragraphs (d) and (e) shall prepare and produce for the commissioner, upon request, a
plan that specifies the amount of money the provider expects to receive that is subject to
the requirements of paragraphs (d) and (e), as well as how that money will be distributed
to increase compensation for employees. The commissioner may recover funds from a
facility that fails to comply with this requirement.
(g) Within six months after the effective date of the rate adjustment, the facility shall
post the distribution plan required under paragraph (f) for a period of at least six weeks in
an area of the facility's operation to which all eligible employees have access, and shall
provide instructions for employees who believe they have not received the wage and other
compensation-related increases specified in the distribution plan. These instructions must
include a mailing address, e-mail address, and telephone number that an employee may
use to contact the commissioner or the commissioner's representative. Facilities shall
make assurances to the commissioner of compliance with this subdivision using forms
prescribed by the commissioner.
(h) For public employees, the increase for wages and benefits for certain staff is
available and pay rates must be increased only to the extent that the increases comply with
laws governing public employees' collective bargaining. Money received by a provider for
pay increases for public employees under this subdivision may be used only for increases
implemented within one month of the effective date of the rate increase and must not be
used for increases implemented prior to that date.

    Sec. 49. Laws 2013, chapter 108, article 14, section 2, subdivision 6, is amended to read:

Subd. 6.Grant Programs

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

(a) Support Services Grants

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

Paid Work Experience. $2,168,000
each year in fiscal years 2015 and 2016
is from the general fund for paid work
experience for long-term MFIP recipients.
Paid work includes full and partial wage
subsidies and other related services such as
job development, marketing, preworksite
training, job coaching, and postplacement
services. These are onetime appropriations.
Unexpended funds for fiscal year 2015 do not
cancel, but are available to the commissioner
for this purpose in fiscal year 2016.
Work Study Funding for MFIP
Participants. $250,000 each year in fiscal
years 2015 and 2016 is from the general fund
to pilot work study jobs for MFIP recipients
in approved postsecondary education
programs. This is a onetime appropriation.
Unexpended funds for fiscal year 2015 do
not cancel, but are available for this purpose
in fiscal year 2016.
Local Strategies to Reduce Disparities.
$2,000,000 each year in fiscal years 2015
and 2016 is from the general fund for
local projects that focus on services for
subgroups within the MFIP caseload
who are experiencing poor employment
outcomes. These are onetime appropriations.
Unexpended funds for fiscal year 2015 do not
cancel, but are available to the commissioner
for this purpose in fiscal year 2016.
Home Visiting Collaborations for MFIP
Teen Parents. $200,000 per year in fiscal
years 2014 and 2015 is from the general fund
and $200,000 in fiscal year 2016 is from the
federal TANF fund for technical assistance
and training to support local collaborations
that provide home visiting services for
MFIP teen parents. The general fund
appropriation is onetime. The federal TANF
fund appropriation is added to the base.
Performance Bonus Funds for Counties.
The TANF fund base is increased by
$1,500,000 each year in fiscal years 2016
and 2017. The commissioner must allocate
this amount each year to counties that exceed
their expected range of performance on the
annualized three-year self-support index
as defined in Minnesota Statutes, section
256J.751, subdivision 2 , clause (6). This is a
permanent base adjustment. Notwithstanding
any contrary provisions in this article, this
provision expires June 30, 2016.
Base Adjustment. The general fund base is
decreased by $200,000 in fiscal year 2016
and $4,618,000 in fiscal year 2017. The
TANF fund base is increased by $1,700,000
in fiscal years 2016 and 2017.

(b) Basic Sliding Fee Child Care Assistance Grants

36,836,000

42,318,000

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

(c) Child Care Development Grants

1,612,000

1,737,000

(d) Child Support Enforcement Grants

50,000

50,000

Federal Child Support Demonstration
Grants. Federal administrative
reimbursement resulting from the federal
child support grant expenditures authorized
under United States Code, title 42, section
1315, is appropriated to the commissioner
for this activity.

