1.1                          A bill for an act 
  1.2             relating to human services; amending and initiating 
  1.3             provisions for long-term care; requiring certain 
  1.4             studies; establishing a pilot project for senior 
  1.5             services; establishing a long-term care revolving 
  1.6             fund; establishing a loan forgiveness program; 
  1.7             requiring nursing services agency registration; 
  1.8             initiating provisions relating to long-term care 
  1.9             insurance; appropriating money; amending Minnesota 
  1.10            Statutes 2000, sections 62A.48, subdivision 4, by 
  1.11            adding subdivisions; 62S.01, by adding subdivisions; 
  1.12            62S.26; 116L.11, subdivision 4; 116L.12, subdivisions 
  1.13            4, 5; 116L.13, subdivision 1; 144.057; 144.1464; 
  1.14            144.1496, subdivision 3; 144A.071, subdivisions 1, 1a, 
  1.15            2, 4a; 144A.073, subdivisions 2, 4, by adding a 
  1.16            subdivision; 144A.16; 144A.62, subdivisions 1, 2, 3, 
  1.17            4; 245A.04, subdivisions 3, 3a, 3b, 3d; 256.975, by 
  1.18            adding subdivisions; 256B.056, subdivision 4; 
  1.19            256B.0911, subdivisions 1, 3, 5, 6, 7, by adding 
  1.20            subdivisions; 256B.0913, subdivisions 1, 2, 4, 5, 6, 
  1.21            7, 8, 9, 10, 11, 12, 13, 14; 256B.0915, subdivisions 
  1.22            1d, 3, 5; 256B.431, subdivisions 2e, 17, by adding 
  1.23            subdivisions; 256B.434, subdivisions 4, 10; 256B.48, 
  1.24            subdivision 1; 256B.501, by adding a subdivision; 
  1.25            256D.35, by adding subdivisions; 256D.44, subdivision 
  1.26            5; Laws 1999, chapter 245, article 3, section 45, as 
  1.27            amended; proposing coding for new law in Minnesota 
  1.28            Statutes, chapters 16A; 62S; 116L; 144; 144A; 256; 
  1.29            256B; repealing Minnesota Statutes 2000, sections 
  1.30            116L.10; 116L.12, subdivisions 2, 7; 256B.0911, 
  1.31            subdivisions 2, 2a, 4, 8, 9; 256B.0913, subdivisions 
  1.32            3, 15a, 15b, 15c, 16; 256B.0915, subdivisions 3a, 3b, 
  1.33            3c; Minnesota Rules, parts 9505.2390, 9505.2395, 
  1.34            9505.2396, 9505.2400, 9505.2405, 9505.2410, 9505.2413, 
  1.35            9505.2415, 9505.2420, 9505.2425, 9505,2426, 9505.2430, 
  1.36            9505.2435, 9505.2440, 9505.2445, 9505.2450, 9505.2455, 
  1.37            9505.2458, 9505.2460, 9505.2465, 9505.2470, 9505.2473, 
  1.38            9505.2475, 9505.2480, 9505.2485, 9505.2486, 9505.2490, 
  1.39            9505.2495, 9505.2496; 9505.2500. 
  1.40  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.41                             ARTICLE 1 
  1.42                CONSUMER INFORMATION AND ASSISTANCE 
  2.1                       AND COMMUNITY-BASED CARE 
  2.2      Section 1.  [144A.35] [EXPANSION OF BED DISTRIBUTION STUDY 
  2.3   AND CREATION OF CRITICAL ACCESS SITES.] 
  2.4      Subdivision 1.  [OLDER ADULT SERVICES DISTRIBUTION 
  2.5   STUDY.] The commissioner of health, in coordination with the 
  2.6   commissioner of human services, shall monitor and analyze the 
  2.7   distribution of older adult services, including, but not limited 
  2.8   to, nursing home beds, senior housing, housing with services 
  2.9   units, and home and community-based services in the different 
  2.10  geographic areas of the state.  The study shall include an 
  2.11  analysis of the impact of amendments to the nursing home 
  2.12  moratorium law which would allow for transfers of nursing home 
  2.13  beds within the state.  The commissioner of health shall submit 
  2.14  to the legislature, beginning January 15, 2002, and each January 
  2.15  15 thereafter, an assessment of the distribution of long-term 
  2.16  health care services by geographic area, with particular 
  2.17  attention to service deficits or problems, the designation of 
  2.18  critical access service sites, and corrective action plans. 
  2.19     Subd. 2.  [CRITICAL ACCESS SERVICE SITE.] "Critical access 
  2.20  service site" shall include nursing homes, senior housing, 
  2.21  housing with services, and home and community-based services 
  2.22  that are certified by the state as necessary providers of health 
  2.23  care services to a specific geographic area.  For purposes of 
  2.24  this requirement, a "necessary provider of health care services" 
  2.25  is a provider that is: 
  2.26     (1) located more than 20 miles, defined as official mileage 
  2.27  as reported by the Minnesota department of transportation, from 
  2.28  the next nearest long-term health care provider; 
  2.29     (2) the sole long-term health care provider in the county; 
  2.30  or 
  2.31     (3) a long-term health care provider located in a medically 
  2.32  underserved area or health professional shortage area. 
  2.33     Subd. 3.  [IDENTIFICATION OF CRITICAL ACCESS SERVICE 
  2.34  SITES.] Based on the results of the analysis completed in 
  2.35  subdivision 1, the commissioners of health and human services 
  2.36  shall identify and designate long-term health care providers as 
  3.1   critical access service sites. 
  3.2      Subd. 4.  [CRITICAL ACCESS SERVICE SITES.] The commissioner 
  3.3   of health, in consultation with the commissioner of human 
  3.4   services, shall: 
  3.5      (1) develop and implement specific waivers to regulations 
  3.6   governing health care personnel scope of duties, physical plant 
  3.7   requirements, and location of community-based services, to 
  3.8   address critical access service site older adult service needs; 
  3.9      (2) identify payment barriers to the continued operation of 
  3.10  older adult services in critical access service sites, and 
  3.11  provide recommendations on changes to reimbursement rates to 
  3.12  facilitate the continued operation of these services. 
  3.13     Sec. 2.  Minnesota Statutes 2000, section 256.975, is 
  3.14  amended by adding a subdivision to read: 
  3.15     Subd. 7.  [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 
  3.16  LINKAGE.] (a) The Minnesota board on aging shall operate a 
  3.17  statewide information and assistance service to aid older 
  3.18  Minnesotans and their families in making informed choices about 
  3.19  long-term care options and health care benefits.  Language 
  3.20  services to persons with limited English language skills must be 
  3.21  made available.  The service, known as Senior LinkAge Line, must 
  3.22  be available during business hours through a statewide toll-free 
  3.23  number and must also be available through the Internet. 
  3.24     (b) The service must assist older adults, caregivers, and 
  3.25  providers in accessing information about choices in long-term 
  3.26  care services that are purchased through private providers or 
  3.27  available through public options.  The service must: 
  3.28     (1) develop a comprehensive database that includes detailed 
  3.29  listings in both consumer- and provider-oriented formats; 
  3.30     (2) make the database accessible on the Internet and 
  3.31  through other telecommunication and media-related tools; 
  3.32     (3) link callers to interactive long-term care screening 
  3.33  tools and make these tools available through the Internet by 
  3.34  integrating the tools with the database; 
  3.35     (4) develop community education materials with a focus on 
  3.36  planning for long-term care and evaluating independent living, 
  4.1   housing, and service options; 
  4.2      (5) conduct an outreach campaign to assist older adults and 
  4.3   their caregivers in finding information on the Internet and 
  4.4   through other means of communication; 
  4.5      (6) implement a messaging system for overflow callers and 
  4.6   respond to these callers by the next business day; 
  4.7      (7) link callers with county human services and other 
  4.8   providers to receive more in-depth assistance and consultation 
  4.9   related to long-term care options; and 
  4.10     (8) link callers with quality profiles for nursing 
  4.11  facilities and other providers developed by the commissioner of 
  4.12  health. 
  4.13     (c) The Minnesota board on aging shall conduct an 
  4.14  evaluation of the effectiveness of the statewide information and 
  4.15  assistance, and submit this evaluation to the legislature by 
  4.16  December 1, 2002.  The evaluation must include an analysis of 
  4.17  funding adequacy, gaps in service delivery, continuity in 
  4.18  information between the service and identified linkages, and 
  4.19  potential use of private funding to enhance the service. 
  4.20     Sec. 3.  [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS 
  4.21  PROGRAM.] 
  4.22     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  4.23  section, the following terms have the meanings given. 
  4.24     (a) "Community" means a town, township, city, or targeted 
  4.25  neighborhood within a city, or a consortium of towns, townships, 
  4.26  cities, or targeted neighborhoods within cities. 
  4.27     (b) "Older adult services" means any services available 
  4.28  under the elderly waiver program or alternative care grant 
  4.29  programs; nursing facility services; transportation services; 
  4.30  respite services; and other community-based services identified 
  4.31  as necessary either to maintain lifestyle choices for older 
  4.32  Minnesotans, or to promote independence. 
  4.33     (c) "Older adult" refers to individuals 65 years of age and 
  4.34  older. 
  4.35     Subd. 2.  [CREATION.] The community services development 
  4.36  grants program is created under the administration of the 
  5.1   commissioner of human services.  
  5.2      Subd. 3.  [PROVISION OF GRANTS.] The commissioner shall 
  5.3   make grants available to communities, providers of older adult 
  5.4   services identified in subdivision 1, or to a consortium of 
  5.5   providers of older adult services, to establish new older adult 
  5.6   services.  Grants may be provided for capital and other costs 
  5.7   including, but not limited to, start-up and training costs, 
  5.8   equipment, and supplies related to the establishment of new 
  5.9   older adult services or other residential or service 
  5.10  alternatives to nursing facility care.  Grants may also be made 
  5.11  to renovate current buildings, provide transportation services, 
  5.12  or expand state-funded programs in the area. 
  5.13     Subd. 4.  [ELIGIBILITY.] Grants may be awarded only to 
  5.14  communities and providers or to a consortium of providers that 
  5.15  have a local match of 50 percent of the costs for the project in 
  5.16  the form of donations, local tax dollars, in-kind donations, 
  5.17  fundraising, or other local matches. 
  5.18     Subd. 5.  [GRANT PREFERENCE.] The commissioner of human 
  5.19  services may award grants to the extent grant funds are 
  5.20  available and to the extent applications are approved by the 
  5.21  commissioner.  Denial of approval of an application in one year 
  5.22  does not preclude submission of an application in a subsequent 
  5.23  year.  The maximum grant amount is limited to $750,000. 
  5.24     Sec. 4.  Minnesota Statutes 2000, section 256B.056, 
  5.25  subdivision 4, is amended to read: 
  5.26     Subd. 4.  [INCOME.] To be eligible for medical assistance, 
  5.27  a person eligible under section 256B.055, subdivision 7, not 
  5.28  receiving supplemental security income program payments, may 
  5.29  have an income up to 100 percent of the federal poverty 
  5.30  guidelines, and families and children may have an income up to 
  5.31  133-1/3 percent of the AFDC income standard in effect under the 
  5.32  July 16, 1996, AFDC state plan.  Effective July 1, 2000, the 
  5.33  base AFDC standard in effect on July 16, 1996, shall be 
  5.34  increased by three percent. Effective January 1, 2000, and each 
  5.35  successive January, recipients of supplemental security income 
  5.36  may have an income up to the supplemental security income 
  6.1   standard in effect on that date.  In computing income to 
  6.2   determine eligibility of persons who are not residents of 
  6.3   long-term care facilities, the commissioner shall disregard 
  6.4   increases in income as required by Public Law Numbers 94-566, 
  6.5   section 503; 99-272; and 99-509.  Veterans aid and attendance 
  6.6   benefits and Veterans Administration unusual medical expense 
  6.7   payments are considered income to the recipient. 
  6.8      Sec. 5.  Minnesota Statutes 2000, section 256B.0911, 
  6.9   subdivision 1, is amended to read: 
  6.10     Subdivision 1.  [PURPOSE AND GOAL.] (a) The purpose of ~~the~~ 
  6.11  ~~preadmission screening program~~ long-term care consultation 
  6.12  services is to assist persons with long-term or chronic care 
  6.13  needs in making long-term care decisions and selecting options 
  6.14  that meet their needs and reflect their preferences.  The 
  6.15  availability of, and access to, information and other types of 
  6.16  assistance is also intended to prevent or delay certified 
  6.17  nursing facility placements ~~by assessing applicants and~~ 
  6.18  ~~residents and offering cost-effective alternatives appropriate~~ 
  6.19  ~~for the person's needs~~ and to provide transition assistance 
  6.20  after admission.  Further, the goal of ~~the program~~ these 
  6.21  services is to contain costs associated with unnecessary 
  6.22  certified nursing facility admissions.  The commissioners of 
  6.23  human services and health shall seek to maximize use of 
  6.24  available federal and state funds and establish the broadest 
  6.25  program possible within the funding available. 
  6.26     (b) These services must be coordinated with services 
  6.27  provided under sections 256.975, subdivision 7, and 256.9772, 
  6.28  and with services provided by other public and private agencies 
  6.29  in the community to offer a variety of cost-effective 
  6.30  alternatives to persons with disabilities and elderly persons.  
  6.31  The county agency providing long-term care consultation services 
  6.32  shall encourage the use of volunteers from families, religious 
  6.33  organizations, social clubs, and similar civic and service 
  6.34  organizations to provide community-based services. 
  6.35     Sec. 6.  Minnesota Statutes 2000, section 256B.0911, is 
  6.36  amended by adding a subdivision to read: 
  7.1      Subd. 1a.  [DEFINITIONS.] For purposes of this section, the 
  7.2   following definitions apply: 
  7.3      (a) "Long-term care consultation services" means: 
  7.4      (1) providing information and education to the general 
  7.5   public regarding availability of the services authorized under 
  7.6   this section; 
  7.7      (2) an intake process that provides access to the services 
  7.8   described in this section; 
  7.9      (3) assessment of the health, psychological, and social 
  7.10  needs of referred individuals; 
  7.11     (4) assistance in identifying services needed to maintain 
  7.12  an individual in the least restrictive environment; 
  7.13     (5) providing recommendations on cost-effective community 
  7.14  services that are available to the individual; 
  7.15     (6) development of an individual's community support plan; 
  7.16     (7) providing information regarding eligibility for 
  7.17  Minnesota health care programs; 
  7.18     (8) preadmission screening to determine the need for a 
  7.19  nursing facility level of care; 
  7.20     (9) preliminary determination of Minnesota health care 
  7.21  programs eligibility for individuals who need a nursing facility 
  7.22  level of care, with appropriate referrals for final 
  7.23  determination; 
  7.24     (10) providing recommendations for nursing facility 
  7.25  placement when there are no cost-effective community services 
  7.26  available; and 
  7.27     (11) assistance to transition people back to community 
  7.28  settings after facility admission. 
  7.29     (b) "Minnesota health care programs" means the medical 
  7.30  assistance program under chapter 256B, the alternative care 
  7.31  program under section 256B.0913, and the prescription drug 
  7.32  program under section 256.955. 
  7.33     Sec. 7.  Minnesota Statutes 2000, section 256B.0911, 
  7.34  subdivision 3, is amended to read: 
  7.35     Subd. 3.  [~~PERSONS RESPONSIBLE FOR CONDUCTING THE~~ 
  7.36  ~~PREADMISSION SCREENING~~ LONG-TERM CARE CONSULTATION TEAM.] (a) A 
  8.1   ~~local screening~~ long-term care consultation team shall be 
  8.2   established by the county board of commissioners.  Each local 
  8.3   ~~screening~~ consultation team shall consist of ~~screeners who are a~~ 
  8.4   at least one social worker and ~~a~~ at least one public health 
  8.5   nurse from their respective county agencies.  The board may 
  8.6   designate public health or social services as the lead agency 
  8.7   for long-term care consultation services.  If a county does not 
  8.8   have a public health nurse available, it may request approval 
  8.9   from the commissioner to assign a county registered nurse with 
  8.10  at least one year experience in home care to participate on the 
  8.11  team.  ~~The screening team members must confer regarding the most~~ 
  8.12  ~~appropriate care for each individual screened.~~  Two or more 
  8.13  counties may collaborate to establish a joint local ~~screening~~ 
  8.14  consultation team or teams. 
  8.15     (b) ~~In assessing a person's needs, screeners shall have a~~ 
  8.16  ~~physician available for consultation and shall consider the~~ 
  8.17  ~~assessment of the individual's attending physician, if any.  The~~ 
  8.18  ~~individual's physician shall be included if the physician~~ 
  8.19  ~~chooses to participate.  Other personnel may be included on the~~ 
  8.20  ~~team as deemed appropriate by the county agencies.~~  The team is 
  8.21  responsible for providing long-term care consultation services 
  8.22  to all persons located in the county who request the services, 
  8.23  regardless of eligibility for Minnesota health care programs. 
  8.24     Sec. 8.  Minnesota Statutes 2000, section 256B.0911, is 
  8.25  amended by adding a subdivision to read: 
  8.26     Subd. 3a.  [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 
  8.27  requesting assessment, services planning, or other assistance 
  8.28  intended to support community-based living must be visited by a 
  8.29  long-term care consultation team within ten working days after 
  8.30  the date on which an assessment was requested or recommended.  
  8.31  Assessments must be conducted according to paragraphs (b) to (g).
  8.32     (b) The county may utilize a team of either the social 
  8.33  worker or public health nurse, or both, to conduct the 
  8.34  assessment in a face-to-face interview.  The screening 
  8.35  consultation team members must confer regarding the most 
  8.36  appropriate care for each individual screened or assessed. 
  9.1      (c) The long-term care consultation team must assess the 
  9.2   health and social needs of the person, using an assessment form 
  9.3   provided by the commissioner of human services. 
  9.4      (d) The team must conduct the assessment in a face-to-face 
  9.5   interview with the person being assessed and the person's legal 
  9.6   representative, if applicable. 
  9.7      (e) The team must provide the person, or the person's legal 
  9.8   representative, with written recommendations for facility- or 
  9.9   community-based services.  The team must document that the most 
  9.10  cost-effective alternatives available were offered to the 
  9.11  individual.  For purposes of this requirement, "cost-effective 
  9.12  alternatives" means community services and living arrangements 
  9.13  that cost the same as or less than nursing facility care. 
  9.14     (f) If the person chooses to use community-based services, 
  9.15  the team must provide the person or the person's legal 
  9.16  representative with a written community support plan, regardless 
  9.17  of whether the individual is eligible for Minnesota health care 
  9.18  programs.  The person may request assistance in developing a 
  9.19  community support plan without participating in a complete 
  9.20  assessment. 
  9.21     (g) The team must give the person receiving assessment or 
  9.22  support planning, or the person's legal representative, 
  9.23  materials supplied by the commissioner of human services 
  9.24  containing the following information: 
  9.25     (1) the purpose of preadmission screening and assessment; 
  9.26     (2) information about Minnesota health care programs; 
  9.27     (3) the person's freedom to accept or reject the 
  9.28  recommendations of the team; 
  9.29     (4) the person's right to confidentiality under the 
  9.30  Minnesota Government Data Practices Act, chapter 13; and 
  9.31     (5) the person's right to appeal the decision regarding the 
  9.32  need for nursing facility level of care or the county's final 
  9.33  decisions regarding public programs eligibility according to 
  9.34  section 256.045, subdivision 3. 
  9.35     Sec. 9.  Minnesota Statutes 2000, section 256B.0911, is 
  9.36  amended by adding a subdivision to read: 
 10.1      Subd. 3b.  [TRANSITION ASSISTANCE.] (a) A long-term care 
 10.2   consultation team shall provide assistance to persons residing 
 10.3   in a nursing facility, hospital, regional treatment center, or 
 10.4   intermediate care facility for persons with mental retardation 
 10.5   who request or are referred for such assistance.  Transition 
 10.6   assistance must include assessment, community support plan 
 10.7   development, referrals to Minnesota health care programs, and 
 10.8   referrals to programs that provide assistance with housing. 
 10.9      (b) The county shall develop transition processes with 
 10.10  institutional social workers and discharge planners to ensure 
 10.11  that: 
 10.12     (1) persons admitted to facilities receive information 
 10.13  about transition assistance that is available; 
 10.14     (2) the assessment is completed for persons within ten 
 10.15  working days of the date of request or recommendation for 
 10.16  assessment; and 
 10.17     (3) there is a plan for transition and follow-up for the 
 10.18  individual's return to the community.  The plan must require 
 10.19  notification of other local agencies when a person who may 
 10.20  require assistance is screened by one county for admission to a 
 10.21  facility located in another county. 
 10.22     (c) If a person who is eligible for a Minnesota health care 
 10.23  program is admitted to a nursing facility, the nursing facility 
 10.24  must include a consultation team member or the case manager in 
 10.25  the discharge planning process. 
 10.26     Sec. 10.  Minnesota Statutes 2000, section 256B.0911, is 
 10.27  amended by adding a subdivision to read: 
 10.28     Subd. 4a.  [PREADMISSION SCREENING ACTIVITIES RELATED TO 
 10.29  NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 
 10.30  certified nursing facilities, including certified boarding care 
 10.31  facilities, must be screened prior to admission regardless of 
 10.32  income, assets, or funding sources for nursing facility care, 
 10.33  except as described in subdivision 4b.  The purpose of the 
 10.34  screening is to determine the need for nursing facility level of 
 10.35  care as described in paragraph (d) and to complete activities 
 10.36  required under federal law related to mental illness and mental 
 11.1   retardation as outlined in paragraph (b). 
 11.2      (b) A person who has a diagnosis or possible diagnosis of 
 11.3   mental illness, mental retardation, or a related condition must 
 11.4   receive a preadmission screening before admission regardless of 
 11.5   the exemptions outlined in subdivision 4b, paragraph (b), to 
 11.6   identify the need for further evaluation and specialized 
 11.7   services, unless the admission prior to screening is authorized 
 11.8   by the local mental health authority or the local developmental 
 11.9   disabilities case manager, or unless authorized by the county 
 11.10  agency according to Public Law Number 100-508.  
 11.11     The following criteria apply to the preadmission screening: 
 11.12     (1) the county must use forms and criteria developed by the 
 11.13  commissioner of human services to identify persons who require 
 11.14  referral for further evaluation and determination of the need 
 11.15  for specialized services; and 
 11.16     (2) the evaluation and determination of the need for 
 11.17  specialized services must be done by: 
 11.18     (i) a qualified independent mental health professional, for 
 11.19  persons with a primary or secondary diagnosis of a serious 
 11.20  mental illness; or 
 11.21     (ii) a qualified mental retardation professional, for 
 11.22  persons with a primary or secondary diagnosis of mental 
 11.23  retardation or related conditions.  For purposes of this 
 11.24  requirement, a qualified mental retardation professional must 
 11.25  meet the standards for a qualified mental retardation 
 11.26  professional under Code of Federal Regulations, title 42, 
 11.27  section 483.430. 
 11.28     (c) The local county mental health authority or the state 
 11.29  mental retardation authority under Public Laws Numbers 100-203 
 11.30  and 101-508 may prohibit admission to a nursing facility if the 
 11.31  individual does not meet the nursing facility level of care 
 11.32  criteria or needs specialized services as defined in Public Laws 
 11.33  Numbers 100-203 and 101-508.  For purposes of this section, 
 11.34  "specialized services" for a person with mental retardation or a 
 11.35  related condition means active treatment as that term is defined 
 11.36  under Code of Federal Regulations, title 42, section 483.440, 
 12.1   paragraph (a), clause (1). 
 12.2      (d) The determination of the need for nursing facility 
 12.3   level of care must be made according to criteria developed by 
 12.4   the commissioner of human services.  In assessing a person's 
 12.5   needs, consultation team members shall have a physician 
 12.6   available for consultation and shall consider the assessment of 
 12.7   the individual's attending physician, if any.  The individual's 
 12.8   physician must be included if the physician chooses to 
 12.9   participate.  Other personnel may be included on the team as 
 12.10  deemed appropriate by the county. 
 12.11     Sec. 11.  Minnesota Statutes 2000, section 256B.0911, is 
 12.12  amended by adding a subdivision to read: 
 12.13     Subd. 4b.  [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 
 12.14  Exemptions from the federal screening requirements outlined in 
 12.15  subdivision 4a, paragraphs (b) and (c), are limited to: 
 12.16     (1) a person who, having entered an acute care facility 
 12.17  from a certified nursing facility, is returning to a certified 
 12.18  nursing facility; and 
 12.19     (2) a person transferring from one certified nursing 
 12.20  facility in Minnesota to another certified nursing facility in 
 12.21  Minnesota. 
 12.22     (b) Persons who are exempt from preadmission screening for 
 12.23  purposes of level of care determination include: 
 12.24     (1) persons described in paragraph (a); 
 12.25     (2) an individual who has a contractual right to have 
 12.26  nursing facility care paid for indefinitely by the veterans' 
 12.27  administration; 
 12.28     (3) an individual enrolled in a demonstration project under 
 12.29  section 256B.69, subdivision 8, at the time of application to a 
 12.30  nursing facility; 
 12.31     (4) an individual currently being served under the 
 12.32  alternative care program or under a home and community-based 
 12.33  services waiver authorized under section 1915(c) of the federal 
 12.34  Social Security Act; and 
 12.35     (5) individuals admitted to a certified nursing facility 
 12.36  for a short-term stay, which is expected to be 14 days or less 
 13.1   in duration based upon a physician's certification, and who have 
 13.2   been assessed and approved for nursing facility admission within 
 13.3   the previous six months.  This exemption applies only if the 
 13.4   consultation team member determines at the time of the initial 
 13.5   assessment of the six-month period that it is appropriate to use 
 13.6   the nursing facility for short-term stays and that there is an 
 13.7   adequate plan of care for return to the home or community-based 
 13.8   setting.  If a stay exceeds 14 days, the individual must be 
 13.9   referred no later than the first county working day following 
 13.10  the 14th resident day for a screening, which must be completed 
 13.11  within five working days of the referral.  The payment 
 13.12  limitations in subdivision 7 apply to an individual found at 
 13.13  screening to not meet the level of care criteria for admission 
 13.14  to a certified nursing facility. 
 13.15     (c) Persons admitted to a Medicaid-certified nursing 
 13.16  facility from the community on an emergency basis as described 
 13.17  in paragraph (d) or from an acute care facility on a nonworking 
 13.18  day must be screened the first working day after admission. 
 13.19     (d) Emergency admission to a nursing facility prior to 
 13.20  screening is permitted when all of the following conditions are 
 13.21  met: 
 13.22     (1) a person is admitted from the community to a certified 
 13.23  nursing or certified boarding care facility during county 
 13.24  nonworking hours; 
 13.25     (2) a physician has determined that delaying admission 
 13.26  until preadmission screening is completed would adversely affect 
 13.27  the person's health and safety; 
 13.28     (3) there is a recent precipitating event that precludes 
 13.29  the client from living safely in the community, such as 
 13.30  sustaining an injury, sudden onset of acute illness, or a 
 13.31  caregiver's inability to continue to provide care; 
 13.32     (4) the attending physician has authorized the emergency 
 13.33  placement and has documented the reason that the emergency 
 13.34  placement is recommended; and 
 13.35     (5) the county is contacted on the first working day 
 13.36  following the emergency admission. 
 14.1   Transfer of a patient from an acute care hospital to a nursing 
 14.2   facility is not considered an emergency except for a person who 
 14.3   has received hospital services in the following situations: 
 14.4   hospital admission for observation, care in an emergency room 
 14.5   without hospital admission, or following hospital 24-hour bed 
 14.6   care. 
 14.7      Sec. 12.  Minnesota Statutes 2000, section 256B.0911, is 
 14.8   amended by adding a subdivision to read: 
 14.9      Subd. 4c.  [SCREENING REQUIREMENTS.] (a) A person may be 
 14.10  screened for nursing facility admission by telephone or in a 
 14.11  face-to-face screening interview.  Consultation team members 
 14.12  shall identify each individual's needs using the following 
 14.13  categories: 
 14.14     (1) the person needs no face-to-face screening interview to 
 14.15  determine the need for nursing facility level of care based on 
 14.16  information obtained from other health care professionals; 
 14.17     (2) the person needs an immediate face-to-face screening 
 14.18  interview to determine the need for nursing facility level of 
 14.19  care and complete activities required under subdivision 4a; or 
 14.20     (3) the person may be exempt from screening requirements as 
 14.21  outlined in subdivision 4b, but will need transitional 
 14.22  assistance after admission or in-person follow-along after a 
 14.23  return home. 
 14.24     (b) Persons admitted on a nonemergency basis to a 
 14.25  Medicaid-certified nursing facility must be screened prior to 
 14.26  admission. 
 14.27     (c) The long-term care consultation team shall recommend a 
 14.28  case mix classification for persons admitted to a certified 
 14.29  nursing facility when sufficient information is received to make 
 14.30  that classification.  The nursing facility is authorized to 
 14.31  conduct all case mix assessments for persons who have been 
 14.32  screened prior to admission for whom the county did not 
 14.33  recommend a case mix classification.  The nursing facility is 
 14.34  authorized to conduct all case mix assessments for persons 
 14.35  admitted to the facility prior to a preadmission screening.  The 
 14.36  county retains the responsibility of distributing appropriate 
 15.1   case mix forms to the nursing facility. 
 15.2      (d) The county screening or intake activity must include 
 15.3   processes to identify persons who may require transition 
 15.4   assistance as described in subdivision 3b. 
 15.5      Sec. 13.  Minnesota Statutes 2000, section 256B.0911, 
 15.6   subdivision 5, is amended to read: 
 15.7      Subd. 5.  [~~SIMPLIFICATION OF FORMS~~ ADMINISTRATIVE 
 15.8   ACTIVITY.] The commissioner shall minimize the number of forms 
 15.9   required in the ~~preadmission screening process~~ provision of 
 15.10  long-term care consultation services and shall limit the 
 15.11  screening document to items necessary for ~~care~~ community support 
 15.12  plan approval, reimbursement, program planning, evaluation, and 
 15.13  policy development. 
 15.14     Sec. 14.  Minnesota Statutes 2000, section 256B.0911, 
 15.15  subdivision 6, is amended to read: 
 15.16     Subd. 6.  [PAYMENT FOR ~~PREADMISSION SCREENING~~ LONG-TERM 
 15.17  CARE CONSULTATION SERVICES.] (a) The total ~~screening~~ payment for 
 15.18  each county must be paid monthly by certified nursing facilities 
 15.19  in the county.  The monthly amount to be paid by each nursing 
 15.20  facility for each fiscal year must be determined by dividing the 
 15.21  county's annual allocation for ~~screenings~~ long-term care 
 15.22  consultation services by 12 to determine the monthly payment and 
 15.23  allocating the monthly payment to each nursing facility based on 
 15.24  the number of licensed beds in the nursing facility.  Payments 
 15.25  to counties in which there is no certified nursing facility must 
 15.26  be made by increasing the payment rate of the two facilities 
 15.27  located nearest to the county seat. 
 15.28     (b) The commissioner shall include the total annual payment 
 15.29  ~~for screening~~ determined under paragraph (a) for each nursing 
 15.30  facility according to section 256B.431, subdivision 2b, 
 15.31  paragraph (g), or 256B.435. 
 15.32     (c) Payments for ~~screening activities~~ long-term care 
 15.33  consultation services are available to the county or counties to 
 15.34  cover staff salaries and expenses to provide the ~~screening~~ 
 15.35  ~~function~~ services described in subdivision 1a.  The ~~lead agency~~ 
 15.36  county shall employ, or contract with other agencies to employ, 
 16.1   within the limits of available funding, sufficient personnel 
 16.2   to ~~conduct the preadmission screening activity~~ provide long-term 
 16.3   care consultation services while meeting the state's long-term 
 16.4   care outcomes and objectives as defined in section 256B.0917, 
 16.5   subdivision 1.  The ~~local agency~~ county shall be accountable for 
 16.6   meeting local objectives as approved by the commissioner in the 
 16.7   CSSA biennial plan. 
 16.8      (d) Notwithstanding section 256B.0641, overpayments 
 16.9   attributable to payment of the screening costs under the medical 
 16.10  assistance program may not be recovered from a facility.  
 16.11     (e) The commissioner of human services shall amend the 
 16.12  Minnesota medical assistance plan to include reimbursement for 
 16.13  the local ~~screening~~ consultation teams. 
 16.14     (f) The county may bill, as case management services, 
 16.15  assessments, support planning, and follow-along provided to 
 16.16  persons determined to be eligible for case management under 
 16.17  Minnesota health care programs.  No individual or family member 
 16.18  shall be charged for an initial assessment or initial support 
 16.19  plan development provided under subdivision 3a or 3b. 
 16.20     Sec. 15.  Minnesota Statutes 2000, section 256B.0911, 
 16.21  subdivision 7, is amended to read: 
 16.22     Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
 16.23  (a) Medical assistance reimbursement for nursing facilities 
 16.24  shall be authorized for a medical assistance recipient only if a 
 16.25  preadmission screening has been conducted prior to admission or 
 16.26  the ~~local~~ county ~~agency~~ has authorized an exemption.  Medical 
 16.27  assistance reimbursement for nursing facilities shall not be 
 16.28  provided for any recipient who the local screener has determined 
 16.29  does not meet the level of care criteria for nursing facility 
 16.30  placement or, if indicated, has not had a level II ~~PASARR~~ OBRA 
 16.31  evaluation as required under the federal Omnibus Reconciliation 
 16.32  Act of 1987 completed unless an admission for a recipient with 
 16.33  mental illness is approved by the local mental health authority 
 16.34  or an admission for a recipient with mental retardation or 
 16.35  related condition is approved by the state mental retardation 
 16.36  authority. 
 17.1      (b) The nursing facility must not bill a person who is not 
 17.2   a medical assistance recipient for resident days that preceded 
 17.3   the date of completion of screening activities as required under 
 17.4   subdivisions 4a, 4b, and 4c.  The nursing facility must include 
 17.5   unreimbursed resident days in the nursing facility resident day 
 17.6   totals reported to the commissioner. 
 17.7      (c) The commissioner shall make a request to the health 
 17.8   care financing administration for a waiver allowing screening 
 17.9   team approval of Medicaid payments for certified nursing 
 17.10  facility care.  An individual has a choice and makes the final 
 17.11  decision between nursing facility placement and community 
 17.12  placement after the screening team's recommendation, except as 
 17.13  provided in ~~paragraphs (b) and (c)~~ subdivision 4a, paragraph (c).
 17.14     ~~(c) The local county mental health authority or the state~~ 
 17.15  ~~mental retardation authority under Public Law Numbers 100-203~~ 
 17.16  ~~and 101-508 may prohibit admission to a nursing facility, if the~~ 
 17.17  ~~individual does not meet the nursing facility level of care~~ 
 17.18  ~~criteria or needs specialized services as defined in Public Law~~ 
 17.19  ~~Numbers 100-203 and 101-508.  For purposes of this section,~~ 
 17.20  ~~"specialized services" for a person with mental retardation or a~~ 
 17.21  ~~related condition means "active treatment" as that term is~~ 
 17.22  ~~defined in Code of Federal Regulations, title 42, section~~ 
 17.23  ~~483.440(a)(1).~~ 
 17.24     ~~(e) Appeals from the screening team's recommendation or the~~ 
 17.25  ~~county agency's final decision shall be made according to~~ 
 17.26  ~~section 256.045, subdivision 3.~~ 
 17.27     Sec. 16.  Minnesota Statutes 2000, section 256B.0913, 
 17.28  subdivision 1, is amended to read: 
 17.29     Subdivision 1.  [PURPOSE AND GOALS.] The purpose of the 
 17.30  alternative care program is to provide funding for ~~or access to~~ 
 17.31  home and community-based services for ~~frail~~ elderly persons, in 
 17.32  order to limit nursing facility placements.  The program is 
 17.33  designed to support ~~frail~~ elderly persons in their desire to 
 17.34  remain in the community as independently and as long as possible 
 17.35  and to support informal caregivers in their efforts to provide 
 17.36  care for ~~frail~~ elderly people.  Further, the goals of the 
 18.1   program are: 
 18.2      (1) to contain medical assistance expenditures by ~~providing~~ 
 18.3   funding care in the community ~~at a cost the same or less than~~ 
 18.4   ~~nursing facility costs~~; and 
 18.5      (2) to maintain the moratorium on new construction of 
 18.6   nursing home beds. 
 18.7      Sec. 17.  Minnesota Statutes 2000, section 256B.0913, 
 18.8   subdivision 2, is amended to read: 
 18.9      Subd. 2.  [ELIGIBILITY FOR SERVICES.] Alternative care 
 18.10  services are available to ~~all frail older~~ Minnesotans~~.  This~~ 
 18.11  ~~includes:~~ 
 18.12     ~~(1) persons who are receiving medical assistance and served~~ 
 18.13  ~~under the medical assistance program or the Medicaid waiver~~ 
 18.14  ~~program;~~ 
 18.15     ~~(2) persons~~ age 65 or older who are not eligible for 
 18.16  medical assistance without a spenddown or waiver obligation but 
 18.17  who would be eligible for medical assistance within 180 days of 
 18.18  admission to a nursing facility and ~~served under~~ subject to 
 18.19  subdivisions 4 to 13~~; and~~ 
 18.20     ~~(3) persons who are paying for their services out-of-pocket~~.
 18.21     Sec. 18.  Minnesota Statutes 2000, section 256B.0913, 
 18.22  subdivision 4, is amended to read: 
 18.23     Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
 18.24  NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
 18.25  under the alternative care program is available to persons who 
 18.26  meet the following criteria: 
 18.27     (1) the person has been ~~screened by the county screening~~ 
 18.28  ~~team or, if previously screened and served under the alternative~~ 
 18.29  ~~care program, assessed by the local county social worker or~~ 
 18.30  ~~public health nurse~~ determined by a community assessment under 
 18.31  section 256B.0911, to be a person who would require the level of 
 18.32  care provided in a nursing facility, but for the provision of 
 18.33  services under the alternative care program; 
 18.34     (2) the person is age 65 or older; 
 18.35     (3) the person would be ~~financially~~ eligible for medical 
 18.36  assistance within 180 days of admission to a nursing facility; 
 19.1      (4) the person ~~meets the asset transfer requirements of~~ is 
 19.2   not ineligible for the medical assistance program due to an 
 19.3   asset transfer penalty; 
 19.4      (5) ~~the screening team would recommend nursing facility~~ 
 19.5   ~~admission or continued stay for the person if alternative care~~ 
 19.6   ~~services were not available;~~ 
 19.7      ~~(6)~~ the person needs services that are not ~~available at~~ 
 19.8   ~~that time in the county~~ funded through other ~~county,~~ state~~,~~ or 
 19.9   federal funding ~~sources~~; and 
 19.10     ~~(7)~~ (6) the monthly cost of the alternative care services 
 19.11  funded by the program for this person does not exceed 75 percent 
 19.12  of the statewide ~~average monthly medical assistance payment for~~ 
 19.13  ~~nursing facility care at the individual's case mix~~ 
 19.14  ~~classification~~ weighted average monthly nursing facility rate of 
 19.15  the case mix resident class to which the individual alternative 
 19.16  care client would be assigned under Minnesota Rules, parts 
 19.17  9549.0050 to 9549.0059, less the recipient's maintenance needs 
 19.18  allowance as described in section 256B.0915, subdivision 1d, 
 19.19  paragraph (a), until the first day of the state fiscal year in 
 19.20  which the resident assessment system, under section 256B.437, 
 19.21  for nursing home rate determination is implemented.  Effective 
 19.22  on the first day of the state fiscal year in which a resident 
 19.23  assessment system, under section 256B.437, for nursing home rate 
 19.24  determination is implemented and the first day of each 
 19.25  subsequent state fiscal year, the monthly cost of alternative 
 19.26  care services for this person shall not exceed the alternative 
 19.27  care monthly cap for the case mix resident class to which the 
 19.28  alternative care client would be assigned under Minnesota Rules, 
 19.29  parts 9549.0050 to 9549.0059, which was in effect on the last 
 19.30  day of the previous state fiscal year, and adjusted by the 
 19.31  greater of any legislatively adopted home and community-based 
 19.32  services cost-of-living percentage increase or any legislatively 
 19.33  adopted statewide percent rate increase for nursing facilities.  
 19.34  This monthly limit does not prohibit the alternative care client 
 19.35  from payment for additional services, but in no case may the 
 19.36  cost of additional services purchased under this section exceed 
 20.1   the difference between the client's monthly service limit 
 20.2   defined under section 256B.0915, subdivision 3, and the 
 20.3   alternative care program monthly service limit defined in this 
 20.4   paragraph.  If medical supplies and equipment or ~~adaptations~~ 
 20.5   environmental modifications are or will be purchased for an 
 20.6   alternative care services recipient, the costs may be prorated 
 20.7   on a monthly basis ~~throughout the year in which they are~~ 
 20.8   ~~purchased~~ for up to 12 consecutive months beginning with the 
 20.9   month of purchase.  If the monthly cost of a recipient's other 
 20.10  alternative care services exceeds the monthly limit established 
 20.11  in this paragraph, the annual cost of the alternative care 
 20.12  services shall be determined.  In this event, the annual cost of 
 20.13  alternative care services shall not exceed 12 times the monthly 
 20.14  limit ~~calculated~~ described in this paragraph. 
 20.15     (b) ~~Individuals who meet the criteria in paragraph (a) and~~ 
 20.16  ~~who have been approved for alternative care funding are called~~ 
 20.17  ~~180-day eligible clients.~~ 
 20.18     ~~(c) The statewide average payment for nursing facility care~~ 
 20.19  ~~is the statewide average monthly nursing facility rate in effect~~ 
 20.20  ~~on July 1 of the fiscal year in which the cost is incurred, less~~ 
 20.21  ~~the statewide average monthly income of nursing facility~~ 
 20.22  ~~residents who are age 65 or older and who are medical assistance~~ 
 20.23  ~~recipients in the month of March of the previous fiscal year.~~  
 20.24  ~~This monthly limit does not prohibit the 180-day eligible client~~ 
 20.25  ~~from paying for additional services needed or desired.~~  
 20.26     ~~(d) In determining the total costs of alternative care~~ 
 20.27  ~~services for one month, the costs of all services funded by the~~ 
 20.28  ~~alternative care program, including supplies and equipment, must~~ 
 20.29  ~~be included.~~ 
 20.30     ~~(e)~~ Alternative care funding under this subdivision is not 
 20.31  available for a person who is a medical assistance recipient or 
 20.32  who would be eligible for medical assistance without a 
 20.33  spenddown~~, unless authorized by the commissioner~~ or waiver 
 20.34  obligation.  A person whose initial application for medical 
 20.35  assistance is being processed may be served under the 
 20.36  alternative care program for a period up to 60 days.  If the 
 21.1   individual is found to be eligible for medical assistance, ~~the~~ 
 21.2   ~~county must bill~~ medical assistance must be billed for services 
 21.3   payable under the federally approved elderly waiver plan and 
 21.4   delivered from the date the individual was found eligible 
 21.5   for ~~services reimbursable under~~ the federally approved elderly 
 21.6   waiver ~~program~~ plan.  Notwithstanding this provision, 
 21.7   alternative care funds may not be used to pay for any service 
 21.8   the cost of which is payable by medical assistance or which is 
 21.9   used by a recipient to meet a medical assistance income 
 21.10  spenddown or waiver obligation.  
 21.11     ~~(f)~~ (c) Alternative care funding is not available for a 
 21.12  person who resides in a licensed nursing home ~~or~~, certified 
 21.13  boarding care home, hospital, or intermediate care facility, 
 21.14  except for case management services which are ~~being~~ provided in 
 21.15  support of the discharge planning process to a nursing home 
 21.16  resident or certified boarding care home resident who is 
 21.17  ineligible for case management funded by medical assistance. 
 21.18     Sec. 19.  Minnesota Statutes 2000, section 256B.0913, 
 21.19  subdivision 5, is amended to read: 
 21.20     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 21.21  Alternative care funding may be used for payment of costs of: 
 21.22     (1) adult foster care; 
 21.23     (2) adult day care; 
 21.24     (3) home health aide; 
 21.25     (4) homemaker services; 
 21.26     (5) personal care; 
 21.27     (6) case management; 
 21.28     (7) respite care; 
 21.29     (8) assisted living; 
 21.30     (9) residential care services; 
 21.31     (10) care-related supplies and equipment; 
 21.32     (11) meals delivered to the home; 
 21.33     (12) transportation; 
 21.34     (13) skilled nursing; 
 21.35     (14) chore services; 
 21.36     (15) companion services; 
 22.1      (16) nutrition services; 
 22.2      (17) training for direct informal caregivers; 
 22.3      (18) telemedicine devices to monitor recipients in their 
 22.4   own homes as an alternative to hospital care, nursing home care, 
 22.5   or home visits; ~~and~~ 
 22.6      (19) other services ~~including~~ which includes discretionary 
 22.7   funds and direct cash payments to clients, ~~approved by the~~ 
 22.8   ~~county agency~~ following approval by the commissioner, subject to 
 22.9   the provisions of paragraph ~~(m)~~ (j).  Total annual payments for "
 22.10  other services" for all clients within a county may not exceed 
 22.11  either ten percent of that county's annual alternative care 
 22.12  program base allocation or $5,000, whichever is greater.  In no 
 22.13  case shall this amount exceed the county's total annual 
 22.14  alternative care program base allocation; and 
 22.15     (20) environmental modifications. 
