1.1                          A bill for an act 
  1.2             relating to human services; expanding consumer 
  1.3             information and assistance; establishing long-term 
  1.4             care consultation services; modifying the alternative 
  1.5             care program; modifying the elderly waiver; 
  1.6             establishing nursing facility resident relocation 
  1.7             procedures; providing rate increases for certain 
  1.8             medical assistance providers; establishing a nursing 
  1.9             facility voluntary closure process; expanding 
  1.10            workforce recruitment and retention programs; 
  1.11            regulating supplemental nursing services agencies; 
  1.12            regulating long-term care insurance; appropriating 
  1.13            money; amending Minnesota Statutes 2000, sections 
  1.14            62A.02, by adding a subdivision; 62A.48, by adding 
  1.15            subdivisions; 62D.04, subdivision 5; 62S.01, by adding 
  1.16            a subdivision; 116L.11, subdivision 4; 116L.12, 
  1.17            subdivisions 4, 5; 116L.13, subdivision 1; 144.057; 
  1.18            144.1464; 144.1496, subdivisions 1, 3, 4; 144A.071, 
  1.19            subdivisions 1, 1a, 2, 4a; 144A.073, subdivision 2; 
  1.20            245A.04, subdivisions 3, 3a, 3b, 3d; 256.975, by 
  1.21            adding subdivisions; 256B.0911, subdivisions 1, 3, 5, 
  1.22            6, 7, by adding subdivisions; 256B.0913, subdivisions 
  1.23            1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14; 256B.0915, 
  1.24            subdivisions 1d, 3, 5; 256B.0917, by adding a 
  1.25            subdivision; 256B.431, by adding subdivisions; 
  1.26            256B.434, subdivision 4; 256B.5012, subdivision 3, by 
  1.27            adding subdivisions; 256L.07, subdivision 2; 626.557, 
  1.28            subdivision 12b; Laws 1999, chapter 245, article 3, 
  1.29            section 45, as amended; proposing coding for new law 
  1.30            in Minnesota Statutes, chapters 62S; 116L; 144; 144A; 
  1.31            256; 256B; repealing Minnesota Statutes 2000, sections 
  1.32            116L.10; 116L.12, subdivisions 2, 7; 144A.16; 
  1.33            256B.0911, subdivisions 2, 2a, 4, 8, 9; 256B.0913, 
  1.34            subdivisions 3, 15a, 15b, 15c, 16; 256B.0915, 
  1.35            subdivisions 3a, 3b, 3c; 256B.436, subdivisions 3, 5, 
  1.36            6, 8; Minnesota Rules, parts 4655.6810; 4655.6820; 
  1.37            4655.6830; 4658.1600; 4658.1605; 4658.1610; 4658.1690; 
  1.38            9505.2390; 9505.2395; 9505.2396; 9505.2400; 9505.2405; 
  1.39            9505.2410; 9505.2413; 9505.2415; 9505.2420; 9505.2425; 
  1.40            9505.2426; 9505.2430; 9505.2435; 9505.2440; 9505.2445; 
  1.41            9505.2450; 9505.2455; 9505.2458; 9505.2460; 9505.2465; 
  1.42            9505.2470; 9505.2473; 9505.2475; 9505.2480; 9505.2485; 
  1.43            9505.2486; 9505.2490; 9505.2495; 9505.2496; 9505.2500; 
  1.44            9546.0010; 9546.0020; 9546.0030; 9546.0040; 9546.0050; 
  1.45            9546.0060. 
  2.1   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.2                              ARTICLE 1
  2.3                 CONSUMER INFORMATION AND ASSISTANCE
  2.4                       AND COMMUNITY-BASED CARE
  2.5      Section 1.  [144A.35] [EXPANSION OF BED DISTRIBUTION STUDY 
  2.6   AND CREATION OF CRITICAL ACCESS SITES.] 
  2.7      Subdivision 1.  [OLDER ADULT SERVICES DISTRIBUTION 
  2.8   STUDY.] The commissioner of health, in coordination with the 
  2.9   commissioner of human services, shall monitor and analyze the 
  2.10  distribution of older adult services, including, but not limited 
  2.11  to, nursing home beds, senior housing, housing with services 
  2.12  units, and home and community-based services, in the different 
  2.13  geographic areas of the state.  The study shall include an 
  2.14  analysis of the impact of amendments to the nursing home 
  2.15  moratorium law that would allow for transfers of nursing home 
  2.16  beds within the state.  The commissioner of health shall submit 
  2.17  to the legislature, beginning January 15, 2002, and each January 
  2.18  15 thereafter, an assessment of the distribution of long-term 
  2.19  health care services by geographic area, with particular 
  2.20  attention to service deficits or problems, the designation of 
  2.21  critical access service sites, and corrective action plans. 
  2.22     Subd. 2.  [CRITICAL ACCESS SERVICE SITE.] "Critical access 
  2.23  service site" shall include nursing homes, senior housing, 
  2.24  housing with services, and home and community-based services 
  2.25  that are certified by the state as necessary providers of health 
  2.26  care services to a specific geographic area.  For purposes of 
  2.27  this requirement, a "necessary provider of health care services" 
  2.28  is a provider that is: 
  2.29     (1) located more than 20 miles, defined as official mileage 
  2.30  as reported by the Minnesota department of transportation, from 
  2.31  the next nearest long-term health care provider; 
  2.32     (2) the sole long-term health care provider in the county; 
  2.33  or 
  2.34     (3) a long-term health care provider located in a medically 
  2.35  underserved area or health professional shortage area. 
  2.36     Subd. 3.  [IDENTIFICATION OF CRITICAL ACCESS SERVICE 
  3.1   SITES.] Based on the results of the analysis completed in 
  3.2   subdivision 1, the commissioners of health and human services 
  3.3   shall identify and designate long-term health care providers as 
  3.4   critical access service sites. 
  3.5      Subd. 4.  [CRITICAL ACCESS SERVICE SITES.] The commissioner 
  3.6   of health, in consultation with the commissioner of human 
  3.7   services, shall: 
  3.8      (1) develop and implement specific waivers to regulations 
  3.9   governing health care personnel scope of duties, physical plant 
  3.10  requirements, and location of community-based services, to 
  3.11  address critical access service site older adult service needs; 
  3.12  and 
  3.13     (2) identify payment barriers to the continued operation of 
  3.14  older adult services in critical access service sites, and 
  3.15  provide recommendations on changes to reimbursement rates to 
  3.16  facilitate the continued operation of these services. 
  3.17     Sec. 2.  Minnesota Statutes 2000, section 256.975, is 
  3.18  amended by adding a subdivision to read: 
  3.19     Subd. 7.  [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 
  3.20  LINKAGE.] (a) The Minnesota board on aging shall operate a 
  3.21  statewide information and assistance service to aid older 
  3.22  Minnesotans and their families in making informed choices about 
  3.23  long-term care options and health care benefits.  Language 
  3.24  services to persons with limited English language skills must be 
  3.25  made available.  The service, known as Senior LinkAge Line, must 
  3.26  be available during business hours through a statewide toll-free 
  3.27  number and must also be available through the Internet. 
  3.28     (b) The service must assist older adults, caregivers, and 
  3.29  providers in accessing information about choices in long-term 
  3.30  care services that are purchased through private providers or 
  3.31  available through public options.  The service must: 
  3.32     (1) develop a comprehensive database that includes detailed 
  3.33  listings in both consumer- and provider-oriented formats; 
  3.34     (2) make the database accessible on the Internet and 
  3.35  through other telecommunication and media-related tools; 
  3.36     (3) link callers to interactive long-term care screening 
  4.1   tools and making these tools available through the Internet by 
  4.2   integrating the tools with the database; 
  4.3      (4) develop community education materials with a focus on 
  4.4   planning for long-term care and evaluating independent living, 
  4.5   housing, and service options; 
  4.6      (5) conduct an outreach campaign to assist older adults and 
  4.7   their caregivers in finding information on the Internet and 
  4.8   through other means of communication; 
  4.9      (6) implement a messaging system for overflow callers and 
  4.10  respond to these callers by the next business day; 
  4.11     (7) link callers with county human services and other 
  4.12  providers to receive more in-depth assistance and consultation 
  4.13  related to long-term care options; and 
  4.14     (8) link callers with quality profiles for nursing 
  4.15  facilities and other providers developed by the commissioner of 
  4.16  human services. 
  4.17     Sec. 3.  [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS 
  4.18  PROGRAM.] 
  4.19     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  4.20  section, the following terms have the meanings given. 
  4.21     (a) "Community" means a town, township, city, or targeted 
  4.22  neighborhood within a city, or a consortium of towns, townships, 
  4.23  cities, or targeted neighborhoods within cities. 
  4.24     (b) "Older adult services" means any services available 
  4.25  under the elderly waiver program or alternative care grant 
  4.26  program; nursing facility services; transportation services; 
  4.27  respite services; and other community-based services identified 
  4.28  as necessary either to maintain lifestyle choices for older 
  4.29  Minnesotans or to promote independence. 
  4.30     (c) "Older adult" refers to individuals 65 years of age and 
  4.31  older. 
  4.32     Subd. 2.  [CREATION.] The community services development 
  4.33  grants program is created under the administration of the 
  4.34  commissioner of human services.  
  4.35     Subd. 3.  [PROVISION OF GRANTS.] The commissioner shall 
  4.36  make grants available to communities, providers of older adult 
  5.1   services identified in subdivision 1, or to a consortium of 
  5.2   providers of older adult services, to establish new older adult 
  5.3   services.  Grants may be provided for capital and other costs 
  5.4   including, but not limited to, start-up and training costs, 
  5.5   equipment, and supplies related to the establishment of new 
  5.6   older adult services or other residential or service 
  5.7   alternatives to nursing facility care.  Grants may also be made 
  5.8   to renovate current buildings, provide transportation services, 
  5.9   or expand state-funded programs in the area. 
  5.10     Subd. 4.  [ELIGIBILITY.] Grants may be awarded only to 
  5.11  communities and providers or to a consortium of providers that 
  5.12  have a local match of 50 percent of the costs for the project in 
  5.13  the form of donations, local tax dollars, in-kind donations, or 
  5.14  other local match. 
  5.15     Sec. 4.  Minnesota Statutes 2000, section 256B.0911, 
  5.16  subdivision 1, is amended to read: 
  5.17     Subdivision 1.  [PURPOSE AND GOAL.] (a) The purpose of ~~the~~ 
  5.18  ~~preadmission screening program~~ long-term care consultation 
  5.19  services is to assist persons with long-term or chronic care 
  5.20  needs in making long-term care decisions and selecting options 
  5.21  that meet their needs and reflect their preferences.  The 
  5.22  availability of, and access to, information and other types of 
  5.23  assistance is also intended to prevent or delay certified 
  5.24  nursing facility placements ~~by assessing applicants and~~ 
  5.25  ~~residents and offering cost-effective alternatives appropriate~~ 
  5.26  ~~for the person's needs~~ and to provide transition assistance 
  5.27  after admission.  Further, the goal of ~~the program~~ these 
  5.28  services is to contain costs associated with unnecessary 
  5.29  certified nursing facility admissions.  The commissioners of 
  5.30  human services and health shall seek to maximize use of 
  5.31  available federal and state funds and establish the broadest 
  5.32  program possible within the funding available. 
  5.33     (b) These services must be coordinated with services 
  5.34  provided under sections 256.975, subdivision 7, and 256.9772, 
  5.35  and with services provided by other public and private agencies 
  5.36  in the community to offer a variety of cost-effective 
  6.1   alternatives to persons with disabilities and elderly persons.  
  6.2   The county agency providing long-term care consultation services 
  6.3   shall encourage the use of volunteers from families, religious 
  6.4   organizations, social clubs, and similar civic and service 
  6.5   organizations to provide community-based services. 
  6.6      Sec. 5.  Minnesota Statutes 2000, section 256B.0911, is 
  6.7   amended by adding a subdivision to read: 
  6.8      Subd. 1a.  [DEFINITIONS.] For purposes of this section, the 
  6.9   following definitions apply: 
  6.10     (a) "Long-term care consultation services" means: 
  6.11     (1) providing information and education to the general 
  6.12  public regarding availability of the services authorized under 
  6.13  this section; 
  6.14     (2) an intake process that provides access to the services 
  6.15  described in this section; 
  6.16     (3) assessment of the health, psychological, and social 
  6.17  needs of referred individuals; 
  6.18     (4) assistance in identifying services needed to maintain 
  6.19  an individual in the least restrictive environment; 
  6.20     (5) providing recommendations on cost-effective community 
  6.21  services that are available to the individual; 
  6.22     (6) development of an individual's community support plan; 
  6.23     (7) providing information regarding eligibility for 
  6.24  Minnesota health care programs; 
  6.25     (8) preadmission screening to determine the need for a 
  6.26  nursing facility level of care; 
  6.27     (9) preliminary determination of Minnesota health care 
  6.28  programs eligibility for individuals who need a nursing facility 
  6.29  level of care, with appropriate referrals for final 
  6.30  determination; 
  6.31     (10) providing recommendations for nursing facility 
  6.32  placement when there are no cost-effective community services 
  6.33  available; and 
  6.34     (11) assistance to transition people back to community 
  6.35  settings after facility admission. 
  6.36     (b) "Minnesota health care programs" means the medical 
  7.1   assistance program under chapter 256B, the alternative care 
  7.2   program under section 256B.0913, and the prescription drug 
  7.3   program under section 256.955. 
  7.4      Sec. 6.  Minnesota Statutes 2000, section 256B.0911, 
  7.5   subdivision 3, is amended to read: 
  7.6      Subd. 3.  [~~PERSONS RESPONSIBLE FOR CONDUCTING THE~~ 
  7.7   ~~PREADMISSION SCREENING~~ LONG-TERM CARE CONSULTATION TEAM.] (a) A 
  7.8   ~~local screening~~ long-term care consultation team shall be 
  7.9   established by the county board of commissioners.  Each local 
  7.10  ~~screening~~ consultation team shall consist of ~~screeners who are a~~ 
  7.11  at least one social worker and ~~a~~ at least one public health 
  7.12  nurse from their respective county agencies.  The board may 
  7.13  designate public health or social services as the lead agency 
  7.14  for long-term care consultation services.  If a county does not 
  7.15  have a public health nurse available, it may request approval 
  7.16  from the commissioner to assign a county registered nurse with 
  7.17  at least one year experience in home care to participate on the 
  7.18  team.  ~~The screening team members must confer regarding the most~~ 
  7.19  ~~appropriate care for each individual screened.~~  Two or more 
  7.20  counties may collaborate to establish a joint local ~~screening~~ 
  7.21  consultation team or teams. 
  7.22     (b) ~~In assessing a person's needs, screeners shall have a~~ 
  7.23  ~~physician available for consultation and shall consider the~~ 
  7.24  ~~assessment of the individual's attending physician, if any.  The~~ 
  7.25  ~~individual's physician shall be included if the physician~~ 
  7.26  ~~chooses to participate.  Other personnel may be included on the~~ 
  7.27  ~~team as deemed appropriate by the county agencies.~~  The team is 
  7.28  responsible for providing long-term care consultation services 
  7.29  to all persons located in the county who request the services, 
  7.30  regardless of eligibility for Minnesota health care programs. 
  7.31     Sec. 7.  Minnesota Statutes 2000, section 256B.0911, is 
  7.32  amended by adding a subdivision to read: 
  7.33     Subd. 3a.  [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 
  7.34  requesting assessment, services planning, or other assistance 
  7.35  intended to support community-based living must be visited by a 
  7.36  long-term care consultation team within ten working days after 
  8.1   the date on which an assessment was requested or recommended.  
  8.2   Assessments must be conducted according to paragraphs (b) to (g).
  8.3      (b) The county may utilize a team of either the social 
  8.4   worker or public health nurse, or both, to conduct the 
  8.5   assessment in a face-to-face interview.  The consultation team 
  8.6   members must confer regarding the most appropriate care for each 
  8.7   individual screened or assessed. 
  8.8      (c) The long-term care consultation team must assess the 
  8.9   health and social needs of the person, using an assessment form 
  8.10  provided by the commissioner. 
  8.11     (d) The team must conduct the assessment in a face-to-face 
  8.12  interview with the person being assessed and the person's legal 
  8.13  representative, if applicable. 
  8.14     (e) The team must provide the person, or the person's legal 
  8.15  representative, with written recommendations for facility- or 
  8.16  community-based services.  The team must document that the most 
  8.17  cost-effective alternatives available were offered to the 
  8.18  individual.  For purposes of this requirement, "cost-effective 
  8.19  alternatives" means community services and living arrangements 
  8.20  that cost the same as or less than nursing facility care. 
  8.21     (f) If the person chooses to use community-based services, 
  8.22  the team must provide the person or the person's legal 
  8.23  representative with a written community support plan, regardless 
  8.24  of whether the individual is eligible for Minnesota health care 
  8.25  programs.  The person may request assistance in developing a 
  8.26  community support plan without participating in a complete 
  8.27  assessment. 
  8.28     (g) The team must give the person receiving assessment or 
  8.29  support planning, or the person's legal representative, 
  8.30  materials supplied by the commissioner containing the following 
  8.31  information: 
  8.32     (1) the purpose of preadmission screening and assessment; 
  8.33     (2) information about Minnesota health care programs; 
  8.34     (3) the person's freedom to accept or reject the 
  8.35  recommendations of the team; 
  8.36     (4) the person's right to confidentiality under the 
  9.1   Minnesota Government Data Practices Act, chapter 13; and 
  9.2      (5) the person's right to appeal the decision regarding the 
  9.3   need for nursing facility level of care or the county's final 
  9.4   decisions regarding public programs eligibility according to 
  9.5   section 256.045, subdivision 3. 
  9.6      Sec. 8.  Minnesota Statutes 2000, section 256B.0911, is 
  9.7   amended by adding a subdivision to read: 
  9.8      Subd. 3b.  [TRANSITION ASSISTANCE.] (a) A long-term care 
  9.9   consultation team shall provide assistance to persons residing 
  9.10  in a nursing facility, hospital, regional treatment center, or 
  9.11  intermediate care facility for persons with mental retardation 
  9.12  who request or are referred for assistance.  Transition 
  9.13  assistance must include assessment, community support plan 
  9.14  development, referrals to Minnesota health care programs, and 
  9.15  referrals to programs that provide assistance with housing. 
  9.16     (b) The county shall develop transition processes with 
  9.17  institutional social workers and discharge planners to ensure 
  9.18  that: 
  9.19     (1) persons admitted to facilities receive information 
  9.20  about transition assistance that is available; 
  9.21     (2) the assessment is completed for persons within ten 
  9.22  working days of the date of referral; and 
  9.23     (3) there is a plan for transition and follow-up for the 
  9.24  individual's return to the community.  The plan must require 
  9.25  notification of other local agencies when a person who may 
  9.26  require assistance is screened by one county for admission to a 
  9.27  facility located in another county. 
  9.28     (c) If a person who is eligible for a Minnesota health care 
  9.29  program is admitted to a nursing facility and has been 
  9.30  determined to have discharge potential by a long-term care 
  9.31  consultation team, the nursing facility must include a 
  9.32  consultation team member or the case manager in the discharge 
  9.33  planning process. 
  9.34     Sec. 9.  Minnesota Statutes 2000, section 256B.0911, is 
  9.35  amended by adding a subdivision to read: 
  9.36     Subd. 3c.  [ACCESS DEMONSTRATIONS.] (a) The commissioner 
 10.1   shall establish demonstration projects that are intended to 
 10.2   target critical areas for improvement in long-term care 
 10.3   consultation services, and to organize resources in a more 
 10.4   efficient, effective, and preferred way.  The demonstrations may 
 10.5   include: 
 10.6      (1) development and implementation of strategies to 
 10.7   increase the number of people who leave nursing facilities, 
 10.8   hospitals, regional treatment centers, and intermediate care 
 10.9   facilities for persons with mental retardation and return to 
 10.10  community living, based on demonstration proposals that: 
 10.11     (i) focus on transitional planning between care settings; 
 10.12     (ii) engage a variety of providers and care settings; 
 10.13     (iii) include participants from both greater Minnesota and 
 10.14  metro communities; 
 10.15     (iv) emphasize regional or other cooperative approaches; 
 10.16  and 
 10.17     (v) identify potential obstacles to individuals returning 
 10.18  to community settings and propose recommendations to address 
 10.19  those obstacles and ways to improve the identification of people 
 10.20  who need transitional assistance; 
 10.21     (2) improved access to and expansion of the availability of 
 10.22  long-term care consultation services, and improved integration 
 10.23  of these services with other local activities designed to 
 10.24  support people in community living; 
 10.25     (3) identification of activities that increase public 
 10.26  awareness of and information about the various forms of 
 10.27  long-term care assistance available, and develop and implement 
 10.28  replicable training efforts; and 
 10.29     (4) selection of sites based on outcome and other 
 10.30  performance criteria outlined in an application process.  
 10.31  Projects can be single-county or multicounty managed.  Project 
 10.32  budgets may include payments to increase the amount of and 
 10.33  encourage innovation in the development of transitional services 
 10.34  within demonstration sites.  Payments for increased assessments, 
 10.35  support plan development, and other activities, as approved in 
 10.36  the budget proposal for selected project sites, shall be 
 11.1   incorporated into the reimbursement for long-term care 
 11.2   consultation services as described in subdivision 6.  Projected 
 11.3   transition assessments included as part of selected 
 11.4   demonstration sites shall be calculated at the rate for county 
 11.5   case management services.  
 11.6      (b) The commissioner of human services shall submit a 
 11.7   report to the legislature describing demonstration models, 
 11.8   implementation activities, and projected outcomes by February 
 11.9   15, 2002.  A final report on the performance of the models and 
 11.10  recommendations for strategies to address relocation or 
 11.11  transitional assistance shall be completed by December 15, 2003. 
 11.12     Sec. 10.  Minnesota Statutes 2000, section 256B.0911, is 
 11.13  amended by adding a subdivision to read: 
 11.14     Subd. 4a.  [PREADMISSION SCREENING ACTIVITIES RELATED TO 
 11.15  NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 
 11.16  certified nursing facilities, including certified boarding care 
 11.17  facilities, must be screened prior to admission regardless of 
 11.18  income, assets, or funding sources for nursing facility care, 
 11.19  except as described in subdivision 4b.  The purpose of the 
 11.20  screening is to determine the need for nursing facility level of 
 11.21  care as described in paragraph (d) and to complete activities 
 11.22  required under federal law related to mental illness and mental 
 11.23  retardation as outlined in paragraph (b). 
 11.24     (b) A person who has a diagnosis or possible diagnosis of 
 11.25  mental illness, mental retardation, or a related condition must 
 11.26  receive a preadmission screening before admission regardless of 
 11.27  the exemptions outlined in subdivision 4b, paragraph (b), to 
 11.28  identify the need for further evaluation and specialized 
 11.29  services, unless the admission prior to screening is authorized 
 11.30  by the local mental health authority or the local developmental 
 11.31  disabilities case manager, or unless authorized by the county 
 11.32  agency according to Public Law Number 100-508.  
 11.33     The following criteria apply to the preadmission screening: 
 11.34     (1) the county must use forms and criteria developed by the 
 11.35  commissioner to identify persons who require referral for 
 11.36  further evaluation and determination of the need for specialized 
 12.1   services; and 
 12.2      (2) the evaluation and determination of the need for 
 12.3   specialized services must be done by: 
 12.4      (i) a qualified independent mental health professional, for 
 12.5   persons with a primary or secondary diagnosis of a serious 
 12.6   mental illness; or 
 12.7      (ii) a qualified mental retardation professional, for 
 12.8   persons with a primary or secondary diagnosis of mental 
 12.9   retardation or related conditions.  For purposes of this 
 12.10  requirement, a qualified mental retardation professional must 
 12.11  meet the standards for a qualified mental retardation 
 12.12  professional under Code of Federal Regulations, title 42, 
 12.13  section 483.430. 
 12.14     (c) The local county mental health authority or the state 
 12.15  mental retardation authority under Public Law Numbers 100-203 
 12.16  and 101-508 may prohibit admission to a nursing facility if the 
 12.17  individual does not meet the nursing facility level of care 
 12.18  criteria or needs specialized services as defined in Public Law 
 12.19  Numbers 100-203 and 101-508.  For purposes of this section, 
 12.20  "specialized services" for a person with mental retardation or a 
 12.21  related condition means active treatment as that term is defined 
 12.22  under Code of Federal Regulations, title 42, section 483.440 
 12.23  (a)(1). 
 12.24     (d) The determination of the need for nursing facility 
 12.25  level of care must be made according to criteria developed by 
 12.26  the commissioner.  In assessing a person's needs, consultation 
 12.27  team members shall have a physician available for consultation 
 12.28  and shall consider the assessment of the individual's attending 
 12.29  physician, if any.  The individual's physician must be included 
 12.30  if the physician chooses to participate.  Other personnel may be 
 12.31  included on the team as deemed appropriate by the county. 
 12.32     Sec. 11.  Minnesota Statutes 2000, section 256B.0911, is 
 12.33  amended by adding a subdivision to read: 
 12.34     Subd. 4b.  [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 
 12.35  Exemptions from the federal screening requirements outlined in 
 12.36  subdivision 4a, paragraphs (b) and (c), are limited to: 
 13.1      (1) a person who, having entered an acute care facility 
 13.2   from a certified nursing facility, is returning to a certified 
 13.3   nursing facility; and 
 13.4      (2) a person transferring from one certified nursing 
 13.5   facility in Minnesota to another certified nursing facility in 
 13.6   Minnesota. 
 13.7      (b) Persons who are exempt from preadmission screening for 
 13.8   purposes of level of care determination include: 
 13.9      (1) persons described in paragraph (a); 
 13.10     (2) an individual who has a contractual right to have 
 13.11  nursing facility care paid for indefinitely by the veterans' 
 13.12  administration; 
 13.13     (3) an individual enrolled in a demonstration project under 
 13.14  section 256B.69, subdivision 8, at the time of application to a 
 13.15  nursing facility; 
 13.16     (4) an individual currently being served under the 
 13.17  alternative care program or under a home and community-based 
 13.18  services waiver authorized under section 1915(c) of the federal 
 13.19  Social Security Act; and 
 13.20     (5) individuals admitted to a certified nursing facility 
 13.21  for a short-term stay, which is expected to be 14 days or less 
 13.22  in duration based upon a physician's certification, and who have 
 13.23  been assessed and approved for nursing facility admission within 
 13.24  the previous six months.  This exemption applies only if the 
 13.25  consultation team member determines at the time of the initial 
 13.26  assessment of the six-month period that it is appropriate to use 
 13.27  the nursing facility for short-term stays and that there is an 
 13.28  adequate plan of care for return to the home or community-based 
 13.29  setting.  If a stay exceeds 14 days, the individual must be 
 13.30  referred no later than the first county working day following 
 13.31  the 14th resident day for a screening, which must be completed 
 13.32  within five working days of the referral.  The payment 
 13.33  limitations in subdivision 7 apply to an individual found at 
 13.34  screening to not meet the level of care criteria for admission 
 13.35  to a certified nursing facility. 
 13.36     (c) Persons admitted to a Medicaid-certified nursing 
 14.1   facility from the community on an emergency basis as described 
 14.2   in paragraph (d) or from an acute care facility on a nonworking 
 14.3   day must be screened the first working day after admission. 
 14.4      (d) Emergency admission to a nursing facility prior to 
 14.5   screening is permitted when all of the following conditions are 
 14.6   met: 
 14.7      (1) a person is admitted from the community to a certified 
 14.8   nursing or certified boarding care facility during county 
 14.9   nonworking hours; 
 14.10     (2) a physician has determined that delaying admission 
 14.11  until preadmission screening is completed would adversely affect 
 14.12  the person's health and safety; 
 14.13     (3) there is a recent precipitating event that precludes 
 14.14  the client from living safely in the community, such as 
 14.15  sustaining an injury, sudden onset of acute illness, or a 
 14.16  caregiver's inability to continue to provide care; 
 14.17     (4) the attending physician has authorized the emergency 
 14.18  placement and has documented the reason that the emergency 
 14.19  placement is recommended; and 
 14.20     (5) the county is contacted on the first working day 
 14.21  following the emergency admission. 
 14.22  Transfer of a patient from an acute care hospital to a nursing 
 14.23  facility is not considered an emergency except for a person who 
 14.24  has received hospital services in the following situations: 
 14.25  hospital admission for observation, care in an emergency room 
 14.26  without hospital admission, or following hospital 24-hour bed 
 14.27  care. 
 14.28     Sec. 12.  Minnesota Statutes 2000, section 256B.0911, is 
 14.29  amended by adding a subdivision to read: 
 14.30     Subd. 4c.  [SCREENING REQUIREMENTS.] (a) A person may be 
 14.31  screened for nursing facility admission by telephone or in a 
 14.32  face-to-face screening interview.  Consultation team members 
 14.33  shall identify each individual's needs using the following 
 14.34  categories: 
 14.35     (1) the person needs no face-to-face screening interview to 
 14.36  determine the need for nursing facility level of care based on 
 15.1   information obtained from other health care professionals; 
 15.2      (2) the person needs an immediate face-to-face screening 
 15.3   interview to determine the need for nursing facility level of 
 15.4   care and complete activities required under subdivision 4a; or 
 15.5      (3) the person may be exempt from screening requirements as 
 15.6   outlined in subdivision 4b, but will need transitional 
 15.7   assistance after admission or in-person follow-along after a 
 15.8   return home. 
 15.9      (b) Persons admitted on a nonemergency basis to a 
 15.10  Medicaid-certified nursing facility must be screened prior to 
 15.11  admission. 
 15.12     (c) The long-term care consultation team shall recommend a 
 15.13  case mix classification for persons admitted to a certified 
 15.14  nursing facility when sufficient information is received to make 
 15.15  that classification.  The nursing facility is authorized to 
 15.16  conduct all case mix assessments for persons who have been 
 15.17  screened prior to admission for whom the county did not 
 15.18  recommend a case mix classification.  The nursing facility is 
 15.19  authorized to conduct all case mix assessments for persons 
 15.20  admitted to the facility prior to a preadmission screening.  The 
 15.21  county retains the responsibility of distributing appropriate 
 15.22  case mix forms to the nursing facility. 
 15.23     (d) The county screening or intake activity must include 
 15.24  processes to identify persons who may require transition 
 15.25  assistance as described in subdivision 3b. 
 15.26     Sec. 13.  Minnesota Statutes 2000, section 256B.0911, 
 15.27  subdivision 5, is amended to read: 
 15.28     Subd. 5.  [~~SIMPLIFICATION OF FORMS~~ ADMINISTRATIVE 
 15.29  ACTIVITY.] The commissioner shall minimize the number of forms 
 15.30  required in the ~~preadmission screening process~~ provision of 
 15.31  long-term care consultation services and shall limit the 
 15.32  screening document to items necessary for ~~care~~ community support 
 15.33  plan approval, reimbursement, program planning, evaluation, and 
 15.34  policy development. 
 15.35     Sec. 14.  Minnesota Statutes 2000, section 256B.0911, 
 15.36  subdivision 6, is amended to read: 
 16.1      Subd. 6.  [PAYMENT FOR ~~PREADMISSION SCREENING~~ LONG-TERM 
 16.2   CARE CONSULTATION SERVICES.] (a) The total ~~screening~~ payment for 
 16.3   each county must be paid monthly by certified nursing facilities 
 16.4   in the county.  The monthly amount to be paid by each nursing 
 16.5   facility for each fiscal year must be determined by dividing the 
 16.6   county's annual allocation for ~~screenings~~ long-term care 
 16.7   consultation services by 12 to determine the monthly payment and 
 16.8   allocating the monthly payment to each nursing facility based on 
 16.9   the number of licensed beds in the nursing facility.  Payments 
 16.10  to counties in which there is no certified nursing facility must 
 16.11  be made by increasing the payment rate of the two facilities 
 16.12  located nearest to the county agency. 