(e) Children's Services Grants

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

Adoption Assistance and Relative Custody
Assistance. $37,453,000 in fiscal year 2014
and $37,453,000 in fiscal year 2015 is for
the adoption assistance and relative custody
assistance programs. The commissioner
shall determine with the commissioner of
Minnesota Management and Budget the
appropriation for Northstar Care for Children
effective January 1, 2015. The commissioner
may transfer appropriations for adoption
assistance, relative custody assistance, and
Northstar Care for Children between fiscal
years and among programs to adjust for
transfers across the programs.
Title IV-E Adoption Assistance. Additional
federal reimbursements to the state as a result
of the Fostering Connections to Success
and Increasing Adoptions Act's expanded
eligibility for Title IV-E adoption assistance
are appropriated for postadoption services,
including a parent-to-parent support network.
Privatized Adoption Grants. Federal
reimbursement for privatized adoption grant
and foster care recruitment grant expenditures
is appropriated to the commissioner for
adoption grants and foster care and adoption
administrative purposes.
Adoption Assistance Incentive Grants.
Federal funds available during fiscal years
2014 and 2015 for adoption incentive grants
are appropriated for postadoption services,
including a parent-to-parent support network.
Base Adjustment. The general fund base is
increased by $5,913,000 in fiscal year 2016
and by $10,297,000 in fiscal year 2017.

(f) Child and Community Service Grants

53,301,000

53,301,000

(g) Child and Economic Support Grants

21,047,000

20,848,000

Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2014 do
not cancel but are available for this purpose
in fiscal year 2015.
Transitional Housing. $250,000 each year
is for the transitional housing programs under
Minnesota Statutes, section 256E.33.
Emergency Services. $250,000 each year
is for emergency services grants under
Minnesota Statutes, section 256E.36.
Family Assets for Independence. $250,000
each year is for the Family Assets for
Independence Minnesota program. This
appropriation is available in either year of the
biennium and may be transferred between
fiscal years.
Food Shelf Programs. $375,000 in fiscal
year 2014 and $375,000 in fiscal year
2015 are for food shelf programs under
Minnesota Statutes, section 256E.34. If the
appropriation for either year is insufficient,
the appropriation for the other year is
available for it. Notwithstanding Minnesota
Statutes, section 256E.34, subdivision 4, no
portion of this appropriation may be used
by Hunger Solutions for its administrative
expenses, including but not limited to rent
and salaries.
Homeless Youth Act. $2,000,000 in fiscal
year 2014 and $2,000,000 in fiscal year 2015
is for purposes of Minnesota Statutes, section
256K.45 .
Safe Harbor Shelter and Housing.
$500,000 in fiscal year 2014 and $500,000 in
fiscal year 2015 is for a safe harbor shelter
and housing fund for housing and supportive
services for youth who are sexually exploited.

(h) Health Care Grants

	Appropriations by Fund
	General	190,000	190,000
	Health Care Access	190,000	190,000

Emergency Medical Assistance Referral
and Assistance Grants. (a) The
commissioner of human services shall
award grants to nonprofit programs that
provide immigration legal services based
on indigency to provide legal services for
immigration assistance to individuals with
emergency medical conditions or complex
and chronic health conditions who are not
currently eligible for medical assistance
or other public health care programs, but
who may meet eligibility requirements with
immigration assistance.
(b) The grantees, in collaboration with
hospitals and safety net providers, shall
provide referral assistance to connect
individuals identified in paragraph (a) with
alternative resources and services to assist in
meeting their health care needs. $100,000
is appropriated in fiscal year 2014 and
$100,000 in fiscal year 2015. This is a
onetime appropriation.
Base Adjustment. The general fund is
decreased by $100,000 in fiscal year 2016
and $100,000 in fiscal year 2017.

(i) Aging and Adult Services Grants

14,827,000 14,812,000

15,010,000 14,936,000

Base Adjustment. The general fund base
is increased by $1,150,000 $1,077,000 in
fiscal year 2016 and $1,151,000 $1,077,000
in fiscal year 2017.
Community Service Development
Grants and Community Services Grants.
Community service development grants and
community services grants are reduced by
$1,150,000 each year. This is a onetime
reduction.