 22.16     (b) The county agency must ensure that the funds are not 
 22.17  used ~~only to supplement and not~~ to supplant services available 
 22.18  through other public assistance or services programs. 
 22.19     (c) Unless specified in statute, the service definitions 
 22.20  and standards for alternative care services shall be the same as 
 22.21  the service definitions and standards ~~defined~~ specified in the 
 22.22  federally approved elderly waiver plan.  Except for the county 
 22.23  agencies' approval of direct cash payments to clients as 
 22.24  described in paragraph (j) or for a provider of supplies and 
 22.25  equipment when the monthly cost of the supplies and equipment is 
 22.26  less than $250, persons or agencies must be employed by or under 
 22.27  a contract with the county agency or the public health nursing 
 22.28  agency of the local board of health in order to receive funding 
 22.29  under the alternative care program.  Supplies and equipment may 
 22.30  be purchased from a non-Medicaid certified vendor if the cost 
 22.31  for the item is less than that of a Medicaid vendor.  
 22.32     (d) The adult foster care rate shall be considered a 
 22.33  difficulty of care payment and shall not include room and 
 22.34  board.  The adult foster care ~~daily~~ rate shall be negotiated 
 22.35  between the county agency and the foster care provider.  ~~The~~ 
 22.36  ~~rate established under this section shall not exceed 75 percent~~ 
 23.1   ~~of the state average monthly nursing home payment for the case~~ 
 23.2   ~~mix classification to which the individual receiving foster care~~ 
 23.3   ~~is assigned, and it must allow for other alternative care~~ 
 23.4   ~~services to be authorized by the case manager.~~  The alternative 
 23.5   care payment for the foster care service in combination with the 
 23.6   payment for other alternative care services, including case 
 23.7   management, must not exceed the limit specified in subdivision 
 23.8   4, paragraph (a), clause (6). 
 23.9      (e) Personal care services ~~may be provided by a personal~~ 
 23.10  ~~care provider organization.~~ must meet the service standards 
 23.11  defined in the federally approved elderly waiver plan, except 
 23.12  that a county agency may contract with a client's relative ~~of~~ 
 23.13  ~~the client~~ who meets the relative hardship waiver requirement as 
 23.14  defined in section 256B.0627, subdivision 4, paragraph (b), 
 23.15  clause (10), to provide personal care services~~, but must ensure~~ 
 23.16  ~~nursing~~ if the county agency ensures supervision of this service 
 23.17  by a registered nurse or mental health practitioner.  ~~Covered~~ 
 23.18  ~~personal care services defined in section 256B.0627, subdivision~~ 
 23.19  ~~4, must meet applicable standards in Minnesota Rules, part~~ 
 23.20  ~~9505.0335.~~ 
 23.21     (f) ~~A county may use alternative care funds to purchase~~ 
 23.22  ~~medical supplies and equipment without prior approval from the~~ 
 23.23  ~~commissioner when:  (1) there is no other funding source; (2)~~ 
 23.24  ~~the supplies and equipment are specified in the individual's~~ 
 23.25  ~~care plan as medically necessary to enable the individual to~~ 
 23.26  ~~remain in the community according to the criteria in Minnesota~~ 
 23.27  ~~Rules, part 9505.0210, item A; and (3) the supplies and~~ 
 23.28  ~~equipment represent an effective and appropriate use of~~ 
 23.29  ~~alternative care funds.  A county may use alternative care funds~~ 
 23.30  ~~to purchase supplies and equipment from a non-Medicaid certified~~ 
 23.31  ~~vendor if the cost for the items is less than that of a Medicaid~~ 
 23.32  ~~vendor.  A county is not required to contract with a provider of~~ 
 23.33  ~~supplies and equipment if the monthly cost of the supplies and~~ 
 23.34  ~~equipment is less than $250.~~  
 23.35     ~~(g)~~ For purposes of this section, residential care services 
 23.36  are services which are provided to individuals living in 
 24.1   residential care homes.  Residential care homes are currently 
 24.2   licensed as board and lodging establishments and are registered 
 24.3   with the department of health as providing special 
 24.4   services under section 157.17 and are not subject to 
 24.5   registration under chapter 144D.  Residential care services are 
 24.6   defined as "supportive services" and "health-related services."  
 24.7   "Supportive services" means the provision of up to 24-hour 
 24.8   supervision and oversight.  Supportive services includes:  (1) 
 24.9   transportation, when provided by the residential care ~~center~~ 
 24.10  home only; (2) socialization, when socialization is part of the 
 24.11  plan of care, has specific goals and outcomes established, and 
 24.12  is not diversional or recreational in nature; (3) assisting 
 24.13  clients in setting up meetings and appointments; (4) assisting 
 24.14  clients in setting up medical and social services; (5) providing 
 24.15  assistance with personal laundry, such as carrying the client's 
 24.16  laundry to the laundry room.  Assistance with personal laundry 
 24.17  does not include any laundry, such as bed linen, that is 
 24.18  included in the room and board rate.  "Health-related services" 
 24.19  are limited to minimal assistance with dressing, grooming, and 
 24.20  bathing and providing reminders to residents to take medications 
 24.21  that are self-administered or providing storage for medications, 
 24.22  if requested.  Individuals receiving residential care services 
 24.23  cannot receive homemaking services funded under this section.  
 24.24     ~~(h)~~ (g) For the purposes of this section, "assisted living" 
 24.25  refers to supportive services provided by a single vendor to 
 24.26  clients who reside in the same apartment building of three or 
 24.27  more units which are not subject to registration under chapter 
 24.28  144D and are licensed by the department of health as a class A 
 24.29  home care provider or a class E home care provider.  Assisted 
 24.30  living services are defined as up to 24-hour supervision, and 
 24.31  oversight, supportive services as defined in clause (1), 
 24.32  individualized home care aide tasks as defined in clause (2), 
 24.33  and individualized home management tasks as defined in clause 
 24.34  (3) provided to residents of a residential center living in 
 24.35  their units or apartments with a full kitchen and bathroom.  A 
 24.36  full kitchen includes a stove, oven, refrigerator, food 
 25.1   preparation counter space, and a kitchen utensil storage 
 25.2   compartment.  Assisted living services must be provided by the 
 25.3   management of the residential center or by providers under 
 25.4   contract with the management or with the county. 
 25.5      (1) Supportive services include:  
 25.6      (i) socialization, when socialization is part of the plan 
 25.7   of care, has specific goals and outcomes established, and is not 
 25.8   diversional or recreational in nature; 
 25.9      (ii) assisting clients in setting up meetings and 
 25.10  appointments; and 
 25.11     (iii) providing transportation, when provided by the 
 25.12  residential center only.  
 25.13     ~~Individuals receiving assisted living services will not~~ 
 25.14  ~~receive both assisted living services and homemaking services.~~  
 25.15  ~~Individualized means services are chosen and designed~~ 
 25.16  ~~specifically for each resident's needs, rather than provided or~~ 
 25.17  ~~offered to all residents regardless of their illnesses,~~ 
 25.18  ~~disabilities, or physical conditions.~~  
 25.19     (2) Home care aide tasks means:  
 25.20     (i) preparing modified diets, such as diabetic or low 
 25.21  sodium diets; 
 25.22     (ii) reminding residents to take regularly scheduled 
 25.23  medications or to perform exercises; 
 25.24     (iii) household chores in the presence of technically 
 25.25  sophisticated medical equipment or episodes of acute illness or 
 25.26  infectious disease; 
 25.27     (iv) household chores when the resident's care requires the 
 25.28  prevention of exposure to infectious disease or containment of 
 25.29  infectious disease; and 
 25.30     (v) assisting with dressing, oral hygiene, hair care, 
 25.31  grooming, and bathing, if the resident is ambulatory, and if the 
 25.32  resident has no serious acute illness or infectious disease.  
 25.33  Oral hygiene means care of teeth, gums, and oral prosthetic 
 25.34  devices.  
 25.35     (3) Home management tasks means:  
 25.36     (i) housekeeping; 
 26.1      (ii) laundry; 
 26.2      (iii) preparation of regular snacks and meals; and 
 26.3      (iv) shopping.  
 26.4      Individuals receiving assisted living services shall not 
 26.5   receive both assisted living services and homemaking services.  
 26.6   Individualized means services are chosen and designed 
 26.7   specifically for each resident's needs, rather than provided or 
 26.8   offered to all residents regardless of their illnesses, 
 26.9   disabilities, or physical conditions.  Assisted living services 
 26.10  as defined in this section shall not be authorized in boarding 
 26.11  and lodging establishments licensed according to sections 
 26.12  157.011 and 157.15 to 157.22. 
 26.13     ~~(i)~~ (h) For establishments registered under chapter 144D, 
 26.14  assisted living services under this section means either the 
 26.15  services described ~~and licensed~~ in paragraph (g) and delivered 
 26.16  by a class E home care provider licensed by the department of 
 26.17  health or the services described under section 144A.4605 and 
 26.18  delivered by an assisted living home care provider or a class A 
 26.19  home care provider licensed by the commissioner of health. 
 26.20     ~~(j) For the purposes of this section, reimbursement~~ (i) 
 26.21  Payment for assisted living services and residential care 
 26.22  services shall be a monthly rate negotiated and authorized by 
 26.23  the county agency based on an individualized service plan for 
 26.24  each resident and may not cover direct rent or food costs.  ~~The~~ 
 26.25  ~~rate~~ 
 26.26     (1) The individualized monthly negotiated payment for 
 26.27  assisted living services as described in subdivision 5, 
 26.28  paragraph (g) or (h), and residential care services as described 
 26.29  in subdivision 5, paragraph (f), shall not exceed the nonfederal 
 26.30  share in effect on July 1 of the state fiscal year for which the 
 26.31  rate limit is being calculated of the greater of either the 
 26.32  statewide or any of the geographic groups' weighted average 
 26.33  monthly ~~medical assistance~~ nursing facility payment rate of the 
 26.34  case mix resident class to which the ~~180-day~~ alternative care 
 26.35  eligible client would be assigned under Minnesota Rules, parts 
 26.36  9549.0050 to 9549.0059, ~~unless the~~ less the maintenance needs 
 27.1   allowance as described in subdivision 1d, paragraph (a), until 
 27.2   the first day of the state fiscal year in which a resident 
 27.3   assessment system, under section 256B.437, of nursing home rate 
 27.4   determination is implemented.  Effective on the first day of the 
 27.5   state fiscal year in which a resident assessment system, under 
 27.6   section 256B.437, of nursing home rate determination is 
 27.7   implemented and the first day of each subsequent state fiscal 
 27.8   year, the individualized monthly negotiated payment for the 
 27.9   services described in this clause shall not exceed the limit 
 27.10  described in this clause which was in effect on the last day of 
 27.11  the previous state fiscal year and which has been adjusted by 
 27.12  the greater of any legislatively adopted home and 
 27.13  community-based services cost-of-living percentage increase or 
 27.14  any legislatively adopted statewide percent rate increase for 
 27.15  nursing facilities. 
 27.16     (2) The individualized monthly negotiated payment for 
 27.17  assisted living services ~~are provided by a home care~~ described 
 27.18  under section 144A.4605 and delivered by a provider licensed by 
 27.19  the department of health as a class A home care provider or an 
 27.20  assisted living home care provider and ~~are~~ provided in a 
 27.21  building that is registered as a housing with services 
 27.22  establishment under chapter 144D and that provides 24-hour 
 27.23  supervision in combination with the payment for other 
 27.24  alternative care services, including case management, must not 
 27.25  exceed the limit specified in subdivision 4, paragraph (a), 
 27.26  clause (6). 
 27.27     ~~(k) For purposes of this section, companion services are~~ 
 27.28  ~~defined as nonmedical care, supervision and oversight, provided~~ 
 27.29  ~~to a functionally impaired adult.  Companions may assist the~~ 
 27.30  ~~individual with such tasks as meal preparation, laundry and~~ 
 27.31  ~~shopping, but do not perform these activities as discrete~~ 
 27.32  ~~services.  The provision of companion services does not entail~~ 
 27.33  ~~hands-on medical care.  Providers may also perform light~~ 
 27.34  ~~housekeeping tasks which are incidental to the care and~~ 
 27.35  ~~supervision of the recipient.  This service must be approved by~~ 
 27.36  ~~the case manager as part of the care plan.  Companion services~~ 
 28.1   ~~must be provided by individuals or organizations who are under~~ 
 28.2   ~~contract with the local agency to provide the service.  Any~~ 
 28.3   ~~person related to the waiver recipient by blood, marriage or~~ 
 28.4   ~~adoption cannot be reimbursed under this service.  Persons~~ 
 28.5   ~~providing companion services will be monitored by the case~~ 
 28.6   ~~manager.~~ 
 28.7      ~~(l) For purposes of this section, training for direct~~ 
 28.8   ~~informal caregivers is defined as a classroom or home course of~~ 
 28.9   ~~instruction which may include:  transfer and lifting skills,~~ 
 28.10  ~~nutrition, personal and physical cares, home safety in a home~~ 
 28.11  ~~environment, stress reduction and management, behavioral~~ 
 28.12  ~~management, long-term care decision making, care coordination~~ 
 28.13  ~~and family dynamics.  The training is provided to an informal~~ 
 28.14  ~~unpaid caregiver of a 180-day eligible client which enables the~~ 
 28.15  ~~caregiver to deliver care in a home setting with high levels of~~ 
 28.16  ~~quality.  The training must be approved by the case manager as~~ 
 28.17  ~~part of the individual care plan.  Individuals, agencies, and~~ 
 28.18  ~~educational facilities which provide caregiver training and~~ 
 28.19  ~~education will be monitored by the case manager.~~ 
 28.20     ~~(m)~~ (j) A county agency may make payment from their 
 28.21  alternative care program allocation for "other services" 
 28.22  ~~provided to an alternative care program recipient if those~~ 
 28.23  ~~services prevent, shorten, or delay institutionalization.  These~~ 
 28.24  ~~services may~~ which include use of "discretionary funds" for 
 28.25  services that are not otherwise defined in this section and 
 28.26  direct cash payments to the ~~recipient~~ client for the purpose of 
 28.27  purchasing the ~~recipient's~~ services.  The following provisions 
 28.28  apply to payments under this paragraph: 
 28.29     (1) a cash payment to a client under this provision cannot 
 28.30  exceed 80 percent of the monthly payment limit for that client 
 28.31  as specified in subdivision 4, paragraph (a), clause ~~(7)~~ (6); 
 28.32     (2) a county may not approve any cash payment for a client 
 28.33  who meets either of the following: 
 28.34     (i) has been assessed as having a dependency in 
 28.35  orientation, unless the client has an authorized 
 28.36  representative ~~under section 256.476, subdivision 2, paragraph~~ 
 29.1   ~~(g), or for a client who~~.  An "authorized representative" means 
 29.2   an individual who is at least 18 years of age and is designated 
 29.3   by the person or the person's legal representative to act on the 
 29.4   person's behalf.  This individual may be a family member, 
 29.5   guardian, representative payee, or other individual designated 
 29.6   by the person or the person's legal representative, if any, to 
 29.7   assist in purchasing and arranging for supports; or 
 29.8      (ii) is concurrently receiving adult foster care, 
 29.9   residential care, or assisted living services; 
 29.10     (3) ~~any service approved under this section must be a~~ 
 29.11  ~~service which meets the purpose and goals of the program as~~ 
 29.12  ~~listed in subdivision 1;~~ 
 29.13     ~~(4) cash payments must also meet the criteria of and are~~ 
 29.14  ~~governed by the procedures and liability protection established~~ 
 29.15  ~~in section 256.476, subdivision 4, paragraphs (b) through (h),~~ 
 29.16  ~~and recipients of cash grants must meet the requirements in~~ 
 29.17  ~~section 256.476, subdivision 10; and~~ cash payments to a person 
 29.18  or a person's family will be provided through a monthly payment 
 29.19  and be in the form of cash, voucher, or direct county payment to 
 29.20  vendor.  Fees or premiums assessed to the person for eligibility 
 29.21  for health and human services are not reimbursable through this 
 29.22  service option.  Services and goods purchased through cash 
 29.23  payments must be identified in the person's individualized care 
 29.24  plan and must meet all of the following criteria: 
 29.25     (i) they must be over and above the normal cost of caring 
 29.26  for the person if the person did not have functional 
 29.27  limitations; 
 29.28     (ii) they must be directly attributable to the person's 
 29.29  functional limitations; 
 29.30     (iii) they must have the potential to be effective at 
 29.31  meeting the goals of the program; 
 29.32     (iv) they must be consistent with the needs identified in 
 29.33  the individualized service plan.  The service plan shall specify 
 29.34  the needs of the person and family, the form and amount of 
 29.35  payment, the items and services to be reimbursed, and the 
 29.36  arrangements for management of the individual grant; and 
 30.1      (v) the person, the person's family, or the legal 
 30.2   representative shall be provided sufficient information to 
 30.3   ensure an informed choice of alternatives.  The local agency 
 30.4   shall document this information in the person's care plan, 
 30.5   including the type and level of expenditures to be reimbursed; 
 30.6      (4) the county, lead agency under contract, or tribal 
 30.7   government under contract to administer the alternative care 
 30.8   program shall not be liable for damages, injuries, or 
 30.9   liabilities sustained through the purchase of direct supports or 
 30.10  goods by the person, the person's family, or the authorized 
 30.11  representative with funds received through the cash payments 
 30.12  under this section.  Liabilities include, but are not limited 
 30.13  to, workers' compensation, the Federal Insurance Contributions 
 30.14  Act (FICA), or the Federal Unemployment Tax Act (FUTA); 
 30.15     (5) persons receiving grants under this section shall have 
 30.16  the following responsibilities: 
 30.17     (i) spend the grant money in a manner consistent with their 
 30.18  individualized service plan with the local agency; 
 30.19     (ii) notify the local agency of any necessary changes in 
 30.20  the grant-expenditures; 
 30.21     (iii) arrange and pay for supports; and 
 30.22     (iv) inform the local agency of areas where they have 
 30.23  experienced difficulty securing or maintaining supports; and 
 30.24     ~~(5)~~ (6) the county shall report client outcomes, services, 
 30.25  and costs under this paragraph in a manner prescribed by the 
 30.26  commissioner. 
 30.27     (k) Upon implementation of direct cash payments to clients 
 30.28  under this section, any person determined eligible for the 
 30.29  alternative care program who chooses a cash payment approved by 
 30.30  the county agency shall receive the cash payment under this 
 30.31  section and not under section 256.476 unless the person was 
 30.32  receiving a consumer support grant under section 256.476 before 
 30.33  implementation of direct cash payments under this section. 
 30.34     Sec. 20.  Minnesota Statutes 2000, section 256B.0913, 
 30.35  subdivision 6, is amended to read: 
 30.36     Subd. 6.  [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 
 31.1   alternative care program is administered by the county agency.  
 31.2   This agency is the lead agency responsible for the local 
 31.3   administration of the alternative care program as described in 
 31.4   this section.  However, it may contract with the public health 
 31.5   nursing service to be the lead agency.  The commissioner may 
 31.6   contract with federally recognized Indian tribes with a 
 31.7   reservation in Minnesota to serve as the lead agency responsible 
 31.8   for the local administration of the alternative care program as 
 31.9   described in the contract. 
 31.10     Sec. 21.  Minnesota Statutes 2000, section 256B.0913, 
 31.11  subdivision 7, is amended to read: 
 31.12     Subd. 7.  [CASE MANAGEMENT.] Providers of case management 
 31.13  services for persons receiving services funded by the 
 31.14  alternative care program must meet the qualification 
 31.15  requirements and standards specified in section 256B.0915, 
 31.16  subdivision 1b.  The case manager must ensure the health and 
 31.17  safety of the individual client and must not approve alternative 
 31.18  care funding for a client in any setting in which the case 
 31.19  manager cannot reasonably ensure the client's health and 
 31.20  safety.  The case manager is responsible for the 
 31.21  cost-effectiveness of the alternative care individual care 
 31.22  plan and must not approve any care plan in which the cost of 
 31.23  services funded by alternative care and client contributions 
 31.24  exceeds the limit specified in section 256B.0915, subdivision 3, 
 31.25  paragraph (b).  The county may allow a case manager employed by 
 31.26  the county to delegate certain aspects of the case management 
 31.27  activity to another individual employed by the county provided 
 31.28  there is oversight of the individual by the case manager.  The 
 31.29  case manager may not delegate those aspects which require 
 31.30  professional judgment including assessments, reassessments, and 
 31.31  care plan development. 
 31.32     Sec. 22.  Minnesota Statutes 2000, section 256B.0913, 
 31.33  subdivision 8, is amended to read: 
 31.34     Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
 31.35  case manager shall implement the plan of care for each ~~180-day~~ 
 31.36  ~~eligible~~ alternative care client and ensure that a client's 
 32.1   service needs and eligibility are reassessed at least every 12 
 32.2   months.  The plan shall include any services prescribed by the 
 32.3   individual's attending physician as necessary to allow the 
 32.4   individual to remain in a community setting.  In developing the 
 32.5   individual's care plan, the case manager should include the use 
 32.6   of volunteers from families and neighbors, religious 
 32.7   organizations, social clubs, and civic and service organizations 
 32.8   to support the formal home care services.  The county shall be 
 32.9   held harmless for damages or injuries sustained through the use 
 32.10  of volunteers under this subdivision including workers' 
 32.11  compensation liability.  ~~The lead agency shall provide~~ 
 32.12  ~~documentation to the commissioner verifying that the~~ 
 32.13  ~~individual's alternative care is not available at that time~~ 
 32.14  ~~through any other public assistance or service program.~~  The 
 32.15  lead agency shall provide documentation in each individual's 
 32.16  plan of care and, if requested, to the commissioner that the 
 32.17  most cost-effective alternatives available have been offered to 
 32.18  the individual and that the individual was free to choose among 
 32.19  available qualified providers, both public and private.  The 
 32.20  case manager must give the individual a ten-day written notice 
 32.21  of any decrease in or termination of alternative care services. 
 32.22     (b) If the county administering alternative care services 
 32.23  is different than the county of financial responsibility, the 
 32.24  care plan may be implemented without the approval of the county 
 32.25  of financial responsibility. 
 32.26     Sec. 23.  Minnesota Statutes 2000, section 256B.0913, 
 32.27  subdivision 9, is amended to read: 
 32.28     Subd. 9.  [CONTRACTING PROVISIONS FOR PROVIDERS.] ~~The lead~~ 
 32.29  ~~agency shall document to the commissioner that the agency made~~ 
 32.30  ~~reasonable efforts to inform potential providers of the~~ 
 32.31  ~~anticipated need for services under the alternative care program~~ 
 32.32  ~~or waiver programs under sections 256B.0915 and 256B.49,~~ 
 32.33  ~~including a minimum of 14 days' written advance notice of the~~ 
 32.34  ~~opportunity to be selected as a service provider and an annual~~ 
 32.35  ~~public meeting with providers to explain and review the criteria~~ 
 32.36  ~~for selection.  The lead agency shall also document to the~~ 
 33.1   ~~commissioner that the agency allowed potential providers an~~ 
 33.2   ~~opportunity to be selected to contract with the county agency.~~  
 33.3   ~~Funds reimbursed to counties under this subdivision~~ Alternative 
 33.4   care funds paid to service providers are subject to audit by the 
 33.5   commissioner for fiscal and utilization control.  
 33.6      The lead agency must select providers for contracts or 
 33.7   agreements using the following criteria and other criteria 
 33.8   established by the county: 
 33.9      (1) the need for the particular services offered by the 
 33.10  provider; 
 33.11     (2) the population to be served, including the number of 
 33.12  clients, the length of time services will be provided, and the 
 33.13  medical condition of clients; 
 33.14     (3) the geographic area to be served; 
 33.15     (4) quality assurance methods, including appropriate 
 33.16  licensure, certification, or standards, and supervision of 
 33.17  employees when needed; 
 33.18     (5) rates for each service and unit of service exclusive of 
 33.19  county administrative costs; 
 33.20     (6) evaluation of services previously delivered by the 
 33.21  provider; and 
 33.22     (7) contract or agreement conditions, including billing 
 33.23  requirements, cancellation, and indemnification. 
 33.24     The county must evaluate its own agency services under the 
 33.25  criteria established for other providers.  ~~The county shall~~ 
 33.26  ~~provide a written statement of the reasons for not selecting~~ 
 33.27  ~~providers.~~ 
 33.28     Sec. 24.  Minnesota Statutes 2000, section 256B.0913, 
 33.29  subdivision 10, is amended to read: 
 33.30     Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
 33.31  appropriation for fiscal years 1992 and beyond shall cover 
 33.32  only ~~180-day~~ alternative care eligible clients.  Prior to July 1 
 33.33  of each year, the commissioner shall allocate to county agencies 
 33.34  the state funds available for alternative care for persons 
 33.35  eligible under subdivision 2. 
 33.36     (b) ~~Prior to July 1 of each year, the commissioner shall~~ 
 34.1   ~~allocate to county agencies the state funds available for~~ 
 34.2   ~~alternative care for persons eligible under subdivision 2.  The~~ 
 34.3   ~~allocation for fiscal year 1992 shall be calculated using a base~~ 
 34.4   ~~that is adjusted to exclude the medical assistance share of~~ 
 34.5   ~~alternative care expenditures.  The adjusted base is calculated~~ 
 34.6   ~~by multiplying each county's allocation for fiscal year 1991 by~~ 
 34.7   ~~the percentage of county alternative care expenditures for~~ 
 34.8   ~~180-day eligible clients.  The percentage is determined based on~~ 
 34.9   ~~expenditures for services rendered in fiscal year 1989 or~~ 
 34.10  ~~calendar year 1989, whichever is greater.~~  The adjusted base for 
 34.11  each county is the county's current fiscal year base allocation 
 34.12  plus any targeted funds approved during the current fiscal 
 34.13  year.  Calculations for paragraphs (c) and (d) are to be made as 
 34.14  follows:  for each county, the determination of alternative care 
 34.15  program expenditures shall be based on payments for services 
 34.16  rendered from April 1 through March 31 in the base year, to the 
 34.17  extent that claims have been submitted and paid by June 1 of 
 34.18  that year.  
 34.19     (c) If the ~~county~~ alternative care program expenditures ~~for~~ 
 34.20  ~~180-day eligible clients~~ as defined in paragraph (b) are 95 
 34.21  percent or more of ~~its~~ the county's adjusted base allocation, 
 34.22  the allocation for the next fiscal year is 100 percent of the 
 34.23  adjusted base, plus inflation to the extent that inflation is 
 34.24  included in the state budget. 
 34.25     (d) If the ~~county~~ alternative care program expenditures ~~for~~ 
 34.26  ~~180-day eligible clients~~ as defined in paragraph (b) are less 
 34.27  than 95 percent of ~~its~~ the county's adjusted base allocation, 
 34.28  the allocation for the next fiscal year is the adjusted base 
 34.29  allocation less the amount of unspent funds below the 95 percent 
 34.30  level. 
 34.31     (e) ~~For fiscal year 1992 only, a county may receive an~~ 
 34.32  ~~increased allocation if annualized service costs for the month~~ 
 34.33  ~~of May 1991 for 180-day eligible clients are greater than the~~ 
 34.34  ~~allocation otherwise determined.  A county may apply for this~~ 
 34.35  ~~increase by reporting projected expenditures for May to the~~ 
 34.36  ~~commissioner by June 1, 1991.  The amount of the allocation may~~ 
 35.1   ~~exceed the amount calculated in paragraph (b).  The projected~~ 
 35.2   ~~expenditures for May must be based on actual 180-day eligible~~ 
 35.3   ~~client caseload and the individual cost of clients' care plans.~~  
 35.4   ~~If a county does not report its expenditures for May, the amount~~ 
 35.5   ~~in paragraph (c) or (d) shall be used.~~ 
 35.6      ~~(f) Calculations for paragraphs (c) and (d) are to be made~~ 
 35.7   ~~as follows:  for each county, the determination of expenditures~~ 
 35.8   ~~shall be based on payments for services rendered from April 1~~ 
 35.9   ~~through March 31 in the base year, to the extent that claims~~ 
 35.10  ~~have been submitted by June 1 of that year.  Calculations for~~ 
 35.11  ~~paragraphs (c) and (d) must also include the funds transferred~~ 
 35.12  ~~to the consumer support grant program for clients who have~~ 
 35.13  ~~transferred to that program from April 1 through March 31 in the~~ 
 35.14  ~~base year.~~  
 35.15     ~~(g) For the biennium ending June 30, 2001, the allocation~~ 
 35.16  ~~of state funds to county agencies shall be calculated as~~ 
 35.17  ~~described in paragraphs (c) and (d).~~  If the annual legislative 
 35.18  appropriation for the alternative care program is inadequate to 
 35.19  fund the combined county allocations for ~~fiscal year 2000 or~~ 
 35.20  ~~2001~~ a biennium, the commissioner shall distribute to each 
 35.21  county the entire annual appropriation as that county's 
 35.22  percentage of the computed base as calculated in ~~paragraph~~ 
 35.23  ~~(f)~~ paragraphs (c) and (d). 
 35.24     Sec. 25.  Minnesota Statutes 2000, section 256B.0913, 
 35.25  subdivision 11, is amended to read: 
 35.26     Subd. 11.  [TARGETED FUNDING.] (a) The purpose of targeted 
 35.27  funding is to make additional money available to counties with 
 35.28  the greatest need.  Targeted funds are not intended to be 
 35.29  distributed equitably among all counties, but rather, allocated 
 35.30  to those with long-term care strategies that meet state goals. 
 35.31     (b) The funds available for targeted funding shall be the 
 35.32  total appropriation for each fiscal year minus county 
 35.33  allocations determined under subdivision 10 as adjusted for any 
 35.34  inflation increases provided in appropriations for the biennium. 
 35.35     (c) The commissioner shall allocate targeted funds to 
 35.36  counties that demonstrate to the satisfaction of the 
 36.1   commissioner that they have developed feasible plans to increase 
 36.2   alternative care spending.  In making targeted funding 
 36.3   allocations, the commissioner shall use the following priorities:
 36.4      (1) counties that received a lower allocation in fiscal 
 36.5   year 1991 than in fiscal year 1990.  Counties remain in this 
 36.6   priority until they have been restored to their fiscal year 1990 
 36.7   level plus inflation; 
 36.8      (2) counties that sustain a base allocation reduction for 
 36.9   failure to spend 95 percent of the allocation if they 
 36.10  demonstrate that the base reduction should be restored; 
 36.11     (3) counties that propose projects to divert community 
 36.12  residents from nursing home placement or convert nursing home 
 36.13  residents to community living; and 
 36.14     (4) counties that can otherwise justify program growth by 
 36.15  demonstrating the existence of waiting lists, demographically 
 36.16  justified needs, or other unmet needs. 
 36.17     (d) Counties that would receive targeted funds according to 
 36.18  paragraph (c) must demonstrate to the commissioner's 
 36.19  satisfaction that the funds would be appropriately spent by 
 36.20  showing how the funds would be used to further the state's 
 36.21  alternative care goals as described in subdivision 1, and that 
 36.22  the county has the administrative and service delivery 
 36.23  capability to use them.  
 36.24     (e) The commissioner shall request applications ~~by June 1~~ 
 36.25  ~~each year, for county agencies to apply~~ for targeted funds by 
 36.26  November 1 of each year.  The counties selected for targeted 
 36.27  funds shall be notified of the amount of their additional 
 36.28  funding ~~by August 1 of each year~~.  Targeted funds allocated to a 
 36.29  county agency in one year shall be treated as part of the 
 36.30  county's base allocation for that year in determining 
 36.31  allocations for subsequent years.  No reallocations between 
 36.32  counties shall be made. 
 36.33     ~~(f) The allocation for each year after fiscal year 1992~~ 
 36.34  ~~shall be determined using the previous fiscal year's allocation,~~ 
 36.35  ~~including any targeted funds, as the base and then applying the~~ 
 36.36  ~~criteria under subdivision 10, paragraphs (c), (d), and (f), to~~ 
 37.1   ~~the current year's expenditures.~~ 
 37.2      Sec. 26.  Minnesota Statutes 2000, section 256B.0913, 
 37.3   subdivision 12, is amended to read: 
 37.4      Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
 37.5   all ~~180-day~~ alternative care eligible clients to help pay for 
 37.6   the cost of participating in the program.  The amount of the 
 37.7   premium for the alternative care client shall be determined as 
 37.8   follows: 
 37.9      (1) when the alternative care client's income less 
 37.10  recurring and predictable medical expenses is greater than the 
 37.11  ~~medical assistance income standard~~ recipient's maintenance needs 
 37.12  allowance as defined in section 256B.0915, subdivision 1d, 
 37.13  paragraph (a), but less than 150 percent of the federal poverty 
 37.14  guideline effective on July 1 of the state fiscal year in which 
 37.15  the premium is being computed, and total assets are less than 
 37.16  $10,000, the fee is zero; 
 37.17     (2) when the alternative care client's income less 
 37.18  recurring and predictable medical expenses is greater than 150 
 37.19  percent of the federal poverty guideline effective on July 1 of 
 37.20  the state fiscal year in which the premium is being computed, 
 37.21  and total assets are less than $10,000, the fee is 25 percent of 
 37.22  the cost of alternative care services or the difference between 
 37.23  150 percent of the federal poverty guideline effective on July 1 
 37.24  of the state fiscal year in which the premium is being computed 
 37.25  and the client's income less recurring and predictable medical 
 37.26  expenses, whichever is less; and 
 37.27     (3) when the alternative care client's total assets are 
 37.28  greater than $10,000, the fee is 25 percent of the cost of 
 37.29  alternative care services.  
 37.30     For married persons, total assets are defined as the total 
 37.31  marital assets less the estimated community spouse asset 
 37.32  allowance, under section 256B.059, if applicable.  For married 
 37.33  persons, total income is defined as the client's income less the 
 37.34  monthly spousal allotment, under section 256B.058. 
 37.35     All alternative care services except case management shall 
 37.36  be included in the estimated costs for the purpose of 
 38.1   determining 25 percent of the costs. 
 38.2      The monthly premium shall be calculated based on the cost 
 38.3   of the first full month of alternative care services and shall 
 38.4   continue unaltered until the next reassessment is completed or 
 38.5   at the end of 12 months, whichever comes first.  Premiums are 
 38.6   due and payable each month alternative care services are 
 38.7   received unless the actual cost of the services is less than the 
 38.8   premium. 
 38.9      (b) The fee shall be waived by the commissioner when: 
 38.10     (1) a person who is residing in a nursing facility is 
 38.11  receiving case management only; 
 38.12     (2) a person is applying for medical assistance; 
 38.13     (3) a married couple is requesting an asset assessment 
 38.14  under the spousal impoverishment provisions; 
 38.15     (4) ~~a person is a medical assistance recipient, but has~~ 
 38.16  ~~been approved for alternative care-funded assisted living~~ 
 38.17  ~~services;~~ 
 38.18     ~~(5)~~ a person is found eligible for alternative care, but is 
 38.19  not yet receiving alternative care services; or 
 38.20     ~~(6)~~ (5) a person's fee under paragraph (a) is less than $25.
 38.21     (c) The county agency must collect the premium from the 
 38.22  client and forward the amounts collected to the commissioner in 
 38.23  the manner and at the times prescribed by the commissioner.  
 38.24  Money collected must be deposited in the general fund and is 
 38.25  appropriated to the commissioner for the alternative care 
 38.26  program.  The client must supply the county with the client's 
 38.27  social security number at the time of application.  If a client 
 38.28  fails or refuses to pay the premium due, the county shall supply 
 38.29  the commissioner with the client's social security number and 
 38.30  other information the commissioner requires to collect the 
 38.31  premium from the client.  The commissioner shall collect unpaid 
 38.32  premiums using the Revenue Recapture Act in chapter 270A and 
 38.33  other methods available to the commissioner.  The commissioner 
 38.34  may require counties to inform clients of the collection 
 38.35  procedures that may be used by the state if a premium is not 
 38.36  paid.  
 39.1      (d) The commissioner shall begin to adopt emergency or 
 39.2   permanent rules governing client premiums within 30 days after 
 39.3   July 1, 1991, including criteria for determining when services 
 39.4   to a client must be terminated due to failure to pay a premium.  
 39.5      Sec. 27.  Minnesota Statutes 2000, section 256B.0913, 
 39.6   subdivision 13, is amended to read: 
 39.7      Subd. 13.  [COUNTY BIENNIAL PLAN.] The county biennial plan 
 39.8   for ~~the preadmission screening program~~ long-term care 
 39.9   consultation under section 256B.0911, the alternative care 
 39.10  program under this section, and waivers for the elderly under 
 39.11  section 256B.0915, ~~and waivers for the disabled under section~~ 
 39.12  ~~256B.49,~~ shall be incorporated into the biennial Community 
 39.13  Social Services Act plan and shall meet the regulations and 
 39.14  timelines of that plan.  ~~This county biennial plan shall include:~~
 39.15     ~~(1) information on the administration of the preadmission~~ 
 39.16  ~~screening program;~~ 
 39.17     ~~(2) information on the administration of the home and~~ 
 39.18  ~~community-based services waivers for the elderly under section~~ 
 39.19  ~~256B.0915, and for the disabled under section 256B.49; and~~ 
 39.20     ~~(3) information on the administration of the alternative~~ 
 39.21  ~~care program.~~ 
 39.22     Sec. 28.  Minnesota Statutes 2000, section 256B.0913, 
 39.23  subdivision 14, is amended to read: 
 39.24     Subd. 14.  [~~REIMBURSEMENT~~ PAYMENT AND RATE ADJUSTMENTS.] (a)
 39.25  ~~Reimbursement~~ Payment for ~~expenditures for the~~ provided 
 39.26  alternative care services as approved by the client's case 
 39.27  manager shall be through the invoice processing procedures of 
 39.28  the department's Medicaid Management Information System (MMIS).  
 39.29  To receive ~~reimbursement~~ payment, the county or vendor must 
 39.30  submit invoices within 12 months following the date of service.  
 39.31  The county agency and its vendors under contract shall not be 
 39.32  reimbursed for services which exceed the county allocation. 
 39.33     (b) If a county collects less than 50 percent of the client 
 39.34  premiums due under subdivision 12, the commissioner may withhold 
 39.35  up to three percent of the county's final alternative care 
 39.36  program allocation determined under subdivisions 10 and 11. 
 40.1      (c) The county shall negotiate individual rates with 
 40.2   vendors and may ~~be reimbursed~~ authorize service payment for 
 40.3   actual costs up to ~~the greater of~~ the county's current approved 
 40.4   rate ~~or 60 percent of the maximum rate in fiscal year 1994 and~~ 
 40.5   ~~65 percent of the maximum rate in fiscal year 1995 for each~~ 
 40.6   ~~alternative care service~~.  Notwithstanding any other rule or 
 40.7   statutory provision to the contrary, the commissioner shall not 
 40.8   be authorized to increase rates by an annual inflation factor, 
 40.9   unless so authorized by the legislature. 
 40.10     (d) ~~On July 1, 1993, the commissioner shall increase the~~ 
 40.11  ~~maximum rate for home delivered meals to $4.50 per meal.~~  To 
 40.12  improve access to community services and eliminate payment 
 40.13  disparities between the alternative care program and the elderly 
 40.14  waiver program, the commissioner shall establish statewide 
 40.15  maximum service rate limits and eliminate county-specific 
 40.16  service rate limits. 
 40.17     (1) Effective July 1, 2001, for service rate limits, except 
 40.18  those in subdivision 5, paragraphs (d) and (j), the rate limit 
 40.19  for each service shall be the greater of the alternative care 
 40.20  statewide maximum rate or the elderly waiver statewide maximum 
 40.21  rate. 
 40.22     (2) Counties may negotiate individual service rates with 
 40.23  vendors for actual costs up to the statewide maximum service 
 40.24  rate limit. 
 40.25     Sec. 29.  Minnesota Statutes 2000, section 256B.0915, 
 40.26  subdivision 1d, is amended to read: 
 40.27     Subd. 1d.  [POSTELIGIBILITY TREATMENT OF INCOME AND 
 40.28  RESOURCES FOR ELDERLY WAIVER.] ~~(a)~~ Notwithstanding the 
 40.29  provisions of section 256B.056, the commissioner shall make the 
 40.30  following amendment to the medical assistance elderly waiver 
 40.31  program effective July 1, 1999, or upon federal approval, 
 40.32  whichever is later. 
 40.33     A recipient's maintenance needs will be an amount equal to 
 40.34  the Minnesota supplemental aid equivalent rate as defined in 
 40.35  section 256I.03, subdivision 5, plus the medical assistance 
 40.36  personal needs allowance as defined in section 256B.35, 
 41.1   subdivision 1, paragraph (a), when applying posteligibility 
 41.2   treatment of income rules to the gross income of elderly waiver 
 41.3   recipients, except for individuals whose income is in excess of 
 41.4   the special income standard according to Code of Federal 
 41.5   Regulations, title 42, section 435.236.  Recipient maintenance 
 41.6   needs shall be adjusted under this provision each July 1. 
 41.7      ~~(b) The commissioner of human services shall secure~~ 
 41.8   ~~approval of additional elderly waiver slots sufficient to serve~~ 
 41.9   ~~persons who will qualify under the revised income standard~~ 
 41.10  ~~described in paragraph (a) before implementing section~~ 
 41.11  ~~256B.0913, subdivision 16.~~ 
 41.12     ~~(c) In implementing this subdivision, the commissioner~~ 
 41.13  ~~shall consider allowing persons who would otherwise be eligible~~ 
 41.14  ~~for the alternative care program but would qualify for the~~ 
 41.15  ~~elderly waiver with a spenddown to remain on the alternative~~ 
 41.16  ~~care program.~~ 
 41.17     Sec. 30.  Minnesota Statutes 2000, section 256B.0915, 
 41.18  subdivision 3, is amended to read: 
 41.19     Subd. 3.  [LIMITS OF CASES, RATES, ~~REIMBURSEMENT~~ PAYMENTS, 
 41.20  AND FORECASTING.] (a) The number of medical assistance waiver 
 41.21  recipients that a county may serve must be allocated according 
 41.22  to the number of medical assistance waiver cases open on July 1 
 41.23  of each fiscal year.  Additional recipients may be served with 
 41.24  the approval of the commissioner. 
 41.25     (b) The monthly limit for the cost of waivered services to 
 41.26  an individual elderly waiver client shall be the ~~statewide~~ 
 41.27  ~~average payment~~ weighted average monthly nursing facility rate 
 41.28  of the case mix resident class to which the elderly waiver 
 41.29  client would be assigned under ~~the medical assistance case mix~~ 
 41.30  ~~reimbursement system.~~  Minnesota Rules, parts 9549.0050 to 
 41.31  9549.0059, less the recipient's maintenance needs allowance as 
 41.32  described in subdivision 1d, paragraph (a), until the first day 
 41.33  of the state fiscal year in which the resident assessment system 
 41.34  as described in section 256B.437 for nursing home rate 
 41.35  determination is implemented.  Effective on the first day of the 
 41.36  state fiscal year in which the resident assessment system as 
 42.1   described in section 256B.437 for nursing home rate 
 42.2   determination is implemented and the first day of each 
 42.3   subsequent state fiscal year, the monthly limit for the cost of 
 42.4   waivered services to an individual elderly waiver client shall 
 42.5   be the rate of the case mix resident class to which the waiver 
 42.6   client would be assigned under Minnesota Rules, parts 9549.0050 
 42.7   to 9549.0059, in effect on the last day of the previous state 
 42.8   fiscal year, adjusted by the greater of any legislatively 
 42.9   adopted home and community-based services cost-of-living 
 42.10  percentage increase or any legislatively adopted statewide 
 42.11  percent rate increase for nursing facilities. 
 42.12     (c) If extended medical supplies and equipment or 
 42.13  ~~adaptations~~ environmental modifications are or will be purchased 
 42.14  for an elderly waiver ~~services recipient~~ client, the costs may 
 42.15  be prorated ~~on a monthly basis throughout the year in which they~~ 
 42.16  ~~are purchased~~ for up to 12 consecutive months beginning with the 
 42.17  month of purchase.  If the monthly cost of a recipient's ~~other~~ 
 42.18  waivered services exceeds the monthly limit established in ~~this~~ 
 42.19  paragraph (b), the annual cost of ~~the~~ all waivered services 
 42.20  shall be determined.  In this event, the annual cost of all 
 42.21  waivered services shall not exceed 12 times the monthly 
 42.22  limit ~~calculated in this paragraph.  The statewide average~~ 
 42.23  ~~payment rate is calculated by determining the statewide average~~ 
 42.24  ~~monthly nursing home rate, effective July 1 of the fiscal year~~ 
 42.25  ~~in which the cost is incurred, less the statewide average~~ 
 42.26  ~~monthly income of nursing home residents who are age 65 or~~ 
 42.27  ~~older, and who are medical assistance recipients in the month of~~ 
 42.28  ~~March of the previous state fiscal year.  The annual cost~~ 
 42.29  ~~divided by 12 of elderly or disabled waivered services~~ of 
 42.30  waivered services as described in paragraph (b).  