 16.13     (b) The commissioner shall include the total annual payment 
 16.14  ~~for screening~~ determined under paragraph (a) for each nursing 
 16.15  facility according to section 256B.431, subdivision 2b, 
 16.16  paragraph (g), or 256B.435. 
 16.17     (c) Payments for ~~screening activities~~ long-term care 
 16.18  consultation services are available to the county or counties to 
 16.19  cover staff salaries and expenses to provide the ~~screening~~ 
 16.20  ~~function~~ services described in subdivision 1a.  The ~~lead agency~~ 
 16.21  county shall employ, or contract with other agencies to employ, 
 16.22  within the limits of available funding, sufficient personnel 
 16.23  to ~~conduct the preadmission screening activity~~ provide long-term 
 16.24  care consultation services while meeting the state's long-term 
 16.25  care outcomes and objectives as defined in section 256B.0917, 
 16.26  subdivision 1.  The ~~local agency~~ county shall be accountable for 
 16.27  meeting local objectives as approved by the commissioner in the 
 16.28  CSSA biennial plan. 
 16.29     (d) Notwithstanding section 256B.0641, overpayments 
 16.30  attributable to payment of the screening costs under the medical 
 16.31  assistance program may not be recovered from a facility.  
 16.32     (e) The commissioner of human services shall amend the 
 16.33  Minnesota medical assistance plan to include reimbursement for 
 16.34  the local ~~screening~~ consultation teams. 
 16.35     (f) The county may bill, as case management services, 
 16.36  assessments, support planning, and follow-along provided to 
 17.1   persons determined to be eligible for case management under 
 17.2   Minnesota health care programs.  No individual or family member 
 17.3   shall be charged for an initial assessment or initial support 
 17.4   plan development provided under subdivision 3a or 3b. 
 17.5      Sec. 15.  Minnesota Statutes 2000, section 256B.0911, 
 17.6   subdivision 7, is amended to read: 
 17.7      Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
 17.8   (a) Medical assistance reimbursement for nursing facilities 
 17.9   shall be authorized for a medical assistance recipient only if a 
 17.10  preadmission screening has been conducted prior to admission or 
 17.11  the ~~local~~ county ~~agency~~ has authorized an exemption.  Medical 
 17.12  assistance reimbursement for nursing facilities shall not be 
 17.13  provided for any recipient who the local screener has determined 
 17.14  does not meet the level of care criteria for nursing facility 
 17.15  placement or, if indicated, has not had a level II ~~PASARR~~ OBRA 
 17.16  evaluation as required under the federal Omnibus Budget 
 17.17  Reconciliation Act of 1987 completed unless an admission for a 
 17.18  recipient with mental illness is approved by the local mental 
 17.19  health authority or an admission for a recipient with mental 
 17.20  retardation or related condition is approved by the state mental 
 17.21  retardation authority. 
 17.22     (b) The nursing facility must not bill a person who is not 
 17.23  a medical assistance recipient for resident days that preceded 
 17.24  the date of completion of screening activities as required under 
 17.25  subdivisions 4a, 4b, and 4c.  The nursing facility must include 
 17.26  unreimbursed resident days in the nursing facility resident day 
 17.27  totals reported to the commissioner. 
 17.28     (c) The commissioner shall make a request to the health 
 17.29  care financing administration for a waiver allowing ~~screening~~ 
 17.30  team approval of Medicaid payments for certified nursing 
 17.31  facility care.  An individual has a choice and makes the final 
 17.32  decision between nursing facility placement and community 
 17.33  placement after the screening team's recommendation, except as 
 17.34  provided in ~~paragraphs (b) and (c)~~ subdivision 4a, paragraph (d).
 17.35     ~~(c) The local county mental health authority or the state~~ 
 17.36  ~~mental retardation authority under Public Law Numbers 100-203~~ 
 18.1   ~~and 101-508 may prohibit admission to a nursing facility, if the~~ 
 18.2   ~~individual does not meet the nursing facility level of care~~ 
 18.3   ~~criteria or needs specialized services as defined in Public Law~~ 
 18.4   ~~Numbers 100-203 and 101-508.  For purposes of this section,~~ 
 18.5   ~~"specialized services" for a person with mental retardation or a~~ 
 18.6   ~~related condition means "active treatment" as that term is~~ 
 18.7   ~~defined in Code of Federal Regulations, title 42, section~~ 
 18.8   ~~483.440(a)(1).~~ 
 18.9      ~~(e) Appeals from the screening team's recommendation or the~~ 
 18.10  ~~county agency's final decision shall be made according to~~ 
 18.11  ~~section 256.045, subdivision 3.~~ 
 18.12     Sec. 16.  Minnesota Statutes 2000, section 256B.0913, 
 18.13  subdivision 1, is amended to read: 
 18.14     Subdivision 1.  [PURPOSE AND GOALS.] The purpose of the 
 18.15  alternative care program is to provide funding for ~~or access to~~ 
 18.16  home and community-based services for ~~frail~~ elderly persons, in 
 18.17  order to limit nursing facility placements.  The program is 
 18.18  designed to support ~~frail~~ elderly persons in their desire to 
 18.19  remain in the community as independently and as long as possible 
 18.20  and to support informal caregivers in their efforts to provide 
 18.21  care for ~~frail~~ elderly people.  Further, the goals of the 
 18.22  program are: 
 18.23     (1) to contain medical assistance expenditures by ~~providing~~ 
 18.24  funding care in the community ~~at a cost the same or less than~~ 
 18.25  ~~nursing facility costs~~; and 
 18.26     (2) to maintain the moratorium on new construction of 
 18.27  nursing home beds. 
 18.28     Sec. 17.  Minnesota Statutes 2000, section 256B.0913, 
 18.29  subdivision 2, is amended to read: 
 18.30     Subd. 2.  [ELIGIBILITY FOR SERVICES.] Alternative care 
 18.31  services are available to ~~all frail older~~ Minnesotans~~.  This~~ 
 18.32  ~~includes:~~ 
 18.33     ~~(1) persons who are receiving medical assistance and served~~ 
 18.34  ~~under the medical assistance program or the Medicaid waiver~~ 
 18.35  ~~program;~~ 
 18.36     ~~(2) persons~~ age 65 or older who are not eligible for 
 19.1   medical assistance without a spenddown or waiver obligation but 
 19.2   who would be eligible for medical assistance within 180 days of 
 19.3   admission to a nursing facility and ~~served under~~ subject to 
 19.4   subdivisions 4 to 13~~; and~~ 
 19.5      ~~(3) persons who are paying for their services out-of-pocket~~.
 19.6      Sec. 18.  Minnesota Statutes 2000, section 256B.0913, 
 19.7   subdivision 4, is amended to read: 
 19.8      Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
 19.9   NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
 19.10  under the alternative care program is available to persons who 
 19.11  meet the following criteria: 
 19.12     (1) the person has been ~~screened by the county screening~~ 
 19.13  ~~team or, if previously screened and served under the alternative~~ 
 19.14  ~~care program, assessed by the local county social worker or~~ 
 19.15  ~~public health nurse~~ determined by a community assessment under 
 19.16  section 256B.0911, to be a person who would require the level of 
 19.17  care provided in a nursing facility, but for the provision of 
 19.18  services under the alternative care program; 
 19.19     (2) the person is age 65 or older; 
 19.20     (3) the person would be ~~financially~~ eligible for medical 
 19.21  assistance within 180 days of admission to a nursing facility; 
 19.22     (4) the person ~~meets the asset transfer requirements of~~ is 
 19.23  not ineligible for the medical assistance program due to an 
 19.24  asset transfer penalty; 
 19.25     (5) ~~the screening team would recommend nursing facility~~ 
 19.26  ~~admission or continued stay for the person if alternative care~~ 
 19.27  ~~services were not available;~~ 
 19.28     ~~(6)~~ the person needs services that are not ~~available at~~ 
 19.29  ~~that time in the county~~ funded through other ~~county,~~ state~~,~~ or 
 19.30  federal funding ~~sources~~; and 
 19.31     ~~(7)~~ (6) the monthly cost of the alternative care services 
 19.32  funded by the program for this person does not exceed 75 percent 
 19.33  of the statewide ~~average monthly medical assistance payment for~~ 
 19.34  ~~nursing facility care at the individual's case mix~~ 
 19.35  ~~classification~~ weighted average monthly nursing facility rate of 
 19.36  the case mix resident class to which the individual alternative 
 20.1   care client would be assigned under Minnesota Rules, parts 
 20.2   9549.0050 to 9549.0059, less the recipient's maintenance needs 
 20.3   allowance as described in section 256B.0915, subdivision 1d, 
 20.4   paragraph (a), until the first day of the state fiscal year in 
 20.5   which the resident assessment system, under section 256B.437, 
 20.6   for nursing home rate determination is implemented.  Effective 
 20.7   on the first day of the state fiscal year in which a resident 
 20.8   assessment system, under section 256B.437, for nursing home rate 
 20.9   determination is implemented and the first day of each 
 20.10  subsequent state fiscal year, the monthly cost of alternative 
 20.11  care services for this person shall not exceed the alternative 
 20.12  care monthly cap for the case mix resident class to which the 
 20.13  alternative care client would be assigned under Minnesota Rules, 
 20.14  parts 9549.0050 to 9549.0059, which was in effect on the last 
 20.15  day of the previous state fiscal year, and adjusted by the 
 20.16  greater of any legislatively adopted home and community-based 
 20.17  services cost-of-living percentage increase or any legislatively 
 20.18  adopted statewide percent rate increase for nursing facilities.  
 20.19  This monthly limit does not prohibit the alternative care client 
 20.20  from payment for additional services, but in no case may the 
 20.21  cost of additional services purchased under this section exceed 
 20.22  the difference between the client's monthly service limit 
 20.23  defined under section 256B.0915, subdivision 3, and the 
 20.24  alternative care program monthly service limit defined in this 
 20.25  paragraph.  If medical supplies and equipment or ~~adaptations~~ 
 20.26  environmental modifications are or will be purchased for an 
 20.27  alternative care services recipient, the costs may be prorated 
 20.28  on a monthly basis ~~throughout the year in which they are~~ 
 20.29  ~~purchased~~ for up to 12 consecutive months beginning with the 
 20.30  month of purchase.  If the monthly cost of a recipient's other 
 20.31  alternative care services exceeds the monthly limit established 
 20.32  in this paragraph, the annual cost of the alternative care 
 20.33  services shall be determined.  In this event, the annual cost of 
 20.34  alternative care services shall not exceed 12 times the monthly 
 20.35  limit ~~calculated~~ described in this paragraph. 
 20.36     (b) ~~Individuals who meet the criteria in paragraph (a) and~~ 
 21.1   ~~who have been approved for alternative care funding are called~~ 
 21.2   ~~180-day eligible clients.~~ 
 21.3      ~~(c) The statewide average payment for nursing facility care~~ 
 21.4   ~~is the statewide average monthly nursing facility rate in effect~~ 
 21.5   ~~on July 1 of the fiscal year in which the cost is incurred, less~~ 
 21.6   ~~the statewide average monthly income of nursing facility~~ 
 21.7   ~~residents who are age 65 or older and who are medical assistance~~ 
 21.8   ~~recipients in the month of March of the previous fiscal year.~~  
 21.9   ~~This monthly limit does not prohibit the 180-day eligible client~~ 
 21.10  ~~from paying for additional services needed or desired.~~  
 21.11     ~~(d) In determining the total costs of alternative care~~ 
 21.12  ~~services for one month, the costs of all services funded by the~~ 
 21.13  ~~alternative care program, including supplies and equipment, must~~ 
 21.14  ~~be included.~~ 
 21.15     ~~(e)~~ Alternative care funding under this subdivision is not 
 21.16  available for a person who is a medical assistance recipient or 
 21.17  who would be eligible for medical assistance without a 
 21.18  spenddown~~, unless authorized by the commissioner~~ or waiver 
 21.19  obligation.  A person whose initial application for medical 
 21.20  assistance is being processed may be served under the 
 21.21  alternative care program for a period up to 60 days.  If the 
 21.22  individual is found to be eligible for medical assistance, ~~the~~ 
 21.23  ~~county must bill~~ medical assistance must be billed for services 
 21.24  payable under the federally approved elderly waiver plan and 
 21.25  delivered from the date the individual was found eligible 
 21.26  for ~~services reimbursable under~~ the federally approved elderly 
 21.27  waiver ~~program~~ plan.  Notwithstanding this provision, 
 21.28  alternative care funds may not be used to pay for any service 
 21.29  the cost of which is payable by medical assistance or which is 
 21.30  used by a recipient to meet a medical assistance income 
 21.31  spenddown or waiver obligation.  
 21.32     ~~(f)~~ (c) Alternative care funding is not available for a 
 21.33  person who resides in a licensed nursing home ~~or~~, certified 
 21.34  boarding care home, hospital, or intermediate care facility, 
 21.35  except for case management services which are ~~being~~ provided in 
 21.36  support of the discharge planning process to a nursing home 
 22.1   resident or certified boarding care home resident who is 
 22.2   ineligible for case management funded by medical assistance. 
 22.3      Sec. 19.  Minnesota Statutes 2000, section 256B.0913, 
 22.4   subdivision 5, is amended to read: 
 22.5      Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
 22.6   Alternative care funding may be used for payment of costs of: 
 22.7      (1) adult foster care; 
 22.8      (2) adult day care; 
 22.9      (3) home health aide; 
 22.10     (4) homemaker services; 
 22.11     (5) personal care; 
 22.12     (6) case management; 
 22.13     (7) respite care; 
 22.14     (8) assisted living; 
 22.15     (9) residential care services; 
 22.16     (10) care-related supplies and equipment; 
 22.17     (11) meals delivered to the home; 
 22.18     (12) transportation; 
 22.19     (13) skilled nursing; 
 22.20     (14) chore services; 
 22.21     (15) companion services; 
 22.22     (16) nutrition services; 
 22.23     (17) training for direct informal caregivers; 
 22.24     (18) telemedicine devices to monitor recipients in their 
 22.25  own homes as an alternative to hospital care, nursing home care, 
 22.26  or home visits; ~~and~~ 
 22.27     (19) "other services" ~~including~~ includes discretionary 
 22.28  funds and direct cash payments to clients, ~~approved by the~~ 
 22.29  ~~county agency~~ following approval by the commissioner, subject to 
 22.30  the provisions of paragraph ~~(m)~~ (j).  Total annual payments for "
 22.31  other services" for all clients within a county may not exceed 
 22.32  either ten percent of that county's annual alternative care 
 22.33  program base allocation or $5,000, whichever is greater.  In no 
 22.34  case shall this amount exceed the county's total annual 
 22.35  alternative care program base allocation; and 
 22.36     (20) environmental modifications. 
 23.1      (b) The county agency must ensure that the funds are not 
 23.2   used ~~only to supplement and not~~ to supplant services available 
 23.3   through other public assistance or services programs. 
 23.4      (c) Unless specified in statute, the service definitions 
 23.5   and standards for alternative care services shall be the same as 
 23.6   the service definitions and standards ~~defined~~ specified in the 
 23.7   federally approved elderly waiver plan.  Except for the county 
 23.8   agencies' approval of direct cash payments to clients as 
 23.9   described in paragraph (j) or for a provider of supplies and 
 23.10  equipment when the monthly cost of the supplies and equipment is 
 23.11  less than $250, persons or agencies must be employed by or under 
 23.12  a contract with the county agency or the public health nursing 
 23.13  agency of the local board of health in order to receive funding 
 23.14  under the alternative care program.  Supplies and equipment may 
 23.15  be purchased from a vendor not certified to participate in the 
 23.16  Medicaid program if the cost for the item is less than that of a 
 23.17  Medicaid vendor.  
 23.18     (d) The adult foster care rate shall be considered a 
 23.19  difficulty of care payment and shall not include room and 
 23.20  board.  The adult foster care ~~daily~~ rate shall be negotiated 
 23.21  between the county agency and the foster care provider.  ~~The~~ 
 23.22  ~~rate established under this section shall not exceed 75 percent~~ 
 23.23  ~~of the state average monthly nursing home payment for the case~~ 
 23.24  ~~mix classification to which the individual receiving foster care~~ 
 23.25  ~~is assigned, and it must allow for other alternative care~~ 
 23.26  ~~services to be authorized by the case manager.~~  The alternative 
 23.27  care payment for the foster care service in combination with the 
 23.28  payment for other alternative care services, including case 
 23.29  management, must not exceed the limit specified in subdivision 
 23.30  4, paragraph (a), clause (6). 
 23.31     (e) Personal care services ~~may be provided by a personal~~ 
 23.32  ~~care provider organization.~~ must meet the service standards 
 23.33  defined in the federally approved elderly waiver plan, except 
 23.34  that a county agency may contract with a client's relative ~~of~~ 
 23.35  ~~the client~~ who meets the relative hardship waiver requirement as 
 23.36  defined in section 256B.0627, subdivision 4, paragraph (b), 
 24.1   clause (10), to provide personal care services~~, but must ensure~~ 
 24.2   ~~nursing~~ if the county agency ensures supervision of this service 
 24.3   by a registered nurse or mental health practitioner.  ~~Covered~~ 
 24.4   ~~personal care services defined in section 256B.0627, subdivision~~ 
 24.5   ~~4, must meet applicable standards in Minnesota Rules, part~~ 
 24.6   ~~9505.0335.~~ 
 24.7      (f) ~~A county may use alternative care funds to purchase~~ 
 24.8   ~~medical supplies and equipment without prior approval from the~~ 
 24.9   ~~commissioner when:  (1) there is no other funding source; (2)~~ 
 24.10  ~~the supplies and equipment are specified in the individual's~~ 
 24.11  ~~care plan as medically necessary to enable the individual to~~ 
 24.12  ~~remain in the community according to the criteria in Minnesota~~ 
 24.13  ~~Rules, part 9505.0210, item A; and (3) the supplies and~~ 
 24.14  ~~equipment represent an effective and appropriate use of~~ 
 24.15  ~~alternative care funds.  A county may use alternative care funds~~ 
 24.16  ~~to purchase supplies and equipment from a non-Medicaid certified~~ 
 24.17  ~~vendor if the cost for the items is less than that of a Medicaid~~ 
 24.18  ~~vendor.  A county is not required to contract with a provider of~~ 
 24.19  ~~supplies and equipment if the monthly cost of the supplies and~~ 
 24.20  ~~equipment is less than $250.~~  
 24.21     ~~(g)~~ For purposes of this section, residential care services 
 24.22  are services which are provided to individuals living in 
 24.23  residential care homes.  Residential care homes are currently 
 24.24  licensed as board and lodging establishments and are registered 
 24.25  with the department of health as providing special 
 24.26  services under section 157.17 and are not subject to 
 24.27  registration under chapter 144D.  Residential care services are 
 24.28  defined as "supportive services" and "health-related services."  
 24.29  "Supportive services" means the provision of up to 24-hour 
 24.30  supervision and oversight.  Supportive services includes:  (1) 
 24.31  transportation, when provided by the residential care ~~center~~ 
 24.32  home only; (2) socialization, when socialization is part of the 
 24.33  plan of care, has specific goals and outcomes established, and 
 24.34  is not diversional or recreational in nature; (3) assisting 
 24.35  clients in setting up meetings and appointments; (4) assisting 
 24.36  clients in setting up medical and social services; (5) providing 
 25.1   assistance with personal laundry, such as carrying the client's 
 25.2   laundry to the laundry room.  Assistance with personal laundry 
 25.3   does not include any laundry, such as bed linen, that is 
 25.4   included in the room and board rate.  "Health-related services" 
 25.5   are limited to minimal assistance with dressing, grooming, and 
 25.6   bathing and providing reminders to residents to take medications 
 25.7   that are self-administered or providing storage for medications, 
 25.8   if requested.  Individuals receiving residential care services 
 25.9   cannot receive homemaking services funded under this section.  
 25.10     ~~(h)~~ (g) For the purposes of this section, "assisted living" 
 25.11  refers to supportive services provided by a single vendor to 
 25.12  clients who reside in the same apartment building of three or 
 25.13  more units which are not subject to registration under chapter 
 25.14  144D and are licensed by the department of health as a class A 
 25.15  home care provider or a class E home care provider.  Assisted 
 25.16  living services are defined as up to 24-hour supervision, and 
 25.17  oversight, supportive services as defined in clause (1), 
 25.18  individualized home care aide tasks as defined in clause (2), 
 25.19  and individualized home management tasks as defined in clause 
 25.20  (3) provided to residents of a residential center living in 
 25.21  their units or apartments with a full kitchen and bathroom.  A 
 25.22  full kitchen includes a stove, oven, refrigerator, food 
 25.23  preparation counter space, and a kitchen utensil storage 
 25.24  compartment.  Assisted living services must be provided by the 
 25.25  management of the residential center or by providers under 
 25.26  contract with the management or with the county. 
 25.27     (1) Supportive services include:  
 25.28     (i) socialization, when socialization is part of the plan 
 25.29  of care, has specific goals and outcomes established, and is not 
 25.30  diversional or recreational in nature; 
 25.31     (ii) assisting clients in setting up meetings and 
 25.32  appointments; and 
 25.33     (iii) providing transportation, when provided by the 
 25.34  residential center only.  
 25.35     ~~Individuals receiving assisted living services will not~~ 
 25.36  ~~receive both assisted living services and homemaking services.~~  
 26.1   ~~Individualized means services are chosen and designed~~ 
 26.2   ~~specifically for each resident's needs, rather than provided or~~ 
 26.3   ~~offered to all residents regardless of their illnesses,~~ 
 26.4   ~~disabilities, or physical conditions.~~  
 26.5      (2) Home care aide tasks means:  
 26.6      (i) preparing modified diets, such as diabetic or low 
 26.7   sodium diets; 
 26.8      (ii) reminding residents to take regularly scheduled 
 26.9   medications or to perform exercises; 
 26.10     (iii) household chores in the presence of technically 
 26.11  sophisticated medical equipment or episodes of acute illness or 
 26.12  infectious disease; 
 26.13     (iv) household chores when the resident's care requires the 
 26.14  prevention of exposure to infectious disease or containment of 
 26.15  infectious disease; and 
 26.16     (v) assisting with dressing, oral hygiene, hair care, 
 26.17  grooming, and bathing, if the resident is ambulatory, and if the 
 26.18  resident has no serious acute illness or infectious disease.  
 26.19  Oral hygiene means care of teeth, gums, and oral prosthetic 
 26.20  devices.  
 26.21     (3) Home management tasks means:  
 26.22     (i) housekeeping; 
 26.23     (ii) laundry; 
 26.24     (iii) preparation of regular snacks and meals; and 
 26.25     (iv) shopping.  
 26.26     Individuals receiving assisted living services shall not 
 26.27  receive both assisted living services and homemaking services.  
 26.28  Individualized means services are chosen and designed 
 26.29  specifically for each resident's needs, rather than provided or 
 26.30  offered to all residents regardless of their illnesses, 
 26.31  disabilities, or physical conditions.  Assisted living services 
 26.32  as defined in this section shall not be authorized in boarding 
 26.33  and lodging establishments licensed according to sections 
 26.34  157.011 and 157.15 to 157.22. 
 26.35     ~~(i)~~ (h) For establishments registered under chapter 144D, 
 26.36  assisted living services under this section means either the 
 27.1   services described ~~and licensed~~ in paragraph (g) and delivered 
 27.2   by a class E home care provider licensed by the department of 
 27.3   health or the services described under section 144A.4605 and 
 27.4   delivered by an assisted living home care provider or a class A 
 27.5   home care provider licensed by the commissioner of health. 
 27.6      ~~(j) For the purposes of this section, reimbursement~~ (i) 
 27.7   Payment for assisted living services and residential care 
 27.8   services shall be a monthly rate negotiated and authorized by 
 27.9   the county agency based on an individualized service plan for 
 27.10  each resident and may not cover direct rent or food costs.  ~~The~~ 
 27.11  ~~rate~~ 
 27.12     (1) The individualized monthly negotiated payment for 
 27.13  assisted living services as described in paragraph (g) or (h), 
 27.14  and residential care services as described in paragraph (f), 
 27.15  shall not exceed the nonfederal share in effect on July 1 of the 
 27.16  state fiscal year for which the rate limit is being calculated 
 27.17  of the greater of either the statewide or any of the geographic 
 27.18  groups' weighted average monthly ~~medical assistance~~ nursing 
 27.19  facility payment rate of the case mix resident class to which 
 27.20  the ~~180-day~~ alternative care eligible client would be assigned 
 27.21  under Minnesota Rules, parts 9549.0050 to 9549.0059, ~~unless the~~ 
 27.22  less the maintenance needs allowance as described in section 
 27.23  256B.0195, subdivision 1d, paragraph (a), until the first day of 
 27.24  the state fiscal year in which a resident assessment system, 
 27.25  under section 256B.437, of nursing home rate determination is 
 27.26  implemented.  Effective on the first day of the state fiscal 
 27.27  year in which a resident assessment system, under section 
 27.28  256B.437, of nursing home rate determination is implemented and 
 27.29  the first day of each subsequent state fiscal year, the 
 27.30  individualized monthly negotiated payment for the services 
 27.31  described in this clause shall not exceed the limit described in 
 27.32  this clause which was in effect on the last day of the previous 
 27.33  state fiscal year and which has been adjusted by the greater of 
 27.34  any legislatively adopted home and community-based services 
 27.35  cost-of-living percentage increase or any legislatively adopted 
 27.36  statewide percent rate increase for nursing facilities. 
 28.1      (2) The individualized monthly negotiated payment for 
 28.2   assisted living services ~~are provided by a home care~~ described 
 28.3   under section 144A.4605 and delivered by a provider licensed by 
 28.4   the department of health as a class A home care provider or an 
 28.5   assisted living home care provider and ~~are~~ provided in a 
 28.6   building that is registered as a housing with services 
 28.7   establishment under chapter 144D and that provides 24-hour 
 28.8   supervision in combination with the payment for other 
 28.9   alternative care services, including case management, must not 
 28.10  exceed the limit specified in subdivision 4, paragraph (a), 
 28.11  clause (6). 
 28.12     ~~(k) For purposes of this section, companion services are~~ 
 28.13  ~~defined as nonmedical care, supervision and oversight, provided~~ 
 28.14  ~~to a functionally impaired adult.  Companions may assist the~~ 
 28.15  ~~individual with such tasks as meal preparation, laundry and~~ 
 28.16  ~~shopping, but do not perform these activities as discrete~~ 
 28.17  ~~services.  The provision of companion services does not entail~~ 
 28.18  ~~hands-on medical care.  Providers may also perform light~~ 
 28.19  ~~housekeeping tasks which are incidental to the care and~~ 
 28.20  ~~supervision of the recipient.  This service must be approved by~~ 
 28.21  ~~the case manager as part of the care plan.  Companion services~~ 
 28.22  ~~must be provided by individuals or organizations who are under~~ 
 28.23  ~~contract with the local agency to provide the service.  Any~~ 
 28.24  ~~person related to the waiver recipient by blood, marriage or~~ 
 28.25  ~~adoption cannot be reimbursed under this service.  Persons~~ 
 28.26  ~~providing companion services will be monitored by the case~~ 
 28.27  ~~manager.~~ 
 28.28     ~~(l) For purposes of this section, training for direct~~ 
 28.29  ~~informal caregivers is defined as a classroom or home course of~~ 
 28.30  ~~instruction which may include:  transfer and lifting skills,~~ 
 28.31  ~~nutrition, personal and physical cares, home safety in a home~~ 
 28.32  ~~environment, stress reduction and management, behavioral~~ 
 28.33  ~~management, long-term care decision making, care coordination~~ 
 28.34  ~~and family dynamics.  The training is provided to an informal~~ 
 28.35  ~~unpaid caregiver of a 180-day eligible client which enables the~~ 
 28.36  ~~caregiver to deliver care in a home setting with high levels of~~ 
 29.1   ~~quality.  The training must be approved by the case manager as~~ 
 29.2   ~~part of the individual care plan.  Individuals, agencies, and~~ 
 29.3   ~~educational facilities which provide caregiver training and~~ 
 29.4   ~~education will be monitored by the case manager.~~ 
 29.5      ~~(m)~~ (j) A county agency may make payment from their 
 29.6   alternative care program allocation for "other services" 
 29.7   ~~provided to an alternative care program recipient if those~~ 
 29.8   ~~services prevent, shorten, or delay institutionalization.  These~~ 
 29.9   ~~services may~~ which include use of "discretionary funds" for 
 29.10  services that are not otherwise defined in this section and 
 29.11  direct cash payments to the ~~recipient~~ client for the purpose of 
 29.12  purchasing the ~~recipient's~~ services.  The following provisions 
 29.13  apply to payments under this paragraph: 
 29.14     (1) a cash payment to a client under this provision cannot 
 29.15  exceed 80 percent of the monthly payment limit for that client 
 29.16  as specified in subdivision 4, paragraph (a), clause ~~(7)~~ (6); 
 29.17     (2) a county may not approve any cash payment for a client 
 29.18  who meets either of the following: 
 29.19     (i) has been assessed as having a dependency in 
 29.20  orientation, unless the client has an authorized 
 29.21  representative ~~under section 256.476, subdivision 2, paragraph~~ 
 29.22  ~~(g), or for a client who~~.  An "authorized representative" means 
 29.23  an individual who is at least 18 years of age and is designated 
 29.24  by the person or the person's legal representative to act on the 
 29.25  person's behalf.  This individual may be a family member, 
 29.26  guardian, representative payee, or other individual designated 
 29.27  by the person or the person's legal representative, if any, to 
 29.28  assist in purchasing and arranging for supports; or 
 29.29     (ii) is concurrently receiving adult foster care, 
 29.30  residential care, or assisted living services; 
 29.31     (3) ~~any service approved under this section must be a~~ 
 29.32  ~~service which meets the purpose and goals of the program as~~ 
 29.33  ~~listed in subdivision 1;~~ 
 29.34     ~~(4) cash payments must also meet the criteria of and are~~ 
 29.35  ~~governed by the procedures and liability protection established~~ 
 29.36  ~~in section 256.476, subdivision 4, paragraphs (b) through (h),~~ 
 30.1   ~~and recipients of cash grants must meet the requirements in~~ 
 30.2   ~~section 256.476, subdivision 10; and~~ cash payments to a person 
 30.3   or a person's family will be provided through a monthly payment 
 30.4   and be in the form of cash, voucher, or direct county payment to 
 30.5   a vendor.  Fees or premiums assessed to the person for 
 30.6   eligibility for health and human services are not reimbursable 
 30.7   through this service option.  Services and goods purchased 
 30.8   through cash payments must be identified in the person's 
 30.9   individualized care plan and must meet all of the following 
 30.10  criteria: 
 30.11     (i) they must be over and above the normal cost of caring 
 30.12  for the person if the person did not have functional 
 30.13  limitations; 
 30.14     (ii) they must be directly attributable to the person's 
 30.15  functional limitations; 
 30.16     (iii) they must have the potential to be effective at 
 30.17  meeting the goals of the program; 
 30.18     (iv) they must be consistent with the needs identified in 
 30.19  the individualized service plan.  The service plan shall specify 
 30.20  the needs of the person and family, the form and amount of 
 30.21  payment, the items and services to be reimbursed, and the 
 30.22  arrangements for management of the individual grant; and 
 30.23     (v) the person, the person's family, or the legal 
 30.24  representative shall be provided sufficient information to 
 30.25  ensure an informed choice of alternatives.  The local agency 
 30.26  shall document this information in the person's care plan, 
 30.27  including the type and level of expenditures to be reimbursed; 
 30.28     (4) the county, lead agency under contract, or tribal 
 30.29  government under contract to administer the alternative care 
 30.30  program shall not be liable for damages, injuries, or 
 30.31  liabilities sustained through the purchase of direct supports or 
 30.32  goods by the person, the person's family, or the authorized 
 30.33  representative with funds received through the cash payments 
 30.34  under this section.  Liabilities include, but are not limited 
 30.35  to, workers' compensation, the Federal Insurance Contributions 
 30.36  Act (FICA), or the Federal Unemployment Tax Act (FUTA); 
 31.1      (5) persons receiving grants under this section shall have 
 31.2   the following responsibilities: 
 31.3      (i) spend the grant money in a manner consistent with their 
 31.4   individualized service plan with the local agency; 
 31.5      (ii) notify the local agency of any necessary changes in 
 31.6   the grant-expenditures; 
 31.7      (iii) arrange and pay for supports; and 
 31.8      (iv) inform the local agency of areas where they have 
 31.9   experienced difficulty securing or maintaining supports; and 
 31.10     ~~(5)~~ (6) the county shall report client outcomes, services, 
 31.11  and costs under this paragraph in a manner prescribed by the 
 31.12  commissioner. 