(j) Deaf and Hard-of-Hearing Grants

1,771,000

1,785,000

(k) Disabilities Grants

18,605,000

18,823,000

Advocating Change Together. $310,000 in
fiscal year 2014 is for a grant to Advocating
Change Together (ACT) to maintain and
promote services for persons with intellectual
and developmental disabilities throughout
the state. This appropriation is onetime. Of
this appropriation:
(1) $120,000 is for direct costs associated
with the delivery and evaluation of
peer-to-peer training programs administered
throughout the state, focusing on education,
employment, housing, transportation, and
voting;
(2) $100,000 is for delivery of statewide
conferences focusing on leadership and
skill development within the disability
community; and
(3) $90,000 is for administrative and general
operating costs associated with managing
or maintaining facilities, program delivery,
staff, and technology.
Base Adjustment. The general fund base
is increased by $535,000 in fiscal year 2016
and by $709,000 in fiscal year 2017.

(l) Adult Mental Health Grants

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

Problem Gambling. $225,000 in fiscal year
2014 and $225,000 in fiscal year 2015 is
appropriated from the lottery prize fund for a
grant to the state affiliate recognized by the
National Council on Problem Gambling. The
affiliate must provide services to increase
public awareness of problem gambling,
education and training for individuals and
organizations providing effective treatment
services to problem gamblers and their
families, and research relating to problem
gambling.
Funding Usage. Up to 75 percent of a fiscal
year's appropriations for adult mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
Base Adjustment. The general fund base is
decreased by $4,427,000 in fiscal years 2016
and 2017.
Mental Health Pilot Project. $230,000
each year is for a grant to the Zumbro
Valley Mental Health Center. The grant
shall be used to implement a pilot project
to test an integrated behavioral health care
coordination model. The grant recipient must
report measurable outcomes and savings
to the commissioner of human services
by January 15, 2016. This is a onetime
appropriation.
High-risk adults. $200,000 in fiscal
year 2014 is for a grant to the nonprofit
organization selected to administer the
demonstration project for high-risk adults
under Laws 2007, chapter 54, article 1,
section 19, in order to complete the project.
This is a onetime appropriation.

(m) Child Mental Health Grants

18,246,000

20,636,000

Text Message Suicide Prevention
Program. $625,000 in fiscal year 2014 and
$625,000 in fiscal year 2015 is for a grant
to a nonprofit organization to establish and
implement a statewide text message suicide
prevention program. The program shall
implement a suicide prevention counseling
text line designed to use text messaging to
connect with crisis counselors and to obtain
emergency information and referrals to
local resources in the local community. The
program shall include training within schools
and communities to encourage the use of the
program.
Mental Health First Aid Training. $22,000
in fiscal year 2014 and $23,000 in fiscal
year 2015 is to train teachers, social service
personnel, law enforcement, and others who
come into contact with children with mental
illnesses, in children and adolescents mental
health first aid training.
Funding Usage. Up to 75 percent of a fiscal
year's appropriation for child mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.

(n) CD Treatment Support Grants

1,816,000

1,816,000

SBIRT Training. (1) $300,000 each year is
for grants to train primary care clinicians to
provide substance abuse brief intervention
and referral to treatment (SBIRT). This is a
onetime appropriation. The commissioner of
human services shall apply to SAMHSA for
an SBIRT professional training grant.
(2) If the commissioner of human services
receives a grant under clause (1) funds
appropriated under this clause, equal to
the grant amount, up to the available
appropriation, shall be transferred to the
Minnesota Organization on Fetal Alcohol
Syndrome (MOFAS). MOFAS must use
the funds for grants. Grant recipients must
be selected from communities that are
not currently served by federal Substance
Abuse Prevention and Treatment Block
Grant funds. Grant money must be used to
reduce the rates of fetal alcohol syndrome
and fetal alcohol effects, and the number of
drug-exposed infants. Grant money may be
used for prevention and intervention services
and programs, including, but not limited to,
community grants, professional eduction,
public awareness, and diagnosis.
Fetal Alcohol Syndrome Grant. $180,000
each year from the general fund is for a
grant to the Minnesota Organization on Fetal
Alcohol Syndrome (MOFAS) to support
nonprofit Fetal Alcohol Spectrum Disorders
(FASD) outreach prevention programs
in Olmsted County. This is a onetime
appropriation.
Base Adjustment. The general fund base is
decreased by $480,000 in fiscal year 2016
and $480,000 in fiscal year 2017.