 42.31     (d) For a person who is a nursing facility resident at the 
 42.32  time of requesting a determination of eligibility for elderly ~~or~~ 
 42.33  ~~disabled~~ waivered services ~~shall be the greater of the monthly~~ 
 42.34  ~~payment for:  (i)~~, a monthly conversion limit for the cost of 
 42.35  elderly waivered services may be requested.  The monthly 
 42.36  conversion limit for the cost of elderly waiver services shall 
 43.1   be the resident class assigned under Minnesota Rules, parts 
 43.2   9549.0050 to 9549.0059, for that resident in the nursing 
 43.3   facility where the resident currently resides~~; or (ii) the~~ 
 43.4   ~~statewide average payment of the case mix resident class to~~ 
 43.5   ~~which the resident would be assigned under the medical~~ 
 43.6   ~~assistance case mix reimbursement system, provided that~~ until 
 43.7   July 1 of the state fiscal year in which the resident assessment 
 43.8   system as described in section 256B.437 for nursing home rate 
 43.9   determination is implemented.  Effective on July 1 of the state 
 43.10  fiscal year in which the resident assessment system as described 
 43.11  in section 256B.437 for nursing home rate determination is 
 43.12  implemented, the monthly conversion limit for the cost of 
 43.13  elderly waiver services shall be the per diem nursing facility 
 43.14  rate as determined by the resident assessment system as 
 43.15  described in section 256B.437 for that resident in the nursing 
 43.16  facility where the resident currently resides multiplied by 365 
 43.17  and divided by 12, less the recipient's maintenance needs 
 43.18  allowance as described in subdivision 1d.  The limit under this 
 43.19  clause only applies to persons discharged from a nursing 
 43.20  facility after a minimum 30-day stay and found eligible for 
 43.21  waivered services on or after July 1, 1997.  The following costs 
 43.22  must be included in determining the total monthly costs for the 
 43.23  waiver client: 
 43.24     (1) cost of all waivered services, including extended 
 43.25  medical supplies and equipment and environmental modifications; 
 43.26  and 
 43.27     (2) cost of skilled nursing, home health aide, and personal 
 43.28  care services reimbursable by medical assistance.  
 43.29     ~~(c)~~ (e) Medical assistance funding for skilled nursing 
 43.30  services, private duty nursing, home health aide, and personal 
 43.31  care services for waiver recipients must be approved by the case 
 43.32  manager and included in the individual care plan. 
 43.33     ~~(d) For both the elderly waiver and the nursing facility~~ 
 43.34  ~~disabled waiver, a county may purchase extended supplies and~~ 
 43.35  ~~equipment without prior approval from the commissioner when~~ 
 43.36  ~~there is no other funding source and the supplies and equipment~~ 
 44.1   ~~are specified in the individual's care plan as medically~~ 
 44.2   ~~necessary to enable the individual to remain in the community~~ 
 44.3   ~~according to the criteria in Minnesota Rules, part 9505.0210,~~ 
 44.4   ~~items A and B.~~  (f) A county is not required to contract with a 
 44.5   provider of supplies and equipment if the monthly cost of the 
 44.6   supplies and equipment is less than $250.  
 44.7      ~~(e)~~ (g) The adult foster care ~~daily~~ rate ~~for the elderly~~ 
 44.8   ~~and disabled waivers~~ shall be considered a difficulty of care 
 44.9   payment and shall not include room and board.  The adult foster 
 44.10  care service rate shall be negotiated between the county agency 
 44.11  and the foster care provider.  ~~The rate established under this~~ 
 44.12  ~~section shall not exceed the state average monthly nursing home~~ 
 44.13  ~~payment for the case mix classification to which the individual~~ 
 44.14  ~~receiving foster care is assigned; the rate must allow for other~~ 
 44.15  ~~waiver and medical assistance home care services to be~~ 
 44.16  ~~authorized by the case manager.~~  The elderly waiver payment for 
 44.17  the foster care service in combination with the payment for all 
 44.18  other elderly waiver services, including case management, must 
 44.19  not exceed the limit specified in paragraph (b). 
 44.20     ~~(f) The assisted living and residential care service rates~~ 
 44.21  ~~for elderly and community alternatives for disabled individuals~~ 
 44.22  ~~(CADI) waivers shall be made to the vendor as a monthly rate~~ 
 44.23  ~~negotiated with the county agency based on an individualized~~ 
 44.24  ~~service plan for each resident.  The rate shall not exceed the~~ 
 44.25  ~~nonfederal share of the greater of either the statewide or any~~ 
 44.26  ~~of the geographic groups' weighted average monthly medical~~ 
 44.27  ~~assistance nursing facility payment rate of the case mix~~ 
 44.28  ~~resident class to which the elderly or disabled client would be~~ 
 44.29  ~~assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,~~ 
 44.30  ~~unless the services are provided by a home care provider~~ 
 44.31  ~~licensed by the department of health and are provided in a~~ 
 44.32  ~~building that is registered as a housing with services~~ 
 44.33  ~~establishment under chapter 144D and that provides 24-hour~~ 
 44.34  ~~supervision.  For alternative care assisted living projects~~ 
 44.35  ~~established under Laws 1988, chapter 689, article 2, section~~ 
 44.36  ~~256, monthly rates may not exceed 65 percent of the greater of~~ 
 45.1   ~~either the statewide or any of the geographic groups' weighted~~ 
 45.2   ~~average monthly medical assistance nursing facility payment rate~~ 
 45.3   ~~for the case mix resident class to which the elderly or disabled~~ 
 45.4   ~~client would be assigned under Minnesota Rules, parts 9549.0050~~ 
 45.5   ~~to 9549.0059.  The rate may not cover direct rent or food costs.~~ 
 45.6      (h) Payment for assisted living service shall be a monthly 
 45.7   rate negotiated and authorized by the county agency based on an 
 45.8   individualized service plan for each resident and may not cover 
 45.9   direct rent or food costs. 
 45.10     (1) The individualized monthly negotiated payment for 
 45.11  assisted living services as described in section 256B.0913, 
 45.12  subdivision 5, paragraph (g) or (h), and residential care 
 45.13  services as described in section 256B.0913, subdivision 5, 
 45.14  paragraph (f), shall not exceed the nonfederal share, in effect 
 45.15  on July 1 of the state fiscal year for which the rate limit is 
 45.16  being calculated, of the greater of either the statewide or any 
 45.17  of the geographic groups' weighted average monthly nursing 
 45.18  facility rate of the case mix resident class to which the 
 45.19  elderly waiver eligible client would be assigned under Minnesota 
 45.20  Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 
 45.21  allowance as described in subdivision 1d, paragraph (a), until 
 45.22  the July 1 of the state fiscal year in which the resident 
 45.23  assessment system as described in section 256B.437 for nursing 
 45.24  home rate determination is implemented.  Effective on July 1 of 
 45.25  the state fiscal year in which the resident assessment system as 
 45.26  described in section 256B.437 for nursing home rate 
 45.27  determination is implemented and July 1 of each subsequent state 
 45.28  fiscal year, the individualized monthly negotiated payment for 
 45.29  the services described in this clause shall not exceed the limit 
 45.30  described in this clause which was in effect on June 30 of the 
 45.31  previous state fiscal year and which has been adjusted by the 
 45.32  greater of any legislatively adopted home and community-based 
 45.33  services cost-of-living percentage increase or any legislatively 
 45.34  adopted statewide percent rate increase for nursing facilities. 
 45.35     (2) The individualized monthly negotiated payment for 
 45.36  assisted living services described in section 144A.4605 and 
 46.1   delivered by a provider licensed by the department of health as 
 46.2   a class A home care provider or an assisted living home care 
 46.3   provider and provided in a building that is registered as a 
 46.4   housing with services establishment under chapter 144D and that 
 46.5   provides 24-hour supervision in combination with the payment for 
 46.6   other elderly waiver services, including case management, must 
 46.7   not exceed the limit specified in paragraph (b). 
 46.8      ~~(g)~~ (i) The county shall negotiate individual service rates 
 46.9   with vendors and may ~~be reimbursed~~ authorize payment for actual 
 46.10  costs up to the ~~greater of the~~ county's current approved rate ~~or~~ 
 46.11  ~~60 percent of the maximum rate in fiscal year 1994 and 65~~ 
 46.12  ~~percent of the maximum rate in fiscal year 1995 for each service~~ 
 46.13  ~~within each program~~.  Persons or agencies must be employed by or 
 46.14  under a contract with the county agency or the public health 
 46.15  nursing agency of the local board of health in order to receive 
 46.16  funding under the elderly waiver program, except as a provider 
 46.17  of supplies and equipment when the monthly cost of the supplies 
 46.18  and equipment is less than $250.  
 46.19     ~~(h) On July 1, 1993, the commissioner shall increase the~~ 
 46.20  ~~maximum rate for home-delivered meals to $4.50 per meal.~~ 
 46.21     ~~(i)~~ (j) Reimbursement for the medical assistance recipients 
 46.22  under the approved waiver shall be made from the medical 
 46.23  assistance account through the invoice processing procedures of 
 46.24  the department's Medicaid Management Information System (MMIS), 
 46.25  only with the approval of the client's case manager.  The budget 
 46.26  for the state share of the Medicaid expenditures shall be 
 46.27  forecasted with the medical assistance budget, and shall be 
 46.28  consistent with the approved waiver.  
 46.29     (k) To improve access to community services and eliminate 
 46.30  payment disparities between the alternative care program and the 
 46.31  elderly waiver, the commissioner shall establish statewide 
 46.32  maximum service rate limits and eliminate county-specific 
 46.33  service rate limits. 
 46.34     (1) Effective July 1, 2001, for service rate limits, except 
 46.35  those described or defined in paragraphs (g) and (h), the rate 
 46.36  limit for each service shall be the greater of the alternative 
 47.1   care statewide maximum rate or the elderly waiver statewide 
 47.2   maximum rate. 
 47.3      (2) Counties may negotiate individual service rates with 
 47.4   vendors for actual costs up to the statewide maximum service 
 47.5   rate limit. 
 47.6      ~~(j)~~ (l) Beginning July 1, 1991, the state shall reimburse 
 47.7   counties according to the payment schedule in section 256.025 
 47.8   for the county share of costs incurred under this subdivision on 
 47.9   or after January 1, 1991, for individuals who are receiving 
 47.10  medical assistance. 
 47.11     ~~(k) For the community alternatives for disabled individuals~~ 
 47.12  ~~waiver, and nursing facility disabled waivers, county may use~~ 
 47.13  ~~waiver funds for the cost of minor adaptations to a client's~~ 
 47.14  ~~residence or vehicle without prior approval from the~~ 
 47.15  ~~commissioner if there is no other source of funding and the~~ 
 47.16  ~~adaptation:~~ 
 47.17     ~~(1) is necessary to avoid institutionalization;~~ 
 47.18     ~~(2) has no utility apart from the needs of the client; and~~ 
 47.19     ~~(3) meets the criteria in Minnesota Rules, part 9505.0210,~~ 
 47.20  ~~items A and B.~~  
 47.21  ~~For purposes of this subdivision, "residence" means the client's~~ 
 47.22  ~~own home, the client's family residence, or a family foster~~ 
 47.23  ~~home.  For purposes of this subdivision, "vehicle" means the~~ 
 47.24  ~~client's vehicle, the client's family vehicle, or the client's~~ 
 47.25  ~~family foster home vehicle.~~ 
 47.26     ~~(l) The commissioner shall establish a maximum rate unit~~ 
 47.27  ~~for baths provided by an adult day care provider that are not~~ 
 47.28  ~~included in the provider's contractual daily or hourly rate.~~ 
 47.29  ~~This maximum rate must equal the home health aide extended rate~~ 
 47.30  ~~and shall be paid for baths provided to clients served under the~~ 
 47.31  ~~elderly and disabled waivers.~~ 
 47.32     Sec. 31.  Minnesota Statutes 2000, section 256B.0915, 
 47.33  subdivision 5, is amended to read: 
 47.34     Subd. 5.  [REASSESSMENTS FOR WAIVER CLIENTS.] A 
 47.35  reassessment of a client served under the elderly ~~or disabled~~ 
 47.36  waiver must be conducted at least every 12 months and at other 
 48.1   times when the case manager determines that there has been 
 48.2   significant change in the client's functioning.  This may 
 48.3   include instances where the client is discharged from the 
 48.4   hospital.  
 48.5      Sec. 32.  [256B.0918] [ESTABLISHMENT AND PURPOSE OF MEDICAL 
 48.6   ASSISTANCE PILOT PROJECT ON SENIOR SERVICES.] 
 48.7      Subdivision 1.  [ESTABLISHMENT AND PURPOSE.] The 
 48.8   commissioner of human services shall establish a medical 
 48.9   assistance pilot project on senior services to determine how 
 48.10  converting the delivery of housing, supportive services, and 
 48.11  health care for seniors into a flexible voucher program will 
 48.12  impact public expenditures for older adult service care and 
 48.13  provide an alternative way to purchase services based on 
 48.14  consumer choice. 
 48.15     Subd. 2.  [FEDERAL WAIVER AUTHORITY.] The commissioner 
 48.16  shall apply for any necessary federal waivers or approvals to 
 48.17  implement this pilot project.  The commissioner shall submit the 
 48.18  waiver request no later than April 15, 2002.  The medical 
 48.19  assistance pilot project on senior services shall be implemented 
 48.20  January 1, 2003, or upon federal approval, whichever is later. 
 48.21     Subd. 3.  [REPORT.] Participating communities and the 
 48.22  commissioner of human services shall collaborate to prepare and 
 48.23  issue an annual report December 1, 2003, and each December 1 
 48.24  thereafter, to the appropriate committee chairs in the senate 
 48.25  and house on:  (1) the use of state resources, including other 
 48.26  funds leveraged for this initiative; (2) the status of 
 48.27  individuals being served in the pilot project; and (3) the 
 48.28  cost-effectiveness of the pilot project.  The commissioner shall 
 48.29  provide data that may be needed to evaluate the pilot project to 
 48.30  communities that request the data. 
 48.31     Subd. 4.  [SUNSET.] This section sunsets June 30, 2008. 
 48.32     Sec. 33.  Minnesota Statutes 2000, section 256D.35, is 
 48.33  amended by adding a subdivision to read: 
 48.34     Subd. 18a.  [SHELTER COSTS.] "Shelter costs" means rent; 
 48.35  manufactured home lot rentals; monthly principal, interest, 
 48.36  insurance premiums, and property taxes due for mortgages or 
 49.1   contracts for deed costs; costs for utilities, including 
 49.2   heating, cooling, electricity, water, and sewage; garbage 
 49.3   collection fees; and the basic service fee for one telephone. 
 49.4      Sec. 34.  Minnesota Statutes 2000, section 256D.35, is 
 49.5   amended by adding a subdivision to read: 
 49.6      Subd. 18b.  [SHELTER NEEDY.] "Shelter needy" means that the 
 49.7   assistance unit incurs monthly shelter costs that exceed 40 
 49.8   percent of the assistance unit's gross income. 
 49.9      Sec. 35.  Minnesota Statutes 2000, section 256D.44, 
 49.10  subdivision 5, is amended to read: 
 49.11     Subd. 5.  [SPECIAL NEEDS.] In addition to the state 
 49.12  standards of assistance established in subdivisions 1 to 4, 
 49.13  payments are allowed for the following special needs of 
 49.14  recipients of Minnesota supplemental aid who are not residents 
 49.15  of a nursing home, a regional treatment center, or a group 
 49.16  residential housing facility. 
 49.17     (a) The county agency shall pay a monthly allowance for 
 49.18  medically prescribed diets payable under the Minnesota family 
 49.19  investment program if the cost of those additional dietary needs 
 49.20  cannot be met through some other maintenance benefit.  
 49.21     (b) Payment for nonrecurring special needs must be allowed 
 49.22  for necessary home repairs or necessary repairs or replacement 
 49.23  of household furniture and appliances using the payment standard 
 49.24  of the AFDC program in effect on July 16, 1996, for these 
 49.25  expenses, as long as other funding sources are not available.  
 49.26     (c) A fee for guardian or conservator service is allowed at 
 49.27  a reasonable rate negotiated by the county or approved by the 
 49.28  court.  This rate shall not exceed five percent of the 
 49.29  assistance unit's gross monthly income up to a maximum of $100 
 49.30  per month.  If the guardian or conservator is a member of the 
 49.31  county agency staff, no fee is allowed. 
 49.32     (d) The county agency shall continue to pay a monthly 
 49.33  allowance of $68 for restaurant meals for a person who was 
 49.34  receiving a restaurant meal allowance on June 1, 1990, and who 
 49.35  eats two or more meals in a restaurant daily.  The allowance 
 49.36  must continue until the person has not received Minnesota 
 50.1   supplemental aid for one full calendar month or until the 
 50.2   person's living arrangement changes and the person no longer 
 50.3   meets the criteria for the restaurant meal allowance, whichever 
 50.4   occurs first. 
 50.5      (e) A fee of ten percent of the recipient's gross income or 
 50.6   $25, whichever is less, is allowed for representative payee 
 50.7   services provided by an agency that meets the requirements under 
 50.8   SSI regulations to charge a fee for representative payee 
 50.9   services.  This special need is available to all recipients of 
 50.10  Minnesota supplemental aid regardless of their living 
 50.11  arrangement. 
 50.12     (f) Notwithstanding the language in this subdivision, an 
 50.13  amount equal to the maximum allotment authorized by the federal 
 50.14  Food Stamp Program for a single individual which is in effect on 
 50.15  the first day of January of the previous state fiscal year will 
 50.16  be added to the standard of assistance established in 
 50.17  subdivisions 1 to 4 for recipients of the elderly waiver program 
 50.18  under section 256B.0915, who are shelter needy.  A recipient of 
 50.19  a federal or state housing subsidy that limits shelter costs to 
 50.20  a percentage of gross income shall not be considered shelter 
 50.21  needy for purposes of this provision. 
 50.22     Sec. 36.  [INTEGRATED SERVICE ACCESS STUDY.] 
 50.23     By February 15, 2002, the commissioner of human services 
 50.24  shall submit to the legislature recommendations for creating 
 50.25  integrated service access at the county agency level for both 
 50.26  publicly subsidized and nonsubsidized long-term care services 
 50.27  and housing options.  The report must: 
 50.28     (1) include a plan to integrate public funding streams to 
 50.29  allow low-income, privately paying consumers to purchase 
 50.30  services through a sliding fee scale; and 
 50.31     (2) evaluate the feasibility of statewide implementation, 
 50.32  based upon an evaluation of public cost, consumer preferences 
 50.33  and satisfaction, and other relevant factors. 
 50.34     Sec. 37.  [RESPITE CARE.] 
 50.35     The Minnesota board on aging shall report to the 
 50.36  legislature by February 1, 2002, on the provision of in-home and 
 51.1   out-of-home respite care services on a sliding scale basis under 
 51.2   the federal Older Americans Act. 
 51.3      Sec. 38.  [APPROPRIATION.] 
 51.4      Subdivision 1.  [SENIOR LINKAGE.] $....... is appropriated 
 51.5   from the general fund to the commissioner of human services for 
 51.6   the biennium ending June 30, 2003, for the board on aging to 
 51.7   expand services provided through Senior LinkAge. 
 51.8      Subd. 2.  [LONG-TERM CARE CONSULTATION SERVICES.] $....... 
 51.9   is appropriated from the general fund to the commissioner of 
 51.10  human services for the biennium ending June 30, 2003, to 
 51.11  increase county allocations for long-term care consultation 
 51.12  services. 
 51.13     Subd. 3.  [ALTERNATIVE CARE AND ELDERLY WAIVER 
 51.14  PROGRAMS.] $....... is appropriated from the general fund to the 
 51.15  commissioner of human services for the biennium ending June 30, 
 51.16  2003, to eliminate county-specific rates and serve additional 
 51.17  individuals under the alternative care and elderly waiver 
 51.18  programs.  
 51.19     Subd. 4.  [MEDICAL ASSISTANCE PILOT PROJECT.] $....... is 
 51.20  appropriated from the general fund to the commissioner of human 
 51.21  services for the biennium ending June 30, 2003, to administer 
 51.22  the medical assistance pilot project under section 32. 
 51.23     Subd. 5.  [IDENTIFICATION OF CRITICAL ACCESS SERVICE 
 51.24  SITES.] $....... is appropriated from the general fund to the 
 51.25  commissioner of health for the biennium ending June 30, 2003, to 
 51.26  implement section 1. 
 51.27     Sec. 39.  [REPEALER.] 
 51.28     Minnesota Statutes 2000, sections 256B.0911, subdivisions 
 51.29  2, 2a, 4, 8, and 9; 256B.0913, subdivisions 3, 15a, 15b, 15c, 
 51.30  and 16; and 256B.0915, subdivisions 3a, 3b, and 3c, and 
 51.31  Minnesota Rules, parts 9505.2390, 9505.2395, 9505.2396, 
 51.32  9505.2400, 9505.2405, 9505.2410, 9505.2413, 9505.2415, 
 51.33  9505.2420, 9505.2425, 9505,2426, 9505.2430, 9505.2435, 
 51.34  9505.2440, 9505.2445, 9505.2450, 9505.2455, 9505.2458, 
 51.35  9505.2460, 9505.2465, 9505.2470, 9505.2473, 9505.2475, 
 51.36  9505.2480, 9505.2485, 9505.2486, 9505.2490, 9505.2495, 
 52.1   9505.2496, and 9505.2500, are repealed. 
 52.2                              ARTICLE 2 
 52.3            LONG-TERM CARE SYSTEM REFORM AND REIMBURSEMENT
 52.4      Section 1.  [16A.88] [ESTABLISHMENT OF LONG-TERM CARE 
 52.5   REVOLVING FUND.] 
 52.6      At the end of each state fiscal year, any unspent and 
 52.7   unencumbered state general fund appropriations for long-term 
 52.8   care for the elderly, including nursing facility, elderly 
 52.9   waiver, alternative care, and home care services, must be 
 52.10  deposited by the commissioner of finance in the long-term care 
 52.11  enhancement fund, which is established.  Money in the long-term 
 52.12  care enhancement fund may be used only to enhance long-term care 
 52.13  services in the state through capital or other one-time 
 52.14  investment projects or through provider rate increases that are 
 52.15  greater than the rate of inflation, measured by the Data 
 52.16  Resources, Inc. forecast of the nursing home market basket index 
 52.17  in the fourth quarter of the calendar year preceding the rate 
 52.18  year, based on the 12-month period from the midpoint of the last 
 52.19  rate year to the midpoint of the rate year for which funds are 
 52.20  being appropriated.  Each year that the long-term care 
 52.21  enhancement fund is forecast to have a balance, the legislature 
 52.22  shall designate the use of the funds. 
 52.23     Sec. 2.  Minnesota Statutes 2000, section 144A.071, 
 52.24  subdivision 1, is amended to read: 
 52.25     Subdivision 1.  [FINDINGS.] The legislature declares that a 
 52.26  moratorium on the licensure and medical assistance certification 
 52.27  of new nursing home beds and construction projects that 
 52.28  exceed ~~$750,000~~ $1,000,000 is necessary to control nursing home 
 52.29  expenditure growth and enable the state to meet the needs of its 
 52.30  elderly by providing high quality services in the most 
 52.31  appropriate manner along a continuum of care.  
 52.32     Sec. 3.  Minnesota Statutes 2000, section 144A.071, 
 52.33  subdivision 1a, is amended to read: 
 52.34     Subd. 1a.  [DEFINITIONS.] For purposes of sections 144A.071 
 52.35  to 144A.073, the following terms have the meanings given them: 
 52.36     (a) "attached fixtures" has the meaning given in Minnesota 
 53.1   Rules, part 9549.0020, subpart 6. 
 53.2      (b) "buildings" has the meaning given in Minnesota Rules, 
 53.3   part 9549.0020, subpart 7. 
 53.4      (c) "capital assets" has the meaning given in section 
 53.5   256B.421, subdivision 16. 
 53.6      (d) "commenced construction" means that all of the 
 53.7   following conditions were met:  the final working drawings and 
 53.8   specifications were approved by the commissioner of health; the 
 53.9   construction contracts were let; a timely construction schedule 
 53.10  was developed, stipulating dates for beginning, achieving 
 53.11  various stages, and completing construction; and all zoning and 
 53.12  building permits were applied for. 
 53.13     (e) "completion date" means the date on which a certificate 
 53.14  of occupancy is issued for a construction project, or if a 
 53.15  certificate of occupancy is not required, the date on which the 
 53.16  construction project is available for facility use. 
 53.17     (f) "construction" means any erection, building, 
 53.18  alteration, reconstruction, modernization, or improvement 
 53.19  necessary to comply with the nursing home licensure rules. 
 53.20     (g) "construction project" means: 
 53.21     (1) a capital asset addition to, or replacement of a 
 53.22  nursing home or certified boarding care home that results in new 
 53.23  space or the remodeling of or renovations to existing facility 
 53.24  space; 
 53.25     (2) the remodeling or renovation of existing facility space 
 53.26  the use of which is modified as a result of the project 
 53.27  described in clause (1).  This existing space and the project 
 53.28  described in clause (1) must be used for the functions as 
 53.29  designated on the construction plans on completion of the 
 53.30  project described in clause (1) for a period of not less than 24 
 53.31  months; or 
 53.32     (3) capital asset additions or replacements that are 
 53.33  completed within 12 months before or after the completion date 
 53.34  of the project described in clause (1). 
 53.35     (h) "new licensed" or "new certified beds" means: 
 53.36     (1) newly constructed beds in a facility or the 
 54.1   construction of a new facility that would increase the total 
 54.2   number of licensed nursing home beds or certified boarding care 
 54.3   or nursing home beds in the state; or 
 54.4      (2) newly licensed nursing home beds or newly certified 
 54.5   boarding care or nursing home beds that result from remodeling 
 54.6   of the facility that involves relocation of beds but does not 
 54.7   result in an increase in the total number of beds, except when 
 54.8   the project involves the upgrade of boarding care beds to 
 54.9   nursing home beds, as defined in section 144A.073, subdivision 
 54.10  1.  "Remodeling" includes any of the type of conversion, 
 54.11  renovation, replacement, or upgrading projects as defined in 
 54.12  section 144A.073, subdivision 1. 
 54.13     (i) "project construction costs" means the cost of the 
 54.14  facility capital asset additions, replacements, renovations, or 
 54.15  remodeling projects, construction site preparation costs, and 
 54.16  related soft costs.  Project construction costs ~~also~~ include the 
 54.17  cost of any remodeling or renovation of existing facility space 
 54.18  which is modified as a result of the construction 
 54.19  project.  Project construction costs also includes the cost of 
 54.20  new technology implemented as part of the construction project. 
 54.21     (j) "technology" means information systems or devices that 
 54.22  make documentation, charting, and staff time more efficient or 
 54.23  encourage and allow for care through alternative settings 
 54.24  including, but not limited to, touch screens, monitors, 
 54.25  hand-helds, swipe cards, motion detectors, pagers, telemedicine, 
 54.26  medication dispensers, and equipment to monitor vital signs and 
 54.27  self-injections, and to observe skin and other conditions. 
 54.28     Sec. 4.  Minnesota Statutes 2000, section 144A.071, 
 54.29  subdivision 2, is amended to read: 
 54.30     Subd. 2.  [MORATORIUM.] The commissioner of health, in 
 54.31  coordination with the commissioner of human services, shall deny 
 54.32  each request for new licensed or certified nursing home or 
 54.33  certified boarding care beds except as provided in subdivision 3 
 54.34  or 4a, or section 144A.073.  "Certified bed" means a nursing 
 54.35  home bed or a boarding care bed certified by the commissioner of 
 54.36  health for the purposes of the medical assistance program, under 
 55.1   United States Code, title 42, sections 1396 et seq.  
 55.2      The commissioner of human services, in coordination with 
 55.3   the commissioner of health, shall deny any request to issue a 
 55.4   license under section 252.28 and chapter 245A to a nursing home 
 55.5   or boarding care home, if that license would result in an 
 55.6   increase in the medical assistance reimbursement amount.  
 55.7      In addition, the commissioner of health must not approve 
 55.8   any construction project whose cost exceeds ~~$750,000~~ $1,000,000 
 55.9   unless: 
 55.10     (a) any construction costs exceeding ~~$750,000~~ $1,000,000 
 55.11  are not added to the facility's appraised value and are not 
 55.12  included in the facility's payment rate for reimbursement under 
 55.13  the medical assistance program; or 
 55.14     (b) the project: 
 55.15     (1) has been approved through the process described in 
 55.16  section 144A.073; 
 55.17     (2) meets an exception in subdivision 3 or 4a; 
 55.18     (3) is necessary to correct violations of state or federal 
 55.19  law issued by the commissioner of health; 
 55.20     (4) is necessary to repair or replace a portion of the 
 55.21  facility that was damaged by fire, lightning, groundshifts, or 
 55.22  other such hazards, including environmental hazards, provided 
 55.23  that the provisions of subdivision 4a, clause (a), are met; 
 55.24     (5) as of May 1, 1992, the facility has submitted to the 
 55.25  commissioner of health written documentation evidencing that the 
 55.26  facility meets the "commenced construction" definition as 
 55.27  specified in subdivision 1a, clause (d), or that substantial 
 55.28  steps have been taken prior to April 1, 1992, relating to the 
 55.29  construction project.  "Substantial steps" require that the 
 55.30  facility has made arrangements with outside parties relating to 
 55.31  the construction project and include the hiring of an architect 
 55.32  or construction firm, submission of preliminary plans to the 
 55.33  department of health or documentation from a financial 
 55.34  institution that financing arrangements for the construction 
 55.35  project have been made; or 
 55.36     (6) is being proposed by a licensed nursing facility that 
 56.1   is not certified to participate in the medical assistance 
 56.2   program and will not result in new licensed or certified beds. 
 56.3      Prior to the final plan approval of any construction 
 56.4   project, the commissioner of health shall be provided with an 
 56.5   itemized cost estimate for the project construction costs.  If a 
 56.6   construction project is anticipated to be completed in phases, 
 56.7   the total estimated cost of all phases of the project shall be 
 56.8   submitted to the commissioner and shall be considered as one 
 56.9   construction project.  Once the construction project is 
 56.10  completed and prior to the final clearance by the commissioner, 
 56.11  the total project construction costs for the construction 
 56.12  project shall be submitted to the commissioner.  If the final 
 56.13  project construction cost exceeds the dollar threshold in this 
 56.14  subdivision, the commissioner of human services shall not 
 56.15  recognize any of the project construction costs or the related 
 56.16  financing costs in excess of this threshold in establishing the 
 56.17  facility's property-related payment rate. 
 56.18     The dollar thresholds for construction projects are as 
 56.19  follows:  for construction projects other than those authorized 
 56.20  in clauses (1) to (6), the dollar threshold 
 56.21  is ~~$750,000~~ $1,000,000.  For projects authorized after July 1, 
 56.22  1993, under clause (1), the dollar threshold is the cost 
 56.23  estimate submitted with a proposal for an exception under 
 56.24  section 144A.073, plus inflation as calculated according to 
 56.25  section 256B.431, subdivision 3f, paragraph (a).  For projects 
 56.26  authorized under clauses (2) to (4), the dollar threshold is the 
 56.27  itemized estimate project construction costs submitted to the 
 56.28  commissioner of health at the time of final plan approval, plus 
 56.29  inflation as calculated according to section 256B.431, 
 56.30  subdivision 3f, paragraph (a). 
 56.31     The commissioner of health shall adopt rules to implement 
 56.32  this section or to amend the emergency rules for granting 
 56.33  exceptions to the moratorium on nursing homes under section 
 56.34  144A.073.  
 56.35     Sec. 5.  Minnesota Statutes 2000, section 144A.071, 
 56.36  subdivision 4a, is amended to read: 
 57.1      Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
 57.2   best interest of the state to ensure that nursing homes and 
 57.3   boarding care homes continue to meet the physical plant 
 57.4   licensing and certification requirements by permitting certain 
 57.5   construction projects.  Facilities should be maintained in 
 57.6   condition to satisfy the physical and emotional needs of 
 57.7   residents while allowing the state to maintain control over 
 57.8   nursing home expenditure growth. 
 57.9      The commissioner of health in coordination with the 
 57.10  commissioner of human services, may approve the renovation, 
 57.11  replacement, upgrading, or relocation of a nursing home or 
 57.12  boarding care home, under the following conditions: 
 57.13     (a) to license or certify beds in a new facility 
 57.14  constructed to replace a facility or to make repairs in an 
 57.15  existing facility that was destroyed or damaged after June 30, 
 57.16  1987, by fire, lightning, or other hazard provided:  
 57.17     (i) destruction was not caused by the intentional act of or 
 57.18  at the direction of a controlling person of the facility; 
 57.19     (ii) at the time the facility was destroyed or damaged the 
 57.20  controlling persons of the facility maintained insurance 
 57.21  coverage for the type of hazard that occurred in an amount that 
 57.22  a reasonable person would conclude was adequate; 
 57.23     (iii) the net proceeds from an insurance settlement for the 
 57.24  damages caused by the hazard are applied to the cost of the new 
 57.25  facility or repairs; 
 57.26     (iv) the new facility is constructed on the same site as 
 57.27  the destroyed facility or on another site subject to the 
 57.28  restrictions in section 144A.073, subdivision 5; 
 57.29     (v) the number of licensed and certified beds in the new 
 57.30  facility does not exceed the number of licensed and certified 
 57.31  beds in the destroyed facility; and 
 57.32     (vi) the commissioner determines that the replacement beds 
 57.33  are needed to prevent an inadequate supply of beds. 
 57.34  Project construction costs incurred for repairs authorized under 
 57.35  this clause shall not be considered in the dollar threshold 
 57.36  amount defined in subdivision 2; 
 58.1      (b) to license or certify beds that are moved from one 
 58.2   location to another within a nursing home facility, provided the 
 58.3   total costs of remodeling performed in conjunction with the 
 58.4   relocation of beds does not exceed ~~$750,000~~ $1,000,000; 
 58.5      (c) to license or certify beds in a project recommended for 
 58.6   approval under section 144A.073; 
 58.7      (d) to license or certify beds that are moved from an 
 58.8   existing state nursing home to a different state facility, 
 58.9   provided there is no net increase in the number of state nursing 
 58.10  home beds; 
 58.11     (e) to certify and license as nursing home beds boarding 
 58.12  care beds in a certified boarding care facility if the beds meet 
 58.13  the standards for nursing home licensure, or in a facility that 
 58.14  was granted an exception to the moratorium under section 
 58.15  144A.073, and if the cost of any remodeling of the facility does 
 58.16  not exceed ~~$750,000~~ $1,000,000.  If boarding care beds are 
 58.17  licensed as nursing home beds, the number of boarding care beds 
 58.18  in the facility must not increase beyond the number remaining at 
 58.19  the time of the upgrade in licensure.  The provisions contained 
 58.20  in section 144A.073 regarding the upgrading of the facilities do 
 58.21  not apply to facilities that satisfy these requirements; 
 58.22     (f) to license and certify up to 40 beds transferred from 
 58.23  an existing facility owned and operated by the Amherst H. Wilder 
 58.24  Foundation in the city of St. Paul to a new unit at the same 
 58.25  location as the existing facility that will serve persons with 
 58.26  Alzheimer's disease and other related disorders.  The transfer 
 58.27  of beds may occur gradually or in stages, provided the total 
 58.28  number of beds transferred does not exceed 40.  At the time of 
 58.29  licensure and certification of a bed or beds in the new unit, 
 58.30  the commissioner of health shall delicense and decertify the 
 58.31  same number of beds in the existing facility.  As a condition of 
 58.32  receiving a license or certification under this clause, the 
 58.33  facility must make a written commitment to the commissioner of 
 58.34  human services that it will not seek to receive an increase in 
 58.35  its property-related payment rate as a result of the transfers 
 58.36  allowed under this paragraph; 
 59.1      (g) to license and certify nursing home beds to replace 
 59.2   currently licensed and certified boarding care beds which may be 
 59.3   located either in a remodeled or renovated boarding care or 
 59.4   nursing home facility or in a remodeled, renovated, newly 
 59.5   constructed, or replacement nursing home facility within the 
 59.6   identifiable complex of health care facilities in which the 
 59.7   currently licensed boarding care beds are presently located, 
 59.8   provided that the number of boarding care beds in the facility 
 59.9   or complex are decreased by the number to be licensed as nursing 
 59.10  home beds and further provided that, if the total costs of new 
 59.11  construction, replacement, remodeling, or renovation exceed ten 
 59.12  percent of the appraised value of the facility or $200,000, 
 59.13  whichever is less, the facility makes a written commitment to 
 59.14  the commissioner of human services that it will not seek to 
 59.15  receive an increase in its property-related payment rate by 
 59.16  reason of the new construction, replacement, remodeling, or 
 59.17  renovation.  The provisions contained in section 144A.073 
 59.18  regarding the upgrading of facilities do not apply to facilities 
 59.19  that satisfy these requirements; 
 59.20     (h) to license as a nursing home and certify as a nursing 
 59.21  facility a facility that is licensed as a boarding care facility 
 59.22  but not certified under the medical assistance program, but only 
 59.23  if the commissioner of human services certifies to the 
 59.24  commissioner of health that licensing the facility as a nursing 
 59.25  home and certifying the facility as a nursing facility will 
 59.26  result in a net annual savings to the state general fund of 
 59.27  $200,000 or more; 
 59.28     (i) to certify, after September 30, 1992, and prior to July 
 59.29  1, 1993, existing nursing home beds in a facility that was 
 59.30  licensed and in operation prior to January 1, 1992; 
 59.31     (j) to license and certify new nursing home beds to replace 
 59.32  beds in a facility acquired by the Minneapolis community 
 59.33  development agency as part of redevelopment activities in a city 
 59.34  of the first class, provided the new facility is located within 
 59.35  three miles of the site of the old facility.  Operating and 
 59.36  property costs for the new facility must be determined and 
 60.1   allowed under section 256B.431 or 256B.434; 
 60.2      (k) to license and certify up to 20 new nursing home beds 
 60.3   in a community-operated hospital and attached convalescent and 
 60.4   nursing care facility with 40 beds on April 21, 1991, that 
 60.5   suspended operation of the hospital in April 1986.  The 
 60.6   commissioner of human services shall provide the facility with 
 60.7   the same per diem property-related payment rate for each 
 60.8   additional licensed and certified bed as it will receive for its 
 60.9   existing 40 beds; 
 60.10     (l) to license or certify beds in renovation, replacement, 
 60.11  or upgrading projects as defined in section 144A.073, 
 60.12  subdivision 1, so long as the cumulative total costs of the 
 60.13  facility's remodeling projects do not 
 60.14  exceed ~~$750,000~~ $1,000,000; 
 60.15     (m) to license and certify beds that are moved from one 
 60.16  location to another for the purposes of converting up to five 
 60.17  four-bed wards to single or double occupancy rooms in a nursing 
 60.18  home that, as of January 1, 1993, was county-owned and had a 
 60.19  licensed capacity of 115 beds; 
 60.20     (n) to allow a facility that on April 16, 1993, was a 
 60.21  106-bed licensed and certified nursing facility located in 
 60.22  Minneapolis to layaway all of its licensed and certified nursing 
 60.23  home beds.  These beds may be relicensed and recertified in a 
 60.24  newly-constructed teaching nursing home facility affiliated with 
 60.25  a teaching hospital upon approval by the legislature.  The 
 60.26  proposal must be developed in consultation with the interagency 
 60.27  committee on long-term care planning.  The beds on layaway 
 60.28  status shall have the same status as voluntarily delicensed and 
 60.29  decertified beds, except that beds on layaway status remain 
 60.30  subject to the surcharge in section 256.9657.  This layaway 
 60.31  provision expires July 1, 1998; 
 60.32     (o) to allow a project which will be completed in 
 60.33  conjunction with an approved moratorium exception project for a 
 60.34  nursing home in southern Cass county and which is directly 
 60.35  related to that portion of the facility that must be repaired, 
 60.36  renovated, or replaced, to correct an emergency plumbing problem 
 61.1   for which a state correction order has been issued and which 
 61.2   must be corrected by August 31, 1993; 
 61.3      (p) to allow a facility that on April 16, 1993, was a 
 61.4   368-bed licensed and certified nursing facility located in 
 61.5   Minneapolis to layaway, upon 30 days prior written notice to the 
 61.6   commissioner, up to 30 of the facility's licensed and certified 
 61.7   beds by converting three-bed wards to single or double 
 61.8   occupancy.  Beds on layaway status shall have the same status as 
 61.9   voluntarily delicensed and decertified beds except that beds on 
 61.10  layaway status remain subject to the surcharge in section 
 61.11  256.9657, remain subject to the license application and renewal 
 61.12  fees under section 144A.07 and shall be subject to a $100 per 
 61.13  bed reactivation fee.  In addition, at any time within three 
 61.14  years of the effective date of the layaway, the beds on layaway 
 61.15  status may be: 
 61.16     (1) relicensed and recertified upon relocation and 
 61.17  reactivation of some or all of the beds to an existing licensed 
 61.18  and certified facility or facilities located in Pine River, 
 61.19  Brainerd, or International Falls; provided that the total 
 61.20  project construction costs related to the relocation of beds 
 61.21  from layaway status for any facility receiving relocated beds 
 61.22  may not exceed the dollar threshold provided in subdivision 2 
 61.23  unless the construction project has been approved through the 
 61.24  moratorium exception process under section 144A.073; 
 61.25     (2) relicensed and recertified, upon reactivation of some 
 61.26  or all of the beds within the facility which placed the beds in 
 61.27  layaway status, if the commissioner has determined a need for 
 61.28  the reactivation of the beds on layaway status. 
 61.29     The property-related payment rate of a facility placing 
 61.30  beds on layaway status must be adjusted by the incremental 
 61.31  change in its rental per diem after recalculating the rental per 
 61.32  diem as provided in section 256B.431, subdivision 3a, paragraph 
 61.33  (c).  The property-related payment rate for a facility 
 61.34  relicensing and recertifying beds from layaway status must be 
 61.35  adjusted by the incremental change in its rental per diem after 
 61.36  recalculating its rental per diem using the number of beds after 
 62.1   the relicensing to establish the facility's capacity day 
 62.2   divisor, which shall be effective the first day of the month 
 62.3   following the month in which the relicensing and recertification 
 62.4   became effective.  Any beds remaining on layaway status more 
 62.5   than three years after the date the layaway status became 
 62.6   effective must be removed from layaway status and immediately 
 62.7   delicensed and decertified; 
 62.8      (q) to license and certify beds in a renovation and 
 62.9   remodeling project to convert 12 four-bed wards into 24 two-bed 
 62.10  rooms, expand space, and add improvements in a nursing home 
 62.11  that, as of January 1, 1994, met the following conditions:  the 
 62.12  nursing home was located in Ramsey county; had a licensed 
 62.13  capacity of 154 beds; and had been ranked among the top 15 
 62.14  applicants by the 1993 moratorium exceptions advisory review 
 62.15  panel.  The total project construction cost estimate for this 
 62.16  project must not exceed the cost estimate submitted in 
 62.17  connection with the 1993 moratorium exception process; 
 62.18     (r) to license and certify up to 117 beds that are 
 62.19  relocated from a licensed and certified 138-bed nursing facility 
 62.20  located in St. Paul to a hospital with 130 licensed hospital 
 62.21  beds located in South St. Paul, provided that the nursing 
 62.22  facility and hospital are owned by the same or a related 
 62.23  organization and that prior to the date the relocation is 
 62.24  completed the hospital ceases operation of its inpatient 
 62.25  hospital services at that hospital.  After relocation, the 
 62.26  nursing facility's status under section 256B.431, subdivision 
 62.27  2j, shall be the same as it was prior to relocation.  The 
 62.28  nursing facility's property-related payment rate resulting from 
 62.29  the project authorized in this paragraph shall become effective 
 62.30  no earlier than April 1, 1996.  For purposes of calculating the 
 62.31  incremental change in the facility's rental per diem resulting 
 62.32  from this project, the allowable appraised value of the nursing 
 62.33  facility portion of the existing health care facility physical 
 62.34  plant prior to the renovation and relocation may not exceed 
 62.35  $2,490,000; 
 62.36     (s) to license and certify two beds in a facility to 
 63.1   replace beds that were voluntarily delicensed and decertified on 
 63.2   June 28, 1991; 
 63.3      (t) to allow 16 licensed and certified beds located on July 
 63.4   1, 1994, in a 142-bed nursing home and 21-bed boarding care home 
 63.5   facility in Minneapolis, notwithstanding the licensure and 
 63.6   certification after July 1, 1995, of the Minneapolis facility as 
 63.7   a 147-bed nursing home facility after completion of a 
 63.8   construction project approved in 1993 under section 144A.073, to 
 63.9   be laid away upon 30 days' prior written notice to the 
 63.10  commissioner.  Beds on layaway status shall have the same status 
 63.11  as voluntarily delicensed or decertified beds except that they 
 63.12  shall remain subject to the surcharge in section 256.9657.  The 
 63.13  16 beds on layaway status may be relicensed as nursing home beds 
 63.14  and recertified at any time within five years of the effective 
 63.15  date of the layaway upon relocation of some or all of the beds 
 63.16  to a licensed and certified facility located in Watertown, 
 63.17  provided that the total project construction costs related to 
 63.18  the relocation of beds from layaway status for the Watertown 
 63.19  facility may not exceed the dollar threshold provided in 
 63.20  subdivision 2 unless the construction project has been approved 
 63.21  through the moratorium exception process under section 144A.073. 