 31.13     (k) Upon implementation of direct cash payments to clients 
 31.14  under this section, any person determined eligible for the 
 31.15  alternative care program who chooses a cash payment approved by 
 31.16  the county agency shall receive the cash payment under this 
 31.17  section and not under section 256.476 unless the person was 
 31.18  receiving a consumer support grant under section 256.476 before 
 31.19  implementation of direct cash payments under this section. 
 31.20     Sec. 20.  Minnesota Statutes 2000, section 256B.0913, 
 31.21  subdivision 6, is amended to read: 
 31.22     Subd. 6.  [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 
 31.23  alternative care program is administered by the county agency.  
 31.24  This agency is the lead agency responsible for the local 
 31.25  administration of the alternative care program as described in 
 31.26  this section.  However, it may contract with the public health 
 31.27  nursing service to be the lead agency.  The commissioner may 
 31.28  contract with federally recognized Indian tribes with a 
 31.29  reservation in Minnesota to serve as the lead agency responsible 
 31.30  for the local administration of the alternative care program as 
 31.31  described in the contract. 
 31.32     Sec. 21.  Minnesota Statutes 2000, section 256B.0913, 
 31.33  subdivision 7, is amended to read: 
 31.34     Subd. 7.  [CASE MANAGEMENT.] Providers of case management 
 31.35  services for persons receiving services funded by the 
 31.36  alternative care program must meet the qualification 
 32.1   requirements and standards specified in section 256B.0915, 
 32.2   subdivision 1b.  The case manager must ~~ensure the health and~~ 
 32.3   ~~safety of the individual client and~~ not approve alternative care 
 32.4   funding for a client in any setting in which the case manager 
 32.5   cannot reasonably ensure the client's health and safety.  The 
 32.6   case manager is responsible for the cost-effectiveness of the 
 32.7   alternative care individual care plan and must not approve any 
 32.8   care plan in which the cost of services funded by alternative 
 32.9   care and client contributions exceeds the limit specified in 
 32.10  section 256B.0915, subdivision 3, paragraph (b).  The county may 
 32.11  allow a case manager employed by the county to delegate certain 
 32.12  aspects of the case management activity to another individual 
 32.13  employed by the county provided there is oversight of the 
 32.14  individual by the case manager.  The case manager may not 
 32.15  delegate those aspects which require professional judgment 
 32.16  including assessments, reassessments, and care plan development. 
 32.17     Sec. 22.  Minnesota Statutes 2000, section 256B.0913, 
 32.18  subdivision 8, is amended to read: 
 32.19     Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
 32.20  case manager shall implement the plan of care for each ~~180-day~~ 
 32.21  ~~eligible~~ alternative care client and ensure that a client's 
 32.22  service needs and eligibility are reassessed at least every 12 
 32.23  months.  The plan shall include any services prescribed by the 
 32.24  individual's attending physician as necessary to allow the 
 32.25  individual to remain in a community setting.  In developing the 
 32.26  individual's care plan, the case manager should include the use 
 32.27  of volunteers from families and neighbors, religious 
 32.28  organizations, social clubs, and civic and service organizations 
 32.29  to support the formal home care services.  The county shall be 
 32.30  held harmless for damages or injuries sustained through the use 
 32.31  of volunteers under this subdivision including workers' 
 32.32  compensation liability.  ~~The lead agency shall provide~~ 
 32.33  ~~documentation to the commissioner verifying that the~~ 
 32.34  ~~individual's alternative care is not available at that time~~ 
 32.35  ~~through any other public assistance or service program.~~  The 
 32.36  lead agency shall provide documentation in each individual's 
 33.1   plan of care and, if requested, to the commissioner that the 
 33.2   most cost-effective alternatives available have been offered to 
 33.3   the individual and that the individual was free to choose among 
 33.4   available qualified providers, both public and private.  The 
 33.5   case manager must give the individual a ten-day written notice 
 33.6   of any decrease in or termination of alternative care services. 
 33.7      (b) If the county administering alternative care services 
 33.8   is different than the county of financial responsibility, the 
 33.9   care plan may be implemented without the approval of the county 
 33.10  of financial responsibility. 
 33.11     Sec. 23.  Minnesota Statutes 2000, section 256B.0913, 
 33.12  subdivision 9, is amended to read: 
 33.13     Subd. 9.  [CONTRACTING PROVISIONS FOR PROVIDERS.] ~~The lead~~ 
 33.14  ~~agency shall document to the commissioner that the agency made~~ 
 33.15  ~~reasonable efforts to inform potential providers of the~~ 
 33.16  ~~anticipated need for services under the alternative care program~~ 
 33.17  ~~or waiver programs under sections 256B.0915 and 256B.49,~~ 
 33.18  ~~including a minimum of 14 days' written advance notice of the~~ 
 33.19  ~~opportunity to be selected as a service provider and an annual~~ 
 33.20  ~~public meeting with providers to explain and review the criteria~~ 
 33.21  ~~for selection.  The lead agency shall also document to the~~ 
 33.22  ~~commissioner that the agency allowed potential providers an~~ 
 33.23  ~~opportunity to be selected to contract with the county agency.~~  
 33.24  ~~Funds reimbursed to counties under this subdivision~~ Alternative 
 33.25  care funds paid to service providers are subject to audit by the 
 33.26  commissioner for fiscal and utilization control.  
 33.27     The lead agency must select providers for contracts or 
 33.28  agreements using the following criteria and other criteria 
 33.29  established by the county: 
 33.30     (1) the need for the particular services offered by the 
 33.31  provider; 
 33.32     (2) the population to be served, including the number of 
 33.33  clients, the length of time services will be provided, and the 
 33.34  medical condition of clients; 
 33.35     (3) the geographic area to be served; 
 33.36     (4) quality assurance methods, including appropriate 
 34.1   licensure, certification, or standards, and supervision of 
 34.2   employees when needed; 
 34.3      (5) rates for each service and unit of service exclusive of 
 34.4   county administrative costs; 
 34.5      (6) evaluation of services previously delivered by the 
 34.6   provider; and 
 34.7      (7) contract or agreement conditions, including billing 
 34.8   requirements, cancellation, and indemnification. 
 34.9      The county must evaluate its own agency services under the 
 34.10  criteria established for other providers.  ~~The county shall~~ 
 34.11  ~~provide a written statement of the reasons for not selecting~~ 
 34.12  ~~providers.~~ 
 34.13     Sec. 24.  Minnesota Statutes 2000, section 256B.0913, 
 34.14  subdivision 10, is amended to read: 
 34.15     Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
 34.16  appropriation for fiscal years 1992 and beyond shall cover 
 34.17  only ~~180-day~~ alternative care eligible clients.  Prior to July 1 
 34.18  of each year, the commissioner shall allocate to county agencies 
 34.19  the state funds available for alternative care for persons 
 34.20  eligible under subdivision 2. 
 34.21     (b) ~~Prior to July 1 of each year, the commissioner shall~~ 
 34.22  ~~allocate to county agencies the state funds available for~~ 
 34.23  ~~alternative care for persons eligible under subdivision 2.  The~~ 
 34.24  ~~allocation for fiscal year 1992 shall be calculated using a base~~ 
 34.25  ~~that is adjusted to exclude the medical assistance share of~~ 
 34.26  ~~alternative care expenditures.  The adjusted base is calculated~~ 
 34.27  ~~by multiplying each county's allocation for fiscal year 1991 by~~ 
 34.28  ~~the percentage of county alternative care expenditures for~~ 
 34.29  ~~180-day eligible clients.  The percentage is determined based on~~ 
 34.30  ~~expenditures for services rendered in fiscal year 1989 or~~ 
 34.31  ~~calendar year 1989, whichever is greater.~~  The adjusted base for 
 34.32  each county is the county's current fiscal year base allocation 
 34.33  plus any targeted funds approved during the current fiscal 
 34.34  year.  Calculations for paragraphs (c) and (d) are to be made as 
 34.35  follows:  for each county, the determination of alternative care 
 34.36  program expenditures shall be based on payments for services 
 35.1   rendered from April 1 through March 31 in the base year, to the 
 35.2   extent that claims have been submitted and paid by June 1 of 
 35.3   that year.  
 35.4      (c) If the ~~county~~ alternative care program expenditures ~~for~~ 
 35.5   ~~180-day eligible clients~~ as defined in paragraph (b) are 95 
 35.6   percent or more of ~~its~~ the county's adjusted base allocation, 
 35.7   the allocation for the next fiscal year is 100 percent of the 
 35.8   adjusted base, plus inflation to the extent that inflation is 
 35.9   included in the state budget. 
 35.10     (d) If the ~~county~~ alternative care program expenditures ~~for~~ 
 35.11  ~~180-day eligible clients~~ as defined in paragraph (b) are less 
 35.12  than 95 percent of ~~its~~ the county's adjusted base allocation, 
 35.13  the allocation for the next fiscal year is the adjusted base 
 35.14  allocation less the amount of unspent funds below the 95 percent 
 35.15  level. 
 35.16     (e) ~~For fiscal year 1992 only, a county may receive an~~ 
 35.17  ~~increased allocation if annualized service costs for the month~~ 
 35.18  ~~of May 1991 for 180-day eligible clients are greater than the~~ 
 35.19  ~~allocation otherwise determined.  A county may apply for this~~ 
 35.20  ~~increase by reporting projected expenditures for May to the~~ 
 35.21  ~~commissioner by June 1, 1991.  The amount of the allocation may~~ 
 35.22  ~~exceed the amount calculated in paragraph (b).  The projected~~ 
 35.23  ~~expenditures for May must be based on actual 180-day eligible~~ 
 35.24  ~~client caseload and the individual cost of clients' care plans.~~  
 35.25  ~~If a county does not report its expenditures for May, the amount~~ 
 35.26  ~~in paragraph (c) or (d) shall be used.~~ 
 35.27     ~~(f) Calculations for paragraphs (c) and (d) are to be made~~ 
 35.28  ~~as follows:  for each county, the determination of expenditures~~ 
 35.29  ~~shall be based on payments for services rendered from April 1~~ 
 35.30  ~~through March 31 in the base year, to the extent that claims~~ 
 35.31  ~~have been submitted by June 1 of that year.  Calculations for~~ 
 35.32  ~~paragraphs (c) and (d) must also include the funds transferred~~ 
 35.33  ~~to the consumer support grant program for clients who have~~ 
 35.34  ~~transferred to that program from April 1 through March 31 in the~~ 
 35.35  ~~base year.~~  
 35.36     ~~(g) For the biennium ending June 30, 2001, the allocation~~ 
 36.1   ~~of state funds to county agencies shall be calculated as~~ 
 36.2   ~~described in paragraphs (c) and (d).~~  If the annual legislative 
 36.3   appropriation for the alternative care program is inadequate to 
 36.4   fund the combined county allocations for ~~fiscal year 2000 or~~ 
 36.5   ~~2001~~ a biennium, the commissioner shall distribute to each 
 36.6   county the entire annual appropriation as that county's 
 36.7   percentage of the computed base as calculated in ~~paragraph~~ 
 36.8   ~~(f)~~ paragraphs (c) and (d). 
 36.9      Sec. 25.  Minnesota Statutes 2000, section 256B.0913, 
 36.10  subdivision 11, is amended to read: 
 36.11     Subd. 11.  [TARGETED FUNDING.] (a) The purpose of targeted 
 36.12  funding is to make additional money available to counties with 
 36.13  the greatest need.  Targeted funds are not intended to be 
 36.14  distributed equitably among all counties, but rather, allocated 
 36.15  to those with long-term care strategies that meet state goals. 
 36.16     (b) The funds available for targeted funding shall be the 
 36.17  total appropriation for each fiscal year minus county 
 36.18  allocations determined under subdivision 10 as adjusted for any 
 36.19  inflation increases provided in appropriations for the biennium. 
 36.20     (c) The commissioner shall allocate targeted funds to 
 36.21  counties that demonstrate to the satisfaction of the 
 36.22  commissioner that they have developed feasible plans to increase 
 36.23  alternative care spending.  In making targeted funding 
 36.24  allocations, the commissioner shall use the following priorities:
 36.25     (1) counties that received a lower allocation in fiscal 
 36.26  year 1991 than in fiscal year 1990.  Counties remain in this 
 36.27  priority until they have been restored to their fiscal year 1990 
 36.28  level plus inflation; 
 36.29     (2) counties that sustain a base allocation reduction for 
 36.30  failure to spend 95 percent of the allocation if they 
 36.31  demonstrate that the base reduction should be restored; 
 36.32     (3) counties that propose projects to divert community 
 36.33  residents from nursing home placement or convert nursing home 
 36.34  residents to community living; and 
 36.35     (4) counties that can otherwise justify program growth by 
 36.36  demonstrating the existence of waiting lists, demographically 
 37.1   justified needs, or other unmet needs. 
 37.2      (d) Counties that would receive targeted funds according to 
 37.3   paragraph (c) must demonstrate to the commissioner's 
 37.4   satisfaction that the funds would be appropriately spent by 
 37.5   showing how the funds would be used to further the state's 
 37.6   alternative care goals as described in subdivision 1, and that 
 37.7   the county has the administrative and service delivery 
 37.8   capability to use them.  
 37.9      (e) The commissioner shall request applications ~~by June 1~~ 
 37.10  ~~each year, for county agencies to apply~~ for targeted funds by 
 37.11  November 1 of each year.  The counties selected for targeted 
 37.12  funds shall be notified of the amount of their additional 
 37.13  funding ~~by August 1 of each year~~.  Targeted funds allocated to a 
 37.14  county agency in one year shall be treated as part of the 
 37.15  county's base allocation for that year in determining 
 37.16  allocations for subsequent years.  No reallocations between 
 37.17  counties shall be made. 
 37.18     ~~(f) The allocation for each year after fiscal year 1992~~ 
 37.19  ~~shall be determined using the previous fiscal year's allocation,~~ 
 37.20  ~~including any targeted funds, as the base and then applying the~~ 
 37.21  ~~criteria under subdivision 10, paragraphs (c), (d), and (f), to~~ 
 37.22  ~~the current year's expenditures.~~ 
 37.23     Sec. 26.  Minnesota Statutes 2000, section 256B.0913, 
 37.24  subdivision 12, is amended to read: 
 37.25     Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
 37.26  all ~~180-day~~ alternative care eligible clients to help pay for 
 37.27  the cost of participating in the program.  The amount of the 
 37.28  premium for the alternative care client shall be determined as 
 37.29  follows: 
 37.30     (1) when the alternative care client's income less 
 37.31  recurring and predictable medical expenses is greater than the 
 37.32  ~~medical assistance income standard~~ recipient's maintenance needs 
 37.33  allowance as defined in section 256B.0915, subdivision 1d, 
 37.34  paragraph (a), but less than 150 percent of the federal poverty 
 37.35  guideline effective on July 1 of the state fiscal year in which 
 37.36  the premium is being computed, and total assets are less than 
 38.1   $10,000, the fee is zero; 
 38.2      (2) when the alternative care client's income less 
 38.3   recurring and predictable medical expenses is greater than 150 
 38.4   percent of the federal poverty guideline effective on July 1 of 
 38.5   the state fiscal year in which the premium is being computed, 
 38.6   and total assets are less than $10,000, the fee is 25 percent of 
 38.7   the cost of alternative care services or the difference between 
 38.8   150 percent of the federal poverty guideline effective on July 1 
 38.9   of the state fiscal year in which the premium is being computed 
 38.10  and the client's income less recurring and predictable medical 
 38.11  expenses, whichever is less; and 
 38.12     (3) when the alternative care client's total assets are 
 38.13  greater than $10,000, the fee is 25 percent of the cost of 
 38.14  alternative care services.  
 38.15     For married persons, total assets are defined as the total 
 38.16  marital assets less the estimated community spouse asset 
 38.17  allowance, under section 256B.059, if applicable.  For married 
 38.18  persons, total income is defined as the client's income less the 
 38.19  monthly spousal allotment, under section 256B.058. 
 38.20     All alternative care services except case management shall 
 38.21  be included in the estimated costs for the purpose of 
 38.22  determining 25 percent of the costs. 
 38.23     The monthly premium shall be calculated based on the cost 
 38.24  of the first full month of alternative care services and shall 
 38.25  continue unaltered until the next reassessment is completed or 
 38.26  at the end of 12 months, whichever comes first.  Premiums are 
 38.27  due and payable each month alternative care services are 
 38.28  received unless the actual cost of the services is less than the 
 38.29  premium. 
 38.30     (b) The fee shall be waived by the commissioner when: 
 38.31     (1) a person who is residing in a nursing facility is 
 38.32  receiving case management only; 
 38.33     (2) a person is applying for medical assistance; 
 38.34     (3) a married couple is requesting an asset assessment 
 38.35  under the spousal impoverishment provisions; 
 38.36     (4) ~~a person is a medical assistance recipient, but has~~ 
 39.1   ~~been approved for alternative care-funded assisted living~~ 
 39.2   ~~services;~~ 
 39.3      ~~(5)~~ a person is found eligible for alternative care, but is 
 39.4   not yet receiving alternative care services; or 
 39.5      ~~(6)~~ (5) a person's fee under paragraph (a) is less than $25.
 39.6      (c) The county agency must collect the premium from the 
 39.7   client and forward the amounts collected to the commissioner in 
 39.8   the manner and at the times prescribed by the commissioner.  
 39.9   Money collected must be deposited in the general fund and is 
 39.10  appropriated to the commissioner for the alternative care 
 39.11  program.  The client must supply the county with the client's 
 39.12  social security number at the time of application.  If a client 
 39.13  fails or refuses to pay the premium due, the county shall supply 
 39.14  the commissioner with the client's social security number and 
 39.15  other information the commissioner requires to collect the 
 39.16  premium from the client.  The commissioner shall collect unpaid 
 39.17  premiums using the Revenue Recapture Act in chapter 270A and 
 39.18  other methods available to the commissioner.  The commissioner 
 39.19  may require counties to inform clients of the collection 
 39.20  procedures that may be used by the state if a premium is not 
 39.21  paid.  
 39.22     (d) The commissioner shall begin to adopt emergency or 
 39.23  permanent rules governing client premiums within 30 days after 
 39.24  July 1, 1991, including criteria for determining when services 
 39.25  to a client must be terminated due to failure to pay a premium.  
 39.26     Sec. 27.  Minnesota Statutes 2000, section 256B.0913, 
 39.27  subdivision 13, is amended to read: 
 39.28     Subd. 13.  [COUNTY BIENNIAL PLAN.] The county biennial plan 
 39.29  for ~~the preadmission screening program~~ long-term care 
 39.30  consultation services under section 256B.0911, the alternative 
 39.31  care program under this section, and waivers for the elderly 
 39.32  under section 256B.0915, ~~and waivers for the disabled under~~ 
 39.33  ~~section 256B.49,~~ shall be incorporated into the biennial 
 39.34  Community Social Services Act plan and shall meet the 
 39.35  regulations and timelines of that plan.  ~~This county biennial~~ 
 39.36  ~~plan shall include:~~ 
 40.1      ~~(1) information on the administration of the preadmission~~ 
 40.2   ~~screening program;~~ 
 40.3      ~~(2) information on the administration of the home and~~ 
 40.4   ~~community-based services waivers for the elderly under section~~ 
 40.5   ~~256B.0915, and for the disabled under section 256B.49; and~~ 
 40.6      ~~(3) information on the administration of the alternative~~ 
 40.7   ~~care program.~~ 
 40.8      Sec. 28.  Minnesota Statutes 2000, section 256B.0913, 
 40.9   subdivision 14, is amended to read: 
 40.10     Subd. 14.  [~~REIMBURSEMENT~~ PAYMENT AND RATE ADJUSTMENTS.] (a)
 40.11  ~~Reimbursement~~ Payment for ~~expenditures for the~~ provided 
 40.12  alternative care services as approved by the client's case 
 40.13  manager shall be through the invoice processing procedures of 
 40.14  the department's Medicaid Management Information System (MMIS).  
 40.15  To receive ~~reimbursement~~ payment, the county or vendor must 
 40.16  submit invoices within 12 months following the date of service.  
 40.17  The county agency and its vendors under contract shall not be 
 40.18  reimbursed for services which exceed the county allocation. 
 40.19     (b) If a county collects less than 50 percent of the client 
 40.20  premiums due under subdivision 12, the commissioner may withhold 
 40.21  up to three percent of the county's final alternative care 
 40.22  program allocation determined under subdivisions 10 and 11. 
 40.23     (c) The county shall negotiate individual rates with 
 40.24  vendors and may ~~be reimbursed~~ authorize service payment for 
 40.25  actual costs up to ~~the greater of~~ the county's current approved 
 40.26  rate ~~or 60 percent of the maximum rate in fiscal year 1994 and~~ 
 40.27  ~~65 percent of the maximum rate in fiscal year 1995 for each~~ 
 40.28  ~~alternative care service~~.  Notwithstanding any other rule or 
 40.29  statutory provision to the contrary, the commissioner shall not 
 40.30  be authorized to increase rates by an annual inflation factor, 
 40.31  unless so authorized by the legislature. 
 40.32     (d) ~~On July 1, 1993, the commissioner shall increase the~~ 
 40.33  ~~maximum rate for home delivered meals to $4.50 per meal~~ To 
 40.34  improve access to community services and eliminate payment 
 40.35  disparities between the alternative care program and the elderly 
 40.36  waiver program, the commissioner shall establish statewide 
 41.1   maximum service rate limits and eliminate county-specific 
 41.2   service rate limits. 
 41.3      (1) Effective July 1, 2001, for service rate limits, except 
 41.4   those in subdivision 5, paragraphs (d) and (j), the rate limit 
 41.5   for each service shall be the greater of the alternative care 
 41.6   statewide maximum rate or the elderly waiver statewide maximum 
 41.7   rate. 
 41.8      (2) Counties may negotiate individual service rates with 
 41.9   vendors for actual costs up to the statewide maximum service 
 41.10  rate limit. 
 41.11     Sec. 29.  Minnesota Statutes 2000, section 256B.0915, 
 41.12  subdivision 1d, is amended to read: 
 41.13     Subd. 1d.  [POSTELIGIBILITY TREATMENT OF INCOME AND 
 41.14  RESOURCES FOR ELDERLY WAIVER.] ~~(a)~~ Notwithstanding the 
 41.15  provisions of section 256B.056, the commissioner shall make the 
 41.16  following amendment to the medical assistance elderly waiver 
 41.17  program effective July 1, 1999, or upon federal approval, 
 41.18  whichever is later. 
 41.19     A recipient's maintenance needs will be an amount equal to 
 41.20  the Minnesota supplemental aid equivalent rate as defined in 
 41.21  section 256I.03, subdivision 5, plus the medical assistance 
 41.22  personal needs allowance as defined in section 256B.35, 
 41.23  subdivision 1, paragraph (a), when applying posteligibility 
 41.24  treatment of income rules to the gross income of elderly waiver 
 41.25  recipients, except for individuals whose income is in excess of 
 41.26  the special income standard according to Code of Federal 
 41.27  Regulations, title 42, section 435.236.  Recipient maintenance 
 41.28  needs shall be adjusted under this provision each July 1. 
 41.29     ~~(b) The commissioner of human services shall secure~~ 
 41.30  ~~approval of additional elderly waiver slots sufficient to serve~~ 
 41.31  ~~persons who will qualify under the revised income standard~~ 
 41.32  ~~described in paragraph (a) before implementing section~~ 
 41.33  ~~256B.0913, subdivision 16.~~ 
 41.34     ~~(c) In implementing this subdivision, the commissioner~~ 
 41.35  ~~shall consider allowing persons who would otherwise be eligible~~ 
 41.36  ~~for the alternative care program but would qualify for the~~ 
 42.1   ~~elderly waiver with a spenddown to remain on the alternative~~ 
 42.2   ~~care program.~~ 
 42.3      Sec. 30.  Minnesota Statutes 2000, section 256B.0915, 
 42.4   subdivision 3, is amended to read: 
 42.5      Subd. 3.  [LIMITS OF CASES, RATES, ~~REIMBURSEMENT~~ PAYMENTS, 
 42.6   AND FORECASTING.] (a) The number of medical assistance waiver 
 42.7   recipients that a county may serve must be allocated according 
 42.8   to the number of medical assistance waiver cases open on July 1 
 42.9   of each fiscal year.  Additional recipients may be served with 
 42.10  the approval of the commissioner. 
 42.11     (b) The monthly limit for the cost of waivered services to 
 42.12  an individual elderly waiver client shall be the ~~statewide~~ 
 42.13  ~~average payment~~ weighted average monthly nursing facility rate 
 42.14  of the case mix resident class to which the elderly waiver 
 42.15  client would be assigned under ~~the medical assistance case mix~~ 
 42.16  ~~reimbursement system.~~  Minnesota Rules, parts 9549.0050 to 
 42.17  9549.0059, less the recipient's maintenance needs allowance as 
 42.18  described in subdivision 1d, paragraph (a), until the first day 
 42.19  of the state fiscal year in which the resident assessment system 
 42.20  as described in section 256B.437 for nursing home rate 
 42.21  determination is implemented.  Effective on the first day of the 
 42.22  state fiscal year in which the resident assessment system as 
 42.23  described in section 256B.437 for nursing home rate 
 42.24  determination is implemented and the first day of each 
 42.25  subsequent state fiscal year, the monthly limit for the cost of 
 42.26  waivered services to an individual elderly waiver client shall 
 42.27  be the rate of the case mix resident class to which the waiver 
 42.28  client would be assigned under Minnesota Rules, parts 9549.0050 
 42.29  to 9549.0059, in effect on the last day of the previous state 
 42.30  fiscal year, adjusted by the greater of any legislatively 
 42.31  adopted home and community-based services cost-of-living 
 42.32  percentage increase or any legislatively adopted statewide 
 42.33  percent rate increase for nursing facilities. 
 42.34     (c) If extended medical supplies and equipment or 
 42.35  ~~adaptations~~ environmental modifications are or will be purchased 
 42.36  for an elderly waiver ~~services recipient, the~~ client, the costs 
 43.1   may be prorated ~~on a monthly basis throughout the year in which~~ 
 43.2   ~~they are purchased~~ for up to 12 consecutive months beginning 
 43.3   with the month of purchase.  If the monthly cost of a 
 43.4   recipient's ~~other~~ waivered services exceeds the monthly limit 
 43.5   established in ~~this~~ paragraph (b), the annual cost of ~~the~~ all 
 43.6   waivered services shall be determined.  In this event, the 
 43.7   annual cost of all waivered services shall not exceed 12 times 
 43.8   the monthly limit ~~calculated in this paragraph.  The statewide~~ 
 43.9   ~~average payment rate is calculated by determining the statewide~~ 
 43.10  ~~average monthly nursing home rate, effective July 1 of the~~ 
 43.11  ~~fiscal year in which the cost is incurred, less the statewide~~ 
 43.12  ~~average monthly income of nursing home residents who are age 65~~ 
 43.13  ~~or older, and who are medical assistance recipients in the month~~ 
 43.14  ~~of March of the previous state fiscal year.  The annual cost~~ 
 43.15  ~~divided by 12 of elderly or disabled waivered services~~ of 
 43.16  waivered services as described in paragraph (b).  
 43.17     (d) For a person who is a nursing facility resident at the 
 43.18  time of requesting a determination of eligibility for elderly ~~or~~ 
 43.19  ~~disabled~~ waivered services ~~shall be the greater of the monthly~~ 
 43.20  ~~payment for:  (i)~~, a monthly conversion limit for the cost of 
 43.21  elderly waivered services may be requested.  The monthly 
 43.22  conversion limit for the cost of elderly waiver services shall 
 43.23  be the resident class assigned under Minnesota Rules, parts 
 43.24  9549.0050 to 9549.0059, for that resident in the nursing 
 43.25  facility where the resident currently resides~~; or (ii) the~~ 
 43.26  ~~statewide average payment of the case mix resident class to~~ 
 43.27  ~~which the resident would be assigned under the medical~~ 
 43.28  ~~assistance case mix reimbursement system, provided that~~ until 
 43.29  July 1 of the state fiscal year in which the resident assessment 
 43.30  system as described in section 256B.437 for nursing home rate 
 43.31  determination is implemented.  Effective on July 1 of the state 
 43.32  fiscal year in which the resident assessment system as described 
 43.33  in section 256B.437 for nursing home rate determination is 
 43.34  implemented, the monthly conversion limit for the cost of 
 43.35  elderly waiver services shall be the per diem nursing facility 
 43.36  rate as determined by the resident assessment system as 
 44.1   described in section 256B.437 for that resident in the nursing 
 44.2   facility where the resident currently resides multiplied by 365 
 44.3   and divided by 12, less the recipient's maintenance needs 
 44.4   allowance as described in subdivision 1d, paragraph (a).  The 
 44.5   limit under this clause only applies to persons discharged from 
 44.6   a nursing facility after a minimum 30-day stay and found 
 44.7   eligible for waivered services on or after July 1, 1997.  The 
 44.8   following costs must be included in determining the total 
 44.9   monthly costs for the waiver client: 
 44.10     (1) cost of all waivered services, including extended 
 44.11  medical supplies and equipment and environmental modifications; 
 44.12  and 
 44.13     (2) cost of skilled nursing, home health aide, and personal 
 44.14  care services reimbursable by medical assistance.  
 44.15     ~~(c)~~ (e) Medical assistance funding for skilled nursing 
 44.16  services, private duty nursing, home health aide, and personal 
 44.17  care services for waiver recipients must be approved by the case 
 44.18  manager and included in the individual care plan. 
 44.19     ~~(d) For both the elderly waiver and the nursing facility~~ 
 44.20  ~~disabled waiver, a county may purchase extended supplies and~~ 
 44.21  ~~equipment without prior approval from the commissioner when~~ 
 44.22  ~~there is no other funding source and the supplies and equipment~~ 
 44.23  ~~are specified in the individual's care plan as medically~~ 
 44.24  ~~necessary to enable the individual to remain in the community~~ 
 44.25  ~~according to the criteria in Minnesota Rules, part 9505.0210,~~ 
 44.26  ~~items A and B.~~  (f) A county is not required to contract with a 
 44.27  provider of supplies and equipment if the monthly cost of the 
 44.28  supplies and equipment is less than $250.  