    Sec. 50. PROVIDER RATE AND GRANT INCREASES EFFECTIVE JULY
1, 2014.
(a) The commissioner of human services shall increase reimbursement rates, grants,
allocations, individual limits, and rate limits, as applicable, by four percent for the rate
period beginning July 1, 2014, for services rendered on or after that date. County or tribal
contracts for services specified in this section must be amended to pass through these rate
increases within 60 days of the effective date.
(b) The rate changes described in this section must be provided to:
(1) home and community-based waiver services for persons with developmental
disabilities, including consumer-directed community supports, under Minnesota Statutes,
section 256B.092;
(2) waiver services under community alternatives for disabled individuals, including
consumer-directed community supports, under Minnesota Statutes, section 256B.49;
(3) community alternative care waiver services, including consumer-directed
community supports, under Minnesota Statutes, section 256B.49;
(4) brain injury waiver services, including consumer-directed community supports,
under Minnesota Statutes, section 256B.49;
(5) home and community-based waiver services for the elderly under Minnesota
Statutes, section 256B.0915;
(6) nursing services and home health services under Minnesota Statutes, section
256B.0625, subdivision 6a;
(7) personal care services and qualified professional supervision of personal care
services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
(8) private duty nursing services under Minnesota Statutes, section 256B.0625,
subdivision 7;
(9) community first services and supports under Minnesota Statutes, section 256B.85;
(10) essential community supports under Minnesota Statutes, section 256B.0922;
(11) day training and habilitation services for adults with developmental disabilities
or related conditions under Minnesota Statutes, sections 252.41 to 252.46, including the
additional cost to counties for rate adjustments to day training and habilitation services
provided as a social service;
(12) alternative care services under Minnesota Statutes, section 256B.0913;
(13) living skills training programs for persons with intractable epilepsy who need
assistance in the transition to independent living under Laws 1988, chapter 689;
(14) consumer support grants under Minnesota Statutes, section 256.476;
(15) semi-independent living services under Minnesota Statutes, section 252.275;
(16) family support grants under Minnesota Statutes, section 252.32;
(17) housing access grants under Minnesota Statutes, section 256B.0658;
(18) self-advocacy grants under Laws 2009, chapter 101;
(19) technology grants under Laws 2009, chapter 79;
(20) aging grants under Minnesota Statutes, sections 256.975 to 256.977 and
256B.0917;
(21) deaf and hard-of-hearing grants, including community support services for deaf
and hard-of-hearing adults with mental illness who use or wish to use sign language as their
primary means of communication under Minnesota Statutes, section 256.01, subdivision 2;
(22) deaf and hard-of-hearing grants under Minnesota Statutes, sections 256C.233,
256C.25, and 256C.261;
(23) Disability Linkage Line grants under Minnesota Statutes, section 256.01,
subdivision 24;
(24) transition initiative grants under Minnesota Statutes, section 256.478;
(25) employment support grants under Minnesota Statutes, section 256B.021,
subdivision 6; and
(26) grants provided to people who are eligible for the Housing Opportunities for
Persons with AIDS program under Minnesota Statutes, section 256B.492.
(c) A managed care plan receiving state payments for the services in paragraph (b)
must include the increases in paragraph (a) in payments to providers. To implement the
rate increase in this section, capitation rates paid by the commissioner to managed care
organizations under Minnesota Statutes, section 256B.69, shall reflect a four percent
increase for the specified services for the period beginning July 1, 2014.
(d) Counties shall increase the budget for each recipient of consumer-directed
community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).
(e) To implement this section, the commissioner shall increase service rates in the
disability waiver payment system authorized in Minnesota Statutes, sections 256B.4913
and 256B.4914.
(f) To receive the rate increase described in this section, providers under paragraphs
(a) and (b) must submit to the commissioner documentation that identifies a quality
improvement project that the provider will implement by June 30, 2015. Documentation
must be provided in a format specified by the commissioner. Projects must:
(1) improve the quality of life of home and community-based services recipients in
a meaningful way;
(2) improve the quality of services in a measurable way; or
(3) deliver good quality service more efficiently.
Providers listed in paragraph (b), clauses (7), (9), (10), and (13) to (26), are not subject
to this requirement.
(g) For a provider that fails to submit documentation described in paragraph (f) by
a date or in a format specified by the commissioner, the commissioner shall reduce the
provider's rate by one percent effective January 1, 2015.
(h) Providers that receive a rate increase under this subdivision shall use 75 percent
of the rate increase to increase compensation-related costs for employees directly
employed by the facility on or after the effective date of the rate adjustments, except:
(1) persons employed in the central office of a corporation or entity that has an
ownership interest in the facility or exercises control over the facility; and
(2) persons paid by the facility under a management contract.
This requirement is subject to audit by the commissioner.
(i) Compensation-related costs include:
(1) wages and salaries;
(2) the employer's share of FICA taxes, Medicare taxes, state and federal
unemployment taxes, workers' compensation, and mileage reimbursement;
(3) the employer's share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and
(4) other benefits provided and workforce needs, including the recruiting and
training of employees as specified in the distribution plan required under paragraph (k).
(j) For public employees, the increase for wages and benefits for certain staff is
available and pay rates must be increased only to the extent that the increases comply with
laws governing public employees' collective bargaining. Money received by a provider
for pay increases for public employees under this section may be used only for increases
implemented within one month of the effective date of the rate increase and must not be
used for increases implemented prior to that date.
(k) A provider that receives a rate adjustment under paragraph (b) that is subject to
paragraphs (h) and (i) shall prepare and produce for the commissioner, upon request, a
plan that specifies the amount of money the provider expects to receive that is subject to
the requirements of paragraphs (h) and (i), as well as how that money will be distributed
to increase compensation for employees. The commissioner may recover funds from a
facility that fails to comply with this requirement.
(l) Within six months after the effective date of the rate adjustment, the provider
shall post the distribution plan required under paragraph (k) for a period of at least six
weeks in an area of the provider's operation to which all eligible employees have access,
and shall provide instructions for employees who believe they have not received the
wage and other compensation-related increases specified in the distribution plan. These
instructions must include a mailing address, e-mail address, and telephone number that
an employee may use to contact the commissioner or the commissioner's representative.
Providers shall make assurances to the commissioner of compliance with this section
using forms prescribed by the commissioner.