 63.22     The property-related payment rate of the facility placing 
 63.23  beds on layaway status must be adjusted by the incremental 
 63.24  change in its rental per diem after recalculating the rental per 
 63.25  diem as provided in section 256B.431, subdivision 3a, paragraph 
 63.26  (c).  The property-related payment rate for the facility 
 63.27  relicensing and recertifying beds from layaway status must be 
 63.28  adjusted by the incremental change in its rental per diem after 
 63.29  recalculating its rental per diem using the number of beds after 
 63.30  the relicensing to establish the facility's capacity day 
 63.31  divisor, which shall be effective the first day of the month 
 63.32  following the month in which the relicensing and recertification 
 63.33  became effective.  Any beds remaining on layaway status more 
 63.34  than five years after the date the layaway status became 
 63.35  effective must be removed from layaway status and immediately 
 63.36  delicensed and decertified; 
 64.1      (u) to license and certify beds that are moved within an 
 64.2   existing area of a facility or to a newly constructed addition 
 64.3   which is built for the purpose of eliminating three- and 
 64.4   four-bed rooms and adding space for dining, lounge areas, 
 64.5   bathing rooms, and ancillary service areas in a nursing home 
 64.6   that, as of January 1, 1995, was located in Fridley and had a 
 64.7   licensed capacity of 129 beds; 
 64.8      (v) to relocate 36 beds in Crow Wing county and four beds 
 64.9   from Hennepin county to a 160-bed facility in Crow Wing county, 
 64.10  provided all the affected beds are under common ownership; 
 64.11     (w) to license and certify a total replacement project of 
 64.12  up to 49 beds located in Norman county that are relocated from a 
 64.13  nursing home destroyed by flood and whose residents were 
 64.14  relocated to other nursing homes.  The operating cost payment 
 64.15  rates for the new nursing facility shall be determined based on 
 64.16  the interim and settle-up payment provisions of Minnesota Rules, 
 64.17  part 9549.0057, and the reimbursement provisions of section 
 64.18  256B.431, except that subdivision 26, paragraphs (a) and (b), 
 64.19  shall not apply until the second rate year after the settle-up 
 64.20  cost report is filed.  Property-related reimbursement rates 
 64.21  shall be determined under section 256B.431, taking into account 
 64.22  any federal or state flood-related loans or grants provided to 
 64.23  the facility; 
 64.24     (x) to license and certify a total replacement project of 
 64.25  up to 129 beds located in Polk county that are relocated from a 
 64.26  nursing home destroyed by flood and whose residents were 
 64.27  relocated to other nursing homes.  The operating cost payment 
 64.28  rates for the new nursing facility shall be determined based on 
 64.29  the interim and settle-up payment provisions of Minnesota Rules, 
 64.30  part 9549.0057, and the reimbursement provisions of section 
 64.31  256B.431, except that subdivision 26, paragraphs (a) and (b), 
 64.32  shall not apply until the second rate year after the settle-up 
 64.33  cost report is filed.  Property-related reimbursement rates 
 64.34  shall be determined under section 256B.431, taking into account 
 64.35  any federal or state flood-related loans or grants provided to 
 64.36  the facility; 
 65.1      (y) to license and certify beds in a renovation and 
 65.2   remodeling project to convert 13 three-bed wards into 13 two-bed 
 65.3   rooms and 13 single-bed rooms, expand space, and add 
 65.4   improvements in a nursing home that, as of January 1, 1994, met 
 65.5   the following conditions:  the nursing home was located in 
 65.6   Ramsey county, was not owned by a hospital corporation, had a 
 65.7   licensed capacity of 64 beds, and had been ranked among the top 
 65.8   15 applicants by the 1993 moratorium exceptions advisory review 
 65.9   panel.  The total project construction cost estimate for this 
 65.10  project must not exceed the cost estimate submitted in 
 65.11  connection with the 1993 moratorium exception process; 
 65.12     (z) to license and certify up to 150 nursing home beds to 
 65.13  replace an existing 285 bed nursing facility located in St. 
 65.14  Paul.  The replacement project shall include both the renovation 
 65.15  of existing buildings and the construction of new facilities at 
 65.16  the existing site.  The reduction in the licensed capacity of 
 65.17  the existing facility shall occur during the construction 
 65.18  project as beds are taken out of service due to the construction 
 65.19  process.  Prior to the start of the construction process, the 
 65.20  facility shall provide written information to the commissioner 
 65.21  of health describing the process for bed reduction, plans for 
 65.22  the relocation of residents, and the estimated construction 
 65.23  schedule.  The relocation of residents shall be in accordance 
 65.24  with the provisions of law and rule; 
 65.25     (aa) to allow the commissioner of human services to license 
 65.26  an additional 36 beds to provide residential services for the 
 65.27  physically handicapped under Minnesota Rules, parts 9570.2000 to 
 65.28  9570.3400, in a 198-bed nursing home located in Red Wing, 
 65.29  provided that the total number of licensed and certified beds at 
 65.30  the facility does not increase; 
 65.31     (bb) to license and certify a new facility in St. Louis 
 65.32  county with 44 beds constructed to replace an existing facility 
 65.33  in St. Louis county with 31 beds, which has resident rooms on 
 65.34  two separate floors and an antiquated elevator that creates 
 65.35  safety concerns for residents and prevents nonambulatory 
 65.36  residents from residing on the second floor.  The project shall 
 66.1   include the elimination of three- and four-bed rooms; 
 66.2      (cc) to license and certify four beds in a 16-bed certified 
 66.3   boarding care home in Minneapolis to replace beds that were 
 66.4   voluntarily delicensed and decertified on or before March 31, 
 66.5   1992.  The licensure and certification is conditional upon the 
 66.6   facility periodically assessing and adjusting its resident mix 
 66.7   and other factors which may contribute to a potential 
 66.8   institution for mental disease declaration.  The commissioner of 
 66.9   human services shall retain the authority to audit the facility 
 66.10  at any time and shall require the facility to comply with any 
 66.11  requirements necessary to prevent an institution for mental 
 66.12  disease declaration, including delicensure and decertification 
 66.13  of beds, if necessary; ~~or~~ 
 66.14     (dd) to license and certify 72 beds in an existing facility 
 66.15  in Mille Lacs county with 80 beds as part of a renovation 
 66.16  project.  The renovation must include construction of an 
 66.17  addition to accommodate ten residents with beginning and 
 66.18  midstage dementia in a self-contained living unit; creation of 
 66.19  three resident households where dining, activities, and support 
 66.20  spaces are located near resident living quarters; designation of 
 66.21  four beds for rehabilitation in a self-contained area; 
 66.22  designation of 30 private rooms; and other improvements; or 
 66.23     (ee) to license and certify beds in a facility that has 
 66.24  undergone remodeling as part of a planned closure under section 
 66.25  256B.437. 
 66.26     Sec. 6.  Minnesota Statutes 2000, section 144A.073, 
 66.27  subdivision 2, is amended to read: 
 66.28     Subd. 2.  [REQUEST FOR PROPOSALS.] At the authorization by 
 66.29  the legislature of additional medical assistance expenditures 
 66.30  for exceptions to the moratorium on nursing homes, the 
 66.31  interagency committee shall publish in the State Register a 
 66.32  request for proposals for nursing home projects to be licensed 
 66.33  or certified under section 144A.071, subdivision 4a, clause 
 66.34  (c).  The public notice of this funding and the request for 
 66.35  proposals must specify how the approval criteria will be 
 66.36  prioritized by the advisory review panel, the interagency 
 67.1   long-term care planning committee, and the commissioner.  The 
 67.2   notice must describe the information that must accompany a 
 67.3   request and state that proposals must be submitted to the 
 67.4   interagency committee within 90 days of the date of 
 67.5   publication.  The notice must include the amount of the 
 67.6   legislative appropriation available for the additional costs to 
 67.7   the medical assistance program of projects approved under this 
 67.8   section.  If no money is appropriated for a year, the 
 67.9   interagency committee shall publish a notice to that effect, and 
 67.10  no proposals shall be requested.  If money is appropriated, the 
 67.11  interagency committee shall initiate the application and review 
 67.12  process described in this section at least twice each biennium 
 67.13  and up to four times each biennium, according to dates 
 67.14  established by rule.  Authorized funds shall be allocated 
 67.15  proportionally to the number of processes.  Funds not encumbered 
 67.16  by an earlier process within a biennium shall carry forward to 
 67.17  subsequent iterations of the process.  ~~Authorization for~~ 
 67.18  ~~expenditures does not carry forward into the following~~ 
 67.19  ~~biennium.~~  To be considered for approval, a proposal must 
 67.20  include the following information: 
 67.21     (1) whether the request is for renovation, replacement, 
 67.22  upgrading, conversion, or relocation; 
 67.23     (2) a description of the problem the project is designed to 
 67.24  address; 
 67.25     (3) a description of the proposed project; 
 67.26     (4) an analysis of projected costs of the nursing facility 
 67.27  proposal, which are not required to exceed the cost threshold 
 67.28  referred to in section 144A.071, subdivision 1, to be considered 
 67.29  under this section, including initial construction and 
 67.30  remodeling costs; site preparation costs; technology costs; 
 67.31  financing costs, including the current estimated long-term 
 67.32  financing costs of the proposal, which consists of estimates of 
 67.33  the amount and sources of money, reserves if required under the 
 67.34  proposed funding mechanism, annual payments schedule, interest 
 67.35  rates, length of term, closing costs and fees, insurance costs, 
 67.36  and any completed marketing study or underwriting review; and 
 68.1   estimated operating costs during the first two years after 
 68.2   completion of the project; 
 68.3      (5) for proposals involving replacement of all or part of a 
 68.4   facility, the proposed location of the replacement facility and 
 68.5   an estimate of the cost of addressing the problem through 
 68.6   renovation; 
 68.7      (6) for proposals involving renovation, an estimate of the 
 68.8   cost of addressing the problem through replacement; 
 68.9      (7) the proposed timetable for commencing construction and 
 68.10  completing the project; 
 68.11     (8) a statement of any licensure or certification issues, 
 68.12  such as certification survey deficiencies; 
 68.13     (9) the proposed relocation plan for current residents if 
 68.14  beds are to be closed so that the department of human services 
 68.15  can estimate the total costs of a proposal; and 
 68.16     (10) other information required by permanent rule of the 
 68.17  commissioner of health in accordance with subdivisions 4 and 8. 
 68.18     Sec. 7.  Minnesota Statutes 2000, section 144A.073, 
 68.19  subdivision 4, is amended to read: 
 68.20     Subd. 4.  [CRITERIA FOR REVIEW.] The following criteria 
 68.21  shall be used in a consistent manner to compare, evaluate, and 
 68.22  rank all proposals submitted.  Except for the criteria specified 
 68.23  in clause (3), the application of criteria listed under this 
 68.24  subdivision shall not reflect any distinction based on the 
 68.25  geographic location of the proposed project: 
 68.26     (1) the extent to which the proposal furthers state 
 68.27  long-term care goals, ~~including the goals stated in section~~ 
 68.28  ~~144A.31, and~~ including the goal of enhancing the availability 
 68.29  and use of alternative care services and the goal of reducing 
 68.30  the number of long-term care resident rooms with more than two 
 68.31  beds; 
 68.32     (2) the proposal's long-term effects on state costs 
 68.33  including the cost estimate of the project according to section 
 68.34  144A.071, subdivision 5a; 
 68.35     (3) the extent to which the proposal promotes equitable 
 68.36  access to long-term care services in nursing homes through 
 69.1   redistribution of the nursing home bed supply, as measured by 
 69.2   the number of beds relative to the population 85 or older, 
 69.3   projected to the year 2000 by the state demographer, and 
 69.4   according to items (i) to (iv): 
 69.5      (i) reduce beds in counties where the supply is high, 
 69.6   relative to the statewide mean, and increase beds in counties 
 69.7   where the supply is low, relative to the statewide mean; 
 69.8      (ii) adjust the bed supply so as to create the greatest 
 69.9   benefits in improving the distribution of beds; 
 69.10     (iii) adjust the existing bed supply in counties so that 
 69.11  the bed supply in a county moves toward the statewide mean; and 
 69.12     (iv) adjust the existing bed supply so that the 
 69.13  distribution of beds as projected for the year 2020 would be 
 69.14  consistent with projected need, based on the methodology 
 69.15  outlined in the interagency long-term care committee's ~~1993~~ 
 69.16  nursing home bed distribution study; 
 69.17     (4) the extent to which the project improves conditions 
 69.18  that affect the health or safety of residents, such as narrow 
 69.19  corridors, narrow door frames, unenclosed fire exits, and wood 
 69.20  frame construction, and similar provisions contained in fire and 
 69.21  life safety codes and licensure and certification rules; 
 69.22     (5) the extent to which the project improves conditions 
 69.23  that affect the comfort or quality of life of residents in a 
 69.24  facility or the ability of the facility to provide efficient 
 69.25  care, such as a relatively high number of residents in a room; 
 69.26  inadequate lighting or ventilation; poor access to bathing or 
 69.27  toilet facilities; a lack of available ancillary space for 
 69.28  dining rooms, day rooms, or rooms used for other activities; 
 69.29  problems relating to heating, cooling, or energy efficiency; 
 69.30  inefficient location of nursing stations; narrow corridors; or 
 69.31  other provisions contained in the licensure and certification 
 69.32  rules; 
 69.33     (6) the extent to which the applicant demonstrates the 
 69.34  delivery of quality care, as defined in state and federal 
 69.35  statutes and rules, to residents as evidenced by the two most 
 69.36  recent state agency certification surveys and the applicants' 
 70.1   response to those surveys; 
 70.2      (7) the extent to which the project removes the need for 
 70.3   waivers or variances previously granted by either the licensing 
 70.4   agency, certifying agency, fire marshal, or local government 
 70.5   entity; ~~and~~ 
 70.6      (8) the extent to which the project increases the number of 
 70.7   private or single bed rooms; and 
 70.8      (9) other factors that may be developed in permanent rule 
 70.9   by the commissioner of health that evaluate and assess how the 
 70.10  proposed project will further promote or protect the health, 
 70.11  safety, comfort, treatment, or well-being of the facility's 
 70.12  residents. 
 70.13     Sec. 8.  Minnesota Statutes 2000, section 144A.073, is 
 70.14  amended by adding a subdivision to read: 
 70.15     Subd. 9a.  [CARRYFORWARD.] Funds appropriated for the 
 70.16  nursing home moratorium exception process that are not 
 70.17  authorized or have expired or are unused by the end of the 
 70.18  biennium are carried forward to the next biennium. 
 70.19     Sec. 9.  Minnesota Statutes 2000, section 144A.16, is 
 70.20  amended to read: 
 70.21     144A.16 [CESSATION OF OPERATIONS.] 
 70.22     If a nursing home voluntarily plans to cease operations or 
 70.23  to curtail operations to the extent that relocation of residents 
 70.24  is necessary, the controlling persons of the facility shall 
 70.25  notify the commissioner of health at least 90 days prior to the 
 70.26  scheduled cessation or curtailment.  ~~The commissioner of health~~ 
 70.27  ~~shall cooperate with and advise the controlling persons of the~~ 
 70.28  ~~nursing home in the resettlement of residents.~~  The commissioner 
 70.29  of health shall notify the commissioner of human services of a 
 70.30  nursing home's intention to cease or curtail operations.  
 70.31  Failure to comply with this section shall be a violation of 
 70.32  section 144A.10. 
 70.33     Sec. 10.  [144A.185] [DEFINITIONS.] 
 70.34     Subdivision 1.  [APPLICABILITY.] For purposes of sections 
 70.35  144A.185 to 144A.1889, the terms defined in this section have 
 70.36  the meanings given them.  
 71.1      Subd. 2.  [CLOSURE.] "Closure" means the cessation of 
 71.2   operations of a nursing home and the delicensure or 
 71.3   decertification of all beds within the facility.  
 71.4      Subd. 3.  [CURTAILMENT, REDUCTION, OR CHANGE IN 
 71.5   OPERATIONS.] "Curtailment, reduction, or change in operations" 
 71.6   means any change in operations or services that would result in 
 71.7   or encourage the relocation of residents. 
 71.8      Subd. 4.  [FACILITY.] "Facility" means a licensed nursing 
 71.9   home or a certified boarding care home licensed according to 
 71.10  sections 144.50 to 144.56. 
 71.11     Subd. 5.  [LICENSEE.] "Licensee" means the owner of the 
 71.12  facility or the owner's designee or the commissioner of health 
 71.13  for a facility in receivership. 
 71.14     Subd. 6.  [LOCAL AGENCY.] "Local agency" means a county or 
 71.15  a multicounty social service agency authorized under section 
 71.16  393.01 as the agency responsible for providing social services.  
 71.17     Subd. 7.  [PLAN.] "Plan" means a process that has been 
 71.18  agreed upon by the parties identified in section 144A.1855, 
 71.19  subdivision 1, for the closure or curtailment, reduction, or 
 71.20  change in operations of a facility and for the subsequent 
 71.21  discharge or transfer of residents.  
 71.22     Subd. 8.  [RELOCATION.] "Relocation" means the discharge of 
 71.23  a resident and movement of the resident to another facility or 
 71.24  living arrangement as a result of a closure or curtailment, 
 71.25  reduction, or change in operations of a facility. 
 71.26     Subd. 9.  [TRANSFER.] "Transfer" means the movement of a 
 71.27  resident within a nursing facility from one assigned room to 
 71.28  another. 
 71.29     Sec. 11.  [144A.1852] [APPLICABILITY.] 
 71.30     Subdivision 1.  [FUNDING MUST BE AVAILABLE.] Sections 
 71.31  144A.185 to 144A.1889 apply only when funding is made available 
 71.32  by an appropriation of the legislature. 
 71.33     Subd. 2.  [COORDINATION WITH OTHER LAW.] The relocation 
 71.34  plan required under section 144A.186, subdivision 2, must be 
 71.35  completed before a nursing home gives notice to the commissioner 
 71.36  of health under section 144A.16.  
 72.1      Sec. 12.  [144A.1855] [INITIAL NOTICE.] 
 72.2      Subdivision 1.  [NOTIFICATION; PARTIES.] A licensee shall 
 72.3   notify the following parties in writing when there is an intent 
 72.4   to close or curtail, reduce, or change operations:  
 72.5      (1) the commissioner of health; 
 72.6      (2) the commissioner of human services; 
 72.7      (3) the local agency; 
 72.8      (4) the office of the ombudsman for older Minnesotans; and 
 72.9      (5) the office of the ombudsman for mental health and 
 72.10  mental retardation.  
 72.11     Subd. 2.  [NOTICE REQUIREMENTS.] The written notice shall 
 72.12  include the names, telephone numbers, fax numbers, and e-mail 
 72.13  addresses of the persons in the facility who are responsible for 
 72.14  coordinating the facility's efforts in the planning process and 
 72.15  the number of residents potentially affected by the closure or 
 72.16  curtailment, reduction, or change in operations.  
 72.17     Sec. 13.  [144A.186] [PLANNING PROCESS.] 
 72.18     Subdivision 1.  [LOCAL AGENCY REQUIREMENTS.] (a) A local 
 72.19  agency, within five working days of receiving an initial notice 
 72.20  from a licensee according to section 144A.1855, shall provide 
 72.21  all parties identified in section 144A.1855, subdivision 1, with 
 72.22  the names, telephone numbers, fax numbers, and e-mail addresses 
 72.23  of those persons who are responsible for coordinating local 
 72.24  agency efforts in the planning process. 
 72.25     (b) Within ten working days of receipt of the notice under 
 72.26  paragraph (a), the local agency and licensee shall convene a 
 72.27  meeting with representatives from the departments of health and 
 72.28  human services, the office of the ombudsman for older 
 72.29  Minnesotans, and the office of the ombudsman for mental health 
 72.30  and mental retardation to develop the relocation plan under 
 72.31  subdivision 2.  The relocation plan must be completed within 45 
 72.32  days. 
 72.33     Subd. 2.  [RELOCATION PLAN.] (a) The plan shall: 
 72.34     (1) identify the expected date of closure or curtailment, 
 72.35  reduction, or change in operations; 
 72.36     (2) outline the process for public notification of the 
 73.1   closure or curtailment, reduction, or change in operations; 
 73.2      (3) outline the process to ensure 60-day advance written 
 73.3   notice to residents, family members, and designated 
 73.4   representatives of residents; 
 73.5      (4) present an aggregate description of the resident 
 73.6   population remaining to be transferred or relocated and the 
 73.7   population's needs; 
 73.8      (5) outline the individual resident assessment process to 
 73.9   be used; 
 73.10     (6) identify an inventory of available transfer or 
 73.11  relocation options, including home and community-based services; 
 73.12     (7) identify a timeline for submission of the list required 
 73.13  under section 144A.1865, subdivision 3; 
 73.14     (8) identify a schedule for each element of the plan; and 
 73.15     (9) estimate the relocation costs to the local agency and 
 73.16  the licensee.  
 73.17     (b) All parties to the plan shall refrain from any public 
 73.18  notification of the intent to close or curtail, reduce, or 
 73.19  change operations until a relocation plan has been established.  
 73.20     Sec. 14.  [144A.1865] [REQUIREMENTS OF LICENSEE.] 
 73.21     Subdivision 1.  [TRANSFER AND RELOCATION.] The licensee 
 73.22  shall provide for the safe, orderly, and appropriate transfer 
 73.23  and relocation of residents.  The licensee and facility staff 
 73.24  shall cooperate with representatives from the local agency, the 
 73.25  departments of health and human services, the office of the 
 73.26  ombudsman for older Minnesotans, and the office of the ombudsman 
 73.27  for mental health and mental retardation in planning for and 
 73.28  implementing the transfer or relocation of residents.  
 73.29     Subd. 2.  [INTERDISCIPLINARY TEAM.] The licensee shall 
 73.30  establish an interdisciplinary team responsible for coordinating 
 73.31  and implementing the plan under section 144A.186, subdivision 
 73.32  2.  The interdisciplinary team shall include representatives 
 73.33  from the local agency, the office of the ombudsman for older 
 73.34  Minnesotans, facility staff who provide direct care services to 
 73.35  the residents, and the facility administration.  
 73.36     Subd. 3.  [RESIDENT LISTS.] The licensee shall provide a 
 74.1   list to the local agency that includes the following information 
 74.2   on each resident to be transferred or relocated:  
 74.3      (1) name; 
 74.4      (2) date of birth; 
 74.5      (3) social security number; 
 74.6      (4) medical assistance ID number; 
 74.7      (5) all diagnoses; and 
 74.8      (6) name of and contact information for the resident's 
 74.9   family or other designated representative.  
 74.10     Subd. 4.  [CONSULTATION WITH LOCAL AGENCY.] The licensee 
 74.11  shall consult with the local agency on the availability and 
 74.12  development of resources and in the resident transfer or 
 74.13  relocation process.  
 74.14     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 74.15  following final enactment. 
 74.16     Sec. 15.  [144A.187] [RESIDENT AND PHYSICIAN NOTICE.] 
 74.17     Subdivision 1.  [RESIDENT NOTICE REQUIRED.] (a) At least 60 
 74.18  days before the proposed date of closure or curtailment, 
 74.19  reduction, or change in operations as agreed to in the plan 
 74.20  under section 144A.186, the licensee shall send a written notice 
 74.21  of closure or curtailment, reduction, or change in operations to 
 74.22  each resident being transferred or relocated, the resident's 
 74.23  family member or designated representative, and the resident's 
 74.24  attending physician. 
 74.25     (b) The notice must include: 
 74.26     (1) the date of the proposed closure or curtailment, 
 74.27  reduction, or change in operations; 
 74.28     (2) the name, address, telephone number, fax number, and 
 74.29  e-mail address of the individuals in the facility responsible 
 74.30  for providing assistance and information; 
 74.31     (3) a notice of upcoming meetings for residents, families, 
 74.32  designated representatives, and resident councils to discuss the 
 74.33  transfer or relocation of residents; 
 74.34     (4) the name, address, and telephone number of the local 
 74.35  agency contact person; 
 74.36     (5) the name, address, and telephone number of the office 
 75.1   of the ombudsman for older Minnesotans and the office of the 
 75.2   ombudsman for mental health and mental retardation; and 
 75.3      (6) a notice of resident rights during transfer and 
 75.4   relocation. 
 75.5      (c) The notice to residents must comply with all applicable 
 75.6   state and federal requirements for notice of transfer or 
 75.7   discharge of nursing home residents.  
 75.8      Subd. 2.  [MEDICAL INFORMATION REQUEST.] The licensee shall 
 75.9   request the attending physician to furnish the licensee with, or 
 75.10  arrange for the release of, any medical information needed to 
 75.11  update a resident's medical records and to prepare transfer 
 75.12  forms and discharge summaries.  
 75.13     Sec. 16.  [144A.1875] [RELOCATION OF RESIDENTS.] 
 75.14     Subdivision 1.  [PREPARATION; PLACEMENT INFORMATION.] A 
 75.15  licensee shall provide sufficient preparation to residents to 
 75.16  ensure safe, orderly, and appropriate discharge and relocation.  
 75.17  The facility is responsible for assisting residents in finding 
 75.18  placement within the resident's desired geographic location 
 75.19  using the Senior LinkAge database of the department of human 
 75.20  services.  The list from Senior LinkAge must contain the name, 
 75.21  address, and telephone and fax numbers of each facility with 
 75.22  available beds, the certification level of the available beds, 
 75.23  the types of services available, and the number of beds that are 
 75.24  available.  The list must include home and community-based 
 75.25  placements, services and settings, and other options for 
 75.26  individuals with special needs.  The list must be made available 
 75.27  to residents, their families or designated representatives, the 
 75.28  office of the ombudsman for older Minnesotans, the office of the 
 75.29  ombudsman for mental health and mental retardation, and the 
 75.30  local agency.  
 75.31     Subd. 2.  [RESIDENT AND FAMILY MEETINGS.] After preparing 
 75.32  the plan according to section 144A.186, the licensee shall 
 75.33  conduct meetings with residents, families, designated 
 75.34  representatives, and resident and family councils to notify them 
 75.35  of the process for resident transfer or relocation.  
 75.36  Representatives from the local agency, the office of the 
 76.1   ombudsman for older Minnesotans, and the office of the ombudsman 
 76.2   for mental health and mental retardation shall receive advance 
 76.3   notice of these meetings. 
 76.4      Subd. 3.  [PERSONAL PROPERTY.] (a) The licensee shall 
 76.5   update the inventory of residents' personal possessions and 
 76.6   provide a copy of the final inventory to each resident and the 
 76.7   resident's family or designated representative prior to the 
 76.8   relocation of the resident.  The licensee is responsible for the 
 76.9   timely transfer of a resident's possessions for all relocations 
 76.10  within the state and within a 50-mile radius of the facility for 
 76.11  relocations outside the state. 
 76.12     (b) The licensee shall complete a final accounting of 
 76.13  personal funds held in trust by the licensee and provide a copy 
 76.14  of the accounting to each resident and the resident's family or 
 76.15  designated representative.  The licensee is responsible for the 
 76.16  timely transfer of all personal funds held in trust by the 
 76.17  licensee. 
 76.18     Subd. 4.  [SITE VISITS.] The licensee is responsible for 
 76.19  assisting residents in making site visits to facilities or other 
 76.20  placements to which the resident may be relocated, unless it is 
 76.21  medically inadvisable, as documented by the attending physician 
 76.22  in the resident's care record.  The licensee shall provide 
 76.23  transportation for site visits to facilities or other placements 
 76.24  within a 50-mile radius. 
 76.25     Subd. 5.  [FINAL NOTICE OF RELOCATION.] (a) Before 
 76.26  relocating a resident, the licensee shall provide a final 
 76.27  written notice to the resident, the resident's family or 
 76.28  designated representative, and the resident's attending 
 76.29  physician. 
 76.30     (b) The final written notice shall: 
 76.31     (1) be provided seven days before the relocation of a 
 76.32  resident, unless the resident agrees to waive the resident's 
 76.33  right to advance notice; and 
 76.34     (2) identify the date of the anticipated relocation and the 
 76.35  location to which the resident is being transferred.  
 76.36     Subd. 6.  [ADMINISTRATIVE DUTIES.] (a) All administrative 
 77.1   duties of the licensee under subdivisions 1, 2, 4, and 5 must be 
 77.2   completed before relocation of a resident.  
 77.3      (b) The licensee is responsible for providing the receiving 
 77.4   facility or other health, housing, or care entity with a 
 77.5   complete and accurate resident record, including information on 
 77.6   family members, designated representatives, guardians, social 
 77.7   service caseworkers, and other contact information.  The record 
 77.8   must also include all information necessary to provide 
 77.9   appropriate medical care and social services, including, but not 
 77.10  limited to, information on preadmission screening, Level I and 
 77.11  Level II screening, minimum data set and all other assessments, 
 77.12  resident diagnosis, behavior, and medication.  
 77.13     (c) For residents with special care needs, the licensee 
 77.14  shall consult with the receiving facility or other placement 
 77.15  entity and provide staff training or other preparation as needed 
 77.16  to assist in providing for the special needs.  
 77.17     (d) The licensee shall assist residents with the transfer 
 77.18  or reconnection of telephone service.  The licensee shall bear 
 77.19  all costs associated with reestablishing telephone service.  
 77.20     Subd. 7.  [TRANSPORTATION; CONTINUITY OF CARE.] The 
 77.21  licensee shall make arrangements or provide for the 
 77.22  transportation of residents to the new facility or placement 
 77.23  within the state or within a 50-mile radius for relocations 
 77.24  outside the state.  The licensee shall provide a staff person to 
 77.25  accompany the resident during transportation, upon request of 
 77.26  the resident, the resident's family, or designated 
 77.27  representative.  The discharge and relocation of residents must 
 77.28  comply with all applicable state and federal requirements and 
 77.29  must be conducted in a safe, orderly, and appropriate manner.  
 77.30  The licensee must ensure that there is no disruption in 
 77.31  providing meals, medications, or treatments of a resident during 
 77.32  the relocation process.  
 77.33     Sec. 17.  [144A.188] [TRANSFER OF RESIDENTS.] 
 77.34     (a) The licensee shall provide for the safe, orderly, and 
 77.35  appropriate transfer of residents.  The licensee and facility 
 77.36  staff shall cooperate with representatives from the local 
 78.1   agency, the departments of health and human services, the office 
 78.2   of the ombudsman for older Minnesotans, and the office of the 
 78.3   ombudsman for mental health and mental retardation in planning 
 78.4   for and implementing the transfer of residents when a change in 
 78.5   facility operation could result in or encourage multiple 
 78.6   intrafacility transfers of individual residents.  
 78.7      (b) The licensee shall comply with all provisions of 
 78.8   sections 144A.1865; 144A.187, subdivision 1; and 144A.1875, 
 78.9   subdivision 2, applicable to residents being transferred.  
 78.10     Sec. 18.  [144A.1885] [RELOCATION REPORTS.] 
 78.11     (a) Beginning the week following development of the initial 
 78.12  relocation plan under section 144A.186, the licensee shall 
 78.13  submit weekly status reports to the commissioners of health and 
 78.14  human services and to the local agency. 
 78.15     (b) The first status report must identify the relocation 
 78.16  plan developed under section 144A.186, the interdisciplinary 
 78.17  team members, and the number of residents to be relocated.  
 78.18     (c) Subsequent status reports must note any modifications 
 78.19  to the relocation plan, any change of interdisciplinary team 
 78.20  members or number of residents relocated, the placement 
 78.21  destination to which residents have been relocated, and the 
 78.22  number of residents remaining to be relocated.  Subsequent 
 78.23  status reports must also identify issues or problems encountered 
 78.24  during the relocation process and the resolution of these issues.
 78.25     Sec. 19.  [144A.1886] [REQUIREMENTS OF LOCAL AGENCY.] 
 78.26     Subdivision 1.  [MEETING; REPRESENTATION.] (a) The local 
 78.27  agency with the licensee shall convene a meeting to develop a 
 78.28  plan according to section 144A.186, subdivision 1, paragraph (b).
 78.29     (b) The local agency shall designate a representative to 
 78.30  the interdisciplinary team established by the licensee 
 78.31  responsible for coordinating the relocation efforts.  
 78.32     Subd. 2.  [RESOURCE.] (a) The local agency shall serve as a 
 78.33  resource in the transfer or relocation process.  
 78.34     (b) Concurrent with the notice sent to residents from the 
 78.35  licensee according to section 144A.187, subdivision 1, the local 
 78.36  agency shall provide written notice to residents, family 
 79.1   members, and designated representatives describing: 
 79.2      (1) the local agency's role in the transfer or relocation 
 79.3   process and in the follow-up to relocation; 
 79.4      (2) a local agency contact name, address, and telephone 
 79.5   number; and 
 79.6      (3) the name, address, and telephone number of the office 
 79.7   of the ombudsman for older Minnesotans and the office of the 
 79.8   ombudsman for mental health and mental retardation.  
 79.9      (c) The local agency is responsible for the safe and 
 79.10  orderly relocation of residents in cases where an emergent need 
 79.11  arises or when the licensee has abrogated the licensee's 
 79.12  responsibilities under the relocation plan.  
 79.13     Subd. 3.  [COORDINATION; OVERSIGHT.] (a) The local agency 
 79.14  shall meet with appropriate facility staff to coordinate any 
 79.15  assistance.  Coordination shall include participating in group 
 79.16  meetings with residents, family members, and designated 
 79.17  representatives to explain the transfer or relocation process.  
 79.18     (b) The local agency shall monitor compliance with all 
 79.19  components of the relocation plan.  When the licensee is not in 
 79.20  compliance, the local agency shall notify the commissioners of 
 79.21  health and human services.  
 79.22     (c) Except as requested by the resident, family member, or 
 79.23  designated representative and within the parameters of the 
 79.24  Vulnerable Adults Act, the local agency may halt a relocation 
 79.25  that it deems inappropriate or dangerous to the health or safety 
 79.26  of a resident. 
 79.27     Subd. 4.  [FOLLOW-UP REVIEW.] (a) A member of the local 
 79.28  agency staff shall visit residents within 30 days after a 
 79.29  transfer or relocation.  Local agency staff shall interview the 
 79.30  resident and family member or designated representative or shall 
 79.31  observe the resident on-site, or both, and review and discuss 
 79.32  pertinent medical or social records with appropriate facility 
 79.33  staff to assess the adjustment of the resident to the new 
 79.34  placement, recommend services or methods to meet any special 
 79.35  needs of the resident, and identify residents at risk.  
 79.36     (b) The local agency may conduct subsequent follow-up 
 80.1   visits in cases where the adjustment of the resident to the new 
 80.2   placement is in question.  
 80.3      (c) Within 60 days of the completion of the follow-up 
 80.4   visits, the local agency shall submit a written summary of the 
 80.5   follow-up work to the commissioners of health and human 
 80.6   services, in a manner approved by the commissioners.  
 80.7      (d) The local agency shall submit a report of any issues 
 80.8   that may require further review or monitoring to the 
 80.9   commissioner of health. 
 80.10     Sec. 20.  [144A.1887] [FUNDING.] 
 80.11     (a) Within 60 days of a nursing home ceasing operations, 
 80.12  the commissioner of human services shall reimburse nursing homes 
 80.13  that are reimbursed under sections 256B.431, 256B.434, and 
 80.14  256B.435 for operating costs incurred by the nursing home during 
 80.15  the closure process.  The amount to be reimbursed to the nursing 
 80.16  home shall be determined by applying paragraphs (b) to (f). 
 80.17     (b) The facility shall provide the commissioner of human 
 80.18  services with the nursing home's operating costs for the time 
 80.19  period of 30 days prior to the notice specified under section 
 80.20  144A.16, to 30 days after the nursing home's closure. 
 80.21     (c) The nursing home shall provide the commissioner of 
 80.22  human services with the number of medical assistance, Medicare, 
 80.23  private pay, and other resident days for the period referenced 
 80.24  in paragraph (b) by the 11 case mix categories. 
 80.25     (d) The commissioner of human services shall calculate a 
 80.26  nursing home closure rate by dividing the facility operating 
 80.27  costs in paragraph (b) by the total resident days in paragraph 
 80.28  (c). 
 80.29     (e) The total closure costs attributable to medical 
 80.30  assistance shall be determined by multiplying the nursing home 
 80.31  closure rate in paragraph (d) by the medical assistance days 
 80.32  provided by the nursing facility in paragraph (c). 
 80.33     (f) The amount to be reimbursed to the nursing home is 
 80.34  equal to the total closure costs in paragraph (e) minus the sum 
 80.35  of the nursing facility's 11 operating rates times their 
 80.36  respective number of medical assistance days by case mix as 
 81.1   referenced in paragraph (c). 
 81.2      Sec. 21.  [144A.36] [TRANSITION PLANNING GRANTS.] 
 81.3      Subdivision 1.  [DEFINITIONS.] "Eligible nursing home" 
 81.4   means any nursing home licensed under sections 144A.01 to 
 81.5   144A.16 and certified by the appropriate authority under United 
 81.6   States Code, title 42, sections 1396-1396p, to participate as a 
 81.7   vendor in the medical assistance program established under 
 81.8   chapter 256B. 
 81.9      Subd. 2.  [GRANTS AUTHORIZED.] (a) The commissioner shall 
 81.10  establish a program of transition planning grants to assist 
 81.11  eligible nursing homes in implementing the provisions in 
 81.12  paragraphs (b) to (d).  
 81.13     (b) Transition planning grants may be used by nursing homes 
 81.14  to develop strategic plans which identify the appropriate 
 81.15  institutional and noninstitutional settings necessary to meet 
 81.16  the older adult service needs of the community.  
 81.17     (c) At a minimum, a strategic plan must consist of: 
 81.18     (1) a needs assessment to determine what older adult 
 81.19  services are needed and desired by the community; 
 81.20     (2) an assessment of the appropriate settings in which to 
 81.21  provide needed older adult services; 
 81.22     (3) an assessment identifying currently available services 
 81.23  and their settings in the community; and 
 81.24     (4) a transition plan to achieve the needed outcome 
 81.25  identified by the assessment. 
 81.26     Subd. 3.  [ALLOCATION OF GRANTS.] (a) Eligible nursing 
 81.27  homes must apply to the commissioner no later than September 1 
 81.28  of each fiscal year for grants awarded in that fiscal year.  A 
 81.29  grant shall be awarded upon signing of a grant contract. 
 81.30     (b) The commissioner must make a final decision on the 
 81.31  funding of each application within 60 days of the deadline for 
 81.32  receiving applications. 
 81.33     Subd. 4.  [EVALUATION.] The commissioner shall evaluate the 
 81.34  overall effectiveness of the grant program.  The commissioner 
 81.35  may collect, from the nursing homes receiving grants, the 
 81.36  information necessary to evaluate the grant program.  
 82.1   Information related to the financial condition of individual 
 82.2   nursing homes shall be classified as nonpublic data. 
 82.3      Sec. 22.  [144A.37] [ALTERNATIVE NURSING HOME SURVEY 
 82.4   PROCESS.] 
 82.5      Subdivision 1.  [ALTERNATIVE NURSING HOME SURVEY 
 82.6   SCHEDULES.] (a) The commissioner of health shall implement 
 82.7   alternative procedures for the nursing home survey process as 
 82.8   authorized under this section.  
 82.9      (b) These alternative survey process procedures seek to:  
 82.10  (1) use department resources more effectively and efficiently to 
 82.11  target problem areas; (2) use other existing or new mechanisms 
 82.12  to provide objective assessments of quality and to measure 
 82.13  quality improvement; (3) provide for frequent collaborative 
 82.14  interaction of facility staff and surveyors rather than a 
 82.15  punitive approach; and (4) reward a nursing home that has 
 82.16  performed very well by extending intervals between full surveys. 
 82.17     (c) The commissioner shall pursue changes in federal law 
 82.18  necessary to accomplish this process and shall apply for any 
 82.19  necessary federal waivers or approval.  If a federal waiver is 
 82.20  required, the commissioner shall submit a formal waiver request 
 82.21  no later than June 15, 2001.  The commissioner shall also pursue 
 82.22  any necessary federal law changes during the 107th Congress. 
 82.23     (d) The alternative nursing home survey schedule shall be 
 82.24  implemented January 1, 2002, or upon federal approval. 
 82.25     Subd. 2.  [SURVEY INTERVALS.] The commissioner of health 
 82.26  must extend the time period between standard surveys up to 30 
 82.27  months based on the criteria established in subdivision 4.  In 
 82.28  using the alternative survey schedule, the requirement for the 
 82.29  statewide average to not exceed 12 months does not apply. 
 82.30     Subd. 3.  [COMPLIANCE HISTORY.] The commissioner shall 
 82.31  develop a process for identifying the survey cycles for skilled 
 82.32  nursing facilities based upon the compliance history of the 
 82.33  facility.  This process can use a range of months for survey 
 82.34  intervals.  At a minimum, the process must be based on 
 82.35  information from the last two survey cycles and shall take into 
 82.36  consideration any deficiencies issued as the result of a survey 
 83.1   or a complaint investigation during the interval.  A skilled 
 83.2   nursing facility with a finding of substandard quality of care 
 83.3   or a finding of immediate jeopardy is not entitled to a survey 
 83.4   interval greater than 12 months.  The commissioner shall alter 
 83.5   the survey cycle for a specific skilled nursing facility based 
 83.6   on findings identified through the completion of a survey, a 
 83.7   monitoring visit, or a complaint investigation.  The 
 83.8   commissioner must also take into consideration information other 
 83.9   than the facility's compliance history. 
 83.10     Subd. 4.  [CRITERIA FOR SURVEY INTERVAL 
 83.11  CLASSIFICATION.] (a) The commissioner shall provide public 
 83.12  notice of the classification process and shall identify the 
 83.13  selected survey cycles for each skilled nursing facility.  The 
 83.14  classification system must be based on an analysis of the 
 83.15  findings made during the past two standard survey intervals, but 
 83.16  it only takes one survey or complaint finding to modify the 
 83.17  interval. 
 83.18     (b) The commissioner shall also take into consideration 
 83.19  information obtained from residents and family members in each 
 83.20  skilled nursing facility and from other sources such as 
 83.21  employees and ombudsmen in determining the appropriate survey 
 83.22  intervals for facilities. 
 83.23     Subd. 5.  [REQUIRED MONITORING.] (a) The commissioner shall 
 83.24  conduct at least one monitoring visit on an annual basis for 
 83.25  every skilled nursing facility which has been selected for a 
 83.26  survey cycle greater than 12 months.  The commissioner shall 
 83.27  develop protocols for the monitoring visits which shall be less 
 83.28  extensive than the requirements for a standard survey.  The 
 83.29  commissioner shall use the criteria in paragraph (b) to 
 83.30  determine whether additional monitoring visits to a facility 
 83.31  will be required.  
 83.32     (b) The criteria shall include, but not be limited to, the 
 83.33  following: 
 83.34     (1) changes in ownership, administration of the facility, 
 83.35  or direction of the facility's nursing service; 
 83.36     (2) changes in the facility's quality indicators which 
 84.1   might evidence a decline in the facility's quality of care; 
 84.2      (3) reductions in staffing or an increase in the 
 84.3   utilization of temporary nursing personnel; and 
 84.4      (4) complaint information or other information that 
 84.5   identifies potential concerns for the quality of the care and 
 84.6   services provided in the skilled nursing facility. 
 84.7      Subd. 6.  [SURVEY REQUIREMENTS FOR FACILITIES NOT APPROVED 
 84.8   FOR EXTENDED SURVEY INTERVALS.] The commissioner shall establish 
 84.9   a process for surveying and monitoring of facilities which 
 84.10  require a survey interval of less than 15 months.  This 
 84.11  information shall identify the steps that the commissioner must 
 84.12  take to monitor the facility in addition to the standard survey. 
 84.13     Subd. 7.  [IMPACT ON SURVEY AGENCY'S BUDGET.] The 
 84.14  implementation of an alternative survey process for the state 
 84.15  must not result in any reduction of funding that would have been 
 84.16  provided to the state survey agency for survey and enforcement 
 84.17  activity based upon the completion of full standard surveys for 
 84.18  each skilled nursing facility in the state. 
 84.19     Subd. 8.  [EDUCATIONAL ACTIVITIES.] The commissioner shall 
 84.20  expand the state survey agency's ability to conduct training and 
 84.21  educational efforts for skilled nursing facilities, residents 
 84.22  and family members, residents and family councils, long-term 
 84.23  care ombudsman programs, and the general public. 
 84.24     Subd. 9.  [EVALUATION.] The commissioner shall develop a 
 84.25  process for the evaluation of the effectiveness of an 
 84.26  alternative survey process conducted under this section. 
 84.27     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 84.28  following final enactment. 