 44.29     ~~(e)~~ (g) The adult foster care ~~daily~~ rate ~~for the elderly~~ 
 44.30  ~~and disabled waivers~~ shall be considered a difficulty of care 
 44.31  payment and shall not include room and board.  The adult foster 
 44.32  care service rate shall be negotiated between the county agency 
 44.33  and the foster care provider.  ~~The rate established under this~~ 
 44.34  ~~section shall not exceed the state average monthly nursing home~~ 
 44.35  ~~payment for the case mix classification to which the individual~~ 
 44.36  ~~receiving foster care is assigned; the rate must allow for other~~ 
 45.1   ~~waiver and medical assistance home care services to be~~ 
 45.2   ~~authorized by the case manager.~~  The elderly waiver payment for 
 45.3   the foster care service in combination with the payment for all 
 45.4   other elderly waiver services, including case management, must 
 45.5   not exceed the limit specified in paragraph (b). 
 45.6      ~~(f) The assisted living and residential care service rates~~ 
 45.7   ~~for elderly and community alternatives for disabled individuals~~ 
 45.8   ~~(CADI) waivers shall be made to the vendor as a monthly rate~~ 
 45.9   ~~negotiated with the county agency based on an individualized~~ 
 45.10  ~~service plan for each resident.  The rate shall not exceed the~~ 
 45.11  ~~nonfederal share of the greater of either the statewide or any~~ 
 45.12  ~~of the geographic groups' weighted average monthly medical~~ 
 45.13  ~~assistance nursing facility payment rate of the case mix~~ 
 45.14  ~~resident class to which the elderly or disabled client would be~~ 
 45.15  ~~assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,~~ 
 45.16  ~~unless the services are provided by a home care provider~~ 
 45.17  ~~licensed by the department of health and are provided in a~~ 
 45.18  ~~building that is registered as a housing with services~~ 
 45.19  ~~establishment under chapter 144D and that provides 24-hour~~ 
 45.20  ~~supervision.  For alternative care assisted living projects~~ 
 45.21  ~~established under Laws 1988, chapter 689, article 2, section~~ 
 45.22  ~~256, monthly rates may not exceed 65 percent of the greater of~~ 
 45.23  ~~either the statewide or any of the geographic groups' weighted~~ 
 45.24  ~~average monthly medical assistance nursing facility payment rate~~ 
 45.25  ~~for the case mix resident class to which the elderly or disabled~~ 
 45.26  ~~client would be assigned under Minnesota Rules, parts 9549.0050~~ 
 45.27  ~~to 9549.0059.  The rate may not cover direct rent or food costs.~~ 
 45.28     (h) Payment for assisted living service shall be a monthly 
 45.29  rate negotiated and authorized by the county agency based on an 
 45.30  individualized service plan for each resident and may not cover 
 45.31  direct rent or food costs. 
 45.32     (1) The individualized monthly negotiated payment for 
 45.33  assisted living services as described in section 256B.0913, 
 45.34  subdivision 5, paragraph (g) or (h), and residential care 
 45.35  services as described in section 256B.0913, subdivision 5, 
 45.36  paragraph (f), shall not exceed the nonfederal share, in effect 
 46.1   on July 1 of the state fiscal year for which the rate limit is 
 46.2   being calculated, of the greater of either the statewide or any 
 46.3   of the geographic groups' weighted average monthly nursing 
 46.4   facility rate of the case mix resident class to which the 
 46.5   elderly waiver eligible client would be assigned under Minnesota 
 46.6   Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 
 46.7   allowance as described in subdivision 1d, paragraph (a), until 
 46.8   the July 1 of the state fiscal year in which the resident 
 46.9   assessment system as described in section 256B.437 for nursing 
 46.10  home rate determination is implemented.  Effective on July 1 of 
 46.11  the state fiscal year in which the resident assessment system as 
 46.12  described in section 256B.437 for nursing home rate 
 46.13  determination is implemented and July 1 of each subsequent state 
 46.14  fiscal year, the individualized monthly negotiated payment for 
 46.15  the services described in this clause shall not exceed the limit 
 46.16  described in this clause which was in effect on June 30 of the 
 46.17  previous state fiscal year and which has been adjusted by the 
 46.18  greater of any legislatively adopted home and community-based 
 46.19  services cost-of-living percentage increase or any legislatively 
 46.20  adopted statewide percent rate increase for nursing facilities. 
 46.21     (2) The individualized monthly negotiated payment for 
 46.22  assisted living services described in section 144A.4605 and 
 46.23  delivered by a provider licensed by the department of health as 
 46.24  a Class A home care provider or an assisted living home care 
 46.25  provider and provided in a building that is registered as a 
 46.26  housing with services establishment under chapter 144D and that 
 46.27  provides 24-hour supervision in combination with the payment for 
 46.28  other elderly waiver services, including case management, must 
 46.29  not exceed the limit specified in paragraph (b). 
 46.30     ~~(g)~~ (i) The county shall negotiate individual service rates 
 46.31  with vendors and may ~~be reimbursed~~ authorize payment for actual 
 46.32  costs up to the ~~greater of the~~ county's current approved rate ~~or~~ 
 46.33  ~~60 percent of the maximum rate in fiscal year 1994 and 65~~ 
 46.34  ~~percent of the maximum rate in fiscal year 1995 for each service~~ 
 46.35  ~~within each program~~.  Persons or agencies must be employed by or 
 46.36  under a contract with the county agency or the public health 
 47.1   nursing agency of the local board of health in order to receive 
 47.2   funding under the elderly waiver program, except as a provider 
 47.3   of supplies and equipment when the monthly cost of the supplies 
 47.4   and equipment is less than $250.  
 47.5      ~~(h) On July 1, 1993, the commissioner shall increase the~~ 
 47.6   ~~maximum rate for home-delivered meals to $4.50 per meal.~~ 
 47.7      ~~(i)~~ (j) Reimbursement for the medical assistance recipients 
 47.8   under the approved waiver shall be made from the medical 
 47.9   assistance account through the invoice processing procedures of 
 47.10  the department's Medicaid Management Information System (MMIS), 
 47.11  only with the approval of the client's case manager.  The budget 
 47.12  for the state share of the Medicaid expenditures shall be 
 47.13  forecasted with the medical assistance budget, and shall be 
 47.14  consistent with the approved waiver.  
 47.15     (k) To improve access to community services and eliminate 
 47.16  payment disparities between the alternative care program and the 
 47.17  elderly waiver, the commissioner shall establish statewide 
 47.18  maximum service rate limits and eliminate county-specific 
 47.19  service rate limits. 
 47.20     (1) Effective July 1, 2001, for service rate limits, except 
 47.21  those described or defined in paragraphs (g) and (h), the rate 
 47.22  limit for each service shall be the greater of the alternative 
 47.23  care statewide maximum rate or the elderly waiver statewide 
 47.24  maximum rate. 
 47.25     (2) Counties may negotiate individual service rates with 
 47.26  vendors for actual costs up to the statewide maximum service 
 47.27  rate limit. 
 47.28     ~~(j)~~ (l) Beginning July 1, 1991, the state shall reimburse 
 47.29  counties according to the payment schedule in section 256.025 
 47.30  for the county share of costs incurred under this subdivision on 
 47.31  or after January 1, 1991, for individuals who are receiving 
 47.32  medical assistance. 
 47.33     ~~(k) For the community alternatives for disabled individuals~~ 
 47.34  ~~waiver, and nursing facility disabled waivers, county may use~~ 
 47.35  ~~waiver funds for the cost of minor adaptations to a client's~~ 
 47.36  ~~residence or vehicle without prior approval from the~~ 
 48.1   ~~commissioner if there is no other source of funding and the~~ 
 48.2   ~~adaptation:~~ 
 48.3      ~~(1) is necessary to avoid institutionalization;~~ 
 48.4      ~~(2) has no utility apart from the needs of the client; and~~ 
 48.5      ~~(3) meets the criteria in Minnesota Rules, part 9505.0210,~~ 
 48.6   ~~items A and B.~~  
 48.7   ~~For purposes of this subdivision, "residence" means the client's~~ 
 48.8   ~~own home, the client's family residence, or a family foster~~ 
 48.9   ~~home.  For purposes of this subdivision, "vehicle" means the~~ 
 48.10  ~~client's vehicle, the client's family vehicle, or the client's~~ 
 48.11  ~~family foster home vehicle.~~ 
 48.12     ~~(l) The commissioner shall establish a maximum rate unit~~ 
 48.13  ~~for baths provided by an adult day care provider that are not~~ 
 48.14  ~~included in the provider's contractual daily or hourly rate.~~ 
 48.15  ~~This maximum rate must equal the home health aide extended rate~~ 
 48.16  ~~and shall be paid for baths provided to clients served under the~~ 
 48.17  ~~elderly and disabled waivers.~~ 
 48.18     Sec. 31.  Minnesota Statutes 2000, section 256B.0915, 
 48.19  subdivision 5, is amended to read: 
 48.20     Subd. 5.  [REASSESSMENTS FOR WAIVER CLIENTS.] A 
 48.21  reassessment of a client served under the elderly ~~or disabled~~ 
 48.22  waiver must be conducted at least every 12 months and at other 
 48.23  times when the case manager determines that there has been 
 48.24  significant change in the client's functioning.  This may 
 48.25  include instances where the client is discharged from the 
 48.26  hospital.  
 48.27     Sec. 32.  Minnesota Statutes 2000, section 256B.0917, is 
 48.28  amended by adding a subdivision to read: 
 48.29     Subd. 13.  [COMMUNITY SERVICE GRANTS.] The commissioner 
 48.30  shall award contracts for grants to public and private nonprofit 
 48.31  agencies to establish services that strengthen a community's 
 48.32  ability to provide a system of home and community-based services 
 48.33  for elderly persons.  The commissioner shall use a request for 
 48.34  proposal process.  Communities that have a planned closure of a 
 48.35  nursing facility approved under section 256B.437 shall be given 
 48.36  preference for grants.  The commissioner shall consider grants 
 49.1   for: 
 49.2      (1) caregiver support and respite care projects under 
 49.3   subdivision 6; 
 49.4      (2) on-site coordination under section 256.9731; 
 49.5      (3) the living-at-home/block nurse grant under subdivisions 
 49.6   7 to 10; and 
 49.7      (4) services identified as needed for community transition. 
 49.8      Sec. 33.  [COORDINATED SERVICE ACCESS STUDY.] 
 49.9      By February 15, 2002, the commissioner of human services 
 49.10  shall submit to the legislature recommendations for creating 
 49.11  coordinated service access at the county agency level for both 
 49.12  publicly subsidized and nonsubsidized long-term care services 
 49.13  and housing options.  The report must: 
 49.14     (1) include a plan to coordinate public funding streams to 
 49.15  allow low-income, privately paying consumers to purchase 
 49.16  services through a sliding fee scale; and 
 49.17     (2) evaluate the feasibility of statewide implementation, 
 49.18  based upon an evaluation of public cost, consumer preferences 
 49.19  and satisfaction, and other relevant factors. 
 49.20     Sec. 34.  [RESPITE CARE.] 
 49.21     The Minnesota board on aging shall present recommendations 
 49.22  to the legislature by February 1, 2002, on the provision of 
 49.23  in-home and out-of-home respite care services on a sliding scale 
 49.24  basis under the federal Older Americans Act. 
 49.25     Sec. 35.  [APPROPRIATION.] 
 49.26     $....... is appropriated from the general fund to the 
 49.27  commissioner of human services for the biennium ending June 30, 
 49.28  2003, for the purposes of this article. 
 49.29     Sec. 36.  [REPEALER.] 
 49.30     (a) Minnesota Statutes 2000, sections 256B.0911, 
 49.31  subdivisions 2, 2a, 4, 8, and 9; 256B.0913, subdivisions 3, 15a, 
 49.32  15b, 15c, and 16; 256B.0915, subdivisions 3a, 3b, and 3c; and 
 49.33  256B.436, subdivisions 3, 5, 6, and 8, are repealed. 
 49.34     (b) Minnesota Rules, parts 9505.2390; 9505.2395; 9505.2396; 
 49.35  9505.2400; 9505.2405; 9505.2410; 9505.2413; 9505.2415; 
 49.36  9505.2420; 9505.2425; 9505.2426; 9505.2430; 9505.2435; 
 50.1   9505.2440; 9505.2445; 9505.2450; 9505.2455; 9505.2458; 
 50.2   9505.2460; 9505.2465; 9505.2470; 9505.2473; 9505.2475; 
 50.3   9505.2480; 9505.2485; 9505.2486; 9505.2490; 9505.2495; 
 50.4   9505.2496; and 9505.2500, are repealed. 
 50.5                              ARTICLE 2
 50.6            LONG-TERM CARE SYSTEM REFORM AND REIMBURSEMENT
 50.7      Section 1.  Minnesota Statutes 2000, section 144A.071, 
 50.8   subdivision 1, is amended to read: 
 50.9      Subdivision 1.  [FINDINGS.] The legislature declares that a 
 50.10  moratorium on the licensure and medical assistance certification 
 50.11  of new nursing home beds and construction projects that 
 50.12  exceed ~~$750,000~~ $1,000,000 is necessary to control nursing home 
 50.13  expenditure growth and enable the state to meet the needs of its 
 50.14  elderly by providing high quality services in the most 
 50.15  appropriate manner along a continuum of care.  
 50.16     Sec. 2.  Minnesota Statutes 2000, section 144A.071, 
 50.17  subdivision 1a, is amended to read: 
 50.18     Subd. 1a.  [DEFINITIONS.] For purposes of sections 144A.071 
 50.19  to 144A.073, the following terms have the meanings given them: 
 50.20     (a) "attached fixtures" has the meaning given in Minnesota 
 50.21  Rules, part 9549.0020, subpart 6. 
 50.22     (b) "buildings" has the meaning given in Minnesota Rules, 
 50.23  part 9549.0020, subpart 7. 
 50.24     (c) "capital assets" has the meaning given in section 
 50.25  256B.421, subdivision 16. 
 50.26     (d) "commenced construction" means that all of the 
 50.27  following conditions were met:  the final working drawings and 
 50.28  specifications were approved by the commissioner of health; the 
 50.29  construction contracts were let; a timely construction schedule 
 50.30  was developed, stipulating dates for beginning, achieving 
 50.31  various stages, and completing construction; and all zoning and 
 50.32  building permits were applied for. 
 50.33     (e) "completion date" means the date on which a certificate 
 50.34  of occupancy is issued for a construction project, or if a 
 50.35  certificate of occupancy is not required, the date on which the 
 50.36  construction project is available for facility use. 
 51.1      (f) "construction" means any erection, building, 
 51.2   alteration, reconstruction, modernization, or improvement 
 51.3   necessary to comply with the nursing home licensure rules. 
 51.4      (g) "construction project" means: 
 51.5      (1) a capital asset addition to, or replacement of a 
 51.6   nursing home or certified boarding care home that results in new 
 51.7   space or the remodeling of or renovations to existing facility 
 51.8   space; 
 51.9      (2) the remodeling or renovation of existing facility space 
 51.10  the use of which is modified as a result of the project 
 51.11  described in clause (1).  This existing space and the project 
 51.12  described in clause (1) must be used for the functions as 
 51.13  designated on the construction plans on completion of the 
 51.14  project described in clause (1) for a period of not less than 24 
 51.15  months; or 
 51.16     (3) capital asset additions or replacements that are 
 51.17  completed within 12 months before or after the completion date 
 51.18  of the project described in clause (1). 
 51.19     (h) "new licensed" or "new certified beds" means: 
 51.20     (1) newly constructed beds in a facility or the 
 51.21  construction of a new facility that would increase the total 
 51.22  number of licensed nursing home beds or certified boarding care 
 51.23  or nursing home beds in the state; or 
 51.24     (2) newly licensed nursing home beds or newly certified 
 51.25  boarding care or nursing home beds that result from remodeling 
 51.26  of the facility that involves relocation of beds but does not 
 51.27  result in an increase in the total number of beds, except when 
 51.28  the project involves the upgrade of boarding care beds to 
 51.29  nursing home beds, as defined in section 144A.073, subdivision 
 51.30  1.  "Remodeling" includes any of the type of conversion, 
 51.31  renovation, replacement, or upgrading projects as defined in 
 51.32  section 144A.073, subdivision 1. 
 51.33     (i) "project construction costs" means the cost of the 
 51.34  facility capital asset additions, replacements, renovations, or 
 51.35  remodeling projects, construction site preparation costs, and 
 51.36  related soft costs.  Project construction costs ~~also~~ include the 
 52.1   cost of any remodeling or renovation of existing facility space 
 52.2   which is modified as a result of the construction 
 52.3   project.  Project construction costs also includes the cost of 
 52.4   new technology implemented as part of the construction project. 
 52.5      (j) "technology" means information systems or devices that 
 52.6   make documentation, charting, and staff time more efficient or 
 52.7   encourage and allow for care through alternative settings 
 52.8   including, but not limited to, touch screens, monitors, 
 52.9   hand-helds, swipe cards, motion detectors, pagers, telemedicine, 
 52.10  medication dispensers, and equipment to monitor vital signs and 
 52.11  self-injections, and to observe skin and other conditions. 
 52.12     Sec. 3.  Minnesota Statutes 2000, section 144A.071, 
 52.13  subdivision 2, is amended to read: 
 52.14     Subd. 2.  [MORATORIUM.] The commissioner of health, in 
 52.15  coordination with the commissioner of human services, shall deny 
 52.16  each request for new licensed or certified nursing home or 
 52.17  certified boarding care beds except as provided in subdivision 3 
 52.18  or 4a, or section 144A.073.  "Certified bed" means a nursing 
 52.19  home bed or a boarding care bed certified by the commissioner of 
 52.20  health for the purposes of the medical assistance program, under 
 52.21  United States Code, title 42, sections 1396 et seq.  
 52.22     The commissioner of human services, in coordination with 
 52.23  the commissioner of health, shall deny any request to issue a 
 52.24  license under section 252.28 and chapter 245A to a nursing home 
 52.25  or boarding care home, if that license would result in an 
 52.26  increase in the medical assistance reimbursement amount.  
 52.27     In addition, the commissioner of health must not approve 
 52.28  any construction project whose cost exceeds ~~$750,000~~ $1,000,000, 
 52.29  unless: 
 52.30     (a) any construction costs exceeding ~~$750,000~~ $1,000,000 
 52.31  are not added to the facility's appraised value and are not 
 52.32  included in the facility's payment rate for reimbursement under 
 52.33  the medical assistance program; or 
 52.34     (b) the project: 
 52.35     (1) has been approved through the process described in 
 52.36  section 144A.073; 
 53.1      (2) meets an exception in subdivision 3 or 4a; 
 53.2      (3) is necessary to correct violations of state or federal 
 53.3   law issued by the commissioner of health; 
 53.4      (4) is necessary to repair or replace a portion of the 
 53.5   facility that was damaged by fire, lightning, groundshifts, or 
 53.6   other such hazards, including environmental hazards, provided 
 53.7   that the provisions of subdivision 4a, clause (a), are met; 
 53.8      (5) as of May 1, 1992, the facility has submitted to the 
 53.9   commissioner of health written documentation evidencing that the 
 53.10  facility meets the "commenced construction" definition as 
 53.11  specified in subdivision 1a, clause (d), or that substantial 
 53.12  steps have been taken prior to April 1, 1992, relating to the 
 53.13  construction project.  "Substantial steps" require that the 
 53.14  facility has made arrangements with outside parties relating to 
 53.15  the construction project and include the hiring of an architect 
 53.16  or construction firm, submission of preliminary plans to the 
 53.17  department of health or documentation from a financial 
 53.18  institution that financing arrangements for the construction 
 53.19  project have been made; or 
 53.20     (6) is being proposed by a licensed nursing facility that 
 53.21  is not certified to participate in the medical assistance 
 53.22  program and will not result in new licensed or certified beds. 
 53.23     Prior to the final plan approval of any construction 
 53.24  project, the commissioner of health shall be provided with an 
 53.25  itemized cost estimate for the project construction costs.  If a 
 53.26  construction project is anticipated to be completed in phases, 
 53.27  the total estimated cost of all phases of the project shall be 
 53.28  submitted to the commissioner and shall be considered as one 
 53.29  construction project.  Once the construction project is 
 53.30  completed and prior to the final clearance by the commissioner, 
 53.31  the total project construction costs for the construction 
 53.32  project shall be submitted to the commissioner.  If the final 
 53.33  project construction cost exceeds the dollar threshold in this 
 53.34  subdivision, the commissioner of human services shall not 
 53.35  recognize any of the project construction costs or the related 
 53.36  financing costs in excess of this threshold in establishing the 
 54.1   facility's property-related payment rate. 
 54.2      The dollar thresholds for construction projects are as 
 54.3   follows:  for construction projects other than those authorized 
 54.4   in clauses (1) to (6), the dollar threshold 
 54.5   is ~~$750,000~~ $1,000,000.  For projects authorized after July 1, 
 54.6   1993, under clause (1), the dollar threshold is the cost 
 54.7   estimate submitted with a proposal for an exception under 
 54.8   section 144A.073, plus inflation as calculated according to 
 54.9   section 256B.431, subdivision 3f, paragraph (a).  For projects 
 54.10  authorized under clauses (2) to (4), the dollar threshold is the 
 54.11  itemized estimate project construction costs submitted to the 
 54.12  commissioner of health at the time of final plan approval, plus 
 54.13  inflation as calculated according to section 256B.431, 
 54.14  subdivision 3f, paragraph (a). 
 54.15     The commissioner of health shall adopt rules to implement 
 54.16  this section or to amend the emergency rules for granting 
 54.17  exceptions to the moratorium on nursing homes under section 
 54.18  144A.073.  
 54.19     Sec. 4.  Minnesota Statutes 2000, section 144A.071, 
 54.20  subdivision 4a, is amended to read: 
 54.21     Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
 54.22  best interest of the state to ensure that nursing homes and 
 54.23  boarding care homes continue to meet the physical plant 
 54.24  licensing and certification requirements by permitting certain 
 54.25  construction projects.  Facilities should be maintained in 
 54.26  condition to satisfy the physical and emotional needs of 
 54.27  residents while allowing the state to maintain control over 
 54.28  nursing home expenditure growth. 
 54.29     The commissioner of health in coordination with the 
 54.30  commissioner of human services, may approve the renovation, 
 54.31  replacement, upgrading, or relocation of a nursing home or 
 54.32  boarding care home, under the following conditions: 
 54.33     (a) to license or certify beds in a new facility 
 54.34  constructed to replace a facility or to make repairs in an 
 54.35  existing facility that was destroyed or damaged after June 30, 
 54.36  1987, by fire, lightning, or other hazard provided:  
 55.1      (i) destruction was not caused by the intentional act of or 
 55.2   at the direction of a controlling person of the facility; 
 55.3      (ii) at the time the facility was destroyed or damaged the 
 55.4   controlling persons of the facility maintained insurance 
 55.5   coverage for the type of hazard that occurred in an amount that 
 55.6   a reasonable person would conclude was adequate; 
 55.7      (iii) the net proceeds from an insurance settlement for the 
 55.8   damages caused by the hazard are applied to the cost of the new 
 55.9   facility or repairs; 
 55.10     (iv) the new facility is constructed on the same site as 
 55.11  the destroyed facility or on another site subject to the 
 55.12  restrictions in section 144A.073, subdivision 5; 
 55.13     (v) the number of licensed and certified beds in the new 
 55.14  facility does not exceed the number of licensed and certified 
 55.15  beds in the destroyed facility; and 
 55.16     (vi) the commissioner determines that the replacement beds 
 55.17  are needed to prevent an inadequate supply of beds. 
 55.18  Project construction costs incurred for repairs authorized under 
 55.19  this clause shall not be considered in the dollar threshold 
 55.20  amount defined in subdivision 2; 
 55.21     (b) to license or certify beds that are moved from one 
 55.22  location to another within a nursing home facility, provided the 
 55.23  total costs of remodeling performed in conjunction with the 
 55.24  relocation of beds does not exceed ~~$750,000~~ $1,000,000; 
 55.25     (c) to license or certify beds in a project recommended for 
 55.26  approval under section 144A.073; 
 55.27     (d) to license or certify beds that are moved from an 
 55.28  existing state nursing home to a different state facility, 
 55.29  provided there is no net increase in the number of state nursing 
 55.30  home beds; 
 55.31     (e) to certify and license as nursing home beds boarding 
 55.32  care beds in a certified boarding care facility if the beds meet 
 55.33  the standards for nursing home licensure, or in a facility that 
 55.34  was granted an exception to the moratorium under section 
 55.35  144A.073, and if the cost of any remodeling of the facility does 
 55.36  not exceed ~~$750,000~~ $1,000,000.  If boarding care beds are 
 56.1   licensed as nursing home beds, the number of boarding care beds 
 56.2   in the facility must not increase beyond the number remaining at 
 56.3   the time of the upgrade in licensure.  The provisions contained 
 56.4   in section 144A.073 regarding the upgrading of the facilities do 
 56.5   not apply to facilities that satisfy these requirements; 
 56.6      (f) to license and certify up to 40 beds transferred from 
 56.7   an existing facility owned and operated by the Amherst H. Wilder 
 56.8   Foundation in the city of St. Paul to a new unit at the same 
 56.9   location as the existing facility that will serve persons with 
 56.10  Alzheimer's disease and other related disorders.  The transfer 
 56.11  of beds may occur gradually or in stages, provided the total 
 56.12  number of beds transferred does not exceed 40.  At the time of 
 56.13  licensure and certification of a bed or beds in the new unit, 
 56.14  the commissioner of health shall delicense and decertify the 
 56.15  same number of beds in the existing facility.  As a condition of 
 56.16  receiving a license or certification under this clause, the 
 56.17  facility must make a written commitment to the commissioner of 
 56.18  human services that it will not seek to receive an increase in 
 56.19  its property-related payment rate as a result of the transfers 
 56.20  allowed under this paragraph; 
 56.21     (g) to license and certify nursing home beds to replace 
 56.22  currently licensed and certified boarding care beds which may be 
 56.23  located either in a remodeled or renovated boarding care or 
 56.24  nursing home facility or in a remodeled, renovated, newly 
 56.25  constructed, or replacement nursing home facility within the 
 56.26  identifiable complex of health care facilities in which the 
 56.27  currently licensed boarding care beds are presently located, 
 56.28  provided that the number of boarding care beds in the facility 
 56.29  or complex are decreased by the number to be licensed as nursing 
 56.30  home beds and further provided that, if the total costs of new 
 56.31  construction, replacement, remodeling, or renovation exceed ten 
 56.32  percent of the appraised value of the facility or $200,000, 
 56.33  whichever is less, the facility makes a written commitment to 
 56.34  the commissioner of human services that it will not seek to 
 56.35  receive an increase in its property-related payment rate by 
 56.36  reason of the new construction, replacement, remodeling, or 
 57.1   renovation.  The provisions contained in section 144A.073 
 57.2   regarding the upgrading of facilities do not apply to facilities 
 57.3   that satisfy these requirements; 
 57.4      (h) to license as a nursing home and certify as a nursing 
 57.5   facility a facility that is licensed as a boarding care facility 
 57.6   but not certified under the medical assistance program, but only 
 57.7   if the commissioner of human services certifies to the 
 57.8   commissioner of health that licensing the facility as a nursing 
 57.9   home and certifying the facility as a nursing facility will 
 57.10  result in a net annual savings to the state general fund of 
 57.11  $200,000 or more; 
 57.12     (i) to certify, after September 30, 1992, and prior to July 
 57.13  1, 1993, existing nursing home beds in a facility that was 
 57.14  licensed and in operation prior to January 1, 1992; 
 57.15     (j) to license and certify new nursing home beds to replace 
 57.16  beds in a facility acquired by the Minneapolis community 
 57.17  development agency as part of redevelopment activities in a city 
 57.18  of the first class, provided the new facility is located within 
 57.19  three miles of the site of the old facility.  Operating and 
 57.20  property costs for the new facility must be determined and 
 57.21  allowed under section 256B.431 or 256B.434; 
 57.22     (k) to license and certify up to 20 new nursing home beds 
 57.23  in a community-operated hospital and attached convalescent and 
 57.24  nursing care facility with 40 beds on April 21, 1991, that 
 57.25  suspended operation of the hospital in April 1986.  The 
 57.26  commissioner of human services shall provide the facility with 
 57.27  the same per diem property-related payment rate for each 
 57.28  additional licensed and certified bed as it will receive for its 
 57.29  existing 40 beds; 
 57.30     (l) to license or certify beds in renovation, replacement, 
 57.31  or upgrading projects as defined in section 144A.073, 
 57.32  subdivision 1, so long as the cumulative total costs of the 
 57.33  facility's remodeling projects do not 
 57.34  exceed ~~$750,000~~ $1,000,000; 
 57.35     (m) to license and certify beds that are moved from one 
 57.36  location to another for the purposes of converting up to five 
 58.1   four-bed wards to single or double occupancy rooms in a nursing 
 58.2   home that, as of January 1, 1993, was county-owned and had a 
 58.3   licensed capacity of 115 beds; 
 58.4      (n) to allow a facility that on April 16, 1993, was a 
 58.5   106-bed licensed and certified nursing facility located in 
 58.6   Minneapolis to layaway all of its licensed and certified nursing 
 58.7   home beds.  These beds may be relicensed and recertified in a 
 58.8   newly-constructed teaching nursing home facility affiliated with 
 58.9   a teaching hospital upon approval by the legislature.  The 
 58.10  proposal must be developed in consultation with the interagency 
 58.11  committee on long-term care planning.  The beds on layaway 
 58.12  status shall have the same status as voluntarily delicensed and 
 58.13  decertified beds, except that beds on layaway status remain 
 58.14  subject to the surcharge in section 256.9657.  This layaway 
 58.15  provision expires July 1, 1998; 
 58.16     (o) to allow a project which will be completed in 
 58.17  conjunction with an approved moratorium exception project for a 
 58.18  nursing home in southern Cass county and which is directly 
 58.19  related to that portion of the facility that must be repaired, 
 58.20  renovated, or replaced, to correct an emergency plumbing problem 
 58.21  for which a state correction order has been issued and which 
 58.22  must be corrected by August 31, 1993; 
 58.23     (p) to allow a facility that on April 16, 1993, was a 
 58.24  368-bed licensed and certified nursing facility located in 
 58.25  Minneapolis to layaway, upon 30 days prior written notice to the 
 58.26  commissioner, up to 30 of the facility's licensed and certified 
 58.27  beds by converting three-bed wards to single or double 
 58.28  occupancy.  Beds on layaway status shall have the same status as 
 58.29  voluntarily delicensed and decertified beds except that beds on 
 58.30  layaway status remain subject to the surcharge in section 
 58.31  256.9657, remain subject to the license application and renewal 
 58.32  fees under section 144A.07 and shall be subject to a $100 per 
 58.33  bed reactivation fee.  In addition, at any time within three 
 58.34  years of the effective date of the layaway, the beds on layaway 
 58.35  status may be: 
 58.36     (1) relicensed and recertified upon relocation and 
 59.1   reactivation of some or all of the beds to an existing licensed 
 59.2   and certified facility or facilities located in Pine River, 
 59.3   Brainerd, or International Falls; provided that the total 
 59.4   project construction costs related to the relocation of beds 
 59.5   from layaway status for any facility receiving relocated beds 
 59.6   may not exceed the dollar threshold provided in subdivision 2 
 59.7   unless the construction project has been approved through the 
 59.8   moratorium exception process under section 144A.073; 
 59.9      (2) relicensed and recertified, upon reactivation of some 
 59.10  or all of the beds within the facility which placed the beds in 
 59.11  layaway status, if the commissioner has determined a need for 
 59.12  the reactivation of the beds on layaway status. 