    Sec. 51. REVISOR'S INSTRUCTION.
In each section of Minnesota Statutes or part of Minnesota Rules referred to in
column A, the revisor of statutes shall delete the word or phrase in column B and insert
the phrase in column C. The revisor shall also make related grammatical changes and
changes in headnotes.

	Column A	Column B	Column C
	section 158.13	defective persons	persons with intellectual disabilities
	section 158.14	defective persons	persons with intellectual disabilities
	section 158.17	defective persons	persons with intellectual disabilities
	section 158.18	persons not defective	persons without intellectual disabilities
		defective person	person with intellectual disabilities
		defective persons	persons with intellectual disabilities
	section 158.19	defective	person with intellectual disabilities
	section 256.94	defective	children with intellectual disabilities and
	section 257.175	defective	children with intellectual disabilities and
	part 2911.1350	retardation	developmental disability

    Sec. 52. REPEALER.
(a) Minnesota Statutes 2013 Supplement, section 245D.061, subdivision 3, is
repealed upon the effective date of rules adopted according to Minnesota Statutes,
section 245.8251, or, if sequential effective dates are used, the first effective date. The
commissioner of human services shall notify the revisor of statutes when this occurs.
(b) Minnesota Statutes 2012, section 245.825, subdivisions 1 and 1b, are repealed
upon the effective date of rules adopted according to Minnesota Statutes, section 245.8251,
or, if sequential effective dates are used, the first effective date. The commissioner of
human services shall notify the revisor of statutes when this occurs.
Minnesota Statutes 2013 Supplement, sections 245D.02, subdivisions 2b, 2c, 5a,
and 23b; 245D.06, subdivisions 5, 6, 7, and 8; and 245D.061, subdivisions 1, 2, 4, 5, 6, 7,
8, and 9, are repealed upon the effective date of rules adopted according to Minnesota
Statutes, section 245.8251, or, if sequential effective dates are used, the first effective date.
The commissioner of human services shall notify the revisor of statutes when this occurs.
(d) Minnesota Rules, parts 9525.2700; and 9525.2810, are repealed upon the
effective date of rules adopted according to Minnesota Statutes, section 245.8251, or, if
sequential effective dates are used, the first effective date. The commissioner of human
services shall notify the revisor of statutes when this occurs.

ARTICLE 6

MISCELLANEOUS

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

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