 84.29     Sec. 23.  [144A.38] [INNOVATIONS IN QUALITY DEMONSTRATION 
 84.30  GRANTS.] 
 84.31     Subdivision 1.  [PROGRAM ESTABLISHED.] The commissioner of 
 84.32  health and the commissioner of human services shall establish a 
 84.33  long-term care grant program that demonstrates best practices 
 84.34  and innovation for long-term care service delivery and housing.  
 84.35  The grants must fund demonstrations that create new means and 
 84.36  models for serving the elderly or demonstrate creativity in 
 85.1   service provision through the scope of their program or service. 
 85.2      Subd. 2.  [ELIGIBILITY.] Grants may only be made to those 
 85.3   who provide direct service or housing to the elderly within the 
 85.4   state.  Grants may only be made for projects that show 
 85.5   innovations and measurable improvement in resident care, quality 
 85.6   of life, use of technology, or customer satisfaction. 
 85.7      Subd. 3.  [AWARDING OF GRANTS.] (a) Applications for grants 
 85.8   must be made to the commissioner on forms prescribed by the 
 85.9   commissioner. 
 85.10     (b) The commissioner shall review applications and award 
 85.11  grants based on the following criteria: 
 85.12     (1) improvement in direct care to residents; 
 85.13     (2) increase in efficiency through the use of technology; 
 85.14     (3) increase in quality of care through the use of 
 85.15  technology; 
 85.16     (4) increase in the access and delivery of service; 
 85.17     (5) enhancement of nursing staff training; 
 85.18     (6) the effectiveness of the project as a demonstration; 
 85.19  and 
 85.20     (7) the immediate transferability of the project to scale. 
 85.21     (c) In reviewing applications and awarding grants, the 
 85.22  commissioner shall consult with long-term care providers, 
 85.23  consumers of long-term care, long-term care researchers, and 
 85.24  staff of other state agencies. 
 85.25     (d) Grants for eligible projects may not exceed $100,000. 
 85.26     Sec. 24.  [144A.39] [LONG-TERM CARE QUALITY PROFILES.] 
 85.27     Subdivision l.  [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 
 85.28  PROFILES.] (a) The commissioner of health and the commissioner 
 85.29  of human services shall develop and implement a quality profile 
 85.30  system for nursing facilities and, beginning not later than July 
 85.31  1, 2003, other providers of long-term care services, except when 
 85.32  the quality profile system would duplicate requirements under 
 85.33  sections 256B.5011 and 256B.5013.  The system must be developed 
 85.34  and implemented to the extent possible without the collection of 
 85.35  significant amounts of new data.  The system must be designed to 
 85.36  provide information on quality: 
 86.1      (1) to consumers and their families to facilitate informed 
 86.2   choices of service providers; 
 86.3      (2) to providers to enable them to measure the results of 
 86.4   their quality improvement efforts and compare quality 
 86.5   achievements with other service providers; and 
 86.6      (3) to public and private purchasers of long-term care 
 86.7   services to enable them to purchase high-quality care. 
 86.8      (b) The system must be developed in consultation with the 
 86.9   long-term care task force and representatives of consumers, 
 86.10  providers, and labor unions.  Within the limits of available 
 86.11  appropriations, the commissioner may employ consultants to 
 86.12  assist with this project. 
 86.13     Subd. 2.  [QUALITY MEASUREMENT TOOLS.] The commissioners 
 86.14  shall identify and apply existing quality measurement tools to: 
 86.15     (1) emphasize quality of care and its relationship to 
 86.16  quality of life; and 
 86.17     (2) address the needs of various users of long-term care 
 86.18  services, including, but not limited to, short-stay residents, 
 86.19  persons with behavioral problems, persons with dementia, and 
 86.20  persons who are members of minority groups. 
 86.21  The tools must be identified and applied, to the extent 
 86.22  possible, without requiring providers to supply information 
 86.23  beyond current state and federal requirements. 
 86.24     Subd. 3.  [CONSUMER SURVEYS.] Following identification of 
 86.25  the quality measurement tool, the commissioners shall conduct 
 86.26  surveys of long-term care service consumers to develop quality 
 86.27  profiles of providers.  To the extent possible, surveys must be 
 86.28  conducted face-to-face by state employees or contractors.  At 
 86.29  the discretion of the commissioners, surveys may be conducted by 
 86.30  telephone or by provider staff.  Surveys must be conducted 
 86.31  periodically to update quality profiles of individual service 
 86.32  providers. 
 86.33     Subd. 4.  [DISSEMINATION OF QUALITY PROFILES.] By July 1, 
 86.34  2002, the commissioners shall implement a system to disseminate 
 86.35  the quality profiles developed from consumer surveys using the 
 86.36  quality measurement tool.  Profiles must be disseminated to the 
 87.1   Senior LinkAge line and to consumers, providers, and purchasers 
 87.2   of long-term care services through all feasible printed and 
 87.3   electronic outlets.  The commissioners shall conduct a public 
 87.4   awareness campaign to inform potential users regarding profile 
 87.5   contents and potential uses. 
 87.6      Sec. 25.  Minnesota Statutes 2000, section 256B.431, 
 87.7   subdivision 2e, is amended to read: 
 87.8      Subd. 2e.  [CONTRACTS FOR SERVICES FOR VENTILATOR DEPENDENT 
 87.9   PERSONS.] The commissioner may contract with a nursing facility 
 87.10  eligible to receive medical assistance payments to provide 
 87.11  services to a ventilator-dependent person identified by the 
 87.12  commissioner according to criteria developed by the 
 87.13  commissioner, including:  
 87.14     (1) nursing facility care has been recommended for the 
 87.15  person by a preadmission screening team; 
 87.16     (2) ~~the person has been assessed at case mix classification~~ 
 87.17  ~~K;~~ 
 87.18     ~~(3)~~ the person has been hospitalized ~~for at least six~~ 
 87.19  ~~months~~ and no longer requires inpatient acute care hospital 
 87.20  services; and 
 87.21     ~~(4)~~ (3) the commissioner has determined that necessary 
 87.22  services for the person cannot be provided under existing 
 87.23  nursing facility rates.  
 87.24     The commissioner may issue a request for proposals to 
 87.25  provide services to a ventilator-dependent person to nursing 
 87.26  facilities eligible to receive medical assistance payments and 
 87.27  shall select nursing facilities from among respondents according 
 87.28  to criteria developed by the commissioner, including:  
 87.29     (1) the cost-effectiveness and appropriateness of services; 
 87.30     (2) the nursing facility's compliance with federal and 
 87.31  state licensing and certification standards; and 
 87.32     (3) the proximity of the nursing facility to a 
 87.33  ventilator-dependent person identified by the commissioner who 
 87.34  requires nursing facility placement.  
 87.35     The commissioner may negotiate an adjustment to the 
 87.36  operating cost payment rate for a nursing facility selected by 
 88.1   the commissioner from among respondents to the request for 
 88.2   proposals.  The negotiated adjustment must reflect only the 
 88.3   actual additional cost of meeting the specialized care needs of 
 88.4   a ventilator-dependent person identified by the commissioner for 
 88.5   whom necessary services cannot be provided under existing 
 88.6   nursing facility rates and which are not otherwise covered under 
 88.7   Minnesota Rules, parts 9549.0010 to 9549.0080 or 9505.0170 to 
 88.8   9505.0475.  For persons initially admitted to a nursing facility 
 88.9   before July 1, 2001, the negotiated payment rate must not exceed 
 88.10  200 percent of the highest multiple bedroom payment rate for ~~a~~ 
 88.11  ~~Minnesota nursing~~ the facility, as initially established by the 
 88.12  commissioner for the rate year for case mix classification K.  
 88.13  For persons initially admitted to a nursing facility on or after 
 88.14  July 1, 2001, the negotiated payment rate must not exceed 300 
 88.15  percent of the facility's multiple bedroom payment rate for case 
 88.16  mix classification K.  The negotiated adjustment shall not 
 88.17  affect the payment rate charged to private paying residents 
 88.18  under the provisions of section 256B.48, subdivision 1.  
 88.19     Sec. 26.  Minnesota Statutes 2000, section 256B.431, 
 88.20  subdivision 17, is amended to read: 
 88.21     Subd. 17.  [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.] 
 88.22  (a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3, 
 88.23  for rate periods beginning on October 1, 1992, and for rate 
 88.24  years beginning after June 30, 1993, a nursing facility that (1) 
 88.25  has completed a construction project approved under section 
 88.26  144A.071, subdivision 4a, clause (m); (2) has completed a 
 88.27  construction project approved under section 144A.071, 
 88.28  subdivision 4a, and effective after June 30, 1995; or (3) has 
 88.29  completed a renovation, replacement, or upgrading project 
 88.30  approved under the moratorium exception process in section 
 88.31  144A.073 shall be reimbursed for costs directly identified to 
 88.32  that project as provided in subdivision 16 and this subdivision. 
 88.33     (b) Notwithstanding Minnesota Rules, part 9549.0060, 
 88.34  subparts 5, item A, subitems (1) and (3), and 7, item D, 
 88.35  allowable interest expense on debt shall include: 
 88.36     (1) interest expense on debt related to the cost of 
 89.1   purchasing or replacing depreciable equipment, excluding 
 89.2   vehicles, not to exceed six percent of the total historical cost 
 89.3   of the project; and 
 89.4      (2) interest expense on debt related to financing or 
 89.5   refinancing costs, including costs related to points, loan 
 89.6   origination fees, financing charges, legal fees, and title 
 89.7   searches; and issuance costs including bond discounts, bond 
 89.8   counsel, underwriter's counsel, corporate counsel, printing, and 
 89.9   financial forecasts.  Allowable debt related to items in this 
 89.10  clause shall not exceed seven percent of the total historical 
 89.11  cost of the project.  To the extent these costs are financed, 
 89.12  the straight-line amortization of the costs in this clause is 
 89.13  not an allowable cost; and 
 89.14     (3) interest on debt incurred for the establishment of a 
 89.15  debt reserve fund, net of the interest earned on the debt 
 89.16  reserve fund. 
 89.17     (c) Debt incurred for costs under paragraph (b) is not 
 89.18  subject to Minnesota Rules, part 9549.0060, subpart 5, item A, 
 89.19  subitem (5) or (6). 
 89.20     (d) The incremental increase in a nursing facility's rental 
 89.21  rate, determined under Minnesota Rules, parts 9549.0010 to 
 89.22  9549.0080, and this section, resulting from the acquisition of 
 89.23  allowable capital assets, and allowable debt and interest 
 89.24  expense under this subdivision shall be added to its 
 89.25  property-related payment rate and shall be effective on the 
 89.26  first day of the month following the month in which the 
 89.27  moratorium project was completed. 
 89.28     (e) Notwithstanding subdivision 3f, paragraph (a), for rate 
 89.29  periods beginning on October 1, 1992, and for rate years 
 89.30  beginning after June 30, 1993, the replacement-costs-new per bed 
 89.31  limit to be used in Minnesota Rules, part 9549.0060, subpart 4, 
 89.32  item B, for a nursing facility that has completed a renovation, 
 89.33  replacement, or upgrading project that has been approved under 
 89.34  the moratorium exception process in section 144A.073, or that 
 89.35  has completed an addition to or replacement of buildings, 
 89.36  attached fixtures, or land improvements for which the total 
 90.1   historical cost exceeds the lesser of $150,000 or ten percent of 
 90.2   the most recent appraised value, must be $47,500 per licensed 
 90.3   bed in multiple-bed rooms and $71,250 per licensed bed in a 
 90.4   single-bed room.  These amounts must be adjusted annually as 
 90.5   specified in subdivision 3f, paragraph (a), beginning January 1, 
 90.6   1993. 
 90.7      (f) For purposes of this paragraph, a total replacement 
 90.8   means the complete replacement of the nursing facility's 
 90.9   physical plant through the construction of a new physical plant, 
 90.10  the transfer of the nursing facility's license from one physical 
 90.11  plant location to another, or a new building addition to 
 90.12  relocate beds from three- and four-bed wards.  For total 
 90.13  replacement projects completed on or after July 1, 1992, the 
 90.14  commissioner shall compute the incremental change in the nursing 
 90.15  facility's rental per diem, for rate years beginning on or after 
 90.16  July 1, 1995, by replacing its appraised value, including the 
 90.17  historical capital asset costs, and the capital debt and 
 90.18  interest costs with the new nursing facility's allowable capital 
 90.19  asset costs and the related allowable capital debt and interest 
 90.20  costs.  If the new nursing facility has decreased its licensed 
 90.21  capacity, the aggregate investment per bed limit in subdivision 
 90.22  3a, paragraph (c), shall apply.  If the new nursing facility has 
 90.23  retained a portion of the original physical plant for nursing 
 90.24  facility usage, then a portion of the appraised value prior to 
 90.25  the replacement must be retained and included in the calculation 
 90.26  of the incremental change in the nursing facility's rental per 
 90.27  diem.  For purposes of this part, the original nursing facility 
 90.28  means the nursing facility prior to the total replacement 
 90.29  project.  The portion of the appraised value to be retained 
 90.30  shall be calculated according to clauses (1) to (3): 
 90.31     (1) The numerator of the allocation ratio shall be the 
 90.32  square footage of the area in the original physical plant which 
 90.33  is being retained for nursing facility usage. 
 90.34     (2) The denominator of the allocation ratio shall be the 
 90.35  total square footage of the original nursing facility physical 
 90.36  plant. 
 91.1      (3) Each component of the nursing facility's allowable 
 91.2   appraised value prior to the total replacement project shall be 
 91.3   multiplied by the allocation ratio developed by dividing clause 
 91.4   (1) by clause (2). 
 91.5      In the case of either type of total replacement as 
 91.6   authorized under section 144A.071 or 144A.073, the provisions of 
 91.7   this subdivision shall also apply.  For purposes of the 
 91.8   moratorium exception authorized under section 144A.071, 
 91.9   subdivision 4a, paragraph (s), if the total replacement involves 
 91.10  the renovation and use of an existing health care facility 
 91.11  physical plant, the new allowable capital asset costs and 
 91.12  related debt and interest costs shall include first the 
 91.13  allowable capital asset costs and related debt and interest 
 91.14  costs of the renovation, to which shall be added the allowable 
 91.15  capital asset costs of the existing physical plant prior to the 
 91.16  renovation, and if reported by the facility, the related 
 91.17  allowable capital debt and interest costs. 
 91.18     (g) Notwithstanding Minnesota Rules, part 9549.0060, 
 91.19  subpart 11, item C, subitem (2), for a total replacement, as 
 91.20  defined in paragraph (f), authorized under section 144A.071 or 
 91.21  144A.073 after July 1, 1999, or any building project that is a 
 91.22  relocation, renovation, upgrading, or conversion ~~authorized~~ 
 91.23  ~~under section 144A.073,~~ complete on or after July 1, 2001, the 
 91.24  replacement-costs-new per bed limit shall be $74,280 per 
 91.25  licensed bed in multiple-bed rooms, $92,850 per licensed bed in 
 91.26  semiprivate rooms with a fixed partition separating the resident 
 91.27  beds, and $111,420 per licensed bed in single rooms.  Minnesota 
 91.28  Rules, part 9549.0060, subpart 11, item C, subitem (2), does not 
 91.29  apply.  These amounts must be adjusted annually as specified in 
 91.30  subdivision 3f, paragraph (a), beginning January 1, 2000.  
 91.31     (h) For a total replacement, as defined in paragraph (f), 
 91.32  authorized under section 144A.073 for a 96-bed nursing home in 
 91.33  Carlton county, the replacement-costs-new per bed limit shall be 
 91.34  $74,280 per licensed bed in multiple-bed rooms, $92,850 per 
 91.35  licensed bed in semiprivate rooms with a fixed partition 
 91.36  separating the resident's beds, and $111,420 per licensed bed in 
 92.1   a single room.  Minnesota Rules, part 9549.0060, subpart 11, 
 92.2   item C, subitem (2), does not apply.  The resulting maximum 
 92.3   allowable replacement-costs-new multiplied by 1.25 shall 
 92.4   constitute the project's dollar threshold for purposes of 
 92.5   application of the limit set forth in section 144A.071, 
 92.6   subdivision 2.  The commissioner of health may waive the 
 92.7   requirements of section 144A.073, subdivision 3b, paragraph (b), 
 92.8   clause (2), on the condition that the other requirements of that 
 92.9   paragraph are met. 
 92.10     (i) For a renovation authorized under section 144A.073 for 
 92.11  a 65-bed nursing home in St. Louis county, the incremental 
 92.12  increase in rental rate for purposes of paragraph (d) shall be 
 92.13  $8.16, and the total replacement cost, allowable appraised 
 92.14  value, allowable debt, and allowable interest shall be increased 
 92.15  according to the incremental increase. 
 92.16     (j) For a total replacement, as defined in paragraph (f), 
 92.17  authorized under section 144A.073 involving a new building 
 92.18  addition that relocates beds from three-bed wards for an 80-bed 
 92.19  nursing home in Redwood county, the replacement-costs-new per 
 92.20  bed limit shall be $74,280 per licensed bed for multiple-bed 
 92.21  rooms; $92,850 per licensed bed for semiprivate rooms with a 
 92.22  fixed partition separating the beds; and $111,420 per licensed 
 92.23  bed for single rooms.  These amounts shall be adjusted annually, 
 92.24  beginning January 1, 2001.  Minnesota Rules, part 9549.0060, 
 92.25  subpart 11, item C, subitem (2), does not apply.  The resulting 
 92.26  maximum allowable replacement-costs-new multiplied by 1.25 shall 
 92.27  constitute the project's dollar threshold for purposes of 
 92.28  application of the limit set forth in section 144A.071, 
 92.29  subdivision 2.  The commissioner of health may waive the 
 92.30  requirements of section 144A.073, subdivision 3b, paragraph (b), 
 92.31  clause (2), on the condition that the other requirements of that 
 92.32  paragraph are met. 
 92.33     Sec. 27.  Minnesota Statutes 2000, section 256B.431, is 
 92.34  amended by adding a subdivision to read: 
 92.35     Subd. 31.  [NURSING FACILITY RATE INCREASES BEGINNING JULY 
 92.36  1, 2001, AND JULY 1, 2002.] (a) For the rate years beginning 
 93.1   July 1, 2001, and July 1, 2002, the commissioner shall provide 
 93.2   each nursing facility reimbursed under this section or section 
 93.3   256B.434 with an adjustment to the total operating payment rates 
 93.4   in effect on June 30, 2001, and June 30, 2002, respectively, 
 93.5   after any increases required by section 256B.434, subdivision 
 93.6   4.  The operating payment rate in effect on June 30, 2001, must 
 93.7   include the adjustment in subdivision 2i, paragraph (c).  
 93.8      (b) The adjustment is calculated according to clauses (1) 
 93.9   to (4): 
 93.10     (1) the commissioner shall calculate the arithmetic mean of 
 93.11  all June 30, 2001, and June 30, 2002, operating rates for each 
 93.12  facility; 
 93.13     (2) the commissioner shall construct an array of nursing 
 93.14  facilities from highest to lowest according to the arithmetic 
 93.15  mean calculated in clause (1).  A numerical rank must be 
 93.16  assigned to each facility in the array.  The facility with the 
 93.17  highest mean must be assigned a numerical rank of one.  The 
 93.18  facility with the lowest mean must be assigned a numerical rank 
 93.19  equal to the total number of nursing facilities in the array.  
 93.20  All other facilities must be assigned a numerical rank according 
 93.21  to their position in the array; 
 93.22     (3) the amount of this rate increase for the rate year 
 93.23  beginning July 1, 2001, is $1 plus an amount equal to $6.11 
 93.24  multiplied by the ratio of the facility's numerical rank divided 
 93.25  by the number of facilities in the array; and 
 93.26     (4) the amount of this rate increase for the rate year 
 93.27  beginning July 1, 2002, is $1 plus an amount equal to $6.40 
 93.28  multiplied by the ratio of the facility's numerical rank divided 
 93.29  by the number of facilities in the array. 
 93.30     Sec. 28.  Minnesota Statutes 2000, section 256B.431, is 
 93.31  amended by adding a subdivision to read: 
 93.32     Subd. 32.  [ADDITIONAL INCREASES FOR LOW RATE 
 93.33  FACILITIES.] Before the calculation of the increases in 
 93.34  subdivision 31, the commissioner must provide for special 
 93.35  increases to facilities determined to be the lowest rate 
 93.36  facilities in the state.  The commissioner shall place all 
 94.1   nursing facilities under section 256B.431 or 256B.434 into one 
 94.2   of the state development regions designated under section 
 94.3   462.385.  Within each of the development regions, the 
 94.4   commissioner shall identify the median nursing facility rates by 
 94.5   case mix category.  Nursing home rates that are below the median 
 94.6   must be adjusted to the greater of their current rates or 98 
 94.7   percent of the region median.  Certified boarding care home 
 94.8   rates that are below the median must be adjusted to the greater 
 94.9   of their current rates or 90 percent of the region median. 
 94.10     Sec. 29.  Minnesota Statutes 2000, section 256B.434, 
 94.11  subdivision 4, is amended to read: 
 94.12     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
 94.13  nursing facilities which have their payment rates determined 
 94.14  under this section rather than section 256B.431, the 
 94.15  commissioner shall establish a rate under this subdivision.  The 
 94.16  nursing facility must enter into a written contract with the 
 94.17  commissioner. 
 94.18     (b) A nursing facility's case mix payment rate for the 
 94.19  first rate year of a facility's contract under this section is 
 94.20  the payment rate the facility would have received under section 
 94.21  256B.431. 
 94.22     (c) A nursing facility's case mix payment rates for the 
 94.23  second and subsequent years of a facility's contract under this 
 94.24  section are the previous rate year's contract payment rates plus 
 94.25  an inflation adjustment.  The index for the inflation adjustment 
 94.26  must be based on the change in the Consumer Price Index-All 
 94.27  Items (United States City average) (CPI-U) forecasted by Data 
 94.28  Resources, Inc., as forecasted in the fourth quarter of the 
 94.29  calendar year preceding the rate year.  The inflation adjustment 
 94.30  must be based on the 12-month period from the midpoint of the 
 94.31  previous rate year to the midpoint of the rate year for which 
 94.32  the rate is being determined.  For the rate years beginning on 
 94.33  July 1, 1999, ~~and~~ July 1, 2000, July 1, 2001, and July 1, 2002, 
 94.34  this paragraph shall apply only to the property-related payment 
 94.35  rate.  In determining the amount of the property-related payment 
 94.36  rate adjustment under this paragraph, the commissioner shall 
 95.1   determine the proportion of the facility's rates that are 
 95.2   property-related based on the facility's most recent cost report.
 95.3      (d) The commissioner shall develop additional 
 95.4   incentive-based payments of up to five percent above the 
 95.5   standard contract rate for achieving outcomes specified in each 
 95.6   contract.  The specified facility-specific outcomes must be 
 95.7   measurable and approved by the commissioner.  The commissioner 
 95.8   may establish, for each contract, various levels of achievement 
 95.9   within an outcome.  After the outcomes have been specified the 
 95.10  commissioner shall assign various levels of payment associated 
 95.11  with achieving the outcome.  Any incentive-based payment cancels 
 95.12  if there is a termination of the contract.  In establishing the 
 95.13  specified outcomes and related criteria the commissioner shall 
 95.14  consider the following state policy objectives: 
 95.15     (1) improved cost effectiveness and quality of life as 
 95.16  measured by improved clinical outcomes; 
 95.17     (2) successful diversion or discharge to community 
 95.18  alternatives; 
 95.19     (3) decreased acute care costs; 
 95.20     (4) improved consumer satisfaction; 
 95.21     (5) the achievement of quality; or 
 95.22     (6) any additional outcomes proposed by a nursing facility 
 95.23  that the commissioner finds desirable. 
 95.24     Sec. 30.  Minnesota Statutes 2000, section 256B.434, 
 95.25  subdivision 10, is amended to read: 
 95.26     Subd. 10.  [EXEMPTIONS.] (a) To the extent permitted by 
 95.27  federal law, (1) a facility that has entered into a contract 
 95.28  under this section is not required to file a cost report, as 
 95.29  defined in Minnesota Rules, part 9549.0020, subpart 13, for any 
 95.30  year after the base year that is the basis for the calculation 
 95.31  of the contract payment rate for the first rate year of the 
 95.32  alternative payment demonstration project contract; and (2) a 
 95.33  facility under contract is not subject to audits of historical 
 95.34  costs or revenues, or paybacks or retroactive adjustments based 
 95.35  on these costs or revenues, except audits, paybacks, or 
 95.36  adjustments relating to the cost report that is the basis for 
 96.1   calculation of the first rate year under the contract. 
 96.2      (b) ~~A facility that is under contract with the commissioner~~ 
 96.3   ~~under this section is not subject to the moratorium on licensure~~ 
 96.4   ~~or certification of new nursing home beds in section 144A.071,~~ 
 96.5   ~~unless the project results in a net increase in bed capacity or~~ 
 96.6   ~~involves relocation of beds from one site to another.  Contract~~ 
 96.7   ~~payment rates must not be adjusted to reflect any additional~~ 
 96.8   ~~costs that a nursing facility incurs as a result of a~~ 
 96.9   ~~construction project undertaken under this paragraph.  In~~ 
 96.10  ~~addition, as a condition of entering into a contract under this~~ 
 96.11  ~~section, a nursing facility must agree that any future medical~~ 
 96.12  ~~assistance payments for nursing facility services will not~~ 
 96.13  ~~reflect any additional costs attributable to the sale of a~~ 
 96.14  ~~nursing facility under this section and to construction~~ 
 96.15  ~~undertaken under this paragraph that otherwise would not be~~ 
 96.16  ~~authorized under the moratorium in section 144A.073.  Nothing in~~ 
 96.17  ~~this section prevents a nursing facility participating in the~~ 
 96.18  ~~alternative payment demonstration project under this section~~ 
 96.19  ~~from seeking approval of an exception to the moratorium through~~ 
 96.20  ~~the process established in section 144A.073, and if approved the~~ 
 96.21  ~~facility's rates shall be adjusted to reflect the cost of the~~ 
 96.22  ~~project.  Nothing in this section prevents a nursing facility~~ 
 96.23  ~~participating in the alternative payment demonstration project~~ 
 96.24  ~~from seeking legislative approval of an exception to the~~ 
 96.25  ~~moratorium under section 144A.071, and, if enacted, the~~ 
 96.26  ~~facility's rates shall be adjusted to reflect the cost of the~~ 
 96.27  ~~project.~~ 
 96.28     ~~(c)~~ Notwithstanding section 256B.48, subdivision 6, 
 96.29  paragraphs (c), (d), and (e), and pursuant to any terms and 
 96.30  conditions contained in the facility's contract, a nursing 
 96.31  facility that is under contract with the commissioner under this 
 96.32  section is in compliance with section 256B.48, subdivision 6, 
 96.33  paragraph (b), if the facility is Medicare certified. 
 96.34     ~~(d)~~ (c) Notwithstanding paragraph (a), if by April 1, 1996, 
 96.35  the health care financing administration has not approved a 
 96.36  required waiver, or the health care financing administration 
 97.1   otherwise requires cost reports to be filed prior to the 
 97.2   waiver's approval, the commissioner shall require a cost report 
 97.3   for the rate year. 
 97.4      ~~(e)~~ (d) A facility that is under contract with the 
 97.5   commissioner under this section shall be allowed to change 
 97.6   therapy arrangements from an unrelated vendor to a related 
 97.7   vendor during the term of the contract.  The commissioner may 
 97.8   develop reasonable requirements designed to prevent an increase 
 97.9   in therapy utilization for residents enrolled in the medical 
 97.10  assistance program. 
 97.11     Sec. 31.  [256B.4351] [CONSTRUCTION PROJECTS FOR 
 97.12  ALTERNATIVE PAYMENT SYSTEM NURSING FACILITIES.] 
 97.13     (a) Beginning July 1, 2001, facilities reimbursed under 
 97.14  section 256B.434 shall receive reimbursement for projects 
 97.15  completed on or after July 1, 2001, as provided in this section. 
 97.16     (b) Facilities reimbursed under section 256B.434 that 
 97.17  complete a project as defined in section 256B.431, subdivision 
 97.18  17, paragraph (e), shall receive an add-on to the total payment 
 97.19  rate as defined in Minnesota Rules, part 9549.0070, subpart 1. 
 97.20     (c) The department of human services shall use the 
 97.21  facility's most recently submitted cost report, project cost 
 97.22  information, and rate setting processes used for projects 
 97.23  defined in section 256B.431, subdivision 17, paragraph (e), to 
 97.24  calculate the rate add-on. 
 97.25     (d) For the rate year beginning July 1, 2001, the 
 97.26  replacement-cost-new per bed limit must be $59,570 per licensed 
 97.27  bed in multiple bedrooms and $89,354 per licensed bed in a 
 97.28  single bedroom.  The replacement-cost-new per bed limits must be 
 97.29  adjusted annually as specified in Minnesota Rules, part 
 97.30  9549.0060, subpart 4, item A, subitem (1), except that the index 
 97.31  that must be used is the Bureau of the Census:  Composite 
 97.32  Fixed-Weighted Price Index as published in the C30 Report, Value 
 97.33  of New Construction Put in Place plus ten percent. 
 97.34     Sec. 32.  [256B.4352] [PRIVATE ROOMS.] 
 97.35     Subdivision 1.  [FEDERAL WAIVER.] The commissioner of human 
 97.36  services shall apply for any necessary waiver of federal 
 98.1   Medicaid regulations or change in state plan to allow the state 
 98.2   to cover the payment for a private or single bed room for 
 98.3   medical assistance recipients, regardless of the medical 
 98.4   necessity status of the recipient. 
 98.5      Subd. 2.  [PRIVATE ROOM RATE.] Effective July 1, 2001, a 
 98.6   private room payment rate of 130 percent of the established 
 98.7   total payment rate for a resident must be allowed if the 
 98.8   resident is a medical assistance recipient, subject to any 
 98.9   limits determined under subdivision 1.  Nursing facilities are 
 98.10  prohibited from discharging residents in order to provide single 
 98.11  bed rooms.  Single bed rooms established through layaway under 
 98.12  section 144A.071 shall not receive rate adjustments under 
 98.13  section 256B.431, subdivision 30.  Single bed rooms established 
 98.14  through planned partial closure shall not receive rate 
 98.15  adjustments under section 256B.437, subdivision 3, paragraph (b).
 98.16     Sec. 33.  [256B.437] [NURSING FACILITY VOLUNTARY CLOSURES 
 98.17  AND PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.] 
 98.18     Subdivision 1.  [DEFINITIONS.] (a) The definitions in this 
 98.19  subdivision apply to subdivisions 2 to 9. 
 98.20     (b) "Closure" means the cessation of operations of a 
 98.21  nursing facility and delicensure and decertification of all beds 
 98.22  within the facility. 
 98.23     (c) "Commencement of closure" means the date on which the 
 98.24  commissioner of health is notified of a planned closure 
 98.25  according to section 144A.16 as part of an approved closure plan.
 98.26     (d) "Completion of closure" means the date on which the 
 98.27  final resident of the nursing facility or facilities designated 
 98.28  for closure in an approved closure plan is discharged from the 
 98.29  facility or facilities. 
 98.30     (e) "Closure plan" means a plan to close one or more 
 98.31  nursing facilities and reallocate the resulting savings to 
 98.32  provide special rate adjustments at other facilities. 
 98.33     (f) "Partial closure" means the delicensure and 
 98.34  decertification of a portion of the beds within the facility. 
 98.35     (g) "Planned closure rate adjustment" means an increase in 
 98.36  a nursing facility's operating rates under this section. 
 99.1      Subd. 2.  [REGIONAL LONG-TERM CARE PLANNING AND 
 99.2   DEVELOPMENT.] (a) The commissioner of human services shall 
 99.3   establish a process to adjust the capacity and distribution of 
 99.4   long-term care services to equalize the supply and demand for 
 99.5   different types of services.  The process must include community 
 99.6   and regional planning, expansion or establishment of needed 
 99.7   services, and voluntary nursing facility closures. 
 99.8      (b) The commissioner shall issue a request for proposals to 
 99.9   contract with regional long-term care planning groups.  Each 
 99.10  group must: 
 99.11     (1) consist of county health and social services agencies, 
 99.12  consumers, housing agencies, a representative of nursing 
 99.13  facilities, a representative of home and community-based 
 99.14  services providers, and area agencies on aging in the geographic 
 99.15  area; and 
 99.16     (2) serve an area that has at least 2,000 people who are 85 
 99.17  years of age or older. 
 99.18  In awarding contracts, the commissioner shall give preference to 
 99.19  groups that represent an entire area agency on aging region 
 99.20  where there is not already a planning and development group 
 99.21  established under section 256B.0917.  An area not included in a 
 99.22  proposal must be included in a group convened by the area agency 
 99.23  on aging of that planning and service area through a contract 
 99.24  negotiated by the commissioner. 
 99.25     (c) Each regional long-term care planning group shall: 
 99.26     (1) conduct a detailed assessment of the region's long-term 
 99.27  care services system.  This assessment must be completed within 
 99.28  90 days of the contract award and must evaluate the adequacy of 
 99.29  nursing facility beds and the impact of potential nursing 
 99.30  facility closures.  The commissioner of health and the 
 99.31  commissioner of human services, as appropriate, shall provide 
 99.32  data to the group on nursing facility bed distribution, 
 99.33  housing-with-service options, the closure of nursing facilities 
 99.34  in the planning area that occur outside of the planned closure 
 99.35  process, the approval of planned closures in the planning area, 
 99.36  the addition of new community long-term care services in the 
100.1   area, the closure of existing community long-term care services 
100.2   in the area, and other available data; 
100.3      (2) plan options for increasing community capacity to 
100.4   provide more home and community-based services to reduce 
100.5   reliance on nursing facility services; 
100.6      (3) respond to a notice from a nursing facility of its 
100.7   intent to propose voluntary bed closures under this section.  
100.8   This response must consist of reviewing, assessing, and 
100.9   providing recommendations to the commissioner of human services, 
100.10  the interagency long-term care planning committee, and the 
100.11  nursing facility about the impact of a nursing facility closure; 
100.12  and 
100.13     (4) develop community services alternatives to ensure that 
100.14  sufficient community-based services are available to meet demand.
100.15     Subd. 3.  [REQUEST FOR APPLICATIONS FOR PLANNED CLOSURE OF 
100.16  NURSING FACILITIES.] (a) By July 15, 2001, the commissioner of 
100.17  human services shall publish a request for applications for 
100.18  closure or partial closure of nursing facilities.  The request 
100.19  for applications must specify: 
100.20     (1) the criteria that will be used by the interagency 
100.21  long-term care planning committee established under section 
100.22  144A.31 and the commissioner to approve or reject applications; 
100.23     (2) a requirement for the submission of a letter of intent 
100.24  before the submission of an application; 
100.25     (3) the information that must accompany an application; 
100.26     (4) a schedule for letters of intent, applications, and 
100.27  consideration of applications for a minimum of four review 
100.28  processes to be conducted before June 30, 2003; and 
100.29     (5) that applications may combine planned closure rate 
100.30  adjustments with moratorium exception funding, in which case a 
100.31  single application may serve both purposes. 
100.32  Between October 1, 2001, and June 30, 2003, the commissioner may 
100.33  approve planned closures of up to 4,000 nursing facility beds, 
100.34  with no more than 2,000 approved for closure prior to July 1, 
100.35  2002. 
100.36     (b) A facility or facilities reimbursed under section 
101.1   256B.431, 256B.434, or 256B.435 with a closure plan approved by 
101.2   the commissioner under subdivision 6 may assign a planned 
101.3   closure rate adjustment to another facility that is not 
101.4   closing.  The planned closure rate adjustment must be calculated 
101.5   under subdivision 7.  A planned closure rate adjustment under 
101.6   this section is effective on the first day of the month 
101.7   following completion of closure of all facilities designated for 
101.8   closure in the application and becomes part of the nursing 
101.9   facility's total operating payment rate. 
101.10     Applicants may use the planned closure rate adjustment to 
101.11  allow for a property payment for a new nursing facility or an 
101.12  addition to an existing nursing facility.  Applications approved 
101.13  under this paragraph are exempt from other requirements for 
101.14  moratorium exceptions under section 144A.073, subdivisions 2 and 
101.15  3.  
101.16     (c) To be considered for approval, an application must 
101.17  include: 
101.18     (1) a description of the proposed closure plan, which must 
101.19  include identification of the facility or facilities to receive 
101.20  a planned closure rate adjustment and the amount and timing of a 
101.21  planned closure rate adjustment proposed for each facility; 
101.22     (2) the proposed timetable for any proposed closure, 
101.23  including the proposed dates for announcement to residents, 
101.24  commencement of closure, and completion of closure; 
101.25     (3) the proposed relocation plan for current residents of 
101.26  any facility designated for closure.  The proposed relocation 
101.27  plan must be designed to comply with all applicable state and 
101.28  federal statutes and regulations, including, but not limited to, 
101.29  section 144A.16 and Minnesota Rules, parts 4655.6810 to 
101.30  4655.6830, 4658.1600 to 4658.1690, and 9546.0010 to 9546.0060; 
101.31     (4) a description of the relationship between the nursing 
101.32  facility that is proposed for closure and the nursing facility 
101.33  or facilities proposed to receive the planned closure rate 
101.34  adjustment.  If these facilities are not under common ownership, 
101.35  copies of any contracts, purchase agreements, or other documents 
101.36  establishing a relationship or proposed relationship must be 
102.1   provided; 
102.2      (5) documentation, in a format approved by the 
102.3   commissioner, that all the nursing facilities receiving a 
102.4   planned closure rate adjustment under the plan have accepted 
102.5   joint and several liability for recovery of overpayments under 
102.6   section 256B.0641, subdivision 2, for the facilities designated 
102.7   for closure under the plan; and 
102.8      (6) a detailed plan developed by the facility submitting 
102.9   the application and by: 
102.10     (i) a regional long-term care planning group established 
102.11  under subdivision 2; 
102.12     (ii) a seniors' agenda for independent living (SAIL) 
102.13  project under section 256B.0917; or 
102.14     (iii) if a grantee under item (i) or (ii) has not been 
102.15  established, a group similar to the group described in 
102.16  subdivision 2 that is coordinated by the area agency on aging 
102.17  and is engaged in regional planning. 
102.18  The plan must address how services will be established or 
102.19  expanded in the community to meet the needs of people who 
102.20  require long-term care or demonstrate that adequate services are 
102.21  already available in the community. 
102.22     (d) The application must address the criteria listed in 
102.23  subdivision 4. 
102.24     Subd. 4.  [CRITERIA FOR REVIEW OF APPLICATION.] In 
102.25  reviewing and approving closure proposals, the commissioner of 
102.26  human services shall consider, but not be limited to, the 
102.27  following criteria: 
102.28     (1) improved quality of care and quality of life for 
102.29  consumers; 
102.30     (2) closure of a nursing facility that has a poor physical 
102.31  plant; 
102.32     (3) the existence of excess nursing facility beds, measured 
102.33  in terms of beds per thousand persons aged 85 or older.  The 
102.34  excess must be measured in reference to: 
102.35     (i) the county in which the facility is located; 
102.36     (ii) the county and all contiguous counties; 
103.1      (iii) the region in which the facility is located; or 
103.2      (iv) the facility's service area. 
103.3   The facility shall indicate in its proposal the area it believes 
103.4   is appropriate for this measurement.  A facility in a county 
103.5   that is in the lowest quartile of counties with reference to 
103.6   beds per thousand persons aged 85 or older is not in an area of 
103.7   excess capacity; 
103.8      (4) low-occupancy rates, provided that the unoccupied beds 
103.9   are not the result of a personnel shortage.  In analyzing 
103.10  occupancy rates, the commissioner shall examine waiting lists in 
103.11  the applicant facility and at facilities in the surrounding 
103.12  area, as determined under clause (3); 
103.13     (5) evidence of a community planning process to determine 
103.14  what services are needed and ensure that needed services are 
103.15  established; 
103.16     (6) innovative use of reinvestment funds; 
103.17     (7) innovative use planned for the closed facility's 
103.18  physical plant; 
103.19     (8) evidence that the proposal serves the interests of the 
103.20  state; and 
103.21     (9) evidence of other factors that affect the viability of 
103.22  the facility, including excessive nursing pool costs. 
103.23     Subd. 5.  [CERTIFICATION.] Upon receipt of an application 
103.24  for planned closure, the commissioner of human services shall 
103.25  provide a copy of the application to the commissioner of 
103.26  health.  The commissioner of health shall certify to the 
103.27  commissioner of human services within 30 days whether the 
103.28  application, if implemented, will satisfy the requirements of 
103.29  section 144A.16 and Minnesota Rules, parts 4655.6810 to 
103.30  4655.6830 and 4658.1600 to 4658.1690.  The commissioner of human 
103.31  services shall reject all applications for which the 
103.32  commissioner of health does not make the certification required 
103.33  under this subdivision. 
103.34     Subd. 6.  [REVIEW AND APPROVAL OF PROPOSALS.] (a) The 
103.35  interagency long-term care planning committee may recommend that 
103.36  the commissioner of human services grant approval, within the 
104.1   limits established in subdivision 3, paragraph (a), to 
104.2   applications that satisfy the requirements of this section.  The 
104.3   interagency committee may appoint an advisory review panel 
104.4   composed of representatives of counties, SAIL projects, 
104.5   consumers, and providers to review proposals and provide 
104.6   comments and recommendations to the committee.  The 
104.7   commissioners of human services and health shall provide staff 
104.8   and technical assistance to the committee for the review and 
104.9   analysis of proposals.  The commissioners of human services and 
104.10  health shall jointly approve or disapprove an application within 
104.11  30 days after receiving the committee's recommendations. 
104.12     (b) Approval of a planned closure expires 18 months after 
104.13  approval by the commissioner of human services, unless 
104.14  commencement of closure has begun. 
104.15     (c) The commissioner of human services may change any 
104.16  provision of the application to which all parties agree. 
104.17     Subd. 7.  [PLANNED CLOSURE RATE ADJUSTMENT.] The 
104.18  commissioner of human services shall calculate the amount of the 
104.19  planned closure rate adjustment available under subdivision 3, 
104.20  paragraph (b), according to clauses (1) to (4): 
104.21     (1) the amount available is the net reduction of nursing 
104.22  facility beds multiplied by $2,080; 
104.23     (2) the total number of beds in the nursing facility 
104.24  receiving the planned closure rate adjustment must be 
104.25  identified; 
104.26     (3) capacity days are determined by multiplying the number 
104.27  determined under clause (2) by 365; and 
104.28     (4) the planned closure rate adjustment is the amount 
104.29  available in clause (1), divided by capacity days determined 
104.30  under clause (3). 
104.31     Subd. 8.  [OTHER RATE ADJUSTMENTS.] Facilities subject to 
104.32  this section remain eligible for any applicable rate adjustments 
104.33  provided under section 256B.431, 256B.434, or any other section. 
104.34     Subd. 9.  [COUNTY COSTS.] The commissioner of human 
104.35  services may allocate up to $400 per nursing facility bed that 
104.36  is closing, within the limits of the appropriation specified for 
105.1   this purpose, to be used for relocation costs incurred by 
105.2   counties for planned closures under this section or resident 
105.3   relocation under section 144A.16.  To be eligible for this 
105.4   allocation, a county in which a nursing facility closes must 
105.5   provide to the commissioner a detailed statement in a form 
105.6   provided by the commissioner of additional costs, not to exceed 
105.7   $400 per bed closed, that are directly incurred related to the 
105.8   county's required role in the relocation process. 
105.9      Sec. 34.  Minnesota Statutes 2000, section 256B.48, 
105.10  subdivision 1, is amended to read: 
105.11     Subdivision 1.  [PROHIBITED PRACTICES.] A nursing facility 
105.12  is not eligible to receive medical assistance payments unless it 
105.13  refrains from all of the following: 
105.14     (a) Charging private paying residents rates for similar 
105.15  services which exceed those which are approved by the state 
105.16  agency for medical assistance recipients as determined by the 
105.17  prospective desk audit rate, except ~~under the following~~ 
105.18  ~~circumstances:  the~~ that a nursing facility may ~~(1) charge~~ 
105.19  ~~private paying residents a higher rate for a private room, and~~ 
105.20  ~~(2)~~ charge for special services which are not included in the 
105.21  daily rate if medical assistance residents are charged 
105.22  separately at the same rate for the same services in addition to 
105.23  the daily rate paid by the commissioner.  Services covered by 
105.24  the payment rate must be the same regardless of payment source.  