 59.13     The property-related payment rate of a facility placing 
 59.14  beds on layaway status must be adjusted by the incremental 
 59.15  change in its rental per diem after recalculating the rental per 
 59.16  diem as provided in section 256B.431, subdivision 3a, paragraph 
 59.17  (c).  The property-related payment rate for a facility 
 59.18  relicensing and recertifying beds from layaway status must be 
 59.19  adjusted by the incremental change in its rental per diem after 
 59.20  recalculating its rental per diem using the number of beds after 
 59.21  the relicensing to establish the facility's capacity day 
 59.22  divisor, which shall be effective the first day of the month 
 59.23  following the month in which the relicensing and recertification 
 59.24  became effective.  Any beds remaining on layaway status more 
 59.25  than three years after the date the layaway status became 
 59.26  effective must be removed from layaway status and immediately 
 59.27  delicensed and decertified; 
 59.28     (q) to license and certify beds in a renovation and 
 59.29  remodeling project to convert 12 four-bed wards into 24 two-bed 
 59.30  rooms, expand space, and add improvements in a nursing home 
 59.31  that, as of January 1, 1994, met the following conditions:  the 
 59.32  nursing home was located in Ramsey county; had a licensed 
 59.33  capacity of 154 beds; and had been ranked among the top 15 
 59.34  applicants by the 1993 moratorium exceptions advisory review 
 59.35  panel.  The total project construction cost estimate for this 
 59.36  project must not exceed the cost estimate submitted in 
 60.1   connection with the 1993 moratorium exception process; 
 60.2      (r) to license and certify up to 117 beds that are 
 60.3   relocated from a licensed and certified 138-bed nursing facility 
 60.4   located in St. Paul to a hospital with 130 licensed hospital 
 60.5   beds located in South St. Paul, provided that the nursing 
 60.6   facility and hospital are owned by the same or a related 
 60.7   organization and that prior to the date the relocation is 
 60.8   completed the hospital ceases operation of its inpatient 
 60.9   hospital services at that hospital.  After relocation, the 
 60.10  nursing facility's status under section 256B.431, subdivision 
 60.11  2j, shall be the same as it was prior to relocation.  The 
 60.12  nursing facility's property-related payment rate resulting from 
 60.13  the project authorized in this paragraph shall become effective 
 60.14  no earlier than April 1, 1996.  For purposes of calculating the 
 60.15  incremental change in the facility's rental per diem resulting 
 60.16  from this project, the allowable appraised value of the nursing 
 60.17  facility portion of the existing health care facility physical 
 60.18  plant prior to the renovation and relocation may not exceed 
 60.19  $2,490,000; 
 60.20     (s) to license and certify two beds in a facility to 
 60.21  replace beds that were voluntarily delicensed and decertified on 
 60.22  June 28, 1991; 
 60.23     (t) to allow 16 licensed and certified beds located on July 
 60.24  1, 1994, in a 142-bed nursing home and 21-bed boarding care home 
 60.25  facility in Minneapolis, notwithstanding the licensure and 
 60.26  certification after July 1, 1995, of the Minneapolis facility as 
 60.27  a 147-bed nursing home facility after completion of a 
 60.28  construction project approved in 1993 under section 144A.073, to 
 60.29  be laid away upon 30 days' prior written notice to the 
 60.30  commissioner.  Beds on layaway status shall have the same status 
 60.31  as voluntarily delicensed or decertified beds except that they 
 60.32  shall remain subject to the surcharge in section 256.9657.  The 
 60.33  16 beds on layaway status may be relicensed as nursing home beds 
 60.34  and recertified at any time within five years of the effective 
 60.35  date of the layaway upon relocation of some or all of the beds 
 60.36  to a licensed and certified facility located in Watertown, 
 61.1   provided that the total project construction costs related to 
 61.2   the relocation of beds from layaway status for the Watertown 
 61.3   facility may not exceed the dollar threshold provided in 
 61.4   subdivision 2 unless the construction project has been approved 
 61.5   through the moratorium exception process under section 144A.073. 
 61.6      The property-related payment rate of the facility placing 
 61.7   beds on layaway status must be adjusted by the incremental 
 61.8   change in its rental per diem after recalculating the rental per 
 61.9   diem as provided in section 256B.431, subdivision 3a, paragraph 
 61.10  (c).  The property-related payment rate for the facility 
 61.11  relicensing and recertifying beds from layaway status must be 
 61.12  adjusted by the incremental change in its rental per diem after 
 61.13  recalculating its rental per diem using the number of beds after 
 61.14  the relicensing to establish the facility's capacity day 
 61.15  divisor, which shall be effective the first day of the month 
 61.16  following the month in which the relicensing and recertification 
 61.17  became effective.  Any beds remaining on layaway status more 
 61.18  than five years after the date the layaway status became 
 61.19  effective must be removed from layaway status and immediately 
 61.20  delicensed and decertified; 
 61.21     (u) to license and certify beds that are moved within an 
 61.22  existing area of a facility or to a newly constructed addition 
 61.23  which is built for the purpose of eliminating three- and 
 61.24  four-bed rooms and adding space for dining, lounge areas, 
 61.25  bathing rooms, and ancillary service areas in a nursing home 
 61.26  that, as of January 1, 1995, was located in Fridley and had a 
 61.27  licensed capacity of 129 beds; 
 61.28     (v) to relocate 36 beds in Crow Wing county and four beds 
 61.29  from Hennepin county to a 160-bed facility in Crow Wing county, 
 61.30  provided all the affected beds are under common ownership; 
 61.31     (w) to license and certify a total replacement project of 
 61.32  up to 49 beds located in Norman county that are relocated from a 
 61.33  nursing home destroyed by flood and whose residents were 
 61.34  relocated to other nursing homes.  The operating cost payment 
 61.35  rates for the new nursing facility shall be determined based on 
 61.36  the interim and settle-up payment provisions of Minnesota Rules, 
 62.1   part 9549.0057, and the reimbursement provisions of section 
 62.2   256B.431, except that subdivision 26, paragraphs (a) and (b), 
 62.3   shall not apply until the second rate year after the settle-up 
 62.4   cost report is filed.  Property-related reimbursement rates 
 62.5   shall be determined under section 256B.431, taking into account 
 62.6   any federal or state flood-related loans or grants provided to 
 62.7   the facility; 
 62.8      (x) to license and certify a total replacement project of 
 62.9   up to 129 beds located in Polk county that are relocated from a 
 62.10  nursing home destroyed by flood and whose residents were 
 62.11  relocated to other nursing homes.  The operating cost payment 
 62.12  rates for the new nursing facility shall be determined based on 
 62.13  the interim and settle-up payment provisions of Minnesota Rules, 
 62.14  part 9549.0057, and the reimbursement provisions of section 
 62.15  256B.431, except that subdivision 26, paragraphs (a) and (b), 
 62.16  shall not apply until the second rate year after the settle-up 
 62.17  cost report is filed.  Property-related reimbursement rates 
 62.18  shall be determined under section 256B.431, taking into account 
 62.19  any federal or state flood-related loans or grants provided to 
 62.20  the facility; 
 62.21     (y) to license and certify beds in a renovation and 
 62.22  remodeling project to convert 13 three-bed wards into 13 two-bed 
 62.23  rooms and 13 single-bed rooms, expand space, and add 
 62.24  improvements in a nursing home that, as of January 1, 1994, met 
 62.25  the following conditions:  the nursing home was located in 
 62.26  Ramsey county, was not owned by a hospital corporation, had a 
 62.27  licensed capacity of 64 beds, and had been ranked among the top 
 62.28  15 applicants by the 1993 moratorium exceptions advisory review 
 62.29  panel.  The total project construction cost estimate for this 
 62.30  project must not exceed the cost estimate submitted in 
 62.31  connection with the 1993 moratorium exception process; 
 62.32     (z) to license and certify up to 150 nursing home beds to 
 62.33  replace an existing 285 bed nursing facility located in St. 
 62.34  Paul.  The replacement project shall include both the renovation 
 62.35  of existing buildings and the construction of new facilities at 
 62.36  the existing site.  The reduction in the licensed capacity of 
 63.1   the existing facility shall occur during the construction 
 63.2   project as beds are taken out of service due to the construction 
 63.3   process.  Prior to the start of the construction process, the 
 63.4   facility shall provide written information to the commissioner 
 63.5   of health describing the process for bed reduction, plans for 
 63.6   the relocation of residents, and the estimated construction 
 63.7   schedule.  The relocation of residents shall be in accordance 
 63.8   with the provisions of law and rule; 
 63.9      (aa) to allow the commissioner of human services to license 
 63.10  an additional 36 beds to provide residential services for the 
 63.11  physically handicapped under Minnesota Rules, parts 9570.2000 to 
 63.12  9570.3400, in a 198-bed nursing home located in Red Wing, 
 63.13  provided that the total number of licensed and certified beds at 
 63.14  the facility does not increase; 
 63.15     (bb) to license and certify a new facility in St. Louis 
 63.16  county with 44 beds constructed to replace an existing facility 
 63.17  in St. Louis county with 31 beds, which has resident rooms on 
 63.18  two separate floors and an antiquated elevator that creates 
 63.19  safety concerns for residents and prevents nonambulatory 
 63.20  residents from residing on the second floor.  The project shall 
 63.21  include the elimination of three- and four-bed rooms; 
 63.22     (cc) to license and certify four beds in a 16-bed certified 
 63.23  boarding care home in Minneapolis to replace beds that were 
 63.24  voluntarily delicensed and decertified on or before March 31, 
 63.25  1992.  The licensure and certification is conditional upon the 
 63.26  facility periodically assessing and adjusting its resident mix 
 63.27  and other factors which may contribute to a potential 
 63.28  institution for mental disease declaration.  The commissioner of 
 63.29  human services shall retain the authority to audit the facility 
 63.30  at any time and shall require the facility to comply with any 
 63.31  requirements necessary to prevent an institution for mental 
 63.32  disease declaration, including delicensure and decertification 
 63.33  of beds, if necessary; ~~or~~ 
 63.34     (dd) to license and certify 72 beds in an existing facility 
 63.35  in Mille Lacs county with 80 beds as part of a renovation 
 63.36  project.  The renovation must include construction of an 
 64.1   addition to accommodate ten residents with beginning and 
 64.2   midstage dementia in a self-contained living unit; creation of 
 64.3   three resident households where dining, activities, and support 
 64.4   spaces are located near resident living quarters; designation of 
 64.5   four beds for rehabilitation in a self-contained area; 
 64.6   designation of 30 private rooms; and other improvements; or 
 64.7      (ee) to license and certify beds in a facility that has 
 64.8   undergone remodeling as part of a planned closure under section 
 64.9   256B.437. 
 64.10     Sec. 5.  Minnesota Statutes 2000, section 144A.073, 
 64.11  subdivision 2, is amended to read: 
 64.12     Subd. 2.  [REQUEST FOR PROPOSALS.] At the authorization by 
 64.13  the legislature of additional medical assistance expenditures 
 64.14  for exceptions to the moratorium on nursing homes, the 
 64.15  interagency committee shall publish in the State Register a 
 64.16  request for proposals for nursing home projects to be licensed 
 64.17  or certified under section 144A.071, subdivision 4a, clause 
 64.18  (c).  The public notice of this funding and the request for 
 64.19  proposals must specify how the approval criteria will be 
 64.20  prioritized by the advisory review panel, the interagency 
 64.21  long-term care planning committee, and the commissioner.  The 
 64.22  notice must describe the information that must accompany a 
 64.23  request and state that proposals must be submitted to the 
 64.24  interagency committee within 90 days of the date of 
 64.25  publication.  The notice must include the amount of the 
 64.26  legislative appropriation available for the additional costs to 
 64.27  the medical assistance program of projects approved under this 
 64.28  section.  If no money is appropriated for a year, the 
 64.29  interagency committee shall publish a notice to that effect, and 
 64.30  no proposals shall be requested.  If money is appropriated, the 
 64.31  interagency committee shall initiate the application and review 
 64.32  process described in this section at least twice each biennium 
 64.33  and up to four times each biennium, according to dates 
 64.34  established by rule.  Authorized funds shall be allocated 
 64.35  proportionally to the number of processes.  Funds not encumbered 
 64.36  by an earlier process within a biennium shall carry forward to 
 65.1   subsequent iterations of the process.  ~~Authorization for~~ 
 65.2   ~~expenditures does not carry forward into the following~~ 
 65.3   ~~biennium.~~  To be considered for approval, a proposal must 
 65.4   include the following information: 
 65.5      (1) whether the request is for renovation, replacement, 
 65.6   upgrading, conversion, or relocation; 
 65.7      (2) a description of the problem the project is designed to 
 65.8   address; 
 65.9      (3) a description of the proposed project; 
 65.10     (4) an analysis of projected costs of the nursing facility 
 65.11  proposal, which are not required to exceed the cost threshold 
 65.12  referred to in section 144A.071, subdivision 1, to be considered 
 65.13  under this section, including initial construction and 
 65.14  remodeling costs; site preparation costs; technology costs; 
 65.15  financing costs, including the current estimated long-term 
 65.16  financing costs of the proposal, which consists of estimates of 
 65.17  the amount and sources of money, reserves if required under the 
 65.18  proposed funding mechanism, annual payments schedule, interest 
 65.19  rates, length of term, closing costs and fees, insurance costs, 
 65.20  and any completed marketing study or underwriting review; and 
 65.21  estimated operating costs during the first two years after 
 65.22  completion of the project; 
 65.23     (5) for proposals involving replacement of all or part of a 
 65.24  facility, the proposed location of the replacement facility and 
 65.25  an estimate of the cost of addressing the problem through 
 65.26  renovation; 
 65.27     (6) for proposals involving renovation, an estimate of the 
 65.28  cost of addressing the problem through replacement; 
 65.29     (7) the proposed timetable for commencing construction and 
 65.30  completing the project; 
 65.31     (8) a statement of any licensure or certification issues, 
 65.32  such as certification survey deficiencies; 
 65.33     (9) the proposed relocation plan for current residents if 
 65.34  beds are to be closed so that the department of human services 
 65.35  can estimate the total costs of a proposal; and 
 65.36     (10) other information required by permanent rule of the 
 66.1   commissioner of health in accordance with subdivisions 4 and 8. 
 66.2      Sec. 6.  [144A.161] [NURSING FACILITY RESIDENT RELOCATION.] 
 66.3      Subdivision 1.  [DEFINITIONS.] The definitions in this 
 66.4   subdivision apply to subdivisions 2 to 9. 
 66.5      (a) "Closure" means the cessation of operations of a 
 66.6   nursing home and the delicensure and decertification of all beds 
 66.7   within the facility. 
 66.8      (b) "Curtailment," "reduction," or "change" refers to any 
 66.9   change in operations which would result in or encourage the 
 66.10  relocation of residents. 
 66.11     (c) "Facility" means a nursing home licensed pursuant to 
 66.12  this chapter, or a certified boarding care home licensed 
 66.13  pursuant to sections 144.50 to 144.56. 
 66.14     (d) "Licensee" means the facility that is proposing a 
 66.15  closure, curtailment, reduction, or change in operations which 
 66.16  may result in the relocation of residents. 
 66.17     (e) "Local agency" means the county or multicounty social 
 66.18  service agency authorized under sections 393.01 and 393.07, as 
 66.19  the agency responsible for providing social services for the 
 66.20  county in which the nursing home is located. 
 66.21     (f) "Plan" means a process developed under subdivision 3, 
 66.22  paragraph (b), for the closure, curtailment, reduction, or 
 66.23  change in operations in a facility and the subsequent relocation 
 66.24  of residents. 
 66.25     (g) "Relocation" means the discharge of a resident and 
 66.26  movement of the resident to another facility or living 
 66.27  arrangement as a result of the closing, curtailment, reduction, 
 66.28  or change in operations of a nursing home or boarding care home. 
 66.29     Subd. 2.  [INITIAL NOTICE FROM LICENSEE.] (a) The licensee 
 66.30  of the facility shall notify the following parties in writing 
 66.31  when there is an intent to close, curtail, reduce, or change 
 66.32  operations or services which would result in the relocation of 
 66.33  residents:  the department of health, the department of human 
 66.34  services, the local agency, the office of ombudsman for older 
 66.35  Minnesotans, and the ombudsman for mental health/mental 
 66.36  retardation. 
 67.1      (b) The written notice shall include the names, telephone 
 67.2   numbers, facsimile numbers, and e-mail addresses of the persons 
 67.3   responsible for coordinating the licensee's efforts in the 
 67.4   planning process, and the number of residents potentially 
 67.5   affected by the closure, curtailment, reduction, or change in 
 67.6   operations. 
 67.7      Subd. 3.  [PLANNING PROCESS.] (a) The local agency shall, 
 67.8   within five working days of receiving initial notice of the 
 67.9   licensee's intent to close, curtail, reduce, or change 
 67.10  operations, provide the licensee and all parties identified in 
 67.11  subdivision 2, paragraph (a), with the names, telephone numbers, 
 67.12  facsimile numbers, and e-mail addresses of those persons 
 67.13  responsible for coordinating local agency efforts in the 
 67.14  planning process. 
 67.15     (b) The licensee shall convene a meeting of representatives 
 67.16  from the department of health, the department of human services, 
 67.17  and the local agency to jointly develop a plan regarding the 
 67.18  closure, curtailment, or change in facility operations.  The 
 67.19  licensee must allow a minimum of 45 days for this planning 
 67.20  process from the day of the initial notice.  However, the plan 
 67.21  may be finalized on an earlier schedule agreed to by all 
 67.22  parties.  The plan shall: 
 67.23     (1) identify the expected date of closure, curtailment, 
 67.24  reduction, or change in operations; 
 67.25     (2) outline the process for public notification of the 
 67.26  closure, curtailment, reduction, or change in operations; 
 67.27     (3) identify and make efforts to include other stakeholders 
 67.28  in the planning process; 
 67.29     (4) outline the process to ensure 60-day advance written 
 67.30  notice to residents, family members, and designated 
 67.31  representatives; 
 67.32     (5) present an aggregate description of the resident 
 67.33  population remaining to be relocated and their needs; 
 67.34     (6) outline the individual resident assessment process to 
 67.35  be utilized; 
 67.36     (7) identify an inventory of available relocation options, 
 68.1   including home and community-based services; 
 68.2      (8) identify a timeline for submission of the list 
 68.3   identified in subdivision 5, paragraph (h); 
 68.4      (9) identify a schedule for the timely completion of each 
 68.5   element of the plan; and 
 68.6      (10) provide an estimate of the relocation costs to the 
 68.7   local agency. 
 68.8      Subd. 4.  [RESPONSIBILITIES OF LICENSEE FOR RESIDENT 
 68.9   RELOCATIONS.] The licensee shall provide for the safe, orderly, 
 68.10  and appropriate relocation of residents.  The licensee and 
 68.11  facility staff shall cooperate with representatives from the 
 68.12  local agency, the department of health, the department of human 
 68.13  services, the office of ombudsman for older Minnesotans, and 
 68.14  ombudsman for mental health/mental retardation, in planning for 
 68.15  and implementing the relocation of residents.  The discharge and 
 68.16  relocation of residents must comply with all applicable state 
 68.17  and federal requirements. 
 68.18     Subd. 5.  [RESPONSIBILITIES PRIOR TO RELOCATION.] (a) The 
 68.19  licensee shall provide an initial notice as described in 
 68.20  subdivision 2, when there is an intent to close, curtail, 
 68.21  reduce, or change in operations which would result in the 
 68.22  relocation of residents. 
 68.23     (b) The licensee shall establish an interdisciplinary team 
 68.24  responsible for coordinating and implementing the plan as 
 68.25  outlined in subdivision 3, paragraph (b).  The interdisciplinary 
 68.26  team shall include representatives from the local agency, the 
 68.27  office of ombudsman for older Minnesotans, facility staff that 
 68.28  provide direct care services to the residents, and facility 
 68.29  administration. 
 68.30     (c) The licensee shall provide a list to the local agency 
 68.31  that includes the following information on each resident to be 
 68.32  relocated: 
 68.33     (1) the resident's name; 
 68.34     (2) date of birth; 
 68.35     (3) social security number; 
 68.36     (4) medical assistance identification number; 
 69.1      (5) all diagnoses; and 
 69.2      (6) the name and contact information for the resident's 
 69.3   family or other designated representative. 
 69.4      (d) The licensee shall consult with the local agency on the 
 69.5   availability and development of available resources, and on the 
 69.6   resident relocation process. 
 69.7      (e) At least 60 days before the proposed date of closing, 
 69.8   curtailment, reduction, or change in operations as agreed to in 
 69.9   the plan, the licensee shall send a written notice of closure, 
 69.10  curtailment, reduction, or change in operations to each resident 
 69.11  being relocated, the resident's family member or designated 
 69.12  representative, and the resident's attending physician.  The 
 69.13  notice must include the following: 
 69.14     (1) the date of the proposed closure, curtailment, 
 69.15  reduction, or change in operations; 
 69.16     (2) the name, address, telephone number, facsimile number, 
 69.17  and e-mail address of the individual or individuals in the 
 69.18  facility responsible for providing assistance and information; 
 69.19     (3) notification of upcoming meetings for individuals, 
 69.20  families, and resident councils to discuss the relocation of 
 69.21  residents; 
 69.22     (4) the name, address, and telephone number of the local 
 69.23  agency contact person; 
 69.24     (5) the name, address, and telephone number of the office 
 69.25  of ombudsman for older Minnesotans and the ombudsman for mental 
 69.26  health/mental retardation; and 
 69.27     (6) a notice of resident rights during discharge and 
 69.28  relocation, in a form approved by the office of ombudsman for 
 69.29  older Minnesotans. 
 69.30     The notice must comply with all applicable state and 
 69.31  federal requirements for notice of transfer or discharge of 
 69.32  nursing home residents. 
 69.33     (f) The licensee shall request the attending physician 
 69.34  provide or arrange for the release of medical information needed 
 69.35  to update resident medical records and prepare all required 
 69.36  forms and discharge summaries. 
 70.1      (g) The licensee shall provide sufficient preparation to 
 70.2   residents to ensure safe, orderly and appropriate discharge, and 
 70.3   relocation.  The licensee shall assist residents in finding 
 70.4   placements that respond to personal preferences, such as desired 
 70.5   geographic location.  
 70.6      (h) The licensee shall prepare a resource list with several 
 70.7   relocation options for each resident.  The list must contain the 
 70.8   following information for each relocation option, when 
 70.9   applicable: 
 70.10     (1) the name, address, and telephone and facsimile numbers 
 70.11  of each facility with appropriate, available beds or services; 
 70.12     (2) the certification level of the available beds; 
 70.13     (3) the types of services available; 
 70.14     (4) the name, address, and telephone and facsimile numbers 
 70.15  of appropriate available home and community-based placements, 
 70.16  services and settings, or other options for individuals with 
 70.17  special needs.  
 70.18  The list shall be made available to residents and their families 
 70.19  or designated representatives, and upon request to the office of 
 70.20  ombudsman for older Minnesotans and ombudsman for mental 
 70.21  health/mental retardation, and the local agency. 
 70.22     (i) Following the establishment of the plan under 
 70.23  subdivision 3, paragraph (b), the licensee shall conduct 
 70.24  meetings with residents, designated representatives, and 
 70.25  resident and family councils to notify them of the process for 
 70.26  resident relocation.  Representatives from the local county 
 70.27  social services agency and the office of ombudsman for older 
 70.28  Minnesotans and the ombudsman for mental health/mental 
 70.29  retardation shall receive advance notice of the meetings.  
 70.30     (j) The licensee shall assist residents in making site 
 70.31  visits to facilities with available beds or other appropriate 
 70.32  living options to which the resident may relocate, unless it is 
 70.33  medically inadvisable, as documented by the attending physician 
 70.34  in the resident's care record.  The licensee shall provide 
 70.35  transportation for site visits to facilities or other living 
 70.36  options within a 50-mile radius to which the resident may 
 71.1   relocate.  The licensee shall provide available written 
 71.2   materials to residents on a potential new facility or living 
 71.3   option. 
 71.4      (k) The licensee shall complete an inventory of resident 
 71.5   personal possessions and provide a copy of the final inventory 
 71.6   to the resident and the resident's designated representative 
 71.7   prior to relocation.  The licensee shall be responsible for the 
 71.8   transfer of the resident's possessions for all relocations 
 71.9   within a 50-mile radius of the facility.  The licensee shall 
 71.10  complete the transfer of resident possessions in a timely 
 71.11  manner, but no later than the date of the actual physical 
 71.12  relocation of the resident. 
 71.13     (l) The licensee shall complete a final accounting of 
 71.14  personal funds held in trust by the facility and provide a copy 
 71.15  of this accounting to the resident and the resident's family or 
 71.16  the resident's designated representative.  The licensee shall be 
 71.17  responsible for the transfer of all personal funds held in trust 
 71.18  by the facility.  The licensee shall complete the transfer of 
 71.19  all personal funds in a timely manner. 
 71.20     (m) The licensee shall assist residents with the transfer 
 71.21  and reconnection of service for telephones or other personal 
 71.22  communication devices or services.  The licensee shall pay the 
 71.23  costs associated with reestablishing service for telephones or 
 71.24  other personal communication devices or services, such as 
 71.25  connection fees or other one-time charges.  The transfer or 
 71.26  reconnection of personal communication devices or services shall 
 71.27  be completed in a timely manner. 
 71.28     (n) The licensee shall provide the resident, the resident's 
 71.29  family or designated representative, and the resident's 
 71.30  attending physician final written notice prior to the relocation 
 71.31  of the resident.  The notice must: 
 71.32     (1) be provided seven days prior to the actual relocation, 
 71.33  unless the resident agrees to waive the right to advance notice; 
 71.34  and 
 71.35     (2) identify the date of the anticipated relocation and the 
 71.36  destination to which the resident is being relocated. 
 72.1      (o) The licensee shall provide the receiving facility or 
 72.2   other health, housing, or care entity with complete and accurate 
 72.3   resident records including information on family members, 
 72.4   designated representatives, guardians, social service 
 72.5   caseworkers, or other contact information.  These records must 
 72.6   also include all information necessary to provide appropriate 
 72.7   medical care and social services.  This includes, but is not 
 72.8   limited to, information on preadmission screening, Level I and 
 72.9   Level II screening, Minimum Data Set (MDS) and all other 
 72.10  assessments, resident diagnoses, social, behavioral, and 
 72.11  medication information. 
 72.12     Subd. 6.  [RESPONSIBILITIES OF THE LICENSEE DURING 
 72.13  RELOCATION.] (a) The licensee shall arrange for the safe 
 72.14  transport of residents to the new facility or placement. 
 72.15     (b) The licensee must ensure that there is no disruption in 
 72.16  the provision of meals, medications, or treatments of the 
 72.17  resident during the relocation process. 
 72.18     (c) Beginning the week following development of the initial 
 72.19  relocation plan, the licensee shall submit biweekly status 
 72.20  reports to the commissioners of the department of health and the 
 72.21  department of human services or their designees, and to the 
 72.22  local agency.  The initial status report must identify: 
 72.23     (1) the relocation plan developed; 
 72.24     (2) the interdisciplinary team members; and 
 72.25     (3) the number of residents to be relocated. 
 72.26     (d) Subsequent status reports must identify: 
 72.27     (1) any modifications to the plan; 
 72.28     (2) any change of interdisciplinary team members; 
 72.29     (3) the number of residents relocated; 
 72.30     (4) the destination to which residents have been relocated; 
 72.31     (5) the number of residents remaining to be relocated; and 
 72.32     (6) issues or problems encountered during the process and 
 72.33  resolution of these issues. 
 72.34     Subd. 7.  [RESPONSIBILITIES OF THE LICENSEE FOLLOWING 
 72.35  RELOCATION.] The licensee shall retain or make arrangements for 
 72.36  the retention of all remaining resident records, for the period 
 73.1   required by law.  The licensee shall provide the department of 
 73.2   health access to these records.  The licensee shall notify the 
 73.3   department of health of the location of any resident records 
 73.4   that have not been transferred to the new facility or other 
 73.5   health care entity. 
 73.6      Subd. 8.  [RESPONSIBILITIES OF THE LOCAL AGENCY.] (a) The 
 73.7   local agency shall participate in the meeting as outlined in 
 73.8   subdivision 3, paragraph (b), to develop a relocation plan. 
 73.9      (b) The local agency shall designate a representative to 
 73.10  the interdisciplinary team established by the licensee 
 73.11  responsible for coordinating the relocation efforts. 
 73.12     (c) The local agency shall serve as a resource in the 
 73.13  relocation process. 
 73.14     (d) Concurrent with the notice sent to residents from the 
 73.15  licensee as provided in subdivision 5, paragraph (e), the local 
 73.16  agency shall provide written notice to residents, family, or 
 73.17  designated representatives describing: 
 73.18     (1) the county's role in the relocation process and in the 
 73.19  follow-up to relocations; 
 73.20     (2) a local agency contact name, address, and telephone 
 73.21  number; and 
 73.22     (3) the name, address, and telephone number of the office 
 73.23  of ombudsman for older Minnesotans and the ombudsman for mental 
 73.24  health/mental retardation. 
 73.25     (e) The local agency designee shall meet with appropriate 
 73.26  facility staff to coordinate any assistance in the relocation 
 73.27  process.  This coordination shall include participating in group 
 73.28  meetings with residents, families, and designated 
 73.29  representatives to explain the relocation process. 
 73.30     (f) The local agency shall monitor compliance with all 
 73.31  components of the plan.  If the licensee is not in compliance, 
 73.32  the local agency shall notify the commissioners of the 
 73.33  department of health and the department of human services. 
 73.34     (g) The local agency shall report to the commissioners of 
 73.35  health and human services any relocations that endanger the 
 73.36  health, safety, or well-being of residents.  The local agency 
 74.1   shall pursue remedies to protect the resident during the 
 74.2   relocation process, including, but not limited to, assisting the 
 74.3   resident with filing an appeal of transfer or discharge, 
 74.4   notification of all appropriate licensing boards and agencies, 
 74.5   and other remedies available to the county under section 
 74.6   626.557, subdivision 10. 
 74.7      (h) A member of the local agency staff shall visit 
 74.8   residents relocated within one hundred miles of the county 
 74.9   within 30 days after the relocation.  Local agency staff shall 
 74.10  interview the resident and family or designated representative, 
 74.11  observe the resident on site, and review and discuss pertinent 
 74.12  medical or social records with facility staff to: 
 74.13     (1) assess the adjustment of the resident to the new 
 74.14  placement; 
 74.15     (2) recommend services or methods to meet any special needs 
 74.16  of the resident; and 
 74.17     (3) identify residents at risk. 
 74.18     (i) The local agency shall have the authority to conduct 
 74.19  subsequent follow-up visits in cases where the adjustment of the 
 74.20  resident to the new placement is in question. 
 74.21     (j) Within 60 days of the completion of the follow-up 
 74.22  visits, the local agency shall submit a written summary of the 
 74.23  follow-up work to the department of health and the department of 
 74.24  human services, in a manner approved by the commissioners. 
 74.25     (k) The local agency shall submit to the department of 
 74.26  health and the department of human services a report of any 
 74.27  issues that may require further review or monitoring. 
 74.28     (l) The local agency shall be responsible for the safe and 
 74.29  orderly relocation of residents in cases where an emergent need 
 74.30  arises or when the licensee has abrogated its responsibilities 
 74.31  under the plan. 
 74.32     Subd. 9.  [FUNDING.] The commissioner of human services 
 74.33  shall negotiate with the local agency to determine an amount of 
 74.34  administrative funding within appropriations specified for this 
 74.35  purpose to make available to the local agency for the costs of 
 74.36  work related to the relocation process. 
 75.1      Subd. 10.  [PENALTIES.] According to sections 144.653 and 
 75.2   144A.10, the licensee shall be subject to correction orders and 
 75.3   civil monetary penalties of up to $500 per day for each 
 75.4   violation of this statute. 
 75.5      Sec. 7.  [144A.1888] [REUSE OF FACILITIES.] 
 75.6      Notwithstanding any local ordinance related to development, 
 75.7   planning, or zoning to the contrary, the conversion or reuse of 
 75.8   a nursing home that closes or that curtails, reduces, or changes 
 75.9   operations shall be considered a conforming use permitted under 
 75.10  local law, provided that the facility is converted to another 
 75.11  long-term care service approved by a regional planning group 
 75.12  under section 256B.437 that serves a smaller number of persons 
 75.13  than the number of persons served before the closure or 
 75.14  curtailment, reduction, or change in operations. 
 75.15     Sec. 8.  [144A.36] [TRANSITION PLANNING GRANTS.] 
 75.16     Subdivision 1.  [DEFINITIONS.] "Eligible nursing home" 
 75.17  means any nursing home licensed under sections 144A.01 to 
 75.18  144A.16 and certified by the appropriate authority under United 
 75.19  States Code, title 42, sections 1396-1396p, to participate as a 
 75.20  vendor in the medical assistance program established under 
 75.21  chapter 256B. 
 75.22     Subd. 2.  [GRANTS AUTHORIZED.] (a) The commissioner shall 
 75.23  establish a program of transition planning grants to assist 
 75.24  eligible nursing homes implement the provisions in paragraphs 
 75.25  (b) and (c).  
 75.26     (b) Transition planning grants may be used by nursing homes 
 75.27  to develop strategic plans which identify the appropriate 
 75.28  institutional and noninstitutional settings necessary to meet 
 75.29  the older adult service needs of the community.  
 75.30     (c) At a minimum, a strategic plan must consist of: 
 75.31     (1) a needs assessment to determine what older adult 
 75.32  services are needed and desired by the community; 
 75.33     (2) an assessment of the appropriate settings in which to 
 75.34  provide needed older adult services; 
 75.35     (3) an assessment identifying currently available services 
 75.36  and their settings in the community; and 
 76.1      (4) a transition plan to achieve the needed outcome 
 76.2   identified by the assessment. 
 76.3      Subd. 3.  [ALLOCATION OF GRANTS.] (a) Eligible nursing 
 76.4   homes must apply to the commissioner no later than September 1 
 76.5   of each fiscal year for grants awarded in that fiscal year.  A 
 76.6   grant shall be awarded upon signing of a grant contract. 
 76.7      (b) The commissioner must make a final decision on the 
 76.8   funding of each application within 60 days of the deadline for 
 76.9   receiving applications. 
 76.10     Subd. 4.  [EVALUATION.] The commissioner shall evaluate the 
 76.11  overall effectiveness of the grant program.  The commissioner 
 76.12  may collect, from the nursing homes receiving grants, 
 76.13  information necessary to evaluate the grant program.  
 76.14  Information related to the financial condition of individual 
 76.15  nursing homes shall be classified as nonpublic data. 
 76.16     Sec. 9.  [144A.37] [ALTERNATIVE NURSING HOME SURVEY 
 76.17  PROCESS.] 
 76.18     Subdivision 1.  [ALTERNATIVE NURSING HOME SURVEY 
 76.19  SCHEDULES.] (a) The commissioner shall implement alternative 
 76.20  procedures for the nursing home survey process as authorized 
 76.21  under this section.  
 76.22     (b) These alternative survey process procedures seek to:  
 76.23     (1) use department resources more effectively and 
 76.24  efficiently to target problem areas; 
 76.25     (2) use other existing or new mechanisms to provide 
 76.26  objective assessments of quality and to measure quality 
 76.27  improvement; 
 76.28     (3) provide for frequent collaborative interaction of 
 76.29  facility staff and surveyors rather than a punitive approach; 
 76.30  and 
 76.31     (4) reward a nursing home that has performed very well by 
 76.32  extending intervals between full surveys. 
 76.33     (c) The commissioner shall pursue changes to federal law 
 76.34  necessary to accomplish this process and shall apply for any 
 76.35  necessary federal waivers or approval.  If a federal waiver is 
 76.36  required, the commissioner shall submit a formal waiver request 
 77.1   no later than June 15, 2001.  The commissioner shall also pursue 
 77.2   any necessary federal law changes during the 107th Congress. 
 77.3      (d) The alternative nursing home survey schedule shall be 
 77.4   implemented January 1, 2002, or upon federal approval. 
 77.5      Subd. 2.  [SURVEY INTERVALS.] The commissioner must extend 
 77.6   the time period between standard surveys to up to 30 months 
 77.7   based on the criteria established in subdivision 4.  In using 
 77.8   the alternative survey schedule, the requirement for the 
 77.9   statewide average to not exceed 12 months does not apply. 
 77.10     Subd. 3.  [COMPLIANCE HISTORY.] The commissioner shall 
 77.11  develop a process for identifying the survey cycles for skilled 
 77.12  nursing facilities based upon the compliance history of the 
 77.13  facility.  This process may use a range of months for survey 
 77.14  intervals.  At a minimum, the process must be based on 
 77.15  information from the last two survey cycles and shall take into 
 77.16  consideration any deficiencies issued as the result of a survey 
 77.17  or a complaint investigation during the interval.  A skilled 
 77.18  nursing facility with a finding of substandard quality of care 
 77.19  or a finding of immediate jeopardy is not entitled to a survey 
 77.20  interval greater than 12 months.  The commissioner shall alter 
 77.21  the survey cycle for a specific skilled nursing facility based 
 77.22  on findings identified through the completion of a survey, a 
 77.23  monitoring visit, or a complaint investigation.  The 
 77.24  commissioner must also take into consideration information other 
 77.25  than the facility's compliance history. 
 77.26     Subd. 4.  [CRITERIA FOR SURVEY INTERVAL 
 77.27  CLASSIFICATION.] (a) The commissioner shall provide public 
 77.28  notice of the classification process and shall identify the 
 77.29  selected survey cycles for each skilled nursing facility.  The 
 77.30  classification system must be based on an analysis of the 
 77.31  findings made during the past two standard survey intervals.  
 77.32  The survey interval may be modified based on one survey or 
 77.33  complaint finding.  
 77.34     (b) The commissioner shall also take into consideration 
 77.35  information obtained from residents and family members in each 
 77.36  skilled nursing facility and from other sources, such as 
 78.1   employees and ombudsmen, in determining the appropriate survey 
 78.2   intervals for facilities. 
 78.3      Subd. 5.  [REQUIRED MONITORING.] (a) The commissioner shall 
 78.4   conduct at least one monitoring visit on an annual basis for 
 78.5   every skilled nursing facility that has been selected for a 
 78.6   survey cycle greater than 12 months.  The commissioner shall 
 78.7   develop protocols for the monitoring visits which shall be less 
 78.8   extensive than the requirements for a standard survey.  The 
 78.9   commissioner shall use the criteria in paragraph (b) to 
 78.10  determine whether additional monitoring visits to a facility 
 78.11  shall be required.  
 78.12     (b) The criteria shall include, but not be limited to, the 
 78.13  following: 
 78.14     (1) changes in ownership, administration of the facility, 
 78.15  or direction of the facility's nursing service; 
 78.16     (2) changes in the facility's quality indicators which 
 78.17  might evidence a decline in the facility's quality of care; 
 78.18     (3) reductions in staffing or an increase in the 
 78.19  utilization of temporary nursing personnel; and 
 78.20     (4) complaint information or other information that 
 78.21  identifies potential concerns for the quality of the care and 
 78.22  services provided in the skilled nursing facility. 
 78.23     Subd. 6.  [SURVEY REQUIREMENTS FOR FACILITIES NOT APPROVED 
 78.24  FOR EXTENDED SURVEY INTERVALS.] The commissioner shall establish 
 78.25  a process for surveying and monitoring facilities that require a 
 78.26  survey interval of less than 15 months.  This process shall 
 78.27  identify the steps that the commissioner must take to monitor 
 78.28  the facility in addition to the standard survey. 
 78.29     Subd. 7.  [IMPACT ON SURVEY AGENCY'S BUDGET.] The 
 78.30  implementation of an alternative survey process for the state 
 78.31  must not result in any reduction of funding that would have been 
 78.32  provided to the state survey agency for survey and enforcement 
 78.33  activity based upon the completion of full standard surveys for 
 78.34  each skilled nursing facility in the state. 
 78.35     Subd. 8.  [EDUCATIONAL ACTIVITIES.] The commissioner shall 
 78.36  expand the state survey agency's ability to conduct training and 
 79.1   educational efforts for skilled nursing facilities, residents 
 79.2   and family members, residents and family councils, long-term 
 79.3   care ombudsman programs, and the general public. 
 79.4      Subd. 9.  [EVALUATION.] The commissioner shall develop a 
 79.5   process for the evaluation of the effectiveness of an 
 79.6   alternative survey process conducted under this section. 
 79.7      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 79.8   following final enactment. 
 79.9      Sec. 10.  Minnesota Statutes 2000, section 256B.431, is 
 79.10  amended by adding a subdivision to read: 
 79.11     Subd. 31.  [NURSING FACILITY RATE INCREASES BEGINNING JULY 
 79.12  1, 2001, AND JULY 1, 2002.] (a) For the rate years beginning 
 79.13  July 1, 2001, and July 1, 2002, the commissioner shall make 
 79.14  available to each nursing facility reimbursed under this section 
 79.15  or section 256B.434 an adjustment to the total operating payment 
 79.16  rates in effect on June 30, 2001, and June 30, 2002, 
 79.17  respectively.  The operating payment rate in effect on June 30, 
 79.18  2001, must include the adjustment in subdivision 2i, paragraph 
 79.19  (c).  The adjustment is comprised of a one percent increase in 
 79.20  the total operating payment rate, to be used for operating 
 79.21  costs, and an adjustment determined under paragraph (b). 
 79.22     (b) The adjustment under this paragraph must be used to 
 79.23  increase the per-hour pay rate of all employees except 
 79.24  management fees, the administrator, and central office staff by 
 79.25  an equal dollar amount and to pay associated costs for FICA, the 
 79.26  Medicare tax, workers' compensation premiums, and federal and 
 79.27  state unemployment insurance.  The adjustment is calculated 
 79.28  according to clauses (1) to (3): 
 79.29     (1) the commissioner shall calculate the arithmetic mean of 
 79.30  all June 30, 2001, and June 30, 2002, operating rates for each 
 79.31  facility; 
 79.32     (2) the commissioner shall construct an array of nursing 
 79.33  facilities from highest to lowest according to the arithmetic 
 79.34  mean calculated in clause (1).  A numerical rank must be 
 79.35  assigned to each facility in the array.  The facility with the 
 79.36  highest mean must be assigned a numerical rank of one.  The 
 80.1   facility with the lowest mean must be assigned a numerical rank 
 80.2   equal to the total number of nursing facilities in the array.  
 80.3   All other facilities must be assigned a numerical rank in 
 80.4   accordance with their position in the array; and 
 80.5      (3) the amount of this rate increase is $1 plus an amount 
 80.6   equal to $3.72 multiplied by the ratio of the facility's numeric 
 80.7   rank divided by the number of facilities in the array. 
 80.8      Money received by a facility as a result of the additional 
 80.9   rate increase provided under this paragraph must be used only 
 80.10  for wage increases implemented on or after July 1, 2001, or July 
 80.11  1, 2002, respectively, and must not be used for wage increases 
 80.12  implemented prior to those dates. 
 80.13     (c) Nursing facilities may apply for the payment rate 
 80.14  adjustment calculated under paragraph (b).  The application must 
 80.15  be made to the commissioner and contain a computation of the 
 80.16  equal per-hour pay rate increase by which the nursing facility 
 80.17  will distribute the payment rate adjustment to employees of the 
 80.18  nursing facility.  For nursing facilities in which the employees 
 80.19  are represented by an exclusive bargaining representative, an 
 80.20  agreement negotiated and agreed to by the employer and the 
 80.21  exclusive bargaining representative constitutes the plan.  A 
 80.22  negotiated agreement may constitute the plan only if the 
 80.23  agreement is finalized after the date of enactment of all 
 80.24  increases for the rate year.  The commissioner shall review the 
 80.25  plan to ensure that the payment rate adjustment per diem is used 
 80.26  as provided in paragraph (b).  To be eligible, a facility must 
 80.27  submit its plan for the compensation distribution by December 31 
 80.28  each year.  If a facility's plan for compensation distribution 
 80.29  is effective for its employees after July 1 of the year that the 
 80.30  funds are available, the payment rate adjustment per diem is 
 80.31  effective the same date as its plan. 
 80.32     (d) A copy of the approved distribution plan must be made 
 80.33  available to all employees by giving each employee a copy or by 
 80.34  posting it in an area of the nursing facility to which all 
 80.35  employees have access.  If an employee does not receive the 
 80.36  compensation adjustment described in the facility's approved 
 81.1   plan and is unable to resolve the problem with the facility's 
 81.2   management or through the employee's union representative, the 
 81.3   employee may contact the commissioner at an address or telephone 
 81.4   number provided by the commissioner and included in the approved 
 81.5   plan.  
 81.6      Sec. 11.  Minnesota Statutes 2000, section 256B.431, is 
 81.7   amended by adding a subdivision to read: 
 81.8      Subd. 32.  [ADDITIONAL INCREASES FOR LOW RATE 
 81.9   FACILITIES.] Before the calculation of the increases in 
 81.10  subdivision 31, the commissioner must provide for special 
 81.11  increases to facilities determined to be the lowest rate 
 81.12  facilities in the state.  The commissioner shall place all 
 81.13  nursing facilities reimbursed under this section or section 
 81.14  256B.434 into one of the state development regions designated 
 81.15  under section 462.385.  Within each of the development regions, 
 81.16  the commissioner shall identify the median nursing facility 
 81.17  rates by case mix category.  Nursing home rates that are below 
 81.18  the median must be adjusted to the greater of their current 
 81.19  rates or 98 percent of the region median.  Certified boarding 
 81.20  care home rates that are below the median must be adjusted to 
 81.21  the greater of their current rates of 90 percent of the region 
 81.22  median. 
 81.23     Sec. 12.  Minnesota Statutes 2000, section 256B.434, 
 81.24  subdivision 4, is amended to read: 
 81.25     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
 81.26  nursing facilities which have their payment rates determined 
 81.27  under this section rather than section 256B.431, the 
 81.28  commissioner shall establish a rate under this subdivision.  The 
 81.29  nursing facility must enter into a written contract with the 
 81.30  commissioner. 
 81.31     (b) A nursing facility's case mix payment rate for the 
 81.32  first rate year of a facility's contract under this section is 
 81.33  the payment rate the facility would have received under section 
 81.34  256B.431. 
 81.35     (c) A nursing facility's case mix payment rates for the 
 81.36  second and subsequent years of a facility's contract under this 
 82.1   section are the previous rate year's contract payment rates plus 
 82.2   an inflation adjustment.  The index for the inflation adjustment 
 82.3   must be based on the change in the Consumer Price Index-All 
 82.4   Items (United States City average) (CPI-U) forecasted by Data 
 82.5   Resources, Inc., as forecasted in the fourth quarter of the 
 82.6   calendar year preceding the rate year.  The inflation adjustment 
 82.7   must be based on the 12-month period from the midpoint of the 
 82.8   previous rate year to the midpoint of the rate year for which 
 82.9   the rate is being determined.  For the rate years beginning on 
 82.10  July 1, 1999, ~~and~~ July 1, 2000, July 1, 2001, and July 1, 2002, 
 82.11  this paragraph shall apply only to the property-related payment 
 82.12  rate.  In determining the amount of the property-related payment 
 82.13  rate adjustment under this paragraph, the commissioner shall 
 82.14  determine the proportion of the facility's rates that are 
 82.15  property-related based on the facility's most recent cost report.
 82.16     (d) The commissioner shall develop additional 
 82.17  incentive-based payments of up to five percent above the 
 82.18  standard contract rate for achieving outcomes specified in each 
 82.19  contract.  The specified facility-specific outcomes must be 
 82.20  measurable and approved by the commissioner.  The commissioner 
 82.21  may establish, for each contract, various levels of achievement 
 82.22  within an outcome.  After the outcomes have been specified the 
 82.23  commissioner shall assign various levels of payment associated 
 82.24  with achieving the outcome.  Any incentive-based payment cancels 
 82.25  if there is a termination of the contract.  In establishing the 
 82.26  specified outcomes and related criteria the commissioner shall 
 82.27  consider the following state policy objectives: 
 82.28     (1) improved cost effectiveness and quality of life as 
 82.29  measured by improved clinical outcomes; 
 82.30     (2) successful diversion or discharge to community 
 82.31  alternatives; 
 82.32     (3) decreased acute care costs; 
 82.33     (4) improved consumer satisfaction; 
 82.34     (5) the achievement of quality; or 
 82.35     (6) any additional outcomes proposed by a nursing facility 
 82.36  that the commissioner finds desirable. 
 83.1      Sec. 13.  [256B.437] [NURSING FACILITY VOLUNTARY CLOSURES 
 83.2   AND PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.] 
 83.3      Subdivision 1.  [DEFINITIONS.] (a) The definitions in this 
 83.4   subdivision apply to subdivisions 2 to 9. 
 83.5      (b) "Closure" means the cessation of operations of a 
 83.6   nursing facility and delicensure and decertification of all beds 
 83.7   within the facility. 
 83.8      (c) "Commencement of closure" means the date on which the 
 83.9   commissioner of health is notified of a planned closure in 
 83.10  accordance with section 144A.16 as part of an approved closure 
 83.11  plan. 
 83.12     (d) "Completion of closure" means the date on which the 
 83.13  final resident of the nursing facility or nursing facilities 
 83.14  designated for closure in an approved closure plan is discharged 
 83.15  from the facility or facilities. 
 83.16     (e) "Closure plan" means a plan to close one or more 
 83.17  nursing facilities and reallocate a portion of the resulting 
 83.18  savings to provide planned closure rate adjustments at other 
 83.19  facilities. 
 83.20     (f) "Partial closure" means the delicensure and 
 83.21  decertification of a portion of the beds within the facility. 
 83.22     (g) "Planned closure rate adjustment" means an increase in 
 83.23  a nursing facility's operating rates resulting from a planned 
 83.24  closure or a planned partial closure of another facility. 
 83.25     Subd. 2.  [REGIONAL LONG-TERM CARE PLANNING AND 
 83.26  DEVELOPMENT.] (a) The commissioner of human services shall 
 83.27  establish a process to adjust the capacity and distribution of 
 83.28  long-term care services to equalize the supply and demand for 
 83.29  different types of services.  The process must include community 
 83.30  and regional planning, expansion or establishment of needed 
 83.31  services, and voluntary nursing facility closures. 
 83.32     (b) The commissioner shall issue a request for proposals to 
 83.33  contract with regional long-term care planning groups.  Each 
 83.34  group must: 
 83.35     (1) consist of county health and social services agencies, 
 83.36  consumers, housing agencies, a representative of nursing 
 84.1   facilities, a representative of home and community-based 
 84.2   services providers, a union representative, and area agencies on 
 84.3   aging in the geographic area; and 
 84.4      (2) serve an area that has at least 2,000 people who are 85 
 84.5   years of age or older. 
 84.6   In awarding contracts, the commissioner shall give preference to 
 84.7   groups that represent an entire area agency on aging region 
 84.8   where there is not already a planning and development group 
 84.9   established under section 256B.0917.  An area not included in a 
 84.10  proposal must be included in a group convened by the area agency 
 84.11  on aging of that planning and service area through a contract 
 84.12  negotiated by the commissioner. 
 84.13     (c) Each regional long-term care planning group shall: 
 84.14     (1) conduct a detailed assessment of the region's long-term 
 84.15  care services system.  This assessment must be completed within 
 84.16  90 days of the contract award and must evaluate the adequacy of 
 84.17  nursing facility beds and the impact of potential nursing 
 84.18  facility closures.  The commissioner of health and the 
 84.19  commissioner of human services, as appropriate, shall provide 
 84.20  data to the group on nursing facility bed distribution, 
 84.21  housing-with-service options, the closure of nursing facilities 
 84.22  in the planning area that occur outside of the planned closure 
 84.23  process, the approval of planned closures in the planning area, 
 84.24  the addition of new community long-term care services in the 
 84.25  area, the closure of existing community long-term care services 
 84.26  in the area, and other available data; 
 84.27     (2) plan options for increasing community capacity to 
 84.28  provide more home and community-based services to reduce 
 84.29  reliance on nursing facility services; 
 84.30     (3) develop community services alternatives to ensure that 
 84.31  sufficient community-based services are available to meet 
 84.32  demand; 
 84.33     (4) assist a nursing facility in the development of a 
 84.34  proposal to the commissioner for voluntary bed closures under 
 84.35  this section; 
 84.36     (5) monitor the success of alternatives to nursing facility 
 85.1   care that are developed that meet the needs of communities; and 
 85.2      (6) respond to requests from the commissioner for 
 85.3   information about long-term care planning and development 
 85.4   activities in the region. 
 85.5      Subd. 2a.  [PLANNING AND DEVELOPMENT OF COMMUNITY-BASED 
 85.6   SERVICES.] (a) The purpose of this subdivision is to promote the 
 85.7   planning and development of community-based services prior to 
 85.8   the transitioning or closure of nursing facilities.  This 
 85.9   process will support early intervention, advocacy, and consumer 
 85.10  protection while providing incentives for the nursing facilities 
 85.11  to transition to meet community needs. 
 85.12     (b) The commissioner shall establish a process to support 
 85.13  and facilitate expansion of community-based services under the 
 85.14  county-administered alternative care program and the elderly 
 85.15  waiver program.  The process shall utilize community assessments 
 85.16  and planning developed for the community health services plan 
 85.17  and plan update and for the Community Social Services Act plan. 
 85.18     (c) The plan shall include recommendations for development 
 85.19  of community-based services, and both planning and 
 85.20  implementation shall be implemented within the amount of funding 
 85.21  made available to the county board for these purposes. 
 85.22     (d) The plan, within the funding allocated, shall: 
 85.23     (1) identify the need for services for all residents in 
 85.24  each community within the county based on demographic and 
 85.25  caseload information; 
 85.26     (2) involve providers, consumers, cities, townships, and 
 85.27  businesses in the planning process; 
 85.28     (3) address the need for all alternative care and elderly 
 85.29  waiver services for eligible recipients; 
 85.30     (4) assess the need for other supportive services such as 
 85.31  transit, housing, and workforce and economic development; 
 85.32     (5) estimate the cost and timelines for development; and 
 85.33     (6) coordinate with the county mental health plan, the 
 85.34  community health services plan, and community social services 
 85.35  plan. 
 85.36     (e) The county board shall cooperate in planning and 
 86.1   implementation with any county having a nursing facility that 
 86.2   includes their county in the immediate service area within the 
 86.3   funding allocated for these purposes. 
 86.4      (f) The commissioner of health, in cooperation with the 
 86.5   commissioner of human services and county boards, shall jointly 
 86.6   report to the legislature by January 15 of each year regarding 
 86.7   the development of community-based services, transition or 
 86.8   closure of nursing facilities, and consumer outcomes achieved. 
 86.9      Subd. 3.  [APPLICATIONS FOR PLANNED CLOSURE OF NURSING 
 86.10  FACILITIES.] (a) By July 15, 2001, the commissioner of human 
 86.11  services shall implement and announce a program for closure or 
 86.12  partial closure of nursing facilities.  The announcement must 
 86.13  specify: 
 86.14     (1) the criteria in subdivision 4 that will be used by the 
 86.15  commissioner to approve or reject applications; 
 86.16     (2) the information that must accompany an application; and 
 86.17     (3) that applications may combine planned closure rate 
 86.18  adjustments with moratorium exception funding, in which case a 
 86.19  single application may serve both purposes. 
 86.20  Between July 1, 2001, and June 30, 2003, the commissioner may 
 86.21  approve planned closures of up to 5,140 nursing facility beds. 
 86.22     (b) A facility or facilities reimbursed under section 
 86.23  256B.431 or 256B.434 with a closure plan approved by the 
 86.24  commissioner under subdivision 6 may assign a planned closure 
 86.25  rate adjustment to another facility or facilities that are not 
 86.26  closing or in the case of a partial closure, to itself.  The 
 86.27  planned closure rate adjustment must be implemented under 
 86.28  subdivision 7.  
 86.29     (c) To be considered for approval, an application must 
 86.30  include: 
 86.31     (1) a description of the proposed closure plan, which must 
 86.32  include identification of the facility or facilities to receive 
 86.33  a planned closure rate adjustment and the amount and timing of a 
 86.34  planned closure rate adjustment proposed for each facility; 
 86.35     (2) the proposed timetable for any proposed closure, 
 86.36  including the proposed dates for announcement to residents, 
 87.1   commencement of closure, and completion of closure; 
 87.2      (3) the proposed relocation plan for current residents of 
 87.3   any facility designated for closure.  The proposed relocation 
 87.4   plan must be designed to comply with all applicable state and 
 87.5   federal statutes and regulations, including, but not limited to, 
 87.6   section 144A.161; 
 87.7      (4) a description of the relationship between the nursing 
 87.8   facility that is proposed for closure and the nursing facility 
 87.9   or facilities proposed to receive the planned closure rate 
 87.10  adjustment.  If these facilities are not under common ownership, 
 87.11  copies of any contracts, purchase agreements, or other documents 
 87.12  establishing a relationship or proposed relationship must be 
 87.13  provided; 
 87.14     (5) documentation, in a format approved by the 
 87.15  commissioner, that all the nursing facilities receiving a 
 87.16  planned closure rate adjustment under the plan have accepted 
 87.17  joint and several liability for recovery of overpayments under 
 87.18  section 256B.0641, subdivision 2, for the facilities designated 
 87.19  for closure under the plan; and 
 87.20     (6) an explanation of how the application coordinates with 
 87.21  the regional plan of the group established under subdivision 2. 
 87.22     (d) The application must address the criteria listed in 
 87.23  subdivision 4. 
 87.24     Subd. 4.  [CRITERIA FOR REVIEW OF APPLICATION.] In 
 87.25  reviewing and approving closure proposals, the commissioner of 
 87.26  human services shall consider, but not be limited to, the 
 87.27  following criteria: 
 87.28     (1) improved quality of care and quality of life for 
 87.29  consumers; 
 87.30     (2) closure of a nursing facility that has a poor physical 
 87.31  plant; 
 87.32     (3) the existence of excess nursing facility beds, measured 
 87.33  in terms of beds per thousand persons aged 85 or older.  The 
 87.34  excess must be measured in reference to: 
 87.35     (i) the county in which the facility is located; 
 87.36     (ii) the county and all contiguous counties; 
 88.1      (iii) the region in which the facility is located; or 
 88.2      (iv) the facility's service area; 
 88.3   the facility shall indicate in its application the service area 
 88.4   it believes is appropriate for this measurement.  A facility in 
 88.5   a county that is in the lowest quartile of counties with 
 88.6   reference to beds per thousand persons aged 85 or older is not 
 88.7   in an area of excess capacity; 
 88.8      (4) low-occupancy rates, provided that the unoccupied beds 
 88.9   are not the result of a personnel shortage.  In analyzing 
 88.10  occupancy rates, the commissioner shall examine waiting lists in 
 88.11  the applicant facility and at facilities in the surrounding 
 88.12  area, as determined under clause (3); 
 88.13     (5) evidence of coordination between the community planning 
 88.14  process and the facility application; 
 88.15     (6) proposed usage of funds available from a planned 
 88.16  closure rate adjustment for care-related purposes; 
 88.17     (7) innovative use planned for the closed facility's 
 88.18  physical plant; 
 88.19     (8) evidence that the proposal serves the interests of the 
 88.20  state; and 
 88.21     (9) evidence of other factors that affect the viability of 
 88.22  the facility, including excessive nursing pool costs. 
 88.23     Subd. 5.  [CERTIFICATION.] Upon receipt of an application 
 88.24  for planned closure, the commissioner of human services shall 
 88.25  provide a copy of the application to the commissioner of 
 88.26  health.  The commissioner of health shall certify to the 
 88.27  commissioner of human services within 14 days whether the 
 88.28  application, if implemented, will satisfy the requirements of 
 88.29  section 144A.161.  The commissioner of human services shall 
 88.30  reject all applications for which the commissioner of health 
 88.31  fails to make the certification required under this subdivision 
 88.32  within 14 days. 
 88.33     Subd. 6.  [REVIEW AND APPROVAL OF APPLICATIONS.] (a) The 
 88.34  commissioner of human services, in consultation with the 
 88.35  commissioner of health, shall approve or disapprove an 
 88.36  application within 30 days after receiving it. 
 89.1      (b) Approval of a planned closure expires 18 months after 
 89.2   approval by the commissioner of human services, unless 
 89.3   commencement of closure has begun. 
 89.4      (c) The commissioner of human services may change any 
 89.5   provision of the application to which the applicant, the 
 89.6   regional planning group, and the commissioner agree. 
 89.7      Subd. 7.  [PLANNED CLOSURE RATE ADJUSTMENT.] (a) The 
 89.8   commissioner of human services shall calculate the amount of the 
 89.9   planned closure rate adjustment available under subdivision 3, 
 89.10  paragraph (b), according to clauses (1) to (4): 
 89.11     (1) the amount available is the net reduction of nursing 
 89.12  facility beds multiplied by $2,080; 
 89.13     (2) the total number of beds in the nursing facility or 
 89.14  facilities receiving the planned closure rate adjustment must be 
 89.15  identified; 
 89.16     (3) capacity days are determined by multiplying the number 
 89.17  determined under clause (2) by 365; and 
 89.18     (4) the planned closure rate adjustment is the amount 
 89.19  available in clause (1), divided by capacity days determined 
 89.20  under clause (3). 
 89.21     (b) A planned closure rate adjustment under this section is 
 89.22  effective on the first day of the month following completion of 
 89.23  closure of the facility designated for closure in the 
 89.24  application and becomes part of the nursing facility's total 
 89.25  operating payment rate. 
 89.26     (c) Applicants may use the planned closure rate adjustment 
 89.27  to allow for a property payment for a new nursing facility or an 
 89.28  addition to an existing nursing facility.  Applications approved 
 89.29  under this subdivision are exempt from other requirements for 
 89.30  moratorium exceptions under section 144A.073, subdivisions 2 and 
 89.31  3. 
 89.32     (d) Upon approval of the commissioner, the closing facility 
 89.33  shall receive a closure rate adjustment of up to $300 per 
 89.34  resident to be relocated to reimburse actual relocation costs or 
 89.35  other costs related to facility downsizing or closure.  The 
 89.36  commissioner shall delay the implementation of the planned 
 90.1   closure rate adjustments to offset the cost of this rate 
 90.2   adjustment. 
 90.3      Subd. 8.  [OTHER RATE ADJUSTMENTS.] Facilities subject to 
 90.4   this section remain eligible for any applicable rate adjustments 
 90.5   provided under section 256B.431, 256B.434, or any other section. 
 90.6      Subd. 9.  [COUNTY COSTS.] The commissioner of human 
 90.7   services may allocate up to $400 per nursing facility bed that 
 90.8   is closing, within the limits of the appropriation specified for 
 90.9   this purpose, to be used for relocation costs incurred by 
 90.10  counties for planned closures under this section or resident 
 90.11  relocation under section 144A.16.  To be eligible for this 
 90.12  allocation, a county in which a nursing facility closes must 
 90.13  provide to the commissioner a detailed statement in a form 
 90.14  provided by the commissioner of additional costs, not to exceed 
 90.15  $400 per bed closed, that are directly incurred related to the 
 90.16  county's required role in the relocation process.  
 90.17     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
 90.18  following final enactment. 
 90.19     Sec. 14.  [256B.438] [LONG-TERM CARE QUALITY PROFILES.] 
 90.20     Subdivision 1.  [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 
 90.21  PROFILES.] (a) The commissioner of human services shall develop 
 90.22  and implement a quality profile system for nursing facilities 
 90.23  and, beginning not later than July 1, 2003, other providers of 
 90.24  long-term care services.  The system must be developed and 
 90.25  implemented to the extent possible without the collection of 
 90.26  significant amounts of new data.  The system must not duplicate 
 90.27  the requirements of section 256B.5011, 256B.5012, or 256B.5013. 