105.25  Special services, if offered, must be available to all residents 
105.26  in all areas of the nursing facility and charged separately at 
105.27  the same rate.  Residents are free to select or decline special 
105.28  services.  Special services must not include services which must 
105.29  be provided by the nursing facility in order to comply with 
105.30  licensure or certification standards and that if not provided 
105.31  would result in a deficiency or violation by the nursing 
105.32  facility.  Services beyond those required to comply with 
105.33  licensure or certification standards must not be charged 
105.34  separately as a special service if they were included in the 
105.35  payment rate for the previous reporting year.  A nursing 
105.36  facility that charges a private paying resident a rate in 
106.1   violation of this clause is subject to an action by the state of 
106.2   Minnesota or any of its subdivisions or agencies for civil 
106.3   damages.  A private paying resident or the resident's legal 
106.4   representative has a cause of action for civil damages against a 
106.5   nursing facility that charges the resident rates in violation of 
106.6   this clause.  The damages awarded shall include three times the 
106.7   payments that result from the violation, together with costs and 
106.8   disbursements, including reasonable attorneys' fees or their 
106.9   equivalent.  A private paying resident or the resident's legal 
106.10  representative, the state, subdivision or agency, or a nursing 
106.11  facility may request a hearing to determine the allowed rate or 
106.12  rates at issue in the cause of action.  Within 15 calendar days 
106.13  after receiving a request for such a hearing, the commissioner 
106.14  shall request assignment of an administrative law judge under 
106.15  sections 14.48 to 14.56 to conduct the hearing as soon as 
106.16  possible or according to agreement by the parties.  The 
106.17  administrative law judge shall issue a report within 15 calendar 
106.18  days following the close of the hearing.  The prohibition set 
106.19  forth in this clause shall not apply to facilities licensed as 
106.20  boarding care facilities which are not certified as skilled or 
106.21  intermediate care facilities level I or II for reimbursement 
106.22  through medical assistance. 
106.23     (b)(1) Charging, soliciting, accepting, or receiving from 
106.24  an applicant for admission to the facility, or from anyone 
106.25  acting in behalf of the applicant, as a condition of admission, 
106.26  expediting the admission, or as a requirement for the 
106.27  individual's continued stay, any fee, deposit, gift, money, 
106.28  donation, or other consideration not otherwise required as 
106.29  payment under the state plan; 
106.30     (2) requiring an individual, or anyone acting in behalf of 
106.31  the individual, to loan any money to the nursing facility; 
106.32     (3) requiring an individual, or anyone acting in behalf of 
106.33  the individual, to promise to leave all or part of the 
106.34  individual's estate to the facility; or 
106.35     (4) requiring a third-party guarantee of payment to the 
106.36  facility as a condition of admission, expedited admission, or 
107.1   continued stay in the facility.  
107.2   Nothing in this paragraph would prohibit discharge for 
107.3   nonpayment of services in accordance with state and federal 
107.4   regulations. 
107.5      (c) Requiring any resident of the nursing facility to 
107.6   utilize a vendor of health care services chosen by the nursing 
107.7   facility.  A nursing facility may require a resident to use 
107.8   pharmacies that utilize unit dose packing systems approved by 
107.9   the Minnesota board of pharmacy, and may require a resident to 
107.10  use pharmacies that are able to meet the federal regulations for 
107.11  safe and timely administration of medications such as systems 
107.12  with specific number of doses, prompt delivery of medications, 
107.13  or access to medications on a 24-hour basis.  Notwithstanding 
107.14  the provisions of this paragraph, nursing facilities shall not 
107.15  restrict a resident's choice of pharmacy because the pharmacy 
107.16  utilizes a specific system of unit dose drug packing. 
107.17     (d) Providing differential treatment on the basis of status 
107.18  with regard to public assistance.  
107.19     (e) Discriminating in admissions, services offered, or room 
107.20  assignment on the basis of status with regard to public 
107.21  assistance or refusal to purchase special services.  Admissions 
107.22  discrimination shall include, but is not limited to:  
107.23     (1) basing admissions decisions upon assurance by the 
107.24  applicant to the nursing facility, or the applicant's guardian 
107.25  or conservator, that the applicant is neither eligible for nor 
107.26  will seek public assistance for payment of nursing facility care 
107.27  costs; and 
107.28     (2) engaging in preferential selection from waiting lists 
107.29  based on an applicant's ability to pay privately or an 
107.30  applicant's refusal to pay for a special service. 
107.31     The collection and use by a nursing facility of financial 
107.32  information of any applicant pursuant to a preadmission 
107.33  screening program established by law shall not raise an 
107.34  inference that the nursing facility is utilizing that 
107.35  information for any purpose prohibited by this paragraph.  
107.36     (f) Requiring any vendor of medical care as defined by 
108.1   section 256B.02, subdivision 7, who is reimbursed by medical 
108.2   assistance under a separate fee schedule, to pay any amount 
108.3   based on utilization or service levels or any portion of the 
108.4   vendor's fee to the nursing facility except as payment for 
108.5   renting or leasing space or equipment or purchasing support 
108.6   services from the nursing facility as limited by section 
108.7   256B.433.  All agreements must be disclosed to the commissioner 
108.8   upon request of the commissioner.  Nursing facilities and 
108.9   vendors of ancillary services that are found to be in violation 
108.10  of this provision shall each be subject to an action by the 
108.11  state of Minnesota or any of its subdivisions or agencies for 
108.12  treble civil damages on the portion of the fee in excess of that 
108.13  allowed by this provision and section 256B.433.  Damages awarded 
108.14  must include three times the excess payments together with costs 
108.15  and disbursements including reasonable attorney's fees or their 
108.16  equivalent.  
108.17     (g) Refusing, for more than 24 hours, to accept a resident 
108.18  returning to the same bed or a bed certified for the same level 
108.19  of care, in accordance with a physician's order authorizing 
108.20  transfer, after receiving inpatient hospital services. 
108.21     For a period not to exceed 180 days, the commissioner may 
108.22  continue to make medical assistance payments to a nursing 
108.23  facility or boarding care home which is in violation of this 
108.24  section if extreme hardship to the residents would result.  In 
108.25  these cases the commissioner shall issue an order requiring the 
108.26  nursing facility to correct the violation.  The nursing facility 
108.27  shall have 20 days from its receipt of the order to correct the 
108.28  violation.  If the violation is not corrected within the 20-day 
108.29  period the commissioner may reduce the payment rate to the 
108.30  nursing facility by up to 20 percent.  The amount of the payment 
108.31  rate reduction shall be related to the severity of the violation 
108.32  and shall remain in effect until the violation is corrected.  
108.33  The nursing facility or boarding care home may appeal the 
108.34  commissioner's action pursuant to the provisions of chapter 14 
108.35  pertaining to contested cases.  An appeal shall be considered 
108.36  timely if written notice of appeal is received by the 
109.1   commissioner within 20 days of notice of the commissioner's 
109.2   proposed action.  
109.3      In the event that the commissioner determines that a 
109.4   nursing facility is not eligible for reimbursement for a 
109.5   resident who is eligible for medical assistance, the 
109.6   commissioner may authorize the nursing facility to receive 
109.7   reimbursement on a temporary basis until the resident can be 
109.8   relocated to a participating nursing facility.  
109.9      Certified beds in facilities which do not allow medical 
109.10  assistance intake on July 1, 1984, or after shall be deemed to 
109.11  be decertified for purposes of section 144A.071 only.  
109.12     Sec. 35.  Minnesota Statutes 2000, section 256B.501, is 
109.13  amended by adding a subdivision to read: 
109.14     Subd. 14.  [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001, 
109.15  AND JULY 1, 2002.] (a) For the rate periods beginning July 1, 
109.16  2001, and July 1, 2002, the commissioner shall make available to 
109.17  each facility reimbursed under this section, section 256B.5011, 
109.18  and Laws 1993, First Special Session chapter 1, article 4, 
109.19  section 11, an adjustment to the total operating payment rate of 
109.20  3.5 percent. 
109.21     (b) For each facility, the commissioner shall make 
109.22  available an adjustment using the percentage specified in 
109.23  paragraph (a) multiplied by the total payment rate, excluding 
109.24  the property-related payment rate in effect on the preceding 
109.25  June 30.  The total operating payment rate shall include the 
109.26  adjustment provided in subdivision 12. 
109.27     (c) Notwithstanding paragraph (a), for the rate increase 
109.28  effective July 1, 2001, the adjustment applied to the increase 
109.29  provided under section 256B.501, subdivision 12, shall be 6.125 
109.30  percent. 
109.31     (d) Any facility whose payment rates are governed by 
109.32  closure agreements, receivership agreements, or Minnesota Rules, 
109.33  part 9553.0075, is not eligible for an adjustment otherwise 
109.34  granted under this subdivision.  
109.35     Sec. 36.  Laws 1999, chapter 245, article 3, section 45, as 
109.36  amended by Laws 2000, chapter 312, section 3, is amended to read:
110.1      Sec. 45.  [STATE LICENSURE CONFLICTS WITH FEDERAL 
110.2   REGULATIONS.] 
110.3      (a) Notwithstanding the provisions of Minnesota Rules, part 
110.4   4658.0520, an incontinent resident must be checked according to 
110.5   a specific time interval written in the resident's care plan.  
110.6   The resident's attending physician must authorize in writing any 
110.7   interval longer than two hours unless the resident, if 
110.8   competent, or a family member or legally appointed conservator, 
110.9   guardian, or health care agent of a resident who is not 
110.10  competent, agrees in writing to waive physician involvement in 
110.11  determining this interval. 
110.12     (b) This section expires July 1, ~~2001~~ 2003. 
110.13     Sec. 37.  [PROVIDER RATE INCREASES.] 
110.14     (a) The commissioner shall increase reimbursement rates by 
110.15  3.5 percent each year of the biennium for the providers listed 
110.16  in paragraph (b).  The increases shall be effective for services 
110.17  rendered on or after July 1 of each year. 
110.18     (b) The rate increases described in this section shall be 
110.19  provided to home and community-based waivered services for 
110.20  persons with mental retardation or related conditions under 
110.21  Minnesota Statutes, section 256B.501; home and community-based 
110.22  waivered services for the elderly under Minnesota Statutes, 
110.23  section 256B.0915; waivered services under community 
110.24  alternatives for disabled individuals under Minnesota Statutes, 
110.25  section 256B.49; community alternative care waivered services 
110.26  under Minnesota Statutes, section 256B.49; traumatic brain 
110.27  injury waivered services under Minnesota Statutes, section 
110.28  256B.49; nursing services and home health services under 
110.29  Minnesota Statutes, section 256B.0625, subdivision 6a; personal 
110.30  care services and nursing supervision of personal care services 
110.31  under Minnesota Statutes, section 256B.0625, subdivision 19a; 
110.32  private-duty nursing services under Minnesota Statutes, section 
110.33  256B.0625, subdivision 7; day training and habilitation services 
110.34  for adults with mental retardation or related conditions under 
110.35  Minnesota Statutes, sections 252.40 to 252.46; alternative care 
110.36  services under Minnesota Statutes, section 256B.0913; adult 
111.1   residential program grants under Minnesota Rules, parts 
111.2   9535.2000 to 9535.3000; adult and family community support 
111.3   grants under Minnesota Rules, parts 9535.1700 to 9535.1760; the 
111.4   group residential housing supplementary service rate under 
111.5   Minnesota Statutes, section 256I.05, subdivision 1a; 
111.6   semi-independent living services under Minnesota Statutes, 
111.7   section 252.275, including SILS funding under county social 
111.8   services grants formerly funded under Minnesota Statutes, 
111.9   chapter 256I; community support services for deaf and 
111.10  hard-of-hearing adults with mental illness who use or wish to 
111.11  use sign language as their primary means of communication; and 
111.12  living skills training programs for persons with intractable 
111.13  epilepsy who need assistance in the transition to independent 
111.14  living. 
111.15     Sec. 38.  [DEVELOPMENT OF NEW NURSING FACILITY 
111.16  REIMBURSEMENT SYSTEM.] 
111.17     (a) The commissioner of human services shall develop and 
111.18  report to the legislature by January 15, 2003, a system to 
111.19  replace the current nursing facility reimbursement system 
111.20  established under Minnesota Statutes, sections 256B.431, 
111.21  256B.434, and 256B.435. 
111.22     (b) The system must be developed in consultation with the 
111.23  long-term care task force and with representatives of consumers, 
111.24  providers, and labor unions.  Within the limits of available 
111.25  appropriations, the commissioner may employ consultants to 
111.26  assist with this project. 
111.27     (c) The new reimbursement system must: 
111.28     (1) provide incentives to enhance quality of life and 
111.29  quality of care; 
111.30     (2) recognize cost differences in the care of different 
111.31  types of populations, including subacute care and dementia care; 
111.32     (3) establish rates that are sufficient without being 
111.33  excessive; 
111.34     (4) be affordable for the state and for private-pay 
111.35  residents; 
111.36     (5) be sensitive to changing conditions in the long-term 
112.1   care environment; 
112.2      (6) avoid creating access problems related to insufficient 
112.3   funding; 
112.4      (7) allow providers maximum flexibility in their business 
112.5   operations; 
112.6      (8) recognize the need for capital investment to improve 
112.7   physical plants; and 
112.8      (9) provide incentives for the development and use of 
112.9   private rooms. 
112.10     (d) Notwithstanding Minnesota Statutes, section 256B.435, 
112.11  the commissioner must not implement a performance-based 
112.12  contracting system for nursing facilities prior to July 1, 2003. 
112.13  The commissioner shall continue to reimburse nursing facilities 
112.14  under Minnesota Statutes, section 256B.431 or 256B.434, until 
112.15  otherwise directed by law. 
112.16     (e) The commissioner of human services, in consultation 
112.17  with the commissioner of health, shall conduct or contract for a 
112.18  time study to determine staff time being spent on various case 
112.19  mix categories; recommend adjustments to the case mix weights 
112.20  based on the time study data; and determine whether current 
112.21  staffing standards are adequate for providing quality care based 
112.22  on professional best practice and consumer experience.  If the 
112.23  commissioner determines the current standards are inadequate, 
112.24  the commissioner shall determine an appropriate staffing 
112.25  standard for the various case mix categories and the financial 
112.26  implications of phasing into this standard over the next four 
112.27  years. 
112.28     Sec. 39.  [REPORT ON STANDARDS FOR SUBACUTE CARE FACILITY 
112.29  LICENSURE.] 
112.30     By January 15, 2003, the commissioner of health shall 
112.31  submit a report to the legislature on implementation of a 
112.32  licensure program for subacute care.  This report must include: 
112.33     (1) definitions of subacute care and applicability of the 
112.34  proposed licensure program to various types of licensed 
112.35  facilities; 
112.36     (2) an analysis of whether specific standards for subacute 
113.1   levels of care need to be developed and the potential for 
113.2   increased costs for existing providers of subacute care; 
113.3      (3) recommendations on the applicability of the nursing 
113.4   home moratorium law to the licensure of subacute care facilities 
113.5   or programs; 
113.6      (4) identification of federal regulations guiding the 
113.7   provision of subacute care and whether further state standards 
113.8   are needed; and 
113.9      (5) identification of current and potential reimbursement 
113.10  for subacute care under Medicare, Medicaid, or managed care 
113.11  programs. 
113.12     Sec. 40.  [REGULATORY FLEXIBILITY.] 
113.13     (a) By July 1, 2001, the commissioners of health and human 
113.14  services shall: 
113.15     (1) develop a summary of federal nursing facility and 
113.16  community long-term care regulations that hamper state 
113.17  flexibility and place burdens on the goal of achieving 
113.18  high-quality care and optimum outcomes for consumers of 
113.19  services; and 
113.20     (2) share this summary with the legislature, other states, 
113.21  national groups that advocate for state interests with Congress, 
113.22  and the Minnesota congressional delegation. 
113.23     (b) The commissioners shall conduct ongoing follow-up with 
113.24  the entities to which this summary is provided and with the 
113.25  health care financing administration to achieve maximum 
113.26  regulatory flexibility, including the possibility of pilot 
113.27  projects to demonstrate regulatory flexibility on less than a 
113.28  statewide basis. 
113.29     Sec. 41.  [REPORT.] 
113.30     By January 15, 2003, the commissioner of health and the 
113.31  commissioner of human services shall report to the senate health 
113.32  and family security committee and the house health and human 
113.33  services policy committee on the number of closures that have 
113.34  taken place under Minnesota Statutes, section 256B.437, and any 
113.35  other nursing facility closures that may have taken place, 
113.36  alternatives to nursing facility care that have been developed, 
114.1   any problems with access to long-term care services that have 
114.2   resulted, and any recommendations for continuation of the 
114.3   regional long-term care planning process and the closure process 
114.4   after June 30, 2003. 
114.5      Sec. 42.  [NURSING ASSISTANT; HOME HEALTH AIDE CURRICULUM.] 
114.6      By January 1, 2003, the commissioner of health, in 
114.7   consultation with long-term care consumers, advocates, unions, 
114.8   and trade associations, shall present to the chairs of the 
114.9   legislative committees dealing with health care policy 
114.10  recommendations for updating the nursing assistant and home 
114.11  health aide curriculum (1998 edition) to help students learn 
114.12  front-line survival skills that support job motivation and 
114.13  satisfaction.  These skills include, but are not limited to, 
114.14  working with challenging behaviors, communication skills, stress 
114.15  management including the impact of personal life stress in the 
114.16  work setting, building relationships with families, cultural 
114.17  competencies, and working with death and dying. 
114.18     Sec. 43.  [REPORT ON WAGE AND BENEFIT INCREASES.] 
114.19     The commissioner of human services shall report to the 
114.20  chairs of the house and senate committees with jurisdiction over 
114.21  health and human services policy and finance by February 1, 
114.22  2002, on the wage and benefit increases provided at each 
114.23  long-term care facility and long-term care provider as a result 
114.24  of reimbursement increases provided by the 2001 legislature. 
114.25     Sec. 44.  [EVALUATION OF REPORTING REQUIREMENTS.] 
114.26     The commissioners of human services and health, in 
114.27  consultation with interested parties, shall evaluate long-term 
114.28  care provider reporting requirements, balancing the need for 
114.29  public accountability with the need to reduce unnecessary 
114.30  paperwork, and shall eliminate unnecessary reporting 
114.31  requirements, seeking any necessary changes in federal and state 
114.32  law.  The commissioner shall present a progress report by 
114.33  February 1, 2002, to the chairs of the house and senate 
114.34  committees with jurisdiction over health and human services 
114.35  policy and finance. 
114.36     Sec. 45.  [APPROPRIATIONS.] 
115.1      (a) The following amounts are appropriated from the general 
115.2   fund to the commissioner of human services for the biennium 
115.3   beginning July 1, 2001, for the purposes indicated: 
115.4      (1) $....... for the following purposes related to the 
115.5   nursing facility planned closure process: 
115.6      (i) $....... for incentive payments to nursing facilities; 
115.7      (ii) $....... for state and county administrative costs; 
115.8   and 
115.9      (iii) $....... for transition planning grants to nursing 
115.10  facilities; 
115.11     (2) $....... to develop and disseminate quality measures in 
115.12  nursing facilities and other long-term care settings; 
115.13     (3) $....... to develop a new nursing facility 
115.14  reimbursement system; and 
115.15     (4) $....... to implement the transition grant program. 
115.16     (b) $....... is appropriated from the general fund to the 
115.17  commissioner of health for the biennium beginning July 1, 2001, 
115.18  for the purposes indicated: 
115.19     (1) $....... to develop different regulatory standards for 
115.20  the licensure of subacute care facilities; and 
115.21     (2) $....... for implementation of an alternative survey 
115.22  schedule. 
115.23                             ARTICLE 3 
115.24                             WORK FORCE 
115.25     Section 1.  Minnesota Statutes 2000, section 116L.11, 
115.26  subdivision 4, is amended to read: 
115.27     Subd. 4.  [QUALIFYING CONSORTIUM.] "Qualifying consortium" 
115.28  means an entity that ~~may include~~ includes a public or private 
115.29  institution of higher education~~, work force center, county,~~ and 
115.30  one ~~or more~~ eligible ~~employers, but must include a public or~~ 
115.31  ~~private institution of higher education and one or more eligible~~ 
115.32  ~~employers~~ employer. 
115.33     Sec. 2.  Minnesota Statutes 2000, section 116L.12, 
115.34  subdivision 4, is amended to read: 
115.35     Subd. 4.  [GRANTS.] Within the limits of available 
115.36  appropriations, the board shall make grants not to exceed 
116.1   $400,000 each to qualifying consortia to operate local, 
116.2   regional, or statewide training and retention programs.  Grants 
116.3   may be made from TANF funds, general fund appropriations, and 
116.4   any other funding sources available to the board, provided the 
116.5   requirements of those funding sources are satisfied.  Grant 
116.6   awards must establish specific, measurable outcomes and 
116.7   timelines for achieving those outcomes. 
116.8      Sec. 3.  Minnesota Statutes 2000, section 116L.12, 
116.9   subdivision 5, is amended to read: 
116.10     Subd. 5.  [LOCAL MATCH REQUIREMENTS.] A consortium must 
116.11  ~~provide at least a 50 percent match from local resources for~~ 
116.12  ~~money appropriated under this section.  The local match~~ 
116.13  ~~requirement must be satisfied on an overall program basis but~~ 
116.14  ~~need not be satisfied for each particular client.  The local~~ 
116.15  ~~match requirement may be reduced for consortia that include a~~ 
116.16  ~~relatively large number of small employers whose financial~~ 
116.17  ~~contribution has been reduced in accordance with section 116L.15.~~
116.18  ~~In-kind services and expenditures under section 116L.13,~~ 
116.19  ~~subdivision 2, may be used to meet this local match~~ 
116.20  ~~requirement.  The grant application must specify the financial~~ 
116.21  ~~contribution from each member of the consortium~~ satisfy the 
116.22  match requirements established in section 116L.02, paragraph (a).
116.23     Sec. 4.  Minnesota Statutes 2000, section 116L.13, 
116.24  subdivision 1, is amended to read: 
116.25     Subdivision 1.  [MARKETING AND RECRUITMENT.] A qualifying 
116.26  consortium must implement a marketing and outreach strategy to 
116.27  recruit into the health care and human services fields persons 
116.28  from one or more of the potential employee target groups.  
116.29  Recruitment strategies must include: 
116.30     (1) a screening process to evaluate whether potential 
116.31  employees may be disqualified as the result of a required 
116.32  background check or are otherwise unlikely to succeed in the 
116.33  position for which they are being recruited; and 
116.34     (2) a process for modifying course work to meet the 
116.35  training needs of non-English-speaking persons, when appropriate.
116.36     Sec. 5.  [116L.146] [EXPEDITED GRANT PROCESS.] 
117.1      (a) The board may authorize grants not to exceed $50,000 
117.2   each through an expedited grant approval process to: 
117.3      (1) eligible employers to provide training programs for up 
117.4   to 50 workers; or 
117.5      (2) a public or private institution of higher education to: 
117.6      (i) provide predevelopment or curriculum development for 
117.7   training programs prior to submission for program funding under 
117.8   section 116L.12; 
117.9      (ii) convert an existing curriculum for distance learning 
117.10  through interactive television or other communication methods; 
117.11  or 
117.12     (iii) enable a training program to be offered when it would 
117.13  otherwise be canceled due to an enrollment shortfall of one or 
117.14  two students when the program is offered in a health-related 
117.15  field with a documented worker shortage and is part of a 
117.16  training program not exceeding two years in length. 
117.17     (b) The board shall develop application procedures and 
117.18  evaluation policies for grants made under this section. 
117.19     Sec. 6.  Minnesota Statutes 2000, section 144.1464, is 
117.20  amended to read: 
117.21     144.1464 [SUMMER HEALTH CARE INTERNS.] 
117.22     Subdivision 1.  [SUMMER INTERNSHIPS.] The commissioner of 
117.23  health, through a contract with a nonprofit organization as 
117.24  required by subdivision 4, shall award grants to hospitals ~~and~~, 
117.25  clinics, nursing facilities, and home care providers to 
117.26  establish a secondary and post-secondary summer health care 
117.27  intern program.  The purpose of the program is to expose 
117.28  interested secondary and post-secondary pupils to various 
117.29  careers within the health care profession. 
117.30     Subd. 2.  [CRITERIA.] (a) The commissioner, through the 
117.31  organization under contract, shall award grants to 
117.32  hospitals ~~and~~, clinics, nursing facilities, and home care 
117.33  providers that agree to:  
117.34     (1) provide secondary and post-secondary summer health care 
117.35  interns with formal exposure to the health care profession; 
117.36     (2) provide an orientation for the secondary and 
118.1   post-secondary summer health care interns; 
118.2      (3) pay one-half the costs of employing the secondary and 
118.3   post-secondary summer health care intern~~, based on an overall~~ 
118.4   ~~hourly wage that is at least the minimum wage but does not~~ 
118.5   ~~exceed $6 an hour~~; 
118.6      (4) interview and hire secondary and post-secondary pupils 
118.7   for a minimum of six weeks and a maximum of 12 weeks; and 
118.8      (5) employ at least one secondary student for each 
118.9   post-secondary student employed, to the extent that there are 
118.10  sufficient qualifying secondary student applicants. 
118.11     (b) In order to be eligible to be hired as a secondary 
118.12  summer health intern by a hospital ~~or~~, clinic, nursing facility, 
118.13  or home care provider, a pupil must: 
118.14     (1) intend to complete high school graduation requirements 
118.15  and be between the junior and senior year of high school; and 
118.16     (2) be from a school district in proximity to the facility~~;~~ 
118.17  ~~and~~ 
118.18     ~~(3) provide the facility with a letter of recommendation~~ 
118.19  ~~from a health occupations or science educator~~. 
118.20     (c) In order to be eligible to be hired as a post-secondary 
118.21  summer health care intern by a hospital or clinic, a pupil must: 
118.22     (1) intend to complete a health care training program or a 
118.23  two-year or four-year degree program and be planning on 
118.24  enrolling in or be enrolled in that training program or degree 
118.25  program; and 
118.26     (2) be enrolled in a Minnesota educational institution or 
118.27  be a resident of the state of Minnesota; priority must be given 
118.28  to applicants from a school district or an educational 
118.29  institution in proximity to the facility~~; and~~ 
118.30     ~~(3) provide the facility with a letter of recommendation~~ 
118.31  ~~from a health occupations or science educator~~. 
118.32     (d) Hospitals ~~and~~, clinics, nursing facilities, and home 
118.33  care providers awarded grants may employ pupils as secondary and 
118.34  post-secondary summer health care interns beginning on or after 
118.35  June 15, 1993, if they agree to pay the intern, during the 
118.36  period before disbursement of state grant money, with money 
119.1   designated as the facility's 50 percent contribution towards 
119.2   internship costs.  
119.3      Subd. 3.  [GRANTS.] The commissioner, through the 
119.4   organization under contract, shall award separate grants to 
119.5   hospitals ~~and~~, clinics, nursing facilities, and home care 
119.6   providers meeting the requirements of subdivision 2.  The grants 
119.7   must be used to pay one-half of the costs of employing secondary 
119.8   and post-secondary pupils in a hospital ~~or~~, clinic, nursing 
119.9   facility, or home care setting during the course of the 
119.10  program.  No more than 50 percent of the participants may be 
119.11  post-secondary students, unless the program does not receive 
119.12  enough qualified secondary applicants per fiscal year.  No more 
119.13  than five pupils may be selected from any secondary or 
119.14  post-secondary institution to participate in the program and no 
119.15  more than one-half of the number of pupils selected may be from 
119.16  the seven-county metropolitan area. 
119.17     Subd. 4.  [CONTRACT.] The commissioner shall contract with 
119.18  a statewide, nonprofit organization representing facilities at 
119.19  which secondary and post-secondary summer health care interns 
119.20  will serve, to administer the grant program established by this 
119.21  section.  Grant funds that are not used in one fiscal year may 
119.22  be carried over to the next fiscal year.  The organization 
119.23  awarded the grant shall provide the commissioner with any 
119.24  information needed by the commissioner to evaluate the program, 
119.25  in the form and at the times specified by the commissioner. 
119.26     Sec. 7.  Minnesota Statutes 2000, section 144.1496, 
119.27  subdivision 3, is amended to read: 
119.28     Subd. 3.  [LOAN FORGIVENESS.] The commissioner may accept 
119.29  up to ~~ten~~ 170 applicants a year.  Applicants are responsible for 
119.30  securing their own loans.  For each year of nursing education, 
119.31  for up to two years, applicants accepted into the loan 
119.32  forgiveness program may designate an agreed amount, not to 
119.33  exceed $3,000, as a qualified loan.  For each year that a 
119.34  participant practices nursing in a nursing home or intermediate 
119.35  care facility for persons with mental retardation or related 
119.36  conditions, up to a maximum of two years, the commissioner shall 
120.1   annually repay an amount equal to one year of qualified loans.  
120.2   Participants who move from one nursing home or intermediate care 
120.3   facility for persons with mental retardation or related 
120.4   conditions to another remain eligible for loan repayment.  
120.5      Sec. 8.  [144.1499] [PROMOTION OF HEALTH CARE AND LONG-TERM 
120.6   CARE CAREERS.] 
120.7      The commissioner of health, in consultation with an 
120.8   organization representing health care employers, long-term care 
120.9   employers, and educational institutions, may make grants to 
120.10  qualifying consortia as defined in section 116L.11, subdivision 
120.11  4, for intergenerational programs to encourage middle and high 
120.12  school students to work and volunteer in health care and 
120.13  long-term care settings.  To qualify for a grant under this 
120.14  section, a consortium shall: 
120.15     (1) develop a health and long-term care careers curriculum 
120.16  that provides career exploration and training in national skill 
120.17  standards for health care and long-term care and that is 
120.18  consistent with Minnesota graduation standards and other related 
120.19  requirements; 
120.20     (2) offer programs for high school students that provide 
120.21  training in health and long-term care careers with credits that 
120.22  articulate into post-secondary programs; and 
120.23     (3) provide technical support to the participating health 
120.24  care and long-term care employer to enable the use of the 
120.25  employer's facilities and programs for K-12 health and long-term 
120.26  care careers education. 
120.27     Sec. 9.  [144.15] [LOAN FORGIVENESS PROGRAM FOR LICENSED 
120.28  PROFESSIONAL STAFF.] 
120.29     Subdivision 1.  [COORDINATION OF EXISTING PROGRAMS.] (a) 
120.30  The commissioner of health shall coordinate all loan 
120.31  forgiveness, grant, tuition waiver programs, and training 
120.32  programs available for licensed and unlicensed health care 
120.33  workers who work or pledge to work in long-term health care 
120.34  settings. 
120.35     (b) Loan forgiveness, grant, tuition waiver programs, and 
120.36  training programs include, but are not limited to: 
121.1      (1) national health services corps state loan repayment 
121.2   program; 
121.3      (2) state rural health network reform initiative; 
121.4      (3) nursing grant program; 
121.5      (4) rural physicians loan forgiveness loan program; 
121.6      (5) rural midlevel practitioner loan forgiveness program; 
121.7      (6) nurses in nursing homes or ICFs/MRs program; 
121.8      (7) rural clinic sites for nurse practitioner education; 
121.9      (8) health care and human services worker training and 
121.10  retention program; 
121.11     (9) health care and human services tuition waiver program; 
121.12     (10) worker development fund; and 
121.13     (11) tuition payback program established under subdivision 
121.14  2. 
121.15     (c) The department of health shall also serve as a 
121.16  clearinghouse on available programs through the dissemination of 
121.17  information to interested individuals and through the 
121.18  development and performance of public education activities and 
121.19  outreach. 
121.20     Subd. 2.  [ESTABLISHMENT OF TUITION PAYBACK PROGRAM.] The 
121.21  commissioner of health shall establish a health care worker 
121.22  tuition payback program, with grants made available to health 
121.23  care facilities for the purpose of:  (1) reimbursing employees' 
121.24  cost of tuition for education needed to perform their current 
121.25  job functions; (2) reimbursing employees' cost of tuition to 
121.26  further their career development in the long-term care field; or 
121.27  (3) payment for past tuition debts in exchange for pledges to 
121.28  work within the facility for a specified period of time. 
121.29     Sec. 10.  Minnesota Statutes 2000, section 144A.62, 
121.30  subdivision 1, is amended to read: 
121.31     Subdivision 1.  [ASSISTANCE WITH EATING AND DRINKING.] (a) 
121.32  Upon federal approval, a nursing home may employ resident 
121.33  attendants to assist with the activities authorized under 
121.34  subdivision 2.  The resident attendant ~~will not~~ shall be counted 
121.35  in the minimum staffing requirements under section 144A.04, 
121.36  subdivision 7. 
122.1      (b) The commissioner shall submit by ~~May~~ July 15, ~~2000~~ 
122.2   2001, a new request for a federal waiver necessary to implement 
122.3   this section. 
122.4      Sec. 11.  Minnesota Statutes 2000, section 144A.62, 
122.5   subdivision 2, is amended to read: 
122.6      Subd. 2.  [DEFINITION.] (a) "Resident attendant" means an 
122.7   individual who assists residents ~~in a nursing home~~ with ~~the~~ one 
122.8   or more of the following activities ~~of eating and drinking~~: 
122.9      (1) eating and drinking; and 
122.10     (2) transporting. 
122.11     (b) A resident attendant does not include an individual who:
122.12     (1) is a licensed health professional or a registered 
122.13  dietitian; 
122.14     (2) volunteers without monetary compensation; or 
122.15     (3) is a registered nursing assistant. 
122.16     Sec. 12.  Minnesota Statutes 2000, section 144A.62, 
122.17  subdivision 3, is amended to read: 
122.18     Subd. 3.  [REQUIREMENTS.] (a) A nursing home may not use on 
122.19  a full-time or other paid basis any individual as a resident 
122.20  attendant in the nursing home unless the individual: 
122.21     (1) has completed a training and competency evaluation 
122.22  program encompassing the ~~tasks~~ activities in subdivision 2 that 
122.23  the individual provides; 
122.24     (2) is competent to provide ~~feeding and hydration services~~ 
122.25  those activities; and 
122.26     (3) is under the supervision of the director of nursing. 
122.27     (b) A nursing home may not use a current employee as a 
122.28  resident attendant unless the employee satisfies the 
122.29  requirements of paragraph (a) and volunteers to be used in that 
122.30  capacity. 
122.31     Sec. 13.  Minnesota Statutes 2000, section 144A.62, 
122.32  subdivision 4, is amended to read: 
122.33     Subd. 4.  [EVALUATION.] The training and competency 
122.34  evaluation program may be facility based.  It must include, at a 
122.35  minimum, the training and competency standards for ~~eating and~~ 
122.36  ~~drinking assistance~~ the specific activities the attendant will 
123.1   be conducting contained in the nursing assistant training 
123.2   curriculum. 
123.3      Sec. 14.  [APPROPRIATIONS.] 
123.4      Subdivision 1.  [SUMMER HEALTH CARE INTERN 
123.5   PROGRAM.] $....... is appropriated from the health care access 
123.6   fund to the commissioner of health for the biennium ending June 
123.7   30, 2003, to expand eligibility for the summer health care 
123.8   intern program and to increase the number of internships funded. 
123.9      Subd. 2.  [NURSE LOAN FORGIVENESS PROGRAM.] $....... is 
123.10  appropriated from the health care access fund to the 
123.11  commissioner of health for the biennium ending June 30, 2003, to 
123.12  expand the nurse loan forgiveness program. 
123.13     Subd. 3.  [MINNESOTA JOB SKILLS.] $....... is appropriated 
123.14  from the general fund to the Minnesota job skills partnership 
123.15  board for the biennium ending June 30, 2003, to fund the health 
123.16  care and human services worker training program. 
123.17     Sec. 15.  [REPEALER.] 
123.18     Minnesota Statutes 2000, sections 116L.10; and 116L.12, 
123.19  subdivisions 2 and 7, are repealed. 
123.20                             ARTICLE 4
123.21                     REGULATION OF SUPPLEMENTAL
123.22                     NURSING SERVICES AGENCIES
123.23     Section 1.  Minnesota Statutes 2000, section 144.057, is 
123.24  amended to read: 
123.25     144.057 [BACKGROUND STUDIES ON LICENSEES AND SUPPLEMENTAL 
123.26  NURSING SERVICES AGENCY PERSONNEL.] 
123.27     Subdivision 1.  [BACKGROUND STUDIES REQUIRED.] The 
123.28  commissioner of health shall contract with the commissioner of 
123.29  human services to conduct background studies of: 
123.30     (1) individuals providing services which have direct 
123.31  contact, as defined under section 245A.04, subdivision 3, with 
123.32  patients and residents in hospitals, boarding care homes, 
123.33  outpatient surgical centers licensed under sections 144.50 to 
123.34  144.58; nursing homes and home care agencies licensed under 
123.35  chapter 144A; residential care homes licensed under chapter 
123.36  144B, and board and lodging establishments that are registered 
124.1   to provide supportive or health supervision services under 
124.2   section 157.17; ~~and~~ 
124.3      (2) beginning July 1, 1999, all other employees in nursing 
124.4   homes licensed under chapter 144A, and boarding care homes 
124.5   licensed under sections 144.50 to 144.58.  A disqualification of 
124.6   an individual in this section shall disqualify the individual 
124.7   from positions allowing direct contact or access to patients or 
124.8   residents receiving services; 
124.9      (3) individuals employed by a supplemental nursing services 
124.10  agency, as defined under section 144A.70, who are providing 
124.11  services in health care facilities; and 
124.12     (4) controlling persons of a supplemental nursing services 
124.13  agency, as defined under section 144A.70. 
124.14     If a facility or program is licensed by the department of 
124.15  human services and subject to the background study provisions of 
124.16  chapter 245A and is also licensed by the department of health, 
124.17  the department of human services is solely responsible for the 
124.18  background studies of individuals in the jointly licensed 
124.19  programs. 
124.20     Subd. 2.  [RESPONSIBILITIES OF DEPARTMENT OF HUMAN 
124.21  SERVICES.] The department of human services shall conduct the 
124.22  background studies required by subdivision 1 in compliance with 
124.23  the provisions of chapter 245A and Minnesota Rules, parts 
124.24  9543.3000 to 9543.3090.  For the purpose of this section, the 
124.25  term "residential program" shall include all facilities 
124.26  described in subdivision 1.  The department of human services 
124.27  shall provide necessary forms and instructions, shall conduct 
124.28  the necessary background studies of individuals, and shall 
124.29  provide notification of the results of the studies to the 
124.30  facilities, supplemental nursing services agencies, individuals, 
124.31  and the commissioner of health.  Individuals shall be 
124.32  disqualified under the provisions of chapter 245A and Minnesota 
124.33  Rules, parts 9543.3000 to 9543.3090.  If an individual is 
124.34  disqualified, the department of human services shall notify the 
124.35  facility, the supplemental nursing services agency, and the 
124.36  individual and shall inform the individual of the right to 
125.1   request a reconsideration of the disqualification by submitting 
125.2   the request to the department of health. 
125.3      Subd. 3.  [RECONSIDERATIONS.] The commissioner of health 
125.4   shall review and decide reconsideration requests, including the 
125.5   granting of variances, in accordance with the procedures and 
125.6   criteria contained in chapter 245A and Minnesota Rules, parts 
125.7   9543.3000 to 9543.3090.  The commissioner's decision shall be 
125.8   provided to the individual and to the department of human 
125.9   services.  The commissioner's decision to grant or deny a 
125.10  reconsideration of disqualification is the final administrative 
125.11  agency action. 
125.12     Subd. 4.  [RESPONSIBILITIES OF FACILITIES AND AGENCIES.] 
125.13  Facilities and agencies described in subdivision 1 shall be 
125.14  responsible for cooperating with the departments in implementing 
125.15  the provisions of this section.  The responsibilities imposed on 
125.16  applicants and licensees under chapter 245A and Minnesota Rules, 
125.17  parts 9543.3000 to 9543.3090, shall apply to these 
125.18  facilities and supplemental nursing services agencies.  The 
125.19  provision of section 245A.04, subdivision 3, paragraph (e), 
125.20  shall apply to applicants, licensees, registrants, or an 
125.21  individual's refusal to cooperate with the completion of the 
125.22  background studies.  Supplemental nursing services agencies 
125.23  subject to the registration requirements in section 144A.71 must 
125.24  maintain records verifying compliance with the background study 
125.25  requirements under this section. 
125.26     Sec. 2.  [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING 
125.27  SERVICES AGENCIES; DEFINITIONS.] 
125.28     Subdivision 1.  [SCOPE.] As used in sections 144A.70 to 
125.29  144A.74, the terms defined in this section have the meanings 
125.30  given them. 
125.31     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
125.32  commissioner of health. 
125.33     Subd. 3.  [CONTROLLING PERSON.] "Controlling person" means 
125.34  a business entity, officer, program administrator, or director 
125.35  whose responsibilities include the direction of the management 
125.36  or policies of a supplemental nursing services agency.  
126.1   Controlling person also means an individual who, directly or 
126.2   indirectly, beneficially owns an interest in a corporation, 
126.3   partnership, or other business association that is a controlling 
126.4   person. 
126.5      Subd. 4.  [HEALTH CARE FACILITY.] "Health care facility" 
126.6   means a hospital, boarding care home, or outpatient surgical 
126.7   center licensed under sections 144.50 to 144.58, a nursing home 
126.8   or home care agency licensed under this chapter, a residential 
126.9   care home, or a board and lodging establishment that is 
126.10  registered to provide supportive or health supervision services 
126.11  under section 157.17. 
126.12     Subd. 5.  [PERSON.] "Person" includes an individual, firm, 
126.13  corporation, partnership, or association. 
126.14     Subd. 6.  [SUPPLEMENTAL NURSING SERVICES 
126.15  AGENCY.] "Supplemental nursing services agency" means a person, 
126.16  firm, corporation, partnership, or association engaged for hire 
126.17  in the business of providing or procuring temporary employment 
126.18  in health care facilities for nurses, nursing assistants, nurse 
126.19  aides, and orderlies.  Supplemental nursing services agency does 
126.20  not include an individual who only engages in providing the 
126.21  individual's services on a temporary basis to health care 
126.22  facilities.  Supplemental nursing services agency also does not 
126.23  include any nursing services agency that is limited to providing 
126.24  temporary nursing personnel solely to one or more health care 
126.25  facilities owned or operated by the same person, firm, 
126.26  corporation, or partnership. 
126.27     Sec. 3.  [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY 
126.28  REGISTRATION.] 
126.29     Subdivision 1.  [DUTY TO REGISTER.] A person who operates a 
126.30  supplemental nursing services agency shall register the agency 
126.31  with the commissioner.  Each separate location of the business 
126.32  of a supplemental nursing services agency shall register the 
126.33  agency with the commissioner.  Each separate location of the 
126.34  business of a supplemental nursing services agency shall have a 
126.35  separate registration. 
126.36     Subd. 2.  [APPLICATION INFORMATION AND FEE.] The 
127.1   commissioner shall establish forms and procedures for processing 
127.2   each supplemental nursing services agency registration 
127.3   application.  An application for a supplemental nursing services 
127.4   agency registration must include at least the following: 
127.5      (1) the names and addresses of the owner or owners of the 
127.6   supplemental nursing services agency; 
127.7      (2) if the owner is a corporation, copies of its articles 
127.8   of incorporation and current bylaws, together with the names and 
127.9   addresses of its officers and directors; 
127.10     (3) any other relevant information that the commissioner 
127.11  determines is necessary to properly evaluate an application for 
127.12  registration; and 
127.13     (4) the annual registration fee for a supplemental nursing 
127.14  services agency, which is $........ 
127.15     Subd. 3.  [REGISTRATION NOT TRANSFERABLE.] A registration 
127.16  issued by the commissioner according to this section is 
127.17  effective for a period of one year from the date of its issuance 
127.18  unless the registration is revoked or suspended under section 
127.19  144A.72, subdivision 2, or unless the supplemental nursing 
127.20  services agency is sold or ownership or management is 
127.21  transferred.  When a supplemental nursing services agency is 
127.22  sold or ownership or management is transferred, the registration 
127.23  of the agency must be voided and the new owner or operator may 
127.24  apply for a new registration. 
127.25     Sec. 4.  [144A.72] [REGISTRATION REQUIREMENTS.] 
127.26     The commissioner shall require that, as a condition of 
127.27  registration: 
127.28     (1) the supplemental nursing services agency shall document 
127.29  that each temporary employee provided to health care facilities 
127.30  currently meets the minimum licensing, training, and continuing 
127.31  education standards for the position in which the employee will 
127.32  be working; 
127.33     (2) the supplemental nursing services agency shall comply 
127.34  with all pertinent requirements relating to the health and other 
127.35  qualifications of personnel employed in health care facilities; 
127.36     (3) the supplemental nursing services agency must not 
128.1   restrict in any manner the employment opportunities of its 
128.2   employees; 
128.3      (4) the supplemental nursing services agency, when 
128.4   supplying temporary employees to a health care facility, and 
128.5   when requested by the facility to do so, shall agree that at 
128.6   least 30 percent of the total personnel hours supplied are 
128.7   during night, holiday, or weekend shifts; 
128.8      (5) the supplemental nursing services agency shall carry 
128.9   medical malpractice insurance to insure against the loss, 
128.10  damage, or expense incident to a claim arising out of the death 
128.11  or injury of any person as the result of negligence or 
128.12  malpractice in the provision of health care services by the 
128.13  supplemental nursing services agency or by any employee of the 
128.14  agency; and 
128.15     (6) the supplemental nursing services agency must not, in 
128.16  any contract with any employee or health care facility, require 
128.17  the payment of liquidated damages, employment fees, or other 
128.18  compensation should the employee be hired as a permanent 
128.19  employee of a health care facility. 
128.20     Sec. 5.  [144A.73] [COMPLAINT SYSTEM.] 
128.21     The commissioner shall establish a system for reporting 
128.22  complaints against a supplemental nursing services agency or its 
128.23  employees.  Complaints may be made by any member of the public.  
128.24  Written complaints must be forwarded to the employer of each 
128.25  person against whom a complaint is made.  The employer shall 
128.26  promptly report to the commissioner any corrective action taken. 
128.27     Sec. 6.  [144A.74] [MAXIMUM CHARGES.] 
128.28     A supplemental nursing services agency must not bill or 
128.29  receive payments from a nursing home licensed under this chapter 
128.30  at a rate higher than 150 percent of the weighted average wage 
128.31  rate for the applicable employee classification for the 
128.32  geographic group to which the nursing home is assigned under 
128.33  chapter 256B.  The weighted average wage rates must be 
128.34  determined by the commissioner of human services and reported to 
128.35  the commissioner of health on an annual basis.  Facilities shall 
128.36  provide information necessary to determine weighted average wage 
129.1   rates to the commissioner of human services in a format 
129.2   requested by the commissioner.  The maximum rate must include 
129.3   all charges for administrative fees, contract fees, or other 
129.4   special charges in addition to the hourly rates for the 
129.5   temporary nursing pool personnel supplied to a nursing home. 
129.6      Sec. 7.  Minnesota Statutes 2000, section 245A.04, 
129.7   subdivision 3, is amended to read: 
129.8      Subd. 3.  [BACKGROUND STUDY OF THE APPLICANT; DEFINITIONS.] 
129.9   (a) Before the commissioner issues a license, the commissioner 
129.10  shall conduct a study of the individuals specified in paragraph 
129.11  ~~(c)~~ (d), clauses (1) to (5), according to rules of the 
129.12  commissioner. 
129.13     Beginning January 1, 1997, the commissioner shall also 
129.14  conduct a study of employees providing direct contact services 
129.15  for nonlicensed personal care provider organizations described 
129.16  in paragraph ~~(c)~~ (d), clause (5). 
129.17     The commissioner shall recover the cost of these background 
129.18  studies through a fee of no more than $12 per study charged to 
129.19  the personal care provider organization.  
129.20     Beginning August 1, 1997, the commissioner shall conduct 
129.21  all background studies required under this chapter for adult 
129.22  foster care providers who are licensed by the commissioner of 
129.23  human services and registered under chapter 144D.  The 
129.24  commissioner shall conduct these background studies in 
129.25  accordance with this chapter.  The commissioner shall initiate a 
129.26  pilot project to conduct up to 5,000 background studies under 
129.27  this chapter in programs with joint licensure as home and 
129.28  community-based services and adult foster care for people with 
129.29  developmental disabilities when the license holder does not 
129.30  reside in the foster care residence. 
129.31     (b) Beginning July 1, 1998, the commissioner shall conduct 
129.32  a background study on individuals specified in 
129.33  paragraph ~~(c)~~ (d), clauses (1) to (5), who perform direct 
129.34  contact services in a nursing home or a home care agency 
129.35  licensed under chapter 144A or a boarding care home licensed 
129.36  under sections 144.50 to 144.58, when the subject of the study 
130.1   resides outside Minnesota; the study must be at least as 
130.2   comprehensive as that of a Minnesota resident and include a 
130.3   search of information from the criminal justice data 
130.4   communications network in the state where the subject of the 
130.5   study resides. 
130.6      (c) Beginning August 1, 2001, the commissioner shall 
130.7   conduct all background studies required under this chapter and 
130.8   initiated by supplemental nursing services agencies registered 
130.9   under chapter 144A.  Studies for the agencies must be initiated 
130.10  annually by each agency.  The commissioner shall conduct the 
130.11  background studies according to this chapter.  The commissioner 
130.12  shall recover the cost of the background studies through a fee 
130.13  of no more than $....... per study, charged to the supplemental 
130.14  nursing services agency. 
130.15     (d) The applicant, license holder, ~~the~~ registrant, bureau 
130.16  of criminal apprehension, ~~the~~ commissioner of health, and county 
130.17  agencies, after written notice to the individual who is the 
130.18  subject of the study, shall help with the study by giving the 
130.19  commissioner criminal conviction data and reports about the 
130.20  maltreatment of adults substantiated under section 626.557 and 
130.21  the maltreatment of minors in licensed programs substantiated 
130.22  under section 626.556.  The individuals to be studied shall 
130.23  include: 
130.24     (1) the applicant; 
130.25     (2) persons over the age of 13 living in the household 
130.26  where the licensed program will be provided; 
130.27     (3) current employees or contractors of the applicant who 
130.28  will have direct contact with persons served by the facility, 
130.29  agency, or program; 
130.30     (4) volunteers or student volunteers who have direct 
130.31  contact with persons served by the program to provide program 
130.32  services, if the contact is not directly supervised by the 
130.33  individuals listed in clause (1) or (3); and 
130.34     (5) any person who, as an individual or as a member of an 
130.35  organization, exclusively offers, provides, or arranges for 
130.36  personal care assistant services under the medical assistance 
131.1   program as authorized under sections 256B.04, subdivision 16, 
131.2   and 256B.0625, subdivision 19a. 
131.3      The juvenile courts shall also help with the study by 
131.4   giving the commissioner existing juvenile court records on 
131.5   individuals described in clause (2) relating to delinquency 
131.6   proceedings held within either the five years immediately 
131.7   preceding the application or the five years immediately 
131.8   preceding the individual's 18th birthday, whichever time period 
131.9   is longer.  The commissioner shall destroy juvenile records 
131.10  obtained pursuant to this subdivision when the subject of the 
131.11  records reaches age 23.  
131.12     For purposes of this section and Minnesota Rules, part 
131.13  9543.3070, a finding that a delinquency petition is proven in 
131.14  juvenile court shall be considered a conviction in state 
131.15  district court. 
131.16     For purposes of this subdivision, "direct contact" means 
131.17  providing face-to-face care, training, supervision, counseling, 
131.18  consultation, or medication assistance to persons served by a 
131.19  program.  For purposes of this subdivision, "directly supervised"
131.20  means an individual listed in clause (1), (3), or (5) is within 
131.21  sight or hearing of a volunteer to the extent that the 
131.22  individual listed in clause (1), (3), or (5) is capable at all 
131.23  times of intervening to protect the health and safety of the 
131.24  persons served by the program who have direct contact with the 
131.25  volunteer. 
131.26     A study of an individual in clauses (1) to (5) shall be 
131.27  conducted at least upon application for initial license or 
131.28  registration and reapplication for a license or registration.  
131.29  The commissioner is not required to conduct a study of an 
131.30  individual at the time of reapplication for a license or if the 
131.31  individual has been continuously affiliated with a foster care 
131.32  provider licensed by the commissioner of human services and 
131.33  registered under chapter 144D, other than a family day care or 
131.34  foster care license, if:  (i) a study of the individual was 
131.35  conducted either at the time of initial licensure or when the 
131.36  individual became affiliated with the license holder; (ii) the 
132.1   individual has been continuously affiliated with the license 
132.2   holder since the last study was conducted; and (iii) the 
132.3   procedure described in paragraph ~~(d)~~ (e) has been implemented 
132.4   and was in effect continuously since the last study was 
132.5   conducted.  For the purposes of this section, a physician 
132.6   licensed under chapter 147 is considered to be continuously 
132.7   affiliated upon the license holder's receipt from the 
132.8   commissioner of health or human services of the physician's 
132.9   background study results.  For individuals who are required to 
132.10  have background studies under clauses (1) to (5) and who have 
132.11  been continuously affiliated with a foster care provider that is 
132.12  licensed in more than one county, criminal conviction data may 
132.13  be shared among those counties in which the foster care programs 
132.14  are licensed.  A county agency's receipt of criminal conviction 
132.15  data from another county agency shall meet the criminal data 
132.16  background study requirements of this section. 
132.17     The commissioner may also conduct studies on individuals 
132.18  specified in clauses (3) and (4) when the studies are initiated 
132.19  by: 
132.20     (i) personnel pool agencies; 
132.21     (ii) temporary personnel agencies; 
132.22     (iii) educational programs that train persons by providing 
132.23  direct contact services in licensed programs; and 
132.24     (iv) professional services agencies that are not licensed 
132.25  and which contract with licensed programs to provide direct 
132.26  contact services or individuals who provide direct contact 
132.27  services. 
132.28     Studies on individuals in items (i) to (iv) must be 
132.29  initiated annually by these agencies, programs, and 
132.30  individuals.  Except for personal care provider 
132.31  organizations and supplemental nursing services agencies, no 
132.32  applicant, license holder, or individual who is the subject of 
132.33  the study shall pay any fees required to conduct the study. 
132.34     (1) At the option of the licensed facility, rather than 
132.35  initiating another background study on an individual required to 
132.36  be studied who has indicated to the licensed facility that a 
133.1   background study by the commissioner was previously completed, 
133.2   the facility may make a request to the commissioner for 
133.3   documentation of the individual's background study status, 
133.4   provided that: 
133.5      (i) the facility makes this request using a form provided 
133.6   by the commissioner; 
133.7      (ii) in making the request the facility informs the 
133.8   commissioner that either: 
133.9      (A) the individual has been continuously affiliated with a 
133.10  licensed facility since the individual's previous background 
133.11  study was completed, or since October 1, 1995, whichever is 
133.12  shorter; or 
133.13     (B) the individual is affiliated only with a personnel pool 
133.14  agency, a temporary personnel agency, an educational program 
133.15  that trains persons by providing direct contact services in 
133.16  licensed programs, or a professional services agency that is not 
133.17  licensed and which contracts with licensed programs to provide 
133.18  direct contact services or individuals who provide direct 
133.19  contact services; and 
133.20     (iii) the facility provides notices to the individual as 
133.21  required in paragraphs (a) to ~~(d)~~ (e), and that the facility is 
133.22  requesting written notification of the individual's background 
133.23  study status from the commissioner.  
133.24     (2) The commissioner shall respond to each request under 
133.25  paragraph (1) with a written or electronic notice to the 
133.26  facility and the study subject.  If the commissioner determines 
133.27  that a background study is necessary, the study shall be 
133.28  completed without further request from a licensed agency or 
133.29  notifications to the study subject.  
133.30     (3) When a background study is being initiated by a 
133.31  licensed facility or a foster care provider that is also 
133.32  registered under chapter 144D, a study subject affiliated with 
133.33  multiple licensed facilities may attach to the background study 
133.34  form a cover letter indicating the additional facilities' names, 
133.35  addresses, and background study identification numbers.  When 
133.36  the commissioner receives such notices, each facility identified 
134.1   by the background study subject shall be notified of the study 
134.2   results.  The background study notice sent to the subsequent 
134.3   agencies shall satisfy those facilities' responsibilities for 
134.4   initiating a background study on that individual. 
134.5      ~~(d)~~ (e) If an individual who is affiliated with a program 
134.6   or facility regulated by the department of human services or 
134.7   department of health or who is affiliated with a nonlicensed 
134.8   personal care provider organization, is convicted of a crime 
134.9   constituting a disqualification under subdivision 3d, the 
134.10  probation officer or corrections agent shall notify the 
134.11  commissioner of the conviction.  The commissioner, in 
134.12  consultation with the commissioner of corrections, shall develop 
134.13  forms and information necessary to implement this paragraph and 
134.14  shall provide the forms and information to the commissioner of 
134.15  corrections for distribution to local probation officers and 
134.16  corrections agents.  The commissioner shall inform individuals 
134.17  subject to a background study that criminal convictions for 
134.18  disqualifying crimes will be reported to the commissioner by the 
134.19  corrections system.  A probation officer, corrections agent, or 
134.20  corrections agency is not civilly or criminally liable for 
134.21  disclosing or failing to disclose the information required by 
134.22  this paragraph.  Upon receipt of disqualifying information, the 
134.23  commissioner shall provide the notifications required in 
134.24  subdivision 3a, as appropriate to agencies on record as having 
134.25  initiated a background study or making a request for 
134.26  documentation of the background study status of the individual.  
134.27  This paragraph does not apply to family day care and child 
134.28  foster care programs. 
134.29     ~~(e)~~ (f) The individual who is the subject of the study must 
134.30  provide the applicant or license holder with sufficient 
134.31  information to ensure an accurate study including the 
134.32  individual's first, middle, and last name; home address, city, 
134.33  county, and state of residence for the past five years; zip 
134.34  code; sex; date of birth; and driver's license number.  The 
134.35  applicant or license holder shall provide this information about 
134.36  an individual in paragraph ~~(c)~~ (d), clauses (1) to (5), on forms 
135.1   prescribed by the commissioner.  By January 1, 2000, for 
135.2   background studies conducted by the department of human 
135.3   services, the commissioner shall implement a system for the 
135.4   electronic transmission of:  (1) background study information to 
135.5   the commissioner; and (2) background study results to the 
135.6   license holder.  The commissioner may request additional 
135.7   information of the individual, which shall be optional for the 
135.8   individual to provide, such as the individual's social security 
135.9   number or race. 
135.10     ~~(f)~~ (g) Except for child foster care, adult foster care, 
135.11  and family day care homes, a study must include information 
135.12  related to names of substantiated perpetrators of maltreatment 
135.13  of vulnerable adults that has been received by the commissioner 
135.14  as required under section 626.557, subdivision 9c, paragraph 
135.15  (i), and the commissioner's records relating to the maltreatment 
135.16  of minors in licensed programs, information from juvenile courts 
135.17  as required in paragraph ~~(c)~~ (d) for persons listed in paragraph 
135.18  ~~(c)~~ (d), clause (2), and information from the bureau of criminal 
135.19  apprehension.  For child foster care, adult foster care, and 
135.20  family day care homes, the study must include information from 
135.21  the county agency's record of substantiated maltreatment of 
135.22  adults, and the maltreatment of minors, information from 
135.23  juvenile courts as required in paragraph ~~(c)~~ (d) for persons 
135.24  listed in paragraph ~~(c)~~ (d), clause (2), and information from 
135.25  the bureau of criminal apprehension.  The commissioner may also 
135.26  review arrest and investigative information from the bureau of 
135.27  criminal apprehension, the commissioner of health, a county 
135.28  attorney, county sheriff, county agency, local chief of police, 
135.29  other states, the courts, or the Federal Bureau of Investigation 
135.30  if the commissioner has reasonable cause to believe the 
135.31  information is pertinent to the disqualification of an 
135.32  individual listed in paragraph ~~(c)~~ (d), clauses (1) to (5).  The 
135.33  commissioner is not required to conduct more than one review of 
135.34  a subject's records from the Federal Bureau of Investigation if 
135.35  a review of the subject's criminal history with the Federal 
135.36  Bureau of Investigation has already been completed by the 
136.1   commissioner and there has been no break in the subject's 
136.2   affiliation with the license holder who initiated the background 
136.3   studies. 
136.4      When the commissioner has reasonable cause to believe that 
136.5   further pertinent information may exist on the subject, the 
136.6   subject shall provide a set of classifiable fingerprints 
136.7   obtained from an authorized law enforcement agency.  For 
136.8   purposes of requiring fingerprints, the commissioner shall be 
136.9   considered to have reasonable cause under, but not limited to, 
136.10  the following circumstances: 
136.11     (1) information from the bureau of criminal apprehension 
136.12  indicates that the subject is a multistate offender; 
136.13     (2) information from the bureau of criminal apprehension 
136.14  indicates that multistate offender status is undetermined; or 
136.15     (3) the commissioner has received a report from the subject 
136.16  or a third party indicating that the subject has a criminal 
136.17  history in a jurisdiction other than Minnesota. 
136.18     ~~(g)~~ (h) An applicant's ~~or~~, license holder's, or 
136.19  registrant's failure or refusal to cooperate with the 
136.20  commissioner is reasonable cause to disqualify a subject, deny a 
136.21  license application or immediately suspend, suspend, or revoke a 
136.22  license or registration.  Failure or refusal of an individual to 
136.23  cooperate with the study is just cause for denying or 
136.24  terminating employment of the individual if the individual's 
136.25  failure or refusal to cooperate could cause the applicant's 
136.26  application to be denied or the license holder's license to be 
136.27  immediately suspended, suspended, or revoked. 
136.28     ~~(h)~~ (i) The commissioner shall not consider an application 
136.29  to be complete until all of the information required to be 
136.30  provided under this subdivision has been received.  
136.31     ~~(i)~~ (j) No person in paragraph ~~(c)~~ (d), clause (1), (2), 
136.32  (3), (4), or (5), who is disqualified as a result of this 
136.33  section may be retained by the agency in a position involving 
136.34  direct contact with persons served by the program. 
136.35     ~~(j)~~ (k) Termination of persons in paragraph ~~(c)~~ (d), clause 
136.36  (1), (2), (3), (4), or (5), made in good faith reliance on a 
137.1   notice of disqualification provided by the commissioner shall 
137.2   not subject the applicant or license holder to civil liability. 
137.3      ~~(k)~~ (l) The commissioner may establish records to fulfill 
137.4   the requirements of this section. 
137.5      ~~(l)~~ (m) The commissioner may not disqualify an individual 
137.6   subject to a study under this section because that person has, 
137.7   or has had, a mental illness as defined in section 245.462, 
137.8   subdivision 20. 
137.9      ~~(m)~~ (n) An individual subject to disqualification under 
137.10  this subdivision has the applicable rights in subdivision 3a, 
137.11  3b, or 3c. 
137.12     ~~(n)~~ (o) For the purposes of background studies completed by 
137.13  tribal organizations performing licensing activities otherwise 
137.14  required of the commissioner under this chapter, after obtaining 
137.15  consent from the background study subject, tribal licensing 
137.16  agencies shall have access to criminal history data in the same 
137.17  manner as county licensing agencies and private licensing 
137.18  agencies under this chapter. 
137.19     Sec. 8.  Minnesota Statutes 2000, section 245A.04, 
137.20  subdivision 3a, is amended to read: 
137.21     Subd. 3a.  [NOTIFICATION TO SUBJECT AND LICENSE HOLDER OF 
137.22  STUDY RESULTS; DETERMINATION OF RISK OF HARM.] (a) The 
137.23  commissioner shall notify the applicant ~~or~~, license holder, or 
137.24  registrant and the individual who is the subject of the study, 
137.25  in writing or by electronic transmission, of the results of the 
137.26  study.  When the study is completed, a notice that the study was 
137.27  undertaken and completed shall be maintained in the personnel 
137.28  files of the program.  For studies on individuals pertaining to 
137.29  a license to provide family day care or group family day care, 
137.30  foster care for children in the provider's own home, or foster 
137.31  care or day care services for adults in the provider's own home, 
137.32  the commissioner is not required to provide a separate notice of 
137.33  the background study results to the individual who is the 
137.34  subject of the study unless the study results in a 
137.35  disqualification of the individual. 
137.36     The commissioner shall notify the individual studied if the 
138.1   information in the study indicates the individual is 
138.2   disqualified from direct contact with persons served by the 
138.3   program.  The commissioner shall disclose the information 
138.4   causing disqualification and instructions on how to request a 
138.5   reconsideration of the disqualification to the individual 
138.6   studied.  An applicant or license holder who is not the subject 
138.7   of the study shall be informed that the commissioner has found 
138.8   information that disqualifies the subject from direct contact 
138.9   with persons served by the program.  However, only the 
138.10  individual studied must be informed of the information contained 
138.11  in the subject's background study unless the only basis for the 
138.12  disqualification is failure to cooperate, the Data Practices Act 
138.13  provides for release of the information, or the individual 
138.14  studied authorizes the release of the information. 
138.15     (b) If the commissioner determines that the individual 
138.16  studied has a disqualifying characteristic, the commissioner 
138.17  shall review the information immediately available and make a 
138.18  determination as to the subject's immediate risk of harm to 
138.19  persons served by the program where the individual studied will 
138.20  have direct contact.  The commissioner shall consider all 
138.21  relevant information available, including the following factors 
138.22  in determining the immediate risk of harm:  the recency of the 
138.23  disqualifying characteristic; the recency of discharge from 
138.24  probation for the crimes; the number of disqualifying 
138.25  characteristics; the intrusiveness or violence of the 
138.26  disqualifying characteristic; the vulnerability of the victim 
138.27  involved in the disqualifying characteristic; and the similarity 
138.28  of the victim to the persons served by the program where the 
138.29  individual studied will have direct contact.  The commissioner 
138.30  may determine that the evaluation of the information immediately 
138.31  available gives the commissioner reason to believe one of the 
138.32  following: 
138.33     (1) The individual poses an imminent risk of harm to 
138.34  persons served by the program where the individual studied will 
138.35  have direct contact.  If the commissioner determines that an 
138.36  individual studied poses an imminent risk of harm to persons 
139.1   served by the program where the individual studied will have 
139.2   direct contact, the individual and the license holder must be 
139.3   sent a notice of disqualification.  The commissioner shall order 
139.4   the license holder to immediately remove the individual studied 
139.5   from direct contact.  The notice to the individual studied must 
139.6   include an explanation of the basis of this determination. 
139.7      (2) The individual poses a risk of harm requiring 
139.8   continuous supervision while providing direct contact services 
139.9   during the period in which the subject may request a 
139.10  reconsideration.  If the commissioner determines that an 
139.11  individual studied poses a risk of harm that requires continuous 
139.12  supervision, the individual and the license holder must be sent 
139.13  a notice of disqualification.  The commissioner shall order the 
139.14  license holder to immediately remove the individual studied from 
139.15  direct contact services or assure that the individual studied is 
139.16  within sight or hearing of another staff person when providing 
139.17  direct contact services during the period in which the 
139.18  individual may request a reconsideration of the 
139.19  disqualification.  If the individual studied does not submit a 
139.20  timely request for reconsideration, or the individual submits a 
139.21  timely request for reconsideration, but the disqualification is 
139.22  not set aside for that license holder, the license holder will 
139.23  be notified of the disqualification and ordered to immediately 
139.24  remove the individual from any position allowing direct contact 
139.25  with persons receiving services from the license holder. 
139.26     (3) The individual does not pose an imminent risk of harm 
139.27  or a risk of harm requiring continuous supervision while 
139.28  providing direct contact services during the period in which the 
139.29  subject may request a reconsideration.  If the commissioner 
139.30  determines that an individual studied does not pose a risk of 
139.31  harm that requires continuous supervision, only the individual 
139.32  must be sent a notice of disqualification.  The license holder 
139.33  must be sent a notice that more time is needed to complete the 
139.34  individual's background study.  If the individual studied 
139.35  submits a timely request for reconsideration, and if the 
139.36  disqualification is set aside for that license holder, the 
140.1   license holder will receive the same notification received by 
140.2   license holders in cases where the individual studied has no 
140.3   disqualifying characteristic.  If the individual studied does 
140.4   not submit a timely request for reconsideration, or the 
140.5   individual submits a timely request for reconsideration, but the 
140.6   disqualification is not set aside for that license holder, the 
140.7   license holder will be notified of the disqualification and 
140.8   ordered to immediately remove the individual from any position 
140.9   allowing direct contact with persons receiving services from the 
140.10  license holder.  
140.11     (c) County licensing agencies performing duties under this 
140.12  subdivision may develop an alternative system for determining 
140.13  the subject's immediate risk of harm to persons served by the 
140.14  program, providing the notices under paragraph (b), and 
140.15  documenting the action taken by the county licensing agency.  
140.16  Each county licensing agency's implementation of the alternative 
140.17  system is subject to approval by the commissioner.  
140.18  Notwithstanding this alternative system, county licensing 
140.19  agencies shall complete the requirements of paragraph (a). 
140.20     Sec. 9.  Minnesota Statutes 2000, section 245A.04, 
140.21  subdivision 3b, is amended to read: 
140.22     Subd. 3b.  [RECONSIDERATION OF DISQUALIFICATION.] (a) The 
140.23  individual who is the subject of the disqualification may 
140.24  request a reconsideration of the disqualification.  
140.25     The individual must submit the request for reconsideration 
140.26  to the commissioner in writing.  A request for reconsideration 
140.27  for an individual who has been sent a notice of disqualification 
140.28  under subdivision 3a, paragraph (b), clause (1) or (2), must be 
140.29  submitted within 30 calendar days of the disqualified 
140.30  individual's receipt of the notice of disqualification.  A 
140.31  request for reconsideration for an individual who has been sent 
140.32  a notice of disqualification under subdivision 3a, paragraph 
140.33  (b), clause (3), must be submitted within 15 calendar days of 
140.34  the disqualified individual's receipt of the notice of 
140.35  disqualification.  Removal of a disqualified individual from 
140.36  direct contact shall be ordered if the individual does not 
141.1   request reconsideration within the prescribed time, and for an 
141.2   individual who submits a timely request for reconsideration, if 
141.3   the disqualification is not set aside.  The individual must 
141.4   present information showing that: 
141.5      (1) the information the commissioner relied upon is 
141.6   incorrect or inaccurate.  If the basis of a reconsideration 
141.7   request is that a maltreatment determination or disposition 
141.8   under section 626.556 or 626.557 is incorrect, and the 
141.9   commissioner has issued a final order in an appeal of that 
141.10  determination or disposition under section 256.045, the 
141.11  commissioner's order is conclusive on the issue of maltreatment; 
141.12  or 
141.13     (2) the subject of the study does not pose a risk of harm 
141.14  to any person served by the applicant ~~or~~, license holder, or 
141.15  registrant. 
141.16     (b) The commissioner may set aside the disqualification 
141.17  under this section if the commissioner finds that the 
141.18  information the commissioner relied upon is incorrect or the 
141.19  individual does not pose a risk of harm to any person served by 
141.20  the applicant ~~or~~, license holder, or registrant.  In determining 
141.21  that an individual does not pose a risk of harm, the 
141.22  commissioner shall consider the consequences of the event or 
141.23  events that lead to disqualification, whether there is more than 
141.24  one disqualifying event, the vulnerability of the victim at the 
141.25  time of the event, the time elapsed without a repeat of the same 
141.26  or similar event, documentation of successful completion by the 
141.27  individual studied of training or rehabilitation pertinent to 
141.28  the event, and any other information relevant to 
141.29  reconsideration.  In reviewing a disqualification under this 
141.30  section, the commissioner shall give preeminent weight to the 
141.31  safety of each person to be served by the license holder ~~or~~, 
141.32  applicant, or registrant over the interests of the license 
141.33  holder ~~or~~, applicant, or registrant. 
141.34     (c) Unless the information the commissioner relied on in 
141.35  disqualifying an individual is incorrect, the commissioner may 
141.36  not set aside the disqualification of an individual in 
142.1   connection with a license to provide family day care for 
142.2   children, foster care for children in the provider's own home, 
142.3   or foster care or day care services for adults in the provider's 
142.4   own home if: 
142.5      (1) less than ten years have passed since the discharge of 
142.6   the sentence imposed for the offense; and the individual has 
142.7   been convicted of a violation of any offense listed in sections 
142.8   609.20 (manslaughter in the first degree), 609.205 (manslaughter 
142.9   in the second degree), criminal vehicular homicide under 609.21 
142.10  (criminal vehicular homicide and injury), 609.215 (aiding 
142.11  suicide or aiding attempted suicide), felony violations under 
142.12  609.221 to 609.2231 (assault in the first, second, third, or 
142.13  fourth degree), 609.713 (terroristic threats), 609.235 (use of 
142.14  drugs to injure or to facilitate crime), 609.24 (simple 
142.15  robbery), 609.245 (aggravated robbery), 609.25 (kidnapping), 
142.16  609.255 (false imprisonment), 609.561 or 609.562 (arson in the 
142.17  first or second degree), 609.71 (riot), burglary in the first or 
142.18  second degree under 609.582 (burglary), 609.66 (dangerous 
142.19  weapon), 609.665 (spring guns), 609.67 (machine guns and 
142.20  short-barreled shotguns), 609.749 (harassment; stalking), 
142.21  152.021 or 152.022 (controlled substance crime in the first or 
142.22  second degree), 152.023, subdivision 1, clause (3) or (4), or 
142.23  subdivision 2, clause (4) (controlled substance crime in the 
142.24  third degree), 152.024, subdivision 1, clause (2), (3), or (4) 
142.25  (controlled substance crime in the fourth degree), 609.224, 
142.26  subdivision 2, paragraph (c) (fifth-degree assault by a 
142.27  caregiver against a vulnerable adult), 609.228 (great bodily 
142.28  harm caused by distribution of drugs), 609.23 (mistreatment of 
142.29  persons confined), 609.231 (mistreatment of residents or 
142.30  patients), 609.2325 (criminal abuse of a vulnerable adult), 
142.31  609.233 (criminal neglect of a vulnerable adult), 609.2335 
142.32  (financial exploitation of a vulnerable adult), 609.234 (failure 
142.33  to report), 609.265 (abduction), 609.2664 to 609.2665 
142.34  (manslaughter of an unborn child in the first or second degree), 
142.35  609.267 to 609.2672 (assault of an unborn child in the first, 
142.36  second, or third degree), 609.268 (injury or death of an unborn 
143.1   child in the commission of a crime), 617.293 (disseminating or 
143.2   displaying harmful material to minors), a gross misdemeanor 
143.3   offense under 609.324, subdivision 1 (other prohibited acts), a 
143.4   gross misdemeanor offense under 609.378 (neglect or endangerment 
143.5   of a child), a gross misdemeanor offense under 609.377 
143.6   (malicious punishment of a child), 609.72, subdivision 3 
143.7   (disorderly conduct against a vulnerable adult); or an attempt 
143.8   or conspiracy to commit any of these offenses, as each of these 
143.9   offenses is defined in Minnesota Statutes; or an offense in any 
143.10  other state, the elements of which are substantially similar to 
143.11  the elements of any of the foregoing offenses; 
143.12     (2) regardless of how much time has passed since the 
143.13  discharge of the sentence imposed for the offense, the 
143.14  individual was convicted of a violation of any offense listed in 
143.15  sections 609.185 to 609.195 (murder in the first, second, or 
143.16  third degree), 609.2661 to 609.2663 (murder of an unborn child 
143.17  in the first, second, or third degree), a felony offense under 
143.18  609.377 (malicious punishment of a child), a felony offense 
143.19  under 609.324, subdivision 1 (other prohibited acts), a felony 
143.20  offense under 609.378 (neglect or endangerment of a child), 
143.21  609.322 (solicitation, inducement, and promotion of 
143.22  prostitution), 609.342 to 609.345 (criminal sexual conduct in 
143.23  the first, second, third, or fourth degree), 609.352 
143.24  (solicitation of children to engage in sexual conduct), 617.246 
143.25  (use of minors in a sexual performance), 617.247 (possession of 
143.26  pictorial representations of a minor), 609.365 (incest), a 
143.27  felony offense under sections 609.2242 and 609.2243 (domestic 
143.28  assault), a felony offense of spousal abuse, a felony offense of 
143.29  child abuse or neglect, a felony offense of a crime against 
143.30  children, or an attempt or conspiracy to commit any of these 
143.31  offenses as defined in Minnesota Statutes, or an offense in any 
143.32  other state, the elements of which are substantially similar to 
143.33  any of the foregoing offenses; 
143.34     (3) within the seven years preceding the study, the 
143.35  individual committed an act that constitutes maltreatment of a 
143.36  child under section 626.556, subdivision 10e, and that resulted 
144.1   in substantial bodily harm as defined in section 609.02, 
144.2   subdivision 7a, or substantial mental or emotional harm as 
144.3   supported by competent psychological or psychiatric evidence; or 
144.4      (4) within the seven years preceding the study, the 
144.5   individual was determined under section 626.557 to be the 
144.6   perpetrator of a substantiated incident of maltreatment of a 
144.7   vulnerable adult that resulted in substantial bodily harm as 
144.8   defined in section 609.02, subdivision 7a, or substantial mental 
144.9   or emotional harm as supported by competent psychological or 
144.10  psychiatric evidence. 
144.11     In the case of any ground for disqualification under 
144.12  clauses (1) to (4), if the act was committed by an individual 
144.13  other than the applicant ~~or~~, license holder, or registrant 
144.14  residing in the applicant's ~~or~~, license holder's, or 
144.15  registrant's home, the applicant ~~or~~, license holder, or 
144.16  registrant may seek reconsideration when the individual who 
144.17  committed the act no longer resides in the home.  
144.18     The disqualification periods provided under clauses (1), 
144.19  (3), and (4) are the minimum applicable disqualification 
144.20  periods.  The commissioner may determine that an individual 
144.21  should continue to be disqualified from licensure or 
144.22  registration because the license holder ~~or~~, registrant, or 
144.23  applicant poses a risk of harm to a person served by that 
144.24  individual after the minimum disqualification period has passed. 
144.25     (d) The commissioner shall respond in writing or by 
144.26  electronic transmission to all reconsideration requests for 
144.27  which the basis for the request is that the information relied 
144.28  upon by the commissioner to disqualify is incorrect or 
144.29  inaccurate within 30 working days of receipt of a request and 
144.30  all relevant information.  If the basis for the request is that 
144.31  the individual does not pose a risk of harm, the commissioner 
144.32  shall respond to the request within 15 working days after 
144.33  receiving the request for reconsideration and all relevant 
144.34  information.  If the disqualification is set aside, the 
144.35  commissioner shall notify the applicant or license holder in 
144.36  writing or by electronic transmission of the decision. 
145.1      (e) Except as provided in subdivision 3c, the 
145.2   commissioner's decision to disqualify an individual, including 
145.3   the decision to grant or deny a rescission or set aside a 
145.4   disqualification under this section, is the final administrative 
145.5   agency action and shall not be subject to further review in a 
145.6   contested case under chapter 14 involving a negative licensing 
145.7   appeal taken in response to the disqualification or involving an 
145.8   accuracy and completeness appeal under section 13.04. 
145.9      Sec. 10.  Minnesota Statutes 2000, section 245A.04, 
145.10  subdivision 3d, is amended to read: 
145.11     Subd. 3d.  [DISQUALIFICATION.] (a) Except as provided in 
145.12  paragraph (b), when a background study completed under 
145.13  subdivision 3 shows any of the following:  a conviction of one 
145.14  or more crimes listed in clauses (1) to (4); the individual has 
145.15  admitted to or a preponderance of the evidence indicates the 
145.16  individual has committed an act or acts that meet the definition 
145.17  of any of the crimes listed in clauses (1) to (4); or an 
145.18  administrative determination listed under clause (4), the 
145.19  individual shall be disqualified from any position allowing 
145.20  direct contact with persons receiving services from the license 
145.21  holder or registrant: 
145.22     (1) regardless of how much time has passed since the 
145.23  discharge of the sentence imposed for the offense, and unless 
145.24  otherwise specified, regardless of the level of the conviction, 
145.25  the individual was convicted of any of the following offenses:  
145.26  sections 609.185 (murder in the first degree); 609.19 (murder in 
145.27  the second degree); 609.195 (murder in the third degree); 
145.28  609.2661 (murder of an unborn child in the first degree); 
145.29  609.2662 (murder of an unborn child in the second degree); 
145.30  609.2663 (murder of an unborn child in the third degree); 
145.31  609.322 (solicitation, inducement, and promotion of 
145.32  prostitution); 609.342 (criminal sexual conduct in the first 
145.33  degree); 609.343 (criminal sexual conduct in the second degree); 
145.34  609.344 (criminal sexual conduct in the third degree); 609.345 
145.35  (criminal sexual conduct in the fourth degree); 609.352 
145.36  (solicitation of children to engage in sexual conduct); 609.365 
146.1   (incest); felony offense under 609.377 (malicious punishment of 
146.2   a child); a felony offense under 609.378 (neglect or 
146.3   endangerment of a child); a felony offense under 609.324, 
146.4   subdivision 1 (other prohibited acts); 617.246 (use of minors in 
146.5   sexual performance prohibited); 617.247 (possession of pictorial 
146.6   representations of minors); a felony offense under sections 
146.7   609.2242 and 609.2243 (domestic assault), a felony offense of 
146.8   spousal abuse, a felony offense of child abuse or neglect, a 
146.9   felony offense of a crime against children; or attempt or 
146.10  conspiracy to commit any of these offenses as defined in 
146.11  Minnesota Statutes, or an offense in any other state or country, 
146.12  where the elements are substantially similar to any of the 
146.13  offenses listed in this clause; 
146.14     (2) if less than 15 years have passed since the discharge 
146.15  of the sentence imposed for the offense; and the individual has 
146.16  received a felony conviction for a violation of any of these 
146.17  offenses:  sections 609.20 (manslaughter in the first degree); 
146.18  609.205 (manslaughter in the second degree); 609.21 (criminal 
146.19  vehicular homicide and injury); 609.215 (suicide); 609.221 to 
146.20  609.2231 (assault in the first, second, third, or fourth 
146.21  degree); repeat offenses under 609.224 (assault in the fifth 
146.22  degree); repeat offenses under 609.3451 (criminal sexual conduct 
146.23  in the fifth degree); 609.713 (terroristic threats); 609.235 
146.24  (use of drugs to injure or facilitate crime); 609.24 (simple 
146.25  robbery); 609.245 (aggravated robbery); 609.25 (kidnapping); 
146.26  609.255 (false imprisonment); 609.561 (arson in the first 
146.27  degree); 609.562 (arson in the second degree); 609.563 (arson in 
146.28  the third degree); repeat offenses under 617.23 (indecent 
146.29  exposure; penalties); repeat offenses under 617.241 (obscene 
146.30  materials and performances; distribution and exhibition 
146.31  prohibited; penalty); 609.71 (riot); 609.66 (dangerous weapons); 
146.32  609.67 (machine guns and short-barreled shotguns); 609.749 
146.33  (harassment; stalking; penalties); 609.228 (great bodily harm 
146.34  caused by distribution of drugs); 609.2325 (criminal abuse of a 
146.35  vulnerable adult); 609.2664 (manslaughter of an unborn child in 
146.36  the first degree); 609.2665 (manslaughter of an unborn child in 
147.1   the second degree); 609.267 (assault of an unborn child in the 
147.2   first degree); 609.2671 (assault of an unborn child in the 
147.3   second degree); 609.268 (injury or death of an unborn child in 
147.4   the commission of a crime); 609.52 (theft); 609.2335 (financial 
147.5   exploitation of a vulnerable adult); 609.521 (possession of 
147.6   shoplifting gear); 609.582 (burglary); 609.625 (aggravated 
147.7   forgery); 609.63 (forgery); 609.631 (check forgery; offering a 
147.8   forged check); 609.635 (obtaining signature by false pretense); 
147.9   609.27 (coercion); 609.275 (attempt to coerce); 609.687 
147.10  (adulteration); 260C.301 (grounds for termination of parental 
147.11  rights); and chapter 152 (drugs; controlled substance).  An 
147.12  attempt or conspiracy to commit any of these offenses, as each 
147.13  of these offenses is defined in Minnesota Statutes; or an 
147.14  offense in any other state or country, the elements of which are 
147.15  substantially similar to the elements of the offenses in this 
147.16  clause.  If the individual studied is convicted of one of the 
147.17  felonies listed in this clause, but the sentence is a gross 
147.18  misdemeanor or misdemeanor disposition, the lookback period for 
147.19  the conviction is the period applicable to the disposition, that 
147.20  is the period for gross misdemeanors or misdemeanors; 
147.21     (3) if less than ten years have passed since the discharge 
147.22  of the sentence imposed for the offense; and the individual has 
147.23  received a gross misdemeanor conviction for a violation of any 
147.24  of the following offenses:  sections 609.224 (assault in the 
147.25  fifth degree); 609.2242 and 609.2243 (domestic assault); 
147.26  violation of an order for protection under 518B.01, subdivision 
147.27  14; 609.3451 (criminal sexual conduct in the fifth degree); 
147.28  repeat offenses under 609.746 (interference with privacy); 
147.29  repeat offenses under 617.23 (indecent exposure); 617.241 
147.30  (obscene materials and performances); 617.243 (indecent 
147.31  literature, distribution); 617.293 (harmful materials; 
147.32  dissemination and display to minors prohibited); 609.71 (riot); 
147.33  609.66 (dangerous weapons); 609.749 (harassment; stalking; 
147.34  penalties); 609.224, subdivision 2, paragraph (c) (assault in 
147.35  the fifth degree by a caregiver against a vulnerable adult); 
147.36  609.23 (mistreatment of persons confined); 609.231 (mistreatment 
148.1   of residents or patients); 609.2325 (criminal abuse of a 
148.2   vulnerable adult); 609.233 (criminal neglect of a vulnerable 
148.3   adult); 609.2335 (financial exploitation of a vulnerable adult); 
148.4   609.234 (failure to report maltreatment of a vulnerable adult); 
148.5   609.72, subdivision 3 (disorderly conduct against a vulnerable 
148.6   adult); 609.265 (abduction); 609.378 (neglect or endangerment of 
148.7   a child); 609.377 (malicious punishment of a child); 609.324, 
148.8   subdivision 1a (other prohibited acts; minor engaged in 
148.9   prostitution); 609.33 (disorderly house); 609.52 (theft); 
148.10  609.582 (burglary); 609.631 (check forgery; offering a forged 
148.11  check); 609.275 (attempt to coerce); or an attempt or conspiracy 
148.12  to commit any of these offenses, as each of these offenses is 
148.13  defined in Minnesota Statutes; or an offense in any other state 
148.14  or country, the elements of which are substantially similar to 
148.15  the elements of any of the offenses listed in this clause.  If 
148.16  the defendant is convicted of one of the gross misdemeanors 
148.17  listed in this clause, but the sentence is a misdemeanor 
148.18  disposition, the lookback period for the conviction is the 
148.19  period applicable to misdemeanors; or 
148.20     (4) if less than seven years have passed since the 
148.21  discharge of the sentence imposed for the offense; and the 
148.22  individual has received a misdemeanor conviction for a violation 
148.23  of any of the following offenses:  sections 609.224 (assault in 
148.24  the fifth degree); 609.2242 (domestic assault); violation of an 
148.25  order for protection under 518B.01 (Domestic Abuse Act); 
148.26  violation of an order for protection under 609.3232 (protective 
148.27  order authorized; procedures; penalties); 609.746 (interference 
148.28  with privacy); 609.79 (obscene or harassing phone calls); 
148.29  609.795 (letter, telegram, or package; opening; harassment); 
148.30  617.23 (indecent exposure; penalties); 609.2672 (assault of an 
148.31  unborn child in the third degree); 617.293 (harmful materials; 
148.32  dissemination and display to minors prohibited); 609.66 
148.33  (dangerous weapons); 609.665 (spring guns); 609.2335 (financial 
148.34  exploitation of a vulnerable adult); 609.234 (failure to report 
148.35  maltreatment of a vulnerable adult); 609.52 (theft); 609.27 
148.36  (coercion); or an attempt or conspiracy to commit any of these 
149.1   offenses, as each of these offenses is defined in Minnesota 
149.2   Statutes; or an offense in any other state or country, the 
149.3   elements of which are substantially similar to the elements of 
149.4   any of the offenses listed in this clause; failure to make 
149.5   required reports under section 626.556, subdivision 3, or 
149.6   626.557, subdivision 3, for incidents in which:  (i) the final 
149.7   disposition under section 626.556 or 626.557 was substantiated 
149.8   maltreatment, and (ii) the maltreatment was recurring or 
149.9   serious; or substantiated serious or recurring maltreatment of a 
149.10  minor under section 626.556 or of a vulnerable adult under 
149.11  section 626.557 for which there is a preponderance of evidence 
149.12  that the maltreatment occurred, and that the subject was 
149.13  responsible for the maltreatment. 
149.14     For the purposes of this section, "serious maltreatment" 
149.15  means sexual abuse; maltreatment resulting in death; or 
149.16  maltreatment resulting in serious injury which reasonably 
149.17  requires the care of a physician whether or not the care of a 
149.18  physician was sought; or abuse resulting in serious injury.  For 
149.19  purposes of this section, "abuse resulting in serious injury" 
149.20  means:  bruises, bites, skin laceration or tissue damage; 
149.21  fractures; dislocations; evidence of internal injuries; head 
149.22  injuries with loss of consciousness; extensive second-degree or 
149.23  third-degree burns and other burns for which complications are 
149.24  present; extensive second-degree or third-degree frostbite, and 
149.25  others for which complications are present; irreversible 
149.26  mobility or avulsion of teeth; injuries to the eyeball; 
149.27  ingestion of foreign substances and objects that are harmful; 
149.28  near drowning; and heat exhaustion or sunstroke.  For purposes 
149.29  of this section, "care of a physician" is treatment received or 
149.30  ordered by a physician, but does not include diagnostic testing, 
149.31  assessment, or observation.  For the purposes of this section, 
149.32  "recurring maltreatment" means more than one incident of 
149.33  maltreatment for which there is a preponderance of evidence that 
149.34  the maltreatment occurred, and that the subject was responsible 
149.35  for the maltreatment. 
149.36     (b) If the subject of a background study is licensed by a 
150.1   health-related licensing board, the board shall make the 
150.2   determination regarding a disqualification under this 
150.3   subdivision based on a finding of substantiated maltreatment 
150.4   under section 626.556 or 626.557.  The commissioner shall notify 
150.5   the health-related licensing board if a background study shows 
150.6   that a licensee would be disqualified because of substantiated 
150.7   maltreatment and the board shall make a determination under 
150.8   section 214.104. 