 90.28  The system must be designed to provide information on quality: 
 90.29     (1) to consumers and their families to facilitate informed 
 90.30  choices of service providers; 
 90.31     (2) to providers to enable them to measure the results of 
 90.32  their quality improvement efforts and compare quality 
 90.33  achievements with other service providers; and 
 90.34     (3) to public and private purchasers of long-term care 
 90.35  services to enable them to purchase high-quality care. 
 90.36     (b) The system must be developed in consultation with the 
 91.1   long-term care task force and representatives of consumers, 
 91.2   providers, and labor unions.  Within the limits of available 
 91.3   appropriations, the commissioner may employ consultants to 
 91.4   assist with this project. 
 91.5      Subd. 2.  [QUALITY MEASUREMENT TOOLS.] The commissioner of 
 91.6   human services shall identify and apply existing quality 
 91.7   measurement tools to: 
 91.8      (1) emphasize quality of care and its relationship to 
 91.9   quality of life; and 
 91.10     (2) address the needs of various users of long-term care 
 91.11  services, including, but not limited to, short-stay residents, 
 91.12  persons with behavioral problems, persons with dementia, and 
 91.13  persons who are members of minority groups. 
 91.14  The tools must be identified and applied, to the extent 
 91.15  possible, without requiring providers to supply information 
 91.16  beyond current state and federal requirements. 
 91.17     Subd. 3.  [CONSUMER SURVEYS.] Following identification of 
 91.18  the quality measurement tool, the commissioner of human services 
 91.19  shall conduct surveys of long-term care service consumers to 
 91.20  develop quality profiles of providers.  To the extent possible, 
 91.21  surveys must be conducted face-to-face by state employees or 
 91.22  contractors.  At the discretion of the commissioner, surveys may 
 91.23  be conducted by telephone or by provider staff.  Surveys must be 
 91.24  conducted periodically to update quality profiles of individual 
 91.25  service providers. 
 91.26     Subd. 4.  [DISSEMINATION OF QUALITY PROFILES.] By July 1, 
 91.27  2002, the commissioner of human services shall implement a 
 91.28  system to disseminate the quality profiles developed from 
 91.29  consumer surveys using the quality measurement tool.  Profiles 
 91.30  must be disseminated to consumers, providers, and purchasers of 
 91.31  long-term care services through all feasible printed and 
 91.32  electronic outlets.  The commissioner shall conduct a public 
 91.33  awareness campaign to inform potential users regarding profile 
 91.34  contents and potential uses. 
 91.35     Sec. 15.  Minnesota Statutes 2000, section 256B.5012, 
 91.36  subdivision 3, is amended to read: 
 92.1      Subd. 3.  [PROPERTY PAYMENT RATE.] (a) The property payment 
 92.2   rate effective October 1, 2000, is based on the facility's 
 92.3   modified property payment rate in effect on September 30, 2000.  
 92.4   The modified property payment rate is the actual property 
 92.5   payment rate exclusive of the effect of gains or losses on 
 92.6   disposal of capital assets or adjustments for excess 
 92.7   depreciation claims.  Effective October 1, 2000, a facility 
 92.8   minimum property rate of $8.13 shall be applied to all existing 
 92.9   ICF/MR facilities.  Facilities with a modified property payment 
 92.10  rate effective September 30, 2000, which is below the minimum 
 92.11  property rate shall receive an increase effective October 1, 
 92.12  2000, equal to the difference between the minimum property 
 92.13  payment rate and the modified property payment rate in effect as 
 92.14  of September 30, 2000.  Facilities with a modified property 
 92.15  payment rate at or above the minimum property payment rate 
 92.16  effective September 30, 2000, shall receive the modified 
 92.17  property payment rate effective October 1, 2000. 
 92.18     (b) ~~Within the limits of appropriations specifically for~~ 
 92.19  ~~this purpose,~~ Facility property payment rates shall be increased 
 92.20  annually for inflation, effective January 1, 2002.  The increase 
 92.21  shall be based on each facility's property payment rate in 
 92.22  effect on September 30, 2000.  Modified property payment rates 
 92.23  effective September 30, 2000, shall be arrayed from highest to 
 92.24  lowest before applying the minimum property payment rate in 
 92.25  paragraph (a).  For modified property payment rates at the 90th 
 92.26  percentile or above, the annual inflation increase shall be 
 92.27  zero.  For modified property payment rates below the 90th 
 92.28  percentile but equal to or above the 75th percentile, the annual 
 92.29  inflation increase shall be one percent.  For modified property 
 92.30  payment rates below the 75th percentile, the annual inflation 
 92.31  increase shall be two percent. 
 92.32     Sec. 16.  Minnesota Statutes 2000, section 256B.5012, is 
 92.33  amended by adding a subdivision to read: 
 92.34     Subd. 4.  [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001, 
 92.35  AND JULY 1, 2002.] (a) For the rate years beginning July 1, 
 92.36  2001, and July 1, 2002, the commissioner shall make available to 
 93.1   each facility reimbursed under this section an adjustment to the 
 93.2   total operating payment rate of 3.5 percent.  Of this 
 93.3   adjustment, 2.5 percentage points must be used to provide an 
 93.4   employee pay rate increase as provided under paragraph (b) and 
 93.5   one percentage point must be used for operating costs. 
 93.6      (b) The adjustment under this paragraph must be used to 
 93.7   increase the per-hour pay rate of all employees except 
 93.8   administrative and central office employees by an equal dollar 
 93.9   amount and to pay associated costs for FICA, the Medicare tax, 
 93.10  workers' compensation premiums, and federal and state 
 93.11  unemployment insurance, provided that this increase must be used 
 93.12  only for wage increases implemented on or after the first day of 
 93.13  the rate year and must not be used for wage increases 
 93.14  implemented prior to that date. 
 93.15     (c) For each facility, the commissioner shall make 
 93.16  available an adjustment using the percentage specified in 
 93.17  paragraph (a) multiplied by the total payment rate, excluding 
 93.18  the property-related payment rate, in effect on the preceding 
 93.19  June 30.  The total payment rate shall include the adjustment 
 93.20  provided in section 256B.501, subdivision 12.  Notwithstanding 
 93.21  paragraph (a), for the rate increase effective July 1, 2001, the 
 93.22  adjustment applied to the increase provided under section 
 93.23  256B.501, subdivision 12, shall be 6.125 percent. 
 93.24     (d) A facility whose payment rates are governed by closure 
 93.25  agreements, receivership agreements, or Minnesota Rules, part 
 93.26  9553.0075, is not eligible for an adjustment otherwise granted 
 93.27  under this subdivision.  
 93.28     (e) A facility may apply for the compensation-related 
 93.29  payment rate adjustment provided under paragraph (b).  The 
 93.30  application must be made to the commissioner and contain a plan 
 93.31  by which the facility will distribute the compensation-related 
 93.32  portion of the payment rate adjustment to employees of the 
 93.33  facility.  For facilities in which the employees are represented 
 93.34  by an exclusive bargaining representative, an agreement 
 93.35  negotiated and agreed to by the employer and the exclusive 
 93.36  bargaining representative constitutes the plan.  A negotiated 
 94.1   agreement may constitute the plan only if the agreement is 
 94.2   finalized after the date of enactment of all rate increases for 
 94.3   the rate year.  The commissioner shall review the plan to ensure 
 94.4   that the payment rate adjustment per diem is used as provided in 
 94.5   this subdivision.  To be eligible, a facility must submit its 
 94.6   plan for the compensation distribution by March 31, 2002, and 
 94.7   March 31, 2003, respectively.  If a facility's plan for 
 94.8   compensation distribution is effective for its employees after 
 94.9   the first day of the applicable rate year that the funds are 
 94.10  available, the payment rate adjustment per diem is effective the 
 94.11  same date as its plan. 
 94.12     (f) A copy of the approved distribution plan must be made 
 94.13  available to all employees by giving each employee a copy or by 
 94.14  posting it in an area of the facility to which all employees 
 94.15  have access.  If an employee does not receive the compensation 
 94.16  adjustment described in the facility's approved plan and is 
 94.17  unable to resolve the problem with the facility's management or 
 94.18  through the employee's union representative, the employee may 
 94.19  contact the commissioner at an address or telephone number 
 94.20  provided by the commissioner and included in the approved plan. 
 94.21     Sec. 17.  Minnesota Statutes 2000, section 626.557, 
 94.22  subdivision 12b, is amended to read: 
 94.23     Subd. 12b.  [DATA MANAGEMENT.] (a)  [COUNTY DATA.] In 
 94.24  performing any of the duties of this section as a lead agency, 
 94.25  the county social service agency shall maintain appropriate 
 94.26  records.  Data collected by the county social service agency 
 94.27  under this section are welfare data under section 13.46.  
 94.28  Notwithstanding section 13.46, subdivision 1, paragraph (a), 
 94.29  data under this paragraph that are inactive investigative data 
 94.30  on an individual who is a vendor of services are private data on 
 94.31  individuals, as defined in section 13.02.  The identity of the 
 94.32  reporter may only be disclosed as provided in paragraph (c). 
 94.33     Data maintained by the common entry point are confidential 
 94.34  data on individuals or protected nonpublic data as defined in 
 94.35  section 13.02.  Notwithstanding section 138.163, the common 
 94.36  entry point shall destroy data three calendar years after date 
 95.1   of receipt. 
 95.2      (b)  [LEAD AGENCY DATA.] The commissioners of health and 
 95.3   human services shall prepare an investigation memorandum for 
 95.4   each report alleging maltreatment investigated under this 
 95.5   section.  During an investigation by the commissioner of health 
 95.6   or the commissioner of human services, data collected under this 
 95.7   section are confidential data on individuals or protected 
 95.8   nonpublic data as defined in section 13.02.  Upon completion of 
 95.9   the investigation, the data are classified as provided in 
 95.10  clauses (1) to (3) and paragraph (c). 
 95.11     (1) The investigation memorandum must contain the following 
 95.12  data, which are public: 
 95.13     (i) the name of the facility investigated; 
 95.14     (ii) a statement of the nature of the alleged maltreatment; 
 95.15     (iii) pertinent information obtained from medical or other 
 95.16  records reviewed; 
 95.17     (iv) the identity of the investigator; 
 95.18     (v) a summary of the investigation's findings; 
 95.19     (vi) statement of whether the report was found to be 
 95.20  substantiated, inconclusive, false, or that no determination 
 95.21  will be made; 
 95.22     (vii) a statement of any action taken by the facility; 
 95.23     (viii) a statement of any action taken by the lead agency; 
 95.24  and 
 95.25     (ix) when a lead agency's determination has substantiated 
 95.26  maltreatment, a statement of whether an individual, individuals, 
 95.27  or a facility were responsible for the substantiated 
 95.28  maltreatment, if known. 
 95.29     The investigation memorandum must be written in a manner 
 95.30  which protects the identity of the reporter and of the 
 95.31  vulnerable adult and may not contain the names or, to the extent 
 95.32  possible, data on individuals or private data listed in clause 
 95.33  (2). 
 95.34     (2) Data on individuals collected and maintained in the 
 95.35  investigation memorandum are private data, including: 
 95.36     (i) the name of the vulnerable adult; 
 96.1      (ii) the identity of the individual alleged to be the 
 96.2   perpetrator; 
 96.3      (iii) the identity of the individual substantiated as the 
 96.4   perpetrator; and 
 96.5      (iv) the identity of all individuals interviewed as part of 
 96.6   the investigation. 
 96.7      (3) Other data on individuals maintained as part of an 
 96.8   investigation under this section are private data on individuals 
 96.9   upon completion of the investigation. 
 96.10     (c)  [IDENTITY OF REPORTER.] The subject of the report may 
 96.11  compel disclosure of the name of the reporter only with the 
 96.12  consent of the reporter or upon a written finding by a court 
 96.13  that the report was false and there is evidence that the report 
 96.14  was made in bad faith.  This subdivision does not alter 
 96.15  disclosure responsibilities or obligations under the rules of 
 96.16  criminal procedure, except that where the identity of the 
 96.17  reporter is relevant to a criminal prosecution, the district 
 96.18  court shall do an in-camera review prior to determining whether 
 96.19  to order disclosure of the identity of the reporter. 
 96.20     (d)  [DESTRUCTION OF DATA.] Notwithstanding section 
 96.21  138.163, data maintained under this section by the commissioners 
 96.22  of health and human services must be destroyed under the 
 96.23  following schedule: 
 96.24     (1) data from reports determined to be false, two years 
 96.25  after the finding was made; 
 96.26     (2) data from reports determined to be inconclusive, four 
 96.27  years after the finding was made; 
 96.28     (3) data from reports determined to be substantiated, seven 
 96.29  years after the finding was made; and 
 96.30     (4) data from reports which were not investigated by a lead 
 96.31  agency and for which there is no final disposition, two years 
 96.32  from the date of the report. 
 96.33     (e)  [SUMMARY OF REPORTS.] The commissioners of health and 
 96.34  human services shall each annually ~~prepare a summary of~~ report 
 96.35  to the legislature and the governor on the number and type of 
 96.36  reports of alleged maltreatment involving licensed facilities 
 97.1   reported under this section, the number of those requiring 
 97.2   investigation under this section, and the resolution of those 
 97.3   investigations.  The report shall identify: 
 97.4      (1) whether and where backlogs of cases result in a failure 
 97.5   to conform with statutory time frames; 
 97.6      (2) where adequate coverage requires additional 
 97.7   appropriations and staffing; and 
 97.8      (3) any other trends that affect the safety of vulnerable 
 97.9   adults. 
 97.10     (f)  [RECORD RETENTION POLICY.] Each lead agency must have 
 97.11  a record retention policy. 
 97.12     (g)  [EXCHANGE OF INFORMATION.] Lead agencies, prosecuting 
 97.13  authorities, and law enforcement agencies may exchange not 
 97.14  public data, as defined in section 13.02, if the agency or 
 97.15  authority requesting the data determines that the data are 
 97.16  pertinent and necessary to the requesting agency in initiating, 
 97.17  furthering, or completing an investigation under this section.  
 97.18  Data collected under this section must be made available to 
 97.19  prosecuting authorities and law enforcement officials, local 
 97.20  county agencies, and licensing agencies investigating the 
 97.21  alleged maltreatment under this section.  The lead agency shall 
 97.22  exchange not public data with the vulnerable adult maltreatment 
 97.23  review panel established in section 256.021 if the data are 
 97.24  pertinent and necessary for a review requested under that 
 97.25  section.  Upon completion of the review, not public data 
 97.26  received by the review panel must be returned to the lead agency.
 97.27     (h)  [COMPLETION TIME.] Each lead agency shall keep records 
 97.28  of the length of time it takes to complete its investigations. 
 97.29     (i)  [NOTIFICATION OF OTHER AFFECTED PARTIES.] A lead 
 97.30  agency may notify other affected parties and their authorized 
 97.31  representative if the agency has reason to believe maltreatment 
 97.32  has occurred and determines the information will safeguard the 
 97.33  well-being of the affected parties or dispel widespread rumor or 
 97.34  unrest in the affected facility. 
 97.35     (j)  [FEDERAL REQUIREMENTS.] Under any notification 
 97.36  provision of this section, where federal law specifically 
 98.1   prohibits the disclosure of patient identifying information, a 
 98.2   lead agency may not provide any notice unless the vulnerable 
 98.3   adult has consented to disclosure in a manner which conforms to 
 98.4   federal requirements. 
 98.5      Sec. 18.  Laws 1999, chapter 245, article 3, section 45, as 
 98.6   amended by Laws 2000, chapter 312, section 3, is amended to read:
 98.7      Sec. 45.  [STATE LICENSURE CONFLICTS WITH FEDERAL 
 98.8   REGULATIONS.] 
 98.9      (a) Notwithstanding the provisions of Minnesota Rules, part 
 98.10  4658.0520, an incontinent resident must be checked according to 
 98.11  a specific time interval written in the resident's care plan.  
 98.12  The resident's attending physician must authorize in writing any 
 98.13  interval longer than two hours unless the resident, if 
 98.14  competent, or a family member or legally appointed conservator, 
 98.15  guardian, or health care agent of a resident who is not 
 98.16  competent, agrees in writing to waive physician involvement in 
 98.17  determining this interval. 
 98.18     (b) This section expires July 1, ~~2001~~ 2003. 
 98.19     Sec. 19.  [DEVELOPMENT OF NEW NURSING FACILITY 
 98.20  REIMBURSEMENT SYSTEM.] 
 98.21     (a) The commissioner of human services shall develop and 
 98.22  report to the legislature by January 15, 2003, a system to 
 98.23  replace the current nursing facility reimbursement system 
 98.24  established under Minnesota Statutes, sections 256B.431, 
 98.25  256B.434, and 256B.435. 
 98.26     (b) The system must be developed in consultation with the 
 98.27  long-term care task force and with representatives of consumers, 
 98.28  providers, and labor unions.  Within the limits of available 
 98.29  appropriations, the commissioner may employ consultants to 
 98.30  assist with this project. 
 98.31     (c) The new reimbursement system must: 
 98.32     (1) provide incentives to enhance quality of life and 
 98.33  quality of care; 
 98.34     (2) recognize cost differences in the care of different 
 98.35  types of populations, including subacute care and dementia care; 
 98.36     (3) establish rates that are sufficient without being 
 99.1   excessive; 
 99.2      (4) be affordable for the state and for private-pay 
 99.3   residents; 
 99.4      (5) be sensitive to changing conditions in the long-term 
 99.5   care environment; 
 99.6      (6) avoid creating access problems related to insufficient 
 99.7   funding; 
 99.8      (7) allow providers maximum flexibility in their business 
 99.9   operations; and 
 99.10     (8) recognize the need for capital investment to improve 
 99.11  physical plants. 
 99.12     (d) Notwithstanding Minnesota Statutes, section 256B.435, 
 99.13  the commissioner must not implement a performance-based 
 99.14  contracting system for nursing facilities prior to July 1, 2003. 
 99.15  The commissioner shall continue to reimburse nursing facilities 
 99.16  under Minnesota Statutes, section 256B.431 or 256B.434, until 
 99.17  otherwise directed by law. 
 99.18     Sec. 20.  [TIME MOTION STUDY.] 
 99.19     (a) The commissioner of human services shall conduct a time 
 99.20  motion study to determine the amount of time devoted to the care 
 99.21  of high-need nursing facility residents, including, but not 
 99.22  limited to, persons with Alzheimer's disease and other 
 99.23  dementias, persons with multiple sclerosis, and persons with 
 99.24  mental illness. 
 99.25     (b) The commissioner shall report the results of the study 
 99.26  to the legislature by December 15, 2002, with an analysis of 
 99.27  whether these costs are adequately reimbursed under the current 
 99.28  reimbursement system and with recommendations for adjusting 
 99.29  nursing facility reimbursement rates as necessary to account for 
 99.30  these costs. 
 99.31     Sec. 21.  [PROVIDER RATE INCREASES.] 
 99.32     (a) The commissioner of human services shall increase 
 99.33  reimbursement rates by 3.5 percent each year of the biennium for 
 99.34  the providers listed in paragraph (b).  The increases are 
 99.35  effective for services rendered on or after July 1 of each year. 
 99.36     (b) The rate increases described in this section must be 
100.1   provided to home and community-based waivered services for: 
100.2      (1) persons with mental retardation or related conditions 
100.3   under Minnesota Statutes, section 256B.501; 
100.4      (2) home and community-based waivered services for the 
100.5   elderly under Minnesota Statutes, section 256B.0915; 
100.6      (3) waivered services under community alternatives for 
100.7   disabled individuals under Minnesota Statutes, section 256B.49; 
100.8      (4) community alternative care waivered services under 
100.9   Minnesota Statutes, section 256B.49; 
100.10     (5) traumatic brain injury waivered services under 
100.11  Minnesota Statutes, section 256B.49; 
100.12     (6) nursing services and home health services under 
100.13  Minnesota Statutes, section 256B.0625, subdivision 6a; 
100.14     (7) personal care services and nursing supervision of 
100.15  personal care services under Minnesota Statutes, section 
100.16  256B.0625, subdivision 19a; 
100.17     (8) private duty nursing services under Minnesota Statutes, 
100.18  section 256B.0625, subdivision 7; 
100.19     (9) day training and habilitation services for adults with 
100.20  mental retardation or related conditions under Minnesota 
100.21  Statutes, sections 252.40 to 252.46; 
100.22     (10) alternative care services under Minnesota Statutes, 
100.23  section 256B.0913; 
100.24     (11) adult residential program grants under Minnesota 
100.25  Rules, parts 9535.2000 to 9535.3000; 
100.26     (12) adult and family community support grants under 
100.27  Minnesota Rules, parts 9535.1700 to 9535.1760; 
100.28     (13) adult mental health integrated fund grants under 
100.29  Minnesota Statutes, section 245.4661; 
100.30     (14) semi-independent living services under Minnesota 
100.31  Statutes, section 252.275, including SILS funding under county 
100.32  social services grants formerly funded under Minnesota Statutes, 
100.33  chapter 256I; 
100.34     (15) community support services for deaf and 
100.35  hard-of-hearing adults with mental illness who use or wish to 
100.36  use sign language as their primary means of communication; and 
101.1      (16) living skills training programs for persons with 
101.2   intractable epilepsy who need assistance in the transition to 
101.3   independent living. 
101.4      (c) Providers that receive a rate increase under this 
101.5   section shall use one percentage point of the additional revenue 
101.6   for operating cost increases and 2.5 percentage points of the 
101.7   additional revenue to increase the per-hour pay rate of all 
101.8   employees other than the administrator and central office staff 
101.9   by an equal dollar amount and to pay associated costs for FICA, 
101.10  the Medicare tax, workers' compensation premiums, and federal 
101.11  and state unemployment insurance.  For public employees, the 
101.12  portion of this increase reserved to increase the per-hour pay 
101.13  rate for certain staff by an equal dollar amount is available 
101.14  and pay rates shall be increased only to the extent that they 
101.15  comply with laws governing public employees collective 
101.16  bargaining.  Money received by a provider for pay increases 
101.17  under this section must be used only for wage increases 
101.18  implemented on or after the first day of the state fiscal year 
101.19  in which the increase is available and must not be used for wage 
101.20  increases implemented prior to that date. 
101.21     (d) A copy of the provider's plan for complying with 
101.22  paragraph (c) must be made available to all employees by giving 
101.23  each employee a copy or by posting it in an area of the 
101.24  provider's operation to which all employees have access.  If an 
101.25  employee does not receive the salary adjustment described in the 
101.26  plan and is unable to resolve the problem with the provider, the 
101.27  employee may contact the employee's union representative.  If 
101.28  the employee is not covered by a collective bargaining 
101.29  agreement, the employee may contact the commissioner at a phone 
101.30  number provided by the commissioner and included in the 
101.31  provider's plan. 
101.32     Sec. 22.  [REGULATORY FLEXIBILITY.] 
101.33     (a) By July 1, 2001, the commissioners of health and human 
101.34  services shall: 
101.35     (1) develop a summary of federal nursing facility and 
101.36  community long-term care regulations that hamper state 
102.1   flexibility and place burdens on the goal of achieving 
102.2   high-quality care and optimum outcomes for consumers of 
102.3   services; and 
102.4      (2) share this summary with the legislature, other states, 
102.5   national groups that advocate for state interests with Congress, 
102.6   and the Minnesota congressional delegation. 
102.7      (b) The commissioners shall conduct ongoing follow-up with 
102.8   the entities to which this summary is provided and with the 
102.9   health care financing administration to achieve maximum 
102.10  regulatory flexibility, including the possibility of pilot 
102.11  projects to demonstrate regulatory flexibility on less than a 
102.12  statewide basis. 
102.13     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
102.14  following final enactment. 
102.15     Sec. 23.  [REPORT.] 
102.16     By January 15, 2003, the commissioner of health and the 
102.17  commissioner of human services shall report to the senate health 
102.18  and family security committee and the house health and human 
102.19  services policy committee on the number of closures that have 
102.20  taken place under this article, alternatives to nursing facility 
102.21  care that have been developed, any problems with access to 
102.22  long-term care services that have resulted, and any 
102.23  recommendations for continuation of the regional long-term care 
102.24  planning process and the closure process after June 30, 2003. 
102.25     Sec. 24.  [STAFFING STANDARDS.] 
102.26     By February 1, 2002, the commissioners of health and of 
102.27  human services, in consultation with long-term care consumers, 
102.28  advocates, unions, and trade associations, shall deliver to the 
102.29  governor and the legislature a plan for updating staffing 
102.30  standards in nursing facilities and home and community-based 
102.31  services.  The plan must be guided by professional best 
102.32  practices, consumer experience, and new and emerging models of 
102.33  resident or client-centered staffing.  The report must identify 
102.34  the magnitude of discrepancy between current staffing and best 
102.35  practices in Minnesota facilities and services.  The report must 
102.36  also identify the costs associated with a three-year plan for 
103.1   improvement and the federal waivers or approvals, if any, that 
103.2   would be required to implement the plan. 
103.3      Sec. 25.  [NURSING ASSISTANT AND HOME HEALTH AIDE 
103.4   CURRICULUM.] 
103.5      By January 1, 2003, the commissioner of health, in 
103.6   consultation with long-term care consumers, advocates, unions, 
103.7   and trade associations, must update the nursing assistant and 
103.8   home health aide curriculum (1998 edition) to help students 
103.9   learn front-line survival skills that support job motivation and 
103.10  satisfaction.  These skills include, but are not limited to, 
103.11  working with challenging behaviors; communication skills; stress 
103.12  management, including the impact of personal life stress in the 
103.13  work setting; building relationships with families; cultural 
103.14  competencies; and working with death and dying. 
103.15     Sec. 26.  [INNOVATIONS IN QUALITY DEMONSTRATION GRANTS.] 
103.16     Subdivision 1.  [PROGRAM ESTABLISHED.] The commissioner of 
103.17  health shall establish a long-term care grant program that 
103.18  demonstrates best practices and innovation for long-term care 
103.19  service delivery and housing.  The grants must fund 
103.20  demonstrations that create new means and models for servicing 
103.21  the elderly or demonstrate creativity in service provision 
103.22  through the scope of their program or service. 
103.23     Subd. 2.  [ELIGIBILITY.] Grants may only be made to those 
103.24  who provide direct service or housing to the elderly within the 
103.25  state.  Grants may only be made for projects that show 
103.26  innovations and measurable improvement in resident care, quality 
103.27  of life, use of technology, or customer satisfaction. 
103.28     Subd. 3.  [AWARDING OF GRANTS.] (a) Applications for grants 
103.29  must be made to the commissioner on forms prescribed by the 
103.30  commissioner. 
103.31     (b) The applications must be reviewed, ranked, and 
103.32  recommended by a review panel.  The review panel shall consist 
103.33  of two representatives from long-term care providers, two 
103.34  citizen members, two representatives from business, one member 
103.35  representing academia, and one state agency representative.  The 
103.36  members shall be appointed by the governor. 
104.1      (c) The review panel shall rank applications according to 
104.2   the following criteria: 
104.3      (1) improvement in direct care to residents; 
104.4      (2) increase in efficiency through the use of technology; 
104.5      (3) increase in quality of care through the use of 
104.6   technology; 
104.7      (4) increase in the access and delivery of service; 
104.8      (5) enhancement of nursing staff training; 
104.9      (6) the effectiveness of the project as a demonstration; 
104.10  and 
104.11     (7) the immediate transferability of the project to a 
104.12  larger scale. 
104.13     (d) The commissioner shall award grants based on the 
104.14  recommendations of the panel.  Grants for eligible projects may 
104.15  not exceed $100,000. 
104.16     Sec. 27.  [REVISOR INSTRUCTION.] 
104.17     The revisor of statutes shall delete any reference to 
104.18  Minnesota Statutes, section 144A.16, in Minnesota Statutes and 
104.19  Minnesota Rules. 
104.20     Sec. 28.  [APPROPRIATIONS.] 
104.21     $........ is appropriated from the general fund to the 
104.22  commissioner of human services for the biennium beginning July 
104.23  1, 2001, for the purposes of this article. 
104.24     Sec. 29.  [REPEALER.] 
104.25     (a) Minnesota Statutes 2000, section 144A.16, is repealed. 
104.26     (b) Minnesota Rules, parts 4655.6810; 4655.6820; 4655.6830; 
104.27  4658.1600; 4658.1605; 4658.1610; 4658.1690; 9546.0010; 
104.28  9546.0020; 9546.0030; 9546.0040; 9546.0050; and 9546.0060, are 
104.29  repealed. 
104.30                             ARTICLE 3
104.31                WORKFORCE RECRUITMENT AND RETENTION
104.32     Section 1.  Minnesota Statutes 2000, section 62D.04, 
104.33  subdivision 5, is amended to read: 
104.34     Subd. 5.  [PARTICIPATION; GOVERNMENT PROGRAMS.] Health 
104.35  maintenance organizations shall, as a condition of receiving and 
104.36  retaining a certificate of authority, participate in the medical 
105.1   assistance, general assistance medical care, and MinnesotaCare 
105.2   programs and the long-term care employee health insurance 
105.3   assistance program established under section 256.956.  A health 
105.4   maintenance organization is required to submit proposals in good 
105.5   faith that meet the requirements of the request for proposal 
105.6   provided that the requirements can be reasonably met by a health 
105.7   maintenance organization to serve individuals eligible for the 
105.8   above programs in a geographic region of the state if, at the 
105.9   time of publication of a request for proposal, the percentage of 
105.10  recipients in the public programs in the region who are enrolled 
105.11  in the health maintenance organization is less than the health 
105.12  maintenance organization's percentage of the total number of 
105.13  individuals enrolled in health maintenance organizations in the 
105.14  same region.  Geographic regions shall be defined by the 
105.15  commissioner of human services in the request for proposals. 
105.16     <b>[EFFECTIVE DATE.]</b> This section is effective 90 days 
105.17  following approval of a federal waiver to receive enhanced 
105.18  matching funds under the state children's health insurance 
105.19  program. 
105.20     Sec. 2.  Minnesota Statutes 2000, section 116L.11, 
105.21  subdivision 4, is amended to read: 
105.22     Subd. 4.  [QUALIFYING CONSORTIUM.] "Qualifying consortium" 
105.23  means an entity that ~~may include~~ includes a public or private 
105.24  institution of higher education~~, work force center, county,~~ and 
105.25  one ~~or more~~ eligible ~~employers, but must include a public or~~ 
105.26  ~~private institution of higher education and one or more eligible~~ 
105.27  ~~employers~~ employer. 
105.28     Sec. 3.  Minnesota Statutes 2000, section 116L.12, 
105.29  subdivision 4, is amended to read: 
105.30     Subd. 4.  [GRANTS.] Within the limits of available 
105.31  appropriations, the board shall make grants not to exceed 
105.32  $400,000 each to qualifying consortia to operate local, 
105.33  regional, or statewide training and retention programs.  Grants 
105.34  may be made from TANF funds, general fund appropriations, and 
105.35  any other funding sources available to the board, provided the 
105.36  requirements of those funding sources are satisfied.  Grant 
106.1   awards must establish specific, measurable outcomes and 
106.2   timelines for achieving those outcomes. 