150.9      Sec. 11.  [REPORT ON SUPPLEMENTAL NURSING SERVICES AGENCY 
150.10  USE.] 
150.11     Beginning July 1, 2001, through June 30, 2003, the 
150.12  commissioner of human services shall require nursing facilities 
150.13  and other providers of long-term care services to report 
150.14  semiannually on the use of supplemental nursing services, in the 
150.15  form and manner specified by the commissioner.  The information 
150.16  reported must include, but is not limited to: 
150.17     (1) number of hours worked by supplemental nursing services 
150.18  personnel, by job classification, for each month; 
150.19     (2) payments to supplemental nursing services agencies, on 
150.20  a per hour worked basis, by job classification, for each month; 
150.21  and 
150.22     (3) percentage of total monthly work hours provided by 
150.23  supplemental nursing services agency personnel, by job 
150.24  classification, for each shift and for weekdays and weekends. 
150.25     Sec. 12.  [APPROPRIATION.] 
150.26     $....... is appropriated from the general fund to the 
150.27  commissioner of health for the biennium beginning July 1, 2001, 
150.28  to regulate supplemental nursing services agencies. 
150.29                             ARTICLE 5 
150.30                      LONG-TERM CARE INSURANCE 
150.31     Section 1.  Minnesota Statutes 2000, section 62A.48, 
150.32  subdivision 4, is amended to read: 
150.33     Subd. 4.  [LOSS RATIO.] The anticipated loss ratio for 
150.34  long-term care policies must not be less than 65 percent for 
150.35  policies issued on a group basis or 60 percent for policies 
150.36  issued on an individual or mass-market basis.  This subdivision 
151.1   does not apply to policies issued on or after January 1, 2002, 
151.2   that comply with sections 62S.021 and 62S.081. 
151.3      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
151.4   following final enactment. 
151.5      Sec. 2.  Minnesota Statutes 2000, section 62A.48, is 
151.6   amended by adding a subdivision to read: 
151.7      Subd. 10.  [REGULATION OF PREMIUMS AND PREMIUM 
151.8   INCREASES.] Policies issued under sections 62A.46 to 62A.56 on 
151.9   or after January 1, 2002, must comply with sections 62S.021, 
151.10  62S.081, 62S.265, and 62S.266 to the same extent as policies 
151.11  issued under chapter 62S. 
151.12     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
151.13  following final enactment. 
151.14     Sec. 3.  Minnesota Statutes 2000, section 62A.48, is 
151.15  amended by adding a subdivision to read: 
151.16     Subd. 11.  [NONFORFEITURE BENEFITS.] Policies issued under 
151.17  sections 62A.46 to 62A.56 on or after January 1, 2002, must 
151.18  comply with section 62S.02, subdivision 2, to the same extent as 
151.19  policies issued under chapter 62S. 
151.20     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
151.21  following final enactment. 
151.22     Sec. 4.  Minnesota Statutes 2000, section 62S.01, is 
151.23  amended by adding a subdivision to read: 
151.24     Subd. 13a.  [EXCEPTIONAL INCREASE.] (a) "Exceptional 
151.25  increase" means only those increases filed by an insurer as 
151.26  exceptional for which the commissioner determines the need for 
151.27  the premium rate increase is justified due to changes in laws or 
151.28  rules applicable to long-term care coverage in this state, or 
151.29  due to increased and unexpected utilization that affects the 
151.30  majority of insurers of similar products. 
151.31     (b) Except as provided in section 62S.265, exceptional 
151.32  increases are subject to the same requirements as other premium 
151.33  rate schedule increases.  The commissioner may request a review 
151.34  by an independent actuary or a professional actuarial body of 
151.35  the basis for a request that an increase be considered an 
151.36  exceptional increase.  The commissioner, in determining that the 
152.1   necessary basis for an exceptional increase exists, shall also 
152.2   determine any potential offsets to higher claims costs. 
152.3      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
152.4   following final enactment. 
152.5      Sec. 5.  Minnesota Statutes 2000, section 62S.01, is 
152.6   amended by adding a subdivision to read: 
152.7      Subd. 17a.  [INCIDENTAL.] "Incidental," as used in section 
152.8   62S.265, subdivision 10, means that the value of the long-term 
152.9   care benefits provided is less than ten percent of the total 
152.10  value of the benefits provided over the life of the policy.  
152.11  These values shall be measured as of the date of issue. 
152.12     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
152.13  following final enactment. 
152.14     Sec. 6.  Minnesota Statutes 2000, section 62S.01, is 
152.15  amended by adding a subdivision to read: 
152.16     Subd. 23a.  [QUALIFIED ACTUARY.] "Qualified actuary" means 
152.17  a member in good standing of the American Academy of Actuaries. 
152.18     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
152.19  following final enactment. 
152.20     Sec. 7.  Minnesota Statutes 2000, section 62S.01, is 
152.21  amended by adding a subdivision to read: 
152.22     Subd. 25a.  [SIMILAR POLICY FORMS.] "Similar policy forms" 
152.23  means all of the long-term care insurance policies and 
152.24  certificates issued by an insurer in the same long-term care 
152.25  benefit classification as the policy form being considered.  
152.26  Certificates of groups that meet the definition in section .... 
152.27  are not considered similar to certificates or policies otherwise 
152.28  issued as long-term care insurance, but are similar to other 
152.29  comparable certificates with the same long-term care benefit 
152.30  classifications.  For purposes of determining similar policy 
152.31  forms, long-term care benefit classifications are defined as 
152.32  follows:  institutional long-term care benefits only, 
152.33  noninstitutional long-term care benefits only, or comprehensive 
152.34  long-term care benefits. 
152.35     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
152.36  following final enactment. 
153.1      Sec. 8.  [62S.021] [LONG-TERM CARE INSURANCE; INITIAL 
153.2   FILING.] 
153.3      Subdivision 1.  [APPLICABILITY.] This section applies to 
153.4   any long-term care policy issued in this state on or after 
153.5   January 1, 2002, under this chapter or sections 62A.46 to 62A.56.
153.6      Subd. 2.  [REQUIRED SUBMISSION TO COMMISSIONER.] An insurer 
153.7   shall provide the following information to the commissioner 30 
153.8   days prior to making a long-term care insurance form available 
153.9   for sale: 
153.10     (1) a copy of the disclosure documents required in section 
153.11  62S.081; and 
153.12     (2) an actuarial certification consisting of at least the 
153.13  following: 
153.14     (i) a statement that the initial premium rate schedule is 
153.15  sufficient to cover anticipated costs under moderately adverse 
153.16  experience and that the premium rate schedule is reasonably 
153.17  expected to be sustainable over the life of the form with no 
153.18  future premium increases anticipated; 
153.19     (ii) a statement that the policy design and coverage 
153.20  provided have been reviewed and taken into consideration; 
153.21     (iii) a statement that the underwriting and claims 
153.22  adjudication processes have been reviewed and taken into 
153.23  consideration; and 
153.24     (iv) a complete description of the basis for contract 
153.25  reserves that are anticipated to be held under the form, to 
153.26  include: 
153.27     (A) sufficient detail or sample calculations provided so as 
153.28  to have a complete depiction of the reserve amounts to be held; 
153.29     (B) a statement that the assumptions used for reserves 
153.30  contain reasonable margins for adverse experience; 
153.31     (C) a statement that the net valuation premium for renewal 
153.32  years does not increase, except for attained-age rating where 
153.33  permitted; 
153.34     (D) a statement that the difference between the gross 
153.35  premium and the net valuation premium for renewal years is 
153.36  sufficient to cover expected renewal expenses, or if such a 
154.1   statement cannot be made, a complete description of the 
154.2   situations where this does not occur.  An aggregate distribution 
154.3   of anticipated issues may be used as long as the underlying 
154.4   gross premiums maintain a reasonably consistent relationship.  
154.5   If the gross premiums for certain age groups appear to be 
154.6   inconsistent with this requirement, the commissioner may request 
154.7   a demonstration under item (i) based on a standard age 
154.8   distribution; and 
154.9      (E) either a statement that the premium rate schedule is 
154.10  not less than the premium rate schedule for existing similar 
154.11  policy forms also available from the insurer except for 
154.12  reasonable differences attributable to benefits, or a comparison 
154.13  of the premium schedules for similar policy forms that are 
154.14  currently available from the insurer with an explanation of the 
154.15  differences. 
154.16     Subd. 3.  [ACTUARIAL DEMONSTRATION.] The commissioner may 
154.17  request an actuarial demonstration that benefits are reasonable 
154.18  in relation to premiums.  The actuarial demonstration shall 
154.19  include either premium and claim experience on similar policy 
154.20  forms, adjusted for any premium or benefit differences, relevant 
154.21  and credible data from other studies, or both.  If the 
154.22  commissioner asks for additional information under this 
154.23  subdivision, the 30-day time limit in subdivision 2 does not 
154.24  include the time during which the insurer is preparing the 
154.25  requested information. 
154.26     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
154.27  following final enactment. 
154.28     Sec. 9.  [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES 
154.29  TO CONSUMERS.] 
154.30     Subdivision 1.  [APPLICATION.] This section shall apply as 
154.31  follows: 
154.32     (a) Except as provided in paragraph (b), this section 
154.33  applies to any long-term care policy or certificate issued in 
154.34  this state on or after January 1, 2002. 
154.35     (b) For certificates issued on or after the effective date 
154.36  of this section under a policy of group long-term care insurance 
155.1   as defined in section 62S.01, subdivision 15, that was in force 
155.2   on the effective date of this section, this section applies on 
155.3   the policy anniversary following June 30, 2002. 
155.4      Subd. 2.  [REQUIRED DISCLOSURES.] Other than policies for 
155.5   which no applicable premium rate or rate schedule increases can 
155.6   be made, insurers shall provide all of the information listed in 
155.7   this subdivision to the applicant at the time of application or 
155.8   enrollment, unless the method of application does not allow for 
155.9   delivery at that time; in this case, an insurer shall provide 
155.10  all of the information listed in this subdivision to the 
155.11  applicant no later than at the time of delivery of the policy or 
155.12  certificate: 
155.13     (1) a statement that the policy may be subject to rate 
155.14  increases in the future; 
155.15     (2) an explanation of potential future premium rate 
155.16  revisions and the policyholder's or certificate holder's option 
155.17  in the event of a premium rate revision; 
155.18     (3) the premium rate or rate schedules applicable to the 
155.19  applicant that will be in effect until a request is made for an 
155.20  increase; 
155.21     (4) a general explanation for applying premium rate or rate 
155.22  schedule adjustments that must include: 
155.23     (i) a description of when premium rate or rate schedule 
155.24  adjustments will be effective, for example the next anniversary 
155.25  date or the next billing date; and 
155.26     (ii) the right to a revised premium rate or rate schedule 
155.27  as provided in clause (3) if the premium rate or rate schedule 
155.28  is changed; and 
155.29     (5)(i) information regarding each premium rate increase on 
155.30  this policy form or similar policy forms over the past ten years 
155.31  for this state or any other state that, at a minimum, identifies:
155.32     (A) the policy forms for which premium rates have been 
155.33  increased; 
155.34     (B) the calendar years when the form was available for 
155.35  purchase; and 
155.36     (C) the amount or percent of each increase.  The percentage 
156.1   may be expressed as a percentage of the premium rate prior to 
156.2   the increase and may also be expressed as minimum and maximum 
156.3   percentages if the rate increase is variable by rating 
156.4   characteristics; 
156.5      (ii) the insurer may, in a fair manner, provide additional 
156.6   explanatory information related to the rate increases; 
156.7      (iii) an insurer has the right to exclude from the 
156.8   disclosure premium rate increases that apply only to blocks of 
156.9   business acquired from other nonaffiliated insurers or the 
156.10  long-term care policies acquired from other nonaffiliated 
156.11  insurers when those increases occurred prior to the acquisition; 
156.12     (iv) if an acquiring insurer files for a rate increase on a 
156.13  long-term care policy form acquired from nonaffiliated insurers 
156.14  or a block of policy forms acquired from nonaffiliated insurers 
156.15  on or before the later of the effective date of this section, or 
156.16  the end of a 24-month period following the acquisition of the 
156.17  block of policies, the acquiring insurer may exclude that rate 
156.18  increase from the disclosure.  However, the nonaffiliated 
156.19  selling company must include the disclosure of that rate 
156.20  increase according to item (i); and 
156.21     (v) if the acquiring insurer in item (iv) files for a 
156.22  subsequent rate increase, even within the 24-month period, on 
156.23  the same policy form acquired from nonaffiliated insurers or 
156.24  block of policy forms acquired from nonaffiliated insurers 
156.25  referenced in item (iv), the acquiring insurer shall make all 
156.26  disclosures required by this subdivision, including disclosure 
156.27  of the earlier rate increase referenced in item (iv). 
156.28     Subd. 3.  [ACKNOWLEDGMENT.] An applicant shall sign an 
156.29  acknowledgment at the time of application, unless the method of 
156.30  application does not allow for signature at that time, that the 
156.31  insurer made the disclosure required under subdivision 2.  If, 
156.32  due to the method of application, the applicant cannot sign an 
156.33  acknowledgment at the time of application, the applicant shall 
156.34  sign no later than at the time of delivery of the policy or 
156.35  certificate. 
156.36     Subd. 4.  [FORMS.] An insurer shall use the forms in 
157.1   Appendices B and F of the Long-term Care Insurance Model 
157.2   Regulation adopted by the National Association of Insurance 
157.3   Commissioners to comply with the requirements of subdivisions 1 
157.4   and 2. 
157.5      Subd. 5.  [NOTICE OF INCREASE.] An insurer shall provide 
157.6   notice of an upcoming premium rate schedule increase, after the 
157.7   increase has been approved by the commissioner, to all 
157.8   policyholders or certificate holders, if applicable, at least 45 
157.9   days prior to the implementation of the premium rate schedule 
157.10  increase by the insurer.  The notice shall include the 
157.11  information required by subdivision 2 when the rate increase is 
157.12  implemented. 
157.13     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
157.14  following final enactment. 
157.15     Sec. 10.  Minnesota Statutes 2000, section 62S.26, is 
157.16  amended to read: 
157.17     62S.26 [LOSS RATIO.] 
157.18     (a) The minimum loss ratio must be at least 60 percent, 
157.19  calculated in a manner which provides for adequate reserving of 
157.20  the long-term care insurance risk.  In evaluating the expected 
157.21  loss ratio, the commissioner shall give consideration to all 
157.22  relevant factors, including: 
157.23     (1) statistical credibility of incurred claims experience 
157.24  and earned premiums; 
157.25     (2) the period for which rates are computed to provide 
157.26  coverage; 
157.27     (3) experienced and projected trends; 
157.28     (4) concentration of experience within early policy 
157.29  duration; 
157.30     (5) expected claim fluctuation; 
157.31     (6) experience refunds, adjustments, or dividends; 
157.32     (7) renewability features; 
157.33     (8) all appropriate expense factors; 
157.34     (9) interest; 
157.35     (10) experimental nature of the coverage; 
157.36     (11) policy reserves; 
158.1      (12) mix of business by risk classification; and 
158.2      (13) product features such as long elimination periods, 
158.3   high deductibles, and high maximum limits. 
158.4      (b) This section does not apply to policies or certificates 
158.5   that are subject to sections 62S.021, 62S.081, and 62S.265, and 
158.6   that comply with those sections. 
158.7      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
158.8   following final enactment. 
158.9      Sec. 11.  [62S.265] [PREMIUM RATE SCHEDULE INCREASES.] 
158.10     Subdivision 1.  [APPLICABILITY.] (a) Except as provided in 
158.11  paragraph (b), this section applies to any long-term care policy 
158.12  or certificate issued in this state on or after January 1, 2002, 
158.13  under this chapter or sections 62A.46 to 62A.56. 
158.14     (b) For certificates issued on or after the effective date 
158.15  of this section under a group long-term care insurance policy as 
158.16  defined in section 62S.01, subdivision 15, or as described in 
158.17  section 62A.46, subdivision 2, that was in force on the 
158.18  effective date of this section, this section applies on the 
158.19  policy anniversary following June 30, 2002. 
158.20     Subd. 2.  [NOTICE.] An insurer shall file a requested 
158.21  premium rate schedule increase, including an exceptional 
158.22  increase, to the commissioner for prior approval at least 60 
158.23  days prior to the notice to the policyholders and shall include: 
158.24     (1) all information required by section 62S.081; 
158.25     (2) certification by a qualified actuary that: 
158.26     (i) if the requested premium rate schedule increase is 
158.27  implemented and the underlying assumptions, which reflect 
158.28  moderately adverse conditions, are realized, no further premium 
158.29  rate schedule increases are anticipated; and 
158.30     (ii) the premium rate filing complies with this section; 
158.31     (3) an actuarial memorandum justifying the rate schedule 
158.32  change request that includes: 
158.33     (i) lifetime projections of earned premiums and incurred 
158.34  claims based on the filed premium rate schedule increase and the 
158.35  method and assumptions used in determining the projected values, 
158.36  including reflection of any assumptions that deviate from those 
159.1   used for pricing other forms currently available for sale; 
159.2      (A) annual values for the five years preceding and the 
159.3   three years following the valuation date shall be provided 
159.4   separately; 
159.5      (B) the projections must include the development of the 
159.6   lifetime loss ratio, unless the rate increase is an exceptional 
159.7   increase; 
159.8      (C) the projections must demonstrate compliance with 
159.9   subdivision 3; and 
159.10     (D) for exceptional increases, the projected experience 
159.11  must be limited to the increases in claims expenses attributable 
159.12  to the approved reasons for the exceptional increase and, if the 
159.13  commissioner determines that offsets to higher claim costs may 
159.14  exist, the insurer shall use appropriate net projected 
159.15  experience; 
159.16     (ii) disclosure of how reserves have been incorporated in 
159.17  this rate increase whenever the rate increase will trigger 
159.18  contingent benefit upon lapse; 
159.19     (iii) disclosure of the analysis performed to determine why 
159.20  a rate adjustment is necessary, which pricing assumptions were 
159.21  not realized and why, and what other actions taken by the 
159.22  company have been relied upon by the actuary; 
159.23     (iv) a statement that policy design, underwriting, and 
159.24  claims adjudication practices have been taken into 
159.25  consideration; and 
159.26     (v) if it is necessary to maintain consistent premium rates 
159.27  for new certificates and certificates receiving a rate increase, 
159.28  the insurer shall file composite rates reflecting projections of 
159.29  new certificates; 
159.30     (4) a statement that renewal premium rate schedules are not 
159.31  greater than new business premium rate schedules except for 
159.32  differences attributable to benefits, unless sufficient 
159.33  justification is provided to the commissioner; and 
159.34     (5) sufficient information for review and approval of the 
159.35  premium rate schedule increase by the commissioner. 
159.36     Subd. 3.  [REQUIREMENTS PERTAINING TO RATE INCREASES.] All 
160.1   premium rate schedule increases must be determined according to 
160.2   the following requirements: 
160.3      (1) exceptional increases shall provide that 70 percent of 
160.4   the present value of projected additional premiums from the 
160.5   exceptional increase will be returned to policyholders in 
160.6   benefits; 
160.7      (2) premium rate schedule increases must be calculated so 
160.8   that the sum of the accumulated value of incurred claims, 
160.9   without the inclusion of active life reserves, and the present 
160.10  value of future projected incurred claims, without the inclusion 
160.11  of active life reserves, will not be less than the sum of the 
160.12  following: 
160.13     (i) the accumulated value of the initial earned premium 
160.14  times 58 percent; 
160.15     (ii) 85 percent of the accumulated value of prior premium 
160.16  rate schedule increases on an earned basis; 
160.17     (iii) the present value of future projected initial earned 
160.18  premiums times 58 percent; and 
160.19     (iv) 85 percent of the present value of future projected 
160.20  premiums not in item (iii) on an earned basis; 
160.21     (3) if a policy form has both exceptional and other 
160.22  increases, the values in clause (2), items (ii) and (iv), must 
160.23  also include 70 percent for exceptional rate increase amounts; 
160.24  and 
160.25     (4) all present and accumulated values used to determine 
160.26  rate increases must use the maximum valuation interest rate for 
160.27  contract reserves permitted for valuation of whole life 
160.28  insurance policies issued in this state on the same date.  The 
160.29  actuary shall disclose as part of the actuarial memorandum the 
160.30  use of any appropriate averages. 
160.31     Subd. 4.  [PROJECTIONS.] For each rate increase that is 
160.32  implemented, the insurer shall file for approval by the 
160.33  commissioner updated projections, as defined in subdivision 2, 
160.34  clause (3), item (i), annually for the next three years and 
160.35  include a comparison of actual results to projected values.  The 
160.36  commissioner may extend the period to greater than three years 
161.1   if actual results are not consistent with projected values from 
161.2   prior projections.  For group insurance policies that meet the 
161.3   conditions in subdivision 11, the projections required by this 
161.4   subdivision must be provided to the policyholder in lieu of 
161.5   filing with the commissioner. 
161.6      Subd. 5.  [LIFETIME PROJECTIONS.] If any premium rate in 
161.7   the revised premium rate schedule is greater than 200 percent of 
161.8   the comparable rate in the initial premium schedule, lifetime 
161.9   projections, as defined in subdivision 2, clause (3), item (i), 
161.10  must be filed for approval by the commissioner every five years 
161.11  following the end of the required period in subdivision 4.  For 
161.12  group insurance policies that meet the conditions in subdivision 
161.13  11, the projections required by this subdivision must be 
161.14  provided to the policyholder in lieu of filing with the 
161.15  commissioner. 
161.16     Subd. 6.  [EFFECT OF ACTUAL EXPERIENCE.] (a) If the 
161.17  commissioner has determined that the actual experience following 
161.18  a rate increase does not adequately match the projected 
161.19  experience and that the current projections under moderately 
161.20  adverse conditions demonstrate that incurred claims will not 
161.21  exceed proportions of premiums specified in subdivision 3, the 
161.22  commissioner may require the insurer to implement any of the 
161.23  following: 
161.24     (1) premium rate schedule adjustments; or 
161.25     (2) other measures to reduce the difference between the 
161.26  projected and actual experience. 
161.27     (b) In determining whether the actual experience adequately 
161.28  matches the projected experience, consideration should be given 
161.29  to subdivision 2, clause (3), item (v), if applicable. 
161.30     Subd. 7.  [CONTINGENT BENEFIT UPON LAPSE.] If the majority 
161.31  of the policies or certificates to which the increase is 
161.32  applicable are eligible for the contingent benefit upon lapse, 
161.33  the insurer shall file: 
161.34     (1) a plan, subject to commissioner approval, for improved 
161.35  administration or claims processing designed to eliminate the 
161.36  potential for further deterioration of the policy form requiring 
162.1   further premium rate schedule increases, or both, or a 
162.2   demonstration that appropriate administration and claims 
162.3   processing have been implemented or are in effect; otherwise, 
162.4   the commissioner may impose the condition in subdivision 8, 
162.5   paragraph (b); and 
162.6      (2) the original anticipated lifetime loss ratio, and the 
162.7   premium rate schedule increase that would have been calculated 
162.8   according to subdivision 3 had the greater of the original 
162.9   anticipated lifetime loss ratio or 58 percent been used in the 
162.10  calculations described in subdivision 3, clause (2), items (i) 
162.11  and (iii). 
162.12     Subd. 8.  [PROJECTED LAPSE RATES.] (a) For a rate increase 
162.13  filing that meets the following criteria, the commissioner shall 
162.14  review, for all policies included in the filing, the projected 
162.15  lapse rates and past lapse rates during the 12 months following 
162.16  each increase to determine if significant adverse lapsation has 
162.17  occurred or is anticipated: 
162.18     (1) the rate increase is not the first rate increase 
162.19  requested for the specific policy form or forms; 
162.20     (2) the rate increase is not an exceptional increase; and 
162.21     (3) the majority of the policies or certificates to which 
162.22  the increase is applicable are eligible for the contingent 
162.23  benefit upon lapse. 
162.24     (b) If significant adverse lapsation has occurred, is 
162.25  anticipated in the filing, or is evidenced in the actual results 
162.26  as presented in the updated projections provided by the insurer 
162.27  following the requested rate increase, the commissioner may 
162.28  determine that a rate spiral exists.  Following the 
162.29  determination that a rate spiral exists, the commissioner may 
162.30  require the insurer to offer, without underwriting, to all 
162.31  in-force insureds subject to the rate increase, the option to 
162.32  replace existing coverage with one or more reasonably comparable 
162.33  products being offered by the insurer or its affiliates.  The 
162.34  offer must: 
162.35     (1) be subject to the approval of the commissioner; 
162.36     (2) be based upon actuarially sound principles, but not be 
163.1   based upon attained age; and 
163.2      (3) provide that maximum benefits under any new policy 
163.3   accepted by an insured shall be reduced by comparable benefits 
163.4   already paid under the existing policy. 
163.5      (c) The insurer shall maintain the experience of all the 
163.6   replacement insureds separate from the experience of insureds 
163.7   originally issued the policy forms.  In the event of a request 
163.8   for a rate increase on the policy form, the rate increase must 
163.9   be limited to the lesser of the maximum rate increase determined 
163.10  based on the combined experience and the maximum rate increase 
163.11  determined based only upon the experience of the insureds 
163.12  originally issued the form plus ten percent. 
163.13     Subd. 9.  [PERSISTENT PRACTICE OF INADEQUATE INITIAL 
163.14  RATES.] If the commissioner determines that the insurer has 
163.15  exhibited a persistent practice of filing inadequate initial 
163.16  premium rates for long-term care insurance, the commissioner 
163.17  may, in addition to the provisions of subdivision 8, prohibit 
163.18  the insurer from either of the following: 
163.19     (1) filing and marketing comparable coverage for a period 
163.20  of up to five years; or 
163.21     (2) offering all other similar coverages and limiting 
163.22  marketing of new applications to the products subject to recent 
163.23  premium rate schedule increases. 
163.24     Subd. 10.  [INCIDENTAL LONG-TERM CARE 
163.25  BENEFITS.] Subdivisions 1 to 9 do not apply to policies for 
163.26  which the long-term care benefits provided by the policy are 
163.27  incidental, as defined in section 62S.01, subdivision 17a, if 
163.28  the policy complies with all of the following provisions: 
163.29     (1) the interest credited internally to determine cash 
163.30  value accumulations, including long-term care, if any, are 
163.31  guaranteed not to be less than the minimum guaranteed interest 
163.32  rate for cash value accumulations without long-term care set 
163.33  forth in the policy; 
163.34     (2) the portion of the policy that provides insurance 
163.35  benefits other than long-term care coverage meets the 
163.36  nonforfeiture requirements as applicable in any of the following:
164.1      (i) for life insurance, section 61A.25; 
164.2      (ii) for individual deferred annuities, section 61A.245; 
164.3   and 
164.4      (iii) for variable annuities, section 61A.21; 
164.5      (3) the policy meets the disclosure requirements of 
164.6   sections 62S.10 and 62S.11 if the policy is governed by chapter 
164.7   62S and of section 62A.50 if the policy is governed by sections 
164.8   62A.46 to 62A.56; 
164.9      (4) the portion of the policy that provides insurance 
164.10  benefits other than long-term care coverage meets the 
164.11  requirements as applicable in the following: 
164.12     (i) policy illustrations to the extent required by state 
164.13  law applicable to life insurance; 
164.14     (ii) disclosure requirements in state law applicable to 
164.15  annuities; and 
164.16     (iii) disclosure requirements applicable to variable 
164.17  annuities; and 
164.18     (5) an actuarial memorandum is filed with the commissioner 
164.19  that includes: 
164.20     (i) a description of the basis on which the long-term care 
164.21  rates were determined; 
164.22     (ii) a description of the basis for the reserves; 
164.23     (iii) a summary of the type of policy, benefits, 
164.24  renewability, general marketing method, and limits on ages of 
164.25  issuance; 
164.26     (iv) a description and a table of each actuarial assumption 
164.27  used.  For expenses, an insurer must include percent of premium 
164.28  dollars per policy and dollars per unit of benefits, if any; 
164.29     (v) a description and a table of the anticipated policy 
164.30  reserves and additional reserves to be held in each future year 
164.31  for active lives; 
164.32     (vi) the estimated average annual premium per policy and 
164.33  the average issue age; 
164.34     (vii) a statement as to whether underwriting is performed 
164.35  at the time of application.  The statement shall indicate 
164.36  whether underwriting is used and, if used, the statement shall 
165.1   include a description of the type or types of underwriting used, 
165.2   such as medical underwriting or functional assessment 
165.3   underwriting. Concerning a group policy, the statement shall 
165.4   indicate whether the enrollee or any dependent will be 
165.5   underwritten and when underwriting occurs; and 
165.6      (viii) a description of the effect of the long-term care 
165.7   policy provision on the required premiums, nonforfeiture values, 
165.8   and reserves on the underlying insurance policy, both for active 
165.9   lives and those in long-term care claim status. 
165.10     Subd. 11.  [LARGE GROUP POLICIES.] Subdivisions 6 and 9 do 
165.11  not apply to group long-term care insurance policies as defined 
165.12  in section 62S.01, subdivision 15, where: 
165.13     (1) the policies insure 250 or more persons, and the 
165.14  policyholder has 5,000 or more eligible employees of a single 
165.15  employer; or 
165.16     (2) the policyholder, and not the certificate holders, pays 
165.17  a material portion of the premium, which is not less than 20 
165.18  percent of the total premium for the group in the calendar year 
165.19  prior to the year in which a rate increase is filed. 
165.20     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
165.21  following final enactment. 
165.22     Sec. 12.  [62S.266] [NONFORFEITURE BENEFIT REQUIREMENT.] 
165.23     Subdivision 1.  [APPLICABILITY.] This section does not 
165.24  apply to life insurance policies or riders containing 
165.25  accelerated long-term care benefits. 
165.26     Subd. 2.  [REQUIREMENT.] An insurer must offer each 
165.27  prospective policyholder a nonforfeiture benefit in compliance 
165.28  with the following requirements: 
165.29     (1) a policy or certificate offered with nonforfeiture 
165.30  benefits must have coverage elements, eligibility, benefit 
165.31  triggers, and benefit length that are the same as coverage to be 
165.32  issued without nonforfeiture benefits.  The nonforfeiture 
165.33  benefit included in the offer must be the benefit described in 
165.34  subdivision 5; and 
165.35     (2) the offer must be in writing if the nonforfeiture 
165.36  benefit is not otherwise described in the outline of coverage or 
166.1   other materials given to the prospective policyholder. 
166.2      Subd. 3.  [EFFECT OF REJECTION OF OFFER.] If the offer 
166.3   required to be made under subdivision 2 is rejected, the insurer 
166.4   shall provide the contingent benefit upon lapse described in 
166.5   this section. 
166.6      Subd. 4.  [CONTINGENT BENEFIT UPON LAPSE.] (a) After 
166.7   rejection of the offer required under subdivision 2, for 
166.8   individual and group policies without nonforfeiture benefits 
166.9   issued after the effective date of this section, the insurer 
166.10  shall provide a contingent benefit upon lapse. 
166.11     (b) If a group policyholder elects to make the 
166.12  nonforfeiture benefit an option to the certificate holder, a 
166.13  certificate shall provide either the nonforfeiture benefit or 
166.14  the contingent benefit upon lapse. 
166.15     (c) The contingent benefit on lapse shall be triggered 
166.16  every time an insurer increases the premium rates to a level 
166.17  which results in a cumulative increase of the annual premium 
166.18  equal to or exceeding the percentage of the insured's initial 
166.19  annual premium based on the insured's issue age, and the policy 
166.20  or certificate lapses within 120 days of the due date of the 
166.21  premium increase.  Unless otherwise required, policyholders 
166.22  shall be notified at least 30 days prior to the due date of the 
166.23  premium reflecting the rate increase. 
166.24           Triggers for a Substantial Premium Increase 
166.25                      Percent Increase
166.26       Issue Age      Over Initial Premium
166.27       29 and Under            200
166.28          30-34                190
166.29          35-39                170
166.30          40-44                150
166.31          45-49                130
166.32          50-54                110
166.33          55-59                 90
166.34             60                 70
166.35             61                 66
166.36             62                 62
167.1              63                 58
167.2              64                 54
167.3              65                 50
167.4              66                 48
167.5              67                 46
167.6              68                 44
167.7              69                 42
167.8              70                 40
167.9              71                 38
167.10             72                 36
167.11             73                 34
167.12             74                 32
167.13             75                 30
167.14             76                 28
167.15             77                 26
167.16             78                 24
167.17             79                 22
167.18             80                 20
167.19             81                 19
167.20             82                 18
167.21             83                 17
167.22             84                 16
167.23             85                 15
167.24             86                 14
167.25             87                 13
167.26             88                 12
167.27             89                 11
167.28         90 and over            10
167.29     (d) On or before the effective date of a substantial 
167.30  premium increase as defined in paragraph (c), the insurer shall: 
167.31     (1) offer to reduce policy benefits provided by the current 
167.32  coverage without the requirement of additional underwriting so 
167.33  that required premium payments are not increased; 
167.34     (2) offer to convert the coverage to a paid-up status with 
167.35  a shortened benefit period according to the terms of subdivision 
167.36  5.  This option may be elected at any time during the 120-day 
168.1   period referenced in paragraph (c); and 
168.2      (3) notify the policyholder or certificate holder that a 
168.3   default or lapse at any time during the 120-day period 
168.4   referenced in paragraph (c) shall be deemed to be the election 
168.5   of the offer to convert in clause (2). 
168.6      Subd. 5.  [NONFORFEITURE BENEFITS; REQUIREMENTS.] (a) 
168.7   Benefits continued as nonforfeiture benefits, including 
168.8   contingent benefits upon lapse, must be as described in this 
168.9   subdivision. 
168.10     (b) For purposes of this subdivision, "attained age rating" 
168.11  is defined as a schedule of premiums starting from the issue 
168.12  date which increases with age at least one percent per year 
168.13  prior to age 50, and at least three percent per year beyond age 
168.14  50. 
168.15     (c) For purposes of this subdivision, the nonforfeiture 
168.16  benefit shall be of a shortened benefit period providing 
168.17  paid-up, long-term care insurance coverage after lapse.  The 
168.18  same benefits, amounts, and frequency in effect at the time of 
168.19  lapse, but not increased thereafter, will be payable for a 
168.20  qualifying claim, but the lifetime maximum dollars or days of 
168.21  benefits shall be determined as specified in paragraph (d). 
168.22     (d) The standard nonforfeiture credit will be equal to 100 
168.23  percent of the sum of all premiums paid, including the premiums 
168.24  paid prior to any changes in benefits.  The insurer may offer 
168.25  additional shortened benefit period options, as long as the 
168.26  benefits for each duration equal or exceed the standard 
168.27  nonforfeiture credit for that duration.  However, the minimum 
168.28  nonforfeiture credit must not be less than 30 times the daily 
168.29  nursing home benefit at the time of lapse.  In either event, the 
168.30  calculation of the nonforfeiture credit is subject to the 
168.31  limitation of this subdivision. 
168.32     (e) The nonforfeiture benefit must begin not later than the 
168.33  end of the third year following the policy or certificate issue 
168.34  date.  The contingent benefit upon lapse must be effective 
168.35  during the first three years as well as thereafter. 
168.36     (f) Notwithstanding paragraph (e), for a policy or 
169.1   certificate with attained age rating, the nonforfeiture benefit 
169.2   must begin on the earlier of: 
169.3      (1) the end of the tenth year following the policy or 
169.4   certificate issue date; or 
169.5      (2) the end of the second year following the date the 
169.6   policy or certificate is no longer subject to attained age 
169.7   rating. 
169.8      (g) Nonforfeiture credits may be used for all care and 
169.9   services qualifying for benefits under the terms of the policy 
169.10  or certificate, up to the limits specified in the policy or 
169.11  certificate. 
169.12     Subd. 6.  [BENEFIT LIMIT.] All benefits paid by the insurer 
169.13  while the policy or certificate is in premium-paying status and 
169.14  in the paid-up status will not exceed the maximum benefits which 
169.15  would be payable if the policy or certificate had remained in 
169.16  premium-paying status. 
169.17     Subd. 7.  [MINIMUM BENEFITS; INDIVIDUAL AND GROUP 
169.18  POLICIES.] There shall be no difference in the minimum 
169.19  nonforfeiture benefits as required under this section for group 
169.20  and individual policies. 
169.21     Subd. 8.  [APPLICATION; EFFECTIVE DATES.] This section 
169.22  becomes effective January 1, 2002, and applies as follows: 
169.23     (a) Except as provided in paragraph (b), this section 
169.24  applies to any long-term care policy issued in this state on or 
169.25  after the effective date of this section. 
169.26     (b) For certificates issued on or after the effective date 
169.27  of this section, under a group long-term care insurance policy 
169.28  that was in force on the effective date of this section, the 
169.29  provisions of this section do not apply. 
169.30     Subd. 9.  [EFFECT ON LOSS RATIO.] Premiums charged for a 
169.31  policy or certificate containing nonforfeiture benefits or a 
169.32  contingent benefit on lapse are subject to the loss ratio 
169.33  requirements of section 62A.48, subdivision 4, or 62S.26, 
169.34  treating the policy as a whole, except for policies or 
169.35  certificates that are subject to sections 62S.021, 62S.081, and 
169.36  62S.265 and that comply with those sections. 
170.1      Subd. 10.  [PURCHASED BLOCKS OF BUSINESS.] To determine 
170.2   whether contingent nonforfeiture upon lapse provisions are 
170.3   triggered under subdivision 4, paragraph (c), a replacing 
170.4   insurer that purchased or otherwise assumed a block or blocks of 
170.5   long-term care insurance policies from another insurer shall 
170.6   calculate the percentage increase based on the initial annual 
170.7   premium paid by the insured when the policy was first purchased 
170.8   from the original insurer. 
170.9      Subd. 11.  [LEVEL PREMIUM CONTRACTS.] A nonforfeiture 
170.10  benefit for qualified long-term care insurance contracts that 
170.11  are level premium contracts shall be offered that meets the 
170.12  following requirements: 
170.13     (1) the nonforfeiture provision shall be appropriately 
170.14  captioned; 
170.15     (2) the nonforfeiture provision shall provide a benefit 
170.16  available in the event of a default in the payment of any 
170.17  premiums and shall state that the amount of the benefit may be 
170.18  adjusted subsequent to being initially granted only as necessary 
170.19  to reflect changes in claims, persistency, and interest as 
170.20  reflected in changes in rates for premium paying contracts 
170.21  approved by the commissioner for the same contract form; and 
170.22     (3) the nonforfeiture provision shall provide at least one 
170.23  of the following: 
170.24     (i) reduced paid-up insurance; 
170.25     (ii) extended term insurance; 
170.26     (iii) shortened benefit period; or 
170.27     (iv) other similar offerings approved by the commissioner. 
170.28     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
170.29  following final enactment. 
170.30     Sec. 13.  Minnesota Statutes 2000, section 256.975, is 
170.31  amended by adding a subdivision to read: 
170.32     Subd. 8.  [PROMOTION OF LONG-TERM CARE INSURANCE.] The 
170.33  Minnesota board on aging, either directly or through contract, 
170.34  shall promote the provision of employer-sponsored, long-term 
170.35  care insurance.  The board shall encourage private and public 
170.36  sector employers to make long-term care insurance available to 
171.1   employees, provide interested employers with information on the 
171.2   long-term care insurance product offered to state employees, and 
171.3   provide technical assistance to employers in designing long-term 
171.4   care insurance products and contacting health plan companies 
171.5   offering long-term care insurance products. 
171.6      Sec. 14.  [256B.0571] [LONG-TERM CARE PARTNERSHIP.] 
171.7      Subdivision 1.  [DEFINITIONS.] For purposes of this 
171.8   section, the following terms have the meanings given them. 
171.9      (a) "Home care service" means care described in section 
171.10  144A.43. 
171.11     (b) "Long-term care insurance" means a policy described in 
171.12  section 62S.01. 
171.13     (c) "Medical assistance" means the program of medical 
171.14  assistance established under section 256B.01. 
171.15     (d) "Nursing home" means nursing home as described in 
171.16  section 144A.01. 
171.17     (e) "Partnership policy" means a long-term care insurance 
171.18  policy that meets the requirements under chapter 62S. 
171.19     (f) "Partnership program" means the Minnesota partnership 
171.20  for long-term care program established under this section. 
171.21     Subd. 2.  [PARTNERSHIP PROGRAM.] (a) Subject to federal 
171.22  waiver approval, the commissioner of human services, along with 
171.23  the commissioner of commerce, shall establish the Minnesota 
171.24  partnership for long-term care program to provide for the 
171.25  financing of long-term care through a combination of private 
171.26  insurance and medical assistance. 
171.27     (b) An individual who meets the requirements in paragraph 
171.28  (c) is eligible to participate in the partnership program. 
171.29     (c) The individual must: 
171.30     (1) be a Minnesota resident; 
171.31     (2) purchase a partnership policy that is delivered, issued 
171.32  for delivery, or renewed on or after the effective date of this 
171.33  section, and maintains the partnership policy in effect 
171.34  throughout the period of participation in the partnership 
171.35  program; and 
171.36     (3) exhaust the minimum benefits under the partnership 
172.1   policy as described in this section.  Benefits received under a 
172.2   long-term care insurance policy before the effective date of 
172.3   this section do not count toward the exhaustion of benefits 
172.4   required in this subdivision. 
172.5      Subd. 3.  [MEDICAL ASSISTANCE ELIGIBILITY.] (a) Upon 
172.6   application of an individual who meets the requirements 
172.7   described in subdivision 2, the commissioner of human services 
172.8   shall determine the individual's eligibility for medical 
172.9   assistance according to paragraphs (b) and (c). 
172.10     (b) After disregarding financial assets exempted under 
172.11  medical assistance eligibility requirements, the department 
172.12  shall disregard an additional amount of financial assets equal 
172.13  to the dollar amount of coverage under the partnership policy.  
172.14     (c) The department shall consider the individual's income 
172.15  according to medical assistance eligibility requirements. 
172.16     Subd. 4.  [FEDERAL APPROVAL.] (a) The commissioner of human 
172.17  services shall seek appropriate amendments to the medical 
172.18  assistance state plan and shall apply for any necessary waiver 
172.19  of medical assistance requirements by the federal Health Care 
172.20  Financing Administration to implement the partnership program.  
172.21  The state shall not implement the partnership program unless the 
172.22  provisions in paragraphs (b) and (c) apply. 
172.23     (b) The commissioner shall seek any necessary federal 
172.24  waiver of medical assistance requirements. 
172.25     (c) Individuals who receive medical assistance under this 
172.26  section are exempt from estate recovery requirements under 
172.27  section 1917, title XIX of the federal Social Security Act, 
172.28  United States Code, title 42, section 1396p. 
172.29     Subd. 5.  [APPROVED POLICIES.] (a) A partnership policy 
172.30  must meet all of the requirements in paragraphs (b) to (h). 
172.31     (b) Minimum coverage shall be for a period of not less than 
172.32  three years and for a dollar amount equal to 36 months of 
172.33  nursing home care at the minimum daily benefit rate determined 
172.34  and adjusted under paragraph (c).  The policy shall provide for 
172.35  home health care benefits to be substituted for nursing home 
172.36  care benefits on the basis of two home health care days for one 
173.1   nursing home care day. 
173.2      (c) Minimum daily benefits shall be $130 for nursing home 
173.3   care or $65 for home care.  These minimum daily benefit amounts 
173.4   shall be adjusted by the department on October 1 of each year, 
173.5   based on the health care index used under medical assistance for 
173.6   nursing home rate setting.  Adjusted minimum daily benefit 
173.7   amounts shall be rounded to the nearest whole dollar. 
173.8      (d) A third party designated by the insured shall be 
173.9   entitled to receive notice if the policy is about to lapse for 
173.10  nonpayment of premium, and an additional 30-day grace period for 
173.11  payment of premium shall be granted following notification to 
173.12  that person. 
173.13     (e) The policy must cover all of the following services: 
173.14     (1) nursing home stay; 
173.15     (2) home care service; 
173.16     (3) care management; and 
173.17     (4) up to 14 days of nursing care in a hospital while the 
173.18  individual is waiting for long-term care placement.  
173.19     (f) Payment for service under paragraph (e), clause (4), 
173.20  must not exceed the daily benefit amount for nursing home care. 
173.21     (g) A partnership policy must offer both options in 
173.22  paragraph (h) for an adjusted premium. 
173.23     (h) The options are: 
173.24     (1) an elimination period of not more than 100 days; and 
173.25     (2) nonforfeiture benefits for applicants between the ages 
173.26  of 18 and 75. 
173.27     Sec. 15.  [APPROPRIATION.] 
173.28     Subdivision 1.  [BOARD ON AGING.] $....... is appropriated 
173.29  from the general fund to the commissioner of human services for 
173.30  the biennium ending June 30, 2003, for the board on aging to 
173.31  promote employer-sponsored long-term care insurance as required 
173.32  under section 13. 
173.33     Subd. 2.  [LONG-TERM CARE PARTNERSHIP PROGRAM.] $....... is 
173.34  appropriated from the general fund to the commissioner of human 
173.35  services for the biennium ending June 30, 2003, for federal 
173.36  waiver development and application under section 14.