106.3      Sec. 4.  Minnesota Statutes 2000, section 116L.12, 
106.4   subdivision 5, is amended to read: 
106.5      Subd. 5.  [LOCAL MATCH REQUIREMENTS.] A consortium must 
106.6   ~~provide at least a 50 percent match from local resources for~~ 
106.7   ~~money appropriated under this section.  The local match~~ 
106.8   ~~requirement must be satisfied on an overall program basis but~~ 
106.9   ~~need not be satisfied for each particular client.  The local~~ 
106.10  ~~match requirement may be reduced for consortia that include a~~ 
106.11  ~~relatively large number of small employers whose financial~~ 
106.12  ~~contribution has been reduced in accordance with section 116L.15.~~
106.13  ~~In-kind services and expenditures under section 116L.13,~~ 
106.14  ~~subdivision 2, may be used to meet this local match~~ 
106.15  ~~requirement.  The grant application must specify the financial~~ 
106.16  ~~contribution from each member of the consortium~~ satisfy the 
106.17  match requirements established in section 116L.02, paragraph (a).
106.18     Sec. 5.  Minnesota Statutes 2000, section 116L.13, 
106.19  subdivision 1, is amended to read: 
106.20     Subdivision 1.  [MARKETING AND RECRUITMENT.] A qualifying 
106.21  consortium must implement a marketing and outreach strategy to 
106.22  recruit into the health care and human services fields persons 
106.23  from one or more of the potential employee target groups.  
106.24  Recruitment strategies must include: 
106.25     (1) a screening process to evaluate whether potential 
106.26  employees may be disqualified as the result of a required 
106.27  background check or are otherwise unlikely to succeed in the 
106.28  position for which they are being recruited; and 
106.29     (2) a process for modifying course work to meet the 
106.30  training needs of non-English-speaking persons, when appropriate.
106.31     Sec. 6.  [116L.146] [EXPEDITED GRANT PROCESS.] 
106.32     (a) The board may authorize grants not to exceed $50,000 
106.33  each through an expedited grant approval process to: 
106.34     (1) eligible employers to provide training programs for up 
106.35  to 50 workers; or 
106.36     (2) a public or private institution of higher education to: 
107.1      (i) do predevelopment or curriculum development for 
107.2   training programs prior to submission for program funding under 
107.3   section 116L.12; 
107.4      (ii) convert an existing curriculum for distance learning 
107.5   through interactive television or other communication methods; 
107.6   or 
107.7      (iii) enable a training program to be offered when it would 
107.8   otherwise be canceled due to an enrollment shortfall of one or 
107.9   two students when the program is offered in a health-related 
107.10  field with a documented worker shortage and is part of a 
107.11  training program not exceeding two years in length. 
107.12     (b) The board shall develop application procedures and 
107.13  evaluation policies for grants made under this section. 
107.14     Sec. 7.  Minnesota Statutes 2000, section 144.1464, is 
107.15  amended to read: 
107.16     144.1464 [SUMMER HEALTH CARE INTERNS.] 
107.17     Subdivision 1.  [SUMMER INTERNSHIPS.] The commissioner of 
107.18  health, through a contract with a nonprofit organization as 
107.19  required by subdivision 4, shall award grants to hospitals ~~and~~, 
107.20  clinics, nursing facilities, and home care providers to 
107.21  establish a secondary and post-secondary summer health care 
107.22  intern program.  The purpose of the program is to expose 
107.23  interested secondary and post-secondary pupils to various 
107.24  careers within the health care profession. 
107.25     Subd. 2.  [CRITERIA.] (a) The commissioner, through the 
107.26  organization under contract, shall award grants to 
107.27  hospitals ~~and~~, clinics, nursing facilities, and home care 
107.28  providers that agree to:  
107.29     (1) provide secondary and post-secondary summer health care 
107.30  interns with formal exposure to the health care profession; 
107.31     (2) provide an orientation for the secondary and 
107.32  post-secondary summer health care interns; 
107.33     (3) pay one-half the costs of employing the secondary and 
107.34  post-secondary summer health care intern~~, based on an overall~~ 
107.35  ~~hourly wage that is at least the minimum wage but does not~~ 
107.36  ~~exceed $6 an hour~~; 
108.1      (4) interview and hire secondary and post-secondary pupils 
108.2   for a minimum of six weeks and a maximum of 12 weeks; and 
108.3      (5) employ at least one secondary student for each 
108.4   post-secondary student employed, to the extent that there are 
108.5   sufficient qualifying secondary student applicants. 
108.6      (b) In order to be eligible to be hired as a secondary 
108.7   summer health intern by a hospital ~~or~~, clinic, nursing facility, 
108.8   or home care provider, a pupil must: 
108.9      (1) intend to complete high school graduation requirements 
108.10  and be between the junior and senior year of high school; and 
108.11     (2) be from a school district in proximity to the facility~~;~~ 
108.12  ~~and~~ 
108.13     ~~(3) provide the facility with a letter of recommendation~~ 
108.14  ~~from a health occupations or science educator~~. 
108.15     (c) In order to be eligible to be hired as a post-secondary 
108.16  summer health care intern by a hospital or clinic, a pupil must: 
108.17     (1) intend to complete a health care training program or a 
108.18  two-year or four-year degree program and be planning on 
108.19  enrolling in or be enrolled in that training program or degree 
108.20  program; and 
108.21     (2) be enrolled in a Minnesota educational institution or 
108.22  be a resident of the state of Minnesota; priority must be given 
108.23  to applicants from a school district or an educational 
108.24  institution in proximity to the facility~~; and~~ 
108.25     ~~(3) provide the facility with a letter of recommendation~~ 
108.26  ~~from a health occupations or science educator~~. 
108.27     (d) Hospitals ~~and~~, clinics, nursing facilities, and home 
108.28  care providers awarded grants may employ pupils as secondary and 
108.29  post-secondary summer health care interns beginning on or after 
108.30  June 15, 1993, if they agree to pay the intern, during the 
108.31  period before disbursement of state grant money, with money 
108.32  designated as the facility's 50 percent contribution towards 
108.33  internship costs.  
108.34     Subd. 3.  [GRANTS.] The commissioner, through the 
108.35  organization under contract, shall award separate grants to 
108.36  hospitals ~~and~~, clinics, nursing facilities, and home care 
109.1   providers meeting the requirements of subdivision 2.  The grants 
109.2   must be used to pay one-half of the costs of employing secondary 
109.3   and post-secondary pupils in a hospital ~~or~~, clinic, nursing 
109.4   facility, or home care setting during the course of the 
109.5   program.  No more than 50 percent of the participants may be 
109.6   post-secondary students, unless the program does not receive 
109.7   enough qualified secondary applicants per fiscal year.  No more 
109.8   than five pupils may be selected from any secondary or 
109.9   post-secondary institution to participate in the program and no 
109.10  more than one-half of the number of pupils selected may be from 
109.11  the seven-county metropolitan area. 
109.12     Subd. 4.  [CONTRACT.] The commissioner shall contract with 
109.13  a statewide, nonprofit organization representing facilities at 
109.14  which secondary and post-secondary summer health care interns 
109.15  will serve, to administer the grant program established by this 
109.16  section.  Grant funds that are not used in one fiscal year may 
109.17  be carried over to the next fiscal year.  The organization 
109.18  awarded the grant shall provide the commissioner with any 
109.19  information needed by the commissioner to evaluate the program, 
109.20  in the form and at the times specified by the commissioner. 
109.21     Sec. 8.  Minnesota Statutes 2000, section 144.1496, 
109.22  subdivision 1, is amended to read: 
109.23     Subdivision 1.  [CREATION OF THE ACCOUNT.] ~~An~~ Education 
109.24  ~~account~~ accounts in the health care access fund ~~is~~ and the 
109.25  general fund are established for a loan forgiveness program for 
109.26  nurses who agree to practice nursing in a nursing home or 
109.27  intermediate care facility for persons with mental retardation 
109.28  or related conditions.  The ~~account consists~~ accounts consist of 
109.29  money appropriated by the legislature and repayments and 
109.30  penalties collected under subdivision 4.  Money from the ~~account~~ 
109.31  accounts must be used for a loan forgiveness program. 
109.32     Sec. 9.  Minnesota Statutes 2000, section 144.1496, 
109.33  subdivision 3, is amended to read: 
109.34     Subd. 3.  [LOAN FORGIVENESS.] The commissioner may accept 
109.35  up to ~~ten~~ 170 applicants a year with payments for the first ten 
109.36  applicants accepted to be made out of the health care access 
110.1   fund education account and payment for the remaining applicants 
110.2   accepted to be made out of the general fund education account.  
110.3   Applicants are responsible for securing their own loans.  For 
110.4   each year of nursing education, for up to two years, applicants 
110.5   accepted into the loan forgiveness program may designate an 
110.6   agreed amount, not to exceed $3,000, as a qualified loan.  For 
110.7   each year that a participant practices nursing in a nursing home 
110.8   or intermediate care facility for persons with mental 
110.9   retardation or related conditions, up to a maximum of two years, 
110.10  the commissioner shall annually repay an amount equal to one 
110.11  year of qualified loans.  Participants who move from one nursing 
110.12  home or intermediate care facility for persons with mental 
110.13  retardation or related conditions to another remain eligible for 
110.14  loan repayment.  
110.15     Sec. 10.  Minnesota Statutes 2000, section 144.1496, 
110.16  subdivision 4, is amended to read: 
110.17     Subd. 4.  [PENALTY FOR NONFULFILLMENT.] If a participant 
110.18  does not fulfill the service commitment required under 
110.19  subdivision 3 for full repayment of all qualified loans, the 
110.20  commissioner shall collect from the participant 100 percent of 
110.21  any payments made for qualified loans and interest at a rate 
110.22  established according to section 270.75.  The commissioner shall 
110.23  deposit the collections in the health care access fund or the 
110.24  general fund, as applicable, to be credited to the ~~account~~ 
110.25  accounts established in subdivision 1.  The commissioner may 
110.26  grant a waiver of all or part of the money owed as a result of a 
110.27  nonfulfillment penalty if emergency circumstances prevented 
110.28  fulfillment of the required service commitment. 
110.29     Sec. 11.  [144.1499] [PROMOTION OF HEALTH CARE AND 
110.30  LONG-TERM CARE CAREERS.] 
110.31     The commissioner of health, in consultation with an 
110.32  organization representing health care employers, long-term care 
110.33  employers, and educational institutions, may make grants to 
110.34  qualifying consortia as defined in section 116L.11, subdivision 
110.35  4, for intergenerational programs to encourage middle and high 
110.36  school students to work and volunteer in health care and 
111.1   long-term care settings.  To qualify for a grant under this 
111.2   section, a consortium shall: 
111.3      (1) develop a health and long-term care careers curriculum 
111.4   that provides career exploration and training in national skill 
111.5   standards for health care and long-term care and that is 
111.6   consistent with Minnesota graduation standards and other related 
111.7   requirements; 
111.8      (2) offer programs for high school students that provide 
111.9   training in health and long-term care careers with credits that 
111.10  articulate into post-secondary programs; and 
111.11     (3) provide technical support to the participating health 
111.12  care and long-term care employer to enable the use of the 
111.13  employer's facilities and programs for K-12 health and long-term 
111.14  care careers education. 
111.15     Sec. 12.  [256.956] [LONG-TERM CARE EMPLOYEE HEALTH 
111.16  INSURANCE ASSISTANCE PROGRAM.] 
111.17     Subdivision 1.  [DEFINITIONS.] (a) For the purpose of this 
111.18  section, the definitions have the meanings given them.  
111.19     (b) "Commissioner" means the commissioner of human services.
111.20     (c) "Dependent" means an unmarried child who is under the 
111.21  age of 19 years.  For the purpose of this definition, a 
111.22  dependent includes a child for whom an eligible employee or an 
111.23  eligible employee's spouse has been appointed legal guardian or 
111.24  an adopted child as defined under section 62A.27.  A dependent 
111.25  does not include: 
111.26     (1) a child of an eligible employee who is eligible for 
111.27  health coverage through medical assistance without a spenddown 
111.28  or through an employer-subsidized health plan where an employer 
111.29  other than the employer of the eligible employee pays at least 
111.30  50 percent of the cost of coverage for the child; or 
111.31     (2) a child of an eligible employee who is excluded from 
111.32  coverage under title XXI of the Social Security Act, United 
111.33  States Code, title 42, section 1397aa et seq. 
111.34     (d) "Eligible employee" means an individual employed by an 
111.35  employer in a position other than as an administrator or in the 
111.36  central office, and includes both full-time and part-time 
112.1   employees.  An "employee" does not include an individual who:  
112.2      (1) works on a temporary or substitute basis; 
112.3      (2) is hired as an independent contractor; or 
112.4      (3) is a state employee.  
112.5      (e) "Employer" means any of the following: 
112.6      (1) a nursing facility reimbursed under section 256B.431 or 
112.7   256B.434; 
112.8      (2) a facility reimbursed under sections 256B.501 and 
112.9   256B.5011 and Laws 1993, First Special Session chapter 1, 
112.10  article 4, section 11; or 
112.11     (3) a provider who meets the following requirements: 
112.12     (i) provides home and community-based waivered services for 
112.13  persons with mental retardation or related conditions under 
112.14  section 256B.501; home and community-based waivered services for 
112.15  the elderly under section 256B.0915; waivered services under 
112.16  community alternatives for disabled individuals under section 
112.17  256B.49; community alternative care waivered services under 
112.18  section 256B.49; traumatic brain injury waivered services under 
112.19  section 256B.49; nursing services and home health services under 
112.20  section 256B.0625, subdivision 6a; personal care services and 
112.21  nursing supervision of personal care services under section 
112.22  256B.0625, subdivision 19a; private duty nursing services under 
112.23  section 256B.0625, subdivision 7; day training and habilitation 
112.24  services for adults with mental retardation or related 
112.25  conditions under sections 252.40 to 252.46; alternative care 
112.26  services under section 256B.0913; adult residential program 
112.27  grants under Minnesota Rules, parts 9535.2000 to 9535.3000; 
112.28  adult and family community support grants under Minnesota Rules, 
112.29  parts 9535.1700 to 9535.1760; semi-independent living services 
112.30  under section 252.275, including SILS funding under county 
112.31  social services grants formerly funded under chapter 256I; 
112.32  community support services for deaf and hard-of-hearing adults 
112.33  with mental illness who use or wish to use sign language as 
112.34  their primary means of communication; or living skills training 
112.35  programs for persons with intractable epilepsy who need 
112.36  assistance in the transition to independent living; and 
113.1      (ii) the revenue received by the provider from medical 
113.2   assistance that equals or exceeds 20 percent of the total 
113.3   revenue received by the provider from all payment sources.  
113.4   Employer includes both for-profit and nonprofit entities. 
113.5      (f) "Program" means the long-term care employee health 
113.6   insurance assistance program.  
113.7      Subd. 2.  [PROGRAM.] (a) The commissioner shall establish 
113.8   and administer the long-term care employee health insurance 
113.9   assistance program to provide the advantages of pooling for the 
113.10  purchase of health coverage for long-term care employers.  
113.11     (b) The commissioner shall solicit bids from health 
113.12  maintenance organizations licensed under chapter 62D to provide 
113.13  health coverage to the dependents of eligible employees.  
113.14  Coverage shall be offered on a guaranteed-issue and renewal 
113.15  basis.  No health maintenance organization is required to 
113.16  provide coverage to an eligible employee's dependent who does 
113.17  not reside within the health maintenance organization's approved 
113.18  service area.  
113.19     (c) The commissioner shall, consistent with the provisions 
113.20  of this section, determine coverage options, premium 
113.21  arrangements, contractual arrangements, and all other matters 
113.22  necessary to administer the program.  
113.23     (d) The commissioner may extend the program to include 
113.24  coverage for the eligible employee and noneligible employee.  
113.25  The cost of coverage for these employees shall be the 
113.26  responsibility of the employer or employee.  
113.27     (e) The commissioner shall consult with representatives of 
113.28  the long-term care industry on issues related to the 
113.29  administration of the program. 
113.30     Subd. 3.  [EMPLOYER REQUIREMENTS.] (a) All employers may 
113.31  participate in the program subject to the requirements of this 
113.32  section.  The commissioner shall establish procedures for an 
113.33  employer to apply for coverage through this program.  These 
113.34  procedures may include requiring eligible employees to provide 
113.35  relevant financial information to determine the eligibility of 
113.36  their dependents.  
114.1      (b) A participating employer must offer dependent coverage 
114.2   to all employees.  For purposes of this paragraph, dependent 
114.3   includes the children excluded under subdivision 1, paragraph 
114.4   (c). 
114.5      (c) The participating employer must provide to the 
114.6   commissioner any employee information deemed necessary by the 
114.7   commissioner to determine eligibility and premium payments and 
114.8   must notify the commissioner upon a change in an employee's or 
114.9   an employee's dependent's eligibility.  
114.10     (d) The initial term of the employer's coverage must be for 
114.11  at least one year but may be made automatically renewable from 
114.12  term to term in the absence of notice of termination by either 
114.13  the employer or the commissioner.  
114.14     Subd. 4.  [INDIVIDUAL ELIGIBILITY.] (a) The commissioner 
114.15  may require a probationary period for new employees of no more 
114.16  than 90 days before the dependents of a new employee become 
114.17  eligible for coverage through the program. 
114.18     (b) A participating employer may elect to offer coverage 
114.19  through the program to: 
114.20     (1) the eligible and noneligible employees, if the program 
114.21  is extended by the commissioner to include these individuals; 
114.22     (2) children of eligible and noneligible employees who are 
114.23  under the age of 25 years and who are full-time students; and 
114.24     (3) the spouses of eligible and noneligible employees. 
114.25  The cost of coverage for the individuals described in this 
114.26  paragraph, the dependents of noneligible employees, and any 
114.27  child of an eligible or noneligible employee who is not 
114.28  considered a dependent in accordance with subdivision 1, 
114.29  paragraph (c), shall be the responsibility of the employer or 
114.30  employee. 
114.31     (c) The commissioner may require a certain percentage of 
114.32  participation of the individuals described in paragraph (b) 
114.33  before coverage can be offered through the program. 
114.34     Subd. 5.  [COVERAGE.] (a) The health plan offered must meet 
114.35  all applicable requirements of chapters 62A and 62D and sections 
114.36  62J.71 to 62J.73; 62M.01 to 62M.16; 62Q.1055; 62Q.106; 62Q.12; 
115.1   62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23; 62Q.43; 62Q.47; 62Q.52 
115.2   to 62Q.58; and 62Q.68 to 62Q.73.  
115.3      (b) The health plan offered must meet all underwriting 
115.4   requirements of chapter 62L and must provide periodic open 
115.5   enrollments for eligible employees where a choice in coverage 
115.6   exists. 
115.7      (c) The commissioner shall establish the benefits to be 
115.8   provided under this program in accordance with the following: 
115.9      (1) the benefits provided must comply with title XXI of the 
115.10  Social Security Act, United States Code, title 42, section 
115.11  1397aa et seq., and be at least equivalent to the lowest 
115.12  benchmark allowable under title XXI; 
115.13     (2) preventive and restorative dental services must be 
115.14  included; and 
115.15     (3) there shall be no deductibles, co-payments, or 
115.16  coinsurance requirements. 
115.17     (d) The health plan requirements described in paragraph (c) 
115.18  apply only to coverage offered to the dependents of eligible 
115.19  employees.  
115.20     Subd. 6.  [PREMIUMS.] (a) The commissioner shall determine 
115.21  premium rates and rating methods for the coverage offered 
115.22  through the program.  
115.23     (b) The commissioner shall pay the premiums for the 
115.24  dependents of eligible employees directly to the health 
115.25  maintenance organization.  
115.26     (c) Payment of any remaining premiums must be collected by 
115.27  the participating employer and paid directly to the health 
115.28  maintenance organization. 
115.29     (d) Any premiums paid by the state under this section are 
115.30  not subject to taxes or surcharges imposed under chapter 297I, 
115.31  chapter 295, or section 256.9657 and shall be excluded when 
115.32  determining a health maintenance organization's total premium 
115.33  under section 62E.11.  
115.34     <b>[EFFECTIVE DATE.]</b> This section is effective 90 days 
115.35  following approval of a federal waiver to receive enhanced 
115.36  matching funds under the state children's health insurance 
116.1   program. 
116.2      Sec. 13.  Minnesota Statutes 2000, section 256B.431, is 
116.3   amended by adding a subdivision to read: 
116.4      Subd. 31.  [EMPLOYEE SCHOLARSHIP COSTS AND TRAINING IN 
116.5   ENGLISH AS A SECOND LANGUAGE.] (a) For the rate year beginning 
116.6   July 1, 2001, the commissioner shall provide to each nursing 
116.7   facility reimbursed under this section, section 256B.434, or any 
116.8   other section an adjustment of 25 cents to the total operating 
116.9   payment rate to be used: 
116.10     (1) for employee scholarships that satisfy the following 
116.11  requirements: 
116.12     (i) scholarships are available to all employees who work an 
116.13  average of at least 20 hours per week at the facility except the 
116.14  administrator, department supervisors, registered nurses, and 
116.15  licensed practical nurses; and 
116.16     (ii) the course of study is expected to lead to employment 
116.17  in a health-related career, including medical care interpreter 
116.18  services and social work; and 
116.19     (2) to provide job-related training on the job site in 
116.20  English as a second language. 
116.21     (b) A facility receiving a rate adjustment under this 
116.22  subdivision must report to the commissioner on a form supplied 
116.23  by the commissioner the following information:  the amount 
116.24  received from this rate adjustment; the amount used for training 
116.25  in English as a second language; the number of persons receiving 
116.26  the training; the name of the person or entity providing the 
116.27  training; and for each scholarship recipient, the name of the 
116.28  recipient, the amount awarded, the educational institution 
116.29  attended, the nature of the educational program, and the program 
116.30  completion date. 
116.31     (c) Amounts spent by a facility for scholarships or for 
116.32  training in English as a second language that satisfy the 
116.33  requirements of this subdivision shall be included in the 
116.34  facility's total payment rates for the purposes of determining 
116.35  future rates under this section, section 256B.434, or any other 
116.36  section. 
117.1      Sec. 14.  Minnesota Statutes 2000, section 256B.5012, is 
117.2   amended by adding a subdivision to read: 
117.3      Subd. 4.  [EMPLOYEE SCHOLARSHIP COSTS.] (a) For the rate 
117.4   year beginning July 1, 2001, the commissioner shall provide to 
117.5   each facility reimbursed under this section an adjustment of 25 
117.6   cents to the total payment rate to be used: 
117.7      (1) for employee scholarships that satisfy the following 
117.8   requirements: 
117.9      (i) scholarships are available to all employees who work an 
117.10  average of at least 20 hours per week at the facility except the 
117.11  administrator, department supervisors, registered nurses, and 
117.12  licensed practical nurses; and 
117.13     (ii) the course of study is expected to lead to employment 
117.14  in a health-related career, including medical care interpreter 
117.15  services and social work; and 
117.16     (2) to provide job-related training on the job site in 
117.17  English as a second language. 
117.18     (b) A facility receiving a rate adjustment under this 
117.19  subdivision must report to the commissioner on a form supplied 
117.20  by the commissioner the following information:  the amount 
117.21  received from this rate adjustment; the amount used for training 
117.22  in English as a second language; the number of persons receiving 
117.23  the training; the name of the person or entity providing the 
117.24  training; and for each scholarship recipient, the name of the 
117.25  recipient, the amount awarded, the educational institution 
117.26  attended, the nature of the educational program, and the program 
117.27  completion date. 
117.28     (c) Amounts spent by a facility for scholarships or for 
117.29  training in English as a second language that satisfy the 
117.30  requirements of this subdivision shall be included in the 
117.31  facility's total payment rates for the purposes of determining 
117.32  future rates under this section or any other section. 
117.33     Sec. 15.  Minnesota Statutes 2000, section 256L.07, 
117.34  subdivision 2, is amended to read: 
117.35     Subd. 2.  [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 
117.36  COVERAGE.] (a) To be eligible, a family or individual must not 
118.1   have access to subsidized health coverage through an employer 
118.2   and must not have had access to employer-subsidized coverage 
118.3   through a current employer for 18 months prior to application or 
118.4   reapplication.  A family or individual whose employer-subsidized 
118.5   coverage is lost due to an employer terminating health care 
118.6   coverage as an employee benefit during the previous 18 months is 
118.7   not eligible.  
118.8      (b) For purposes of this requirement, subsidized health 
118.9   coverage means health coverage for which the employer pays at 
118.10  least 50 percent of the cost of coverage for the employee or 
118.11  dependent, or a higher percentage as specified by the 
118.12  commissioner.  Children are eligible for employer-subsidized 
118.13  coverage through either parent, including the noncustodial 
118.14  parent.  Children who are eligible for coverage under the 
118.15  long-term care employee health insurance assistance program 
118.16  established under section 256.956 are considered to have access 
118.17  to subsidized health coverage under this subdivision.  The 
118.18  commissioner must treat employer contributions to Internal 
118.19  Revenue Code Section 125 plans and any other employer benefits 
118.20  intended to pay health care costs as qualified employer 
118.21  subsidies toward the cost of health coverage for employees for 
118.22  purposes of this subdivision.  
118.23     <b>[EFFECTIVE DATE.]</b> This section is effective 90 days 
118.24  following approval of a federal waiver to receive enhanced 
118.25  matching funds under the state children's health insurance 
118.26  program. 
118.27     Sec. 16.  [EMPLOYEE SCHOLARSHIP COSTS.] 
118.28     (a) The commissioner of human services shall increase 
118.29  reimbursement rates by .25 percent for the providers listed in 
118.30  paragraph (d), effective for services rendered on or after July 
118.31  1, 2001, to be used: 
118.32     (1) for employee scholarships that satisfy the following 
118.33  requirements: 
118.34     (i) scholarships are available to all employees who work an 
118.35  average of at least 20 hours per week at the facility except the 
118.36  administrator, department supervisors, registered nurses, and 
119.1   licensed practical nurses; and 
119.2      (ii) the course of study is expected to lead to employment 
119.3   in a health-related career, including medical care interpreter 
119.4   services and social work; and 
119.5      (2) to provide job-related training on the job site in 
119.6   English as a second language. 
119.7      (b) A provider receiving a rate adjustment under this 
119.8   subdivision must report to the commissioner on a form supplied 
119.9   by the commissioner the following information:  the amount 
119.10  received from this rate adjustment; the amount used for training 
119.11  in English as a second language; the number of persons receiving 
119.12  the training; the name of the person or entity providing the 
119.13  training; and for each scholarship recipient, the name of the 
119.14  recipient, the amount awarded, the educational institution 
119.15  attended, the nature of the educational program, and the program 
119.16  completion date. 
119.17     (c) Amounts spent by a provider for scholarships or for 
119.18  training in English as a second language that satisfy the 
119.19  requirements of this section shall be included in the provider's 
119.20  total payment rates for the purposes of determining future rates.
119.21     (d) The rate increases described in this section shall be 
119.22  provided to home and community-based waivered services for 
119.23  persons with mental retardation or related conditions under 
119.24  Minnesota Statutes, section 256B.501; home and community-based 
119.25  waivered services for the elderly under Minnesota Statutes, 
119.26  section 256B.0915; waivered services under community 
119.27  alternatives for disabled individuals under Minnesota Statutes, 
119.28  section 256B.49; community alternative care waivered services 
119.29  under Minnesota Statutes, section 256B.49; traumatic brain 
119.30  injury waivered services under Minnesota Statutes, section 
119.31  256B.49; nursing services and home health services under 
119.32  Minnesota Statutes, section 256B.0625, subdivision 6a; personal 
119.33  care services and nursing supervision of personal care services 
119.34  under Minnesota Statutes, section 256B.0625, subdivision 19a; 
119.35  private duty nursing services under Minnesota Statutes, section 
119.36  256B.0625, subdivision 7; day training and habilitation services 
120.1   for adults with mental retardation or related conditions under 
120.2   Minnesota Statutes, sections 252.40 to 252.46; alternative care 
120.3   services under Minnesota Statutes, section 256B.0913; adult 
120.4   residential program grants under Minnesota Rules, parts 
120.5   9535.2000 to 9535.3000; adult and family community support 
120.6   grants under Minnesota Rules, parts 9535.1700 to 9535.1760; 
120.7   adult mental health integrated fund grants under Minnesota 
120.8   Statutes, section 245.4661; semi-independent living services 
120.9   under Minnesota Statutes, section 252.275, including SILS 
120.10  funding under county social services grants formerly funded 
120.11  under Minnesota Statutes, chapter 256I; community support 
120.12  services for deaf and hard-of-hearing adults with mental illness 
120.13  who use or wish to use sign language as their primary means of 
120.14  communication; and living skills training programs for persons 
120.15  with intractable epilepsy who need assistance in the transition 
120.16  to independent living. 
120.17     Sec. 17.  [CHIP WAIVER.] 
120.18     The commissioner of human services shall seek all waivers 
120.19  necessary to obtain enhanced matching funds under the state 
120.20  children's health insurance program established as title XXI of 
120.21  the Social Security Act, United States Code, title 42, section 
120.22  1397aa et seq. 
120.23     <b>[EFFECTIVE DATE.]</b> This section is effective the day 
120.24  following final enactment.  
120.25     Sec. 18.  [S-CHIP ALLOTMENT.] 
120.26     Upon federal approval of the waiver required under section 
120.27  4, the commissioner shall claim eligible expenditures against 
120.28  Minnesota's available funding under the state children's health 
120.29  insurance program in the following order: 
120.30     (1) expenditures made according to Minnesota Statutes, 
120.31  section 256B.057, subdivision 8; 
120.32     (2) expenditures for outreach and other state or local 
120.33  expenditures that are authorized to be claimed under Laws 1998, 
120.34  chapter 407, article 5, section 46; 
120.35     (3) expenditures under the long-term care employee health 
120.36  insurance assistance program; and 
121.1      (4) expenditures that may be eligible for matching funds 
121.2   under S-CHIP that otherwise may be claimed as Medicaid 
121.3   expenditures. 
121.4      <b>[EFFECTIVE DATE.]</b> This section is effective the day 
121.5   following final enactment. 
121.6      Sec. 19.  [APPROPRIATIONS.] 
121.7      Subdivision 1.  [SUMMER HEALTH CARE INTERN 
121.8   PROGRAM.] $....... is appropriated from the general fund to the 
121.9   commissioner of health for the biennium ending June 30, 2003, to 
121.10  expand eligibility for the summer health care intern program and 
121.11  to increase the number of internships funded. 
121.12     Subd. 2.  [NURSE LOAN FORGIVENESS PROGRAM.] $....... is 
121.13  appropriated from the general fund to the commissioner of health 
121.14  for the biennium ending June 30, 2003, to expand the nurse loan 
121.15  forgiveness program. 
121.16     Subd. 3.  [SCHOLARSHIPS AND ENGLISH AS A SECOND LANGUAGE 
121.17  TRAINING.] $....... is appropriated from the general fund to the 
121.18  commissioner of human services for the biennium beginning July 
121.19  1, 2001, for the purposes of sections 13, 14, and 16. 
121.20     Subd. 4.  [MINNESOTA JOB SKILLS.] $....... is appropriated 
121.21  from the general fund to the Minnesota job skills partnership 
121.22  board for the biennium ending June 30, 2003, to fund the health 
121.23  care and human services worker training program. 
121.24     Subd. 5.  [LONG-TERM CARE EMPLOYEE HEALTH INSURANCE 
121.25  ASSISTANCE PROGRAM.] $....... is appropriated in the biennium 
121.26  ending June 30, 2003, from the general fund to the commissioner 
121.27  of human services for the long-term care employee health 
121.28  insurance assistance program. 
121.29     Sec. 20.  [REPEALER.] 
121.30     Minnesota Statutes 2000, sections 116L.10; and 116L.12, 
121.31  subdivisions 2 and 7, are repealed. 
121.32                             ARTICLE 4
121.33                     REGULATION OF SUPPLEMENTAL
121.34                     NURSING SERVICES AGENCIES
121.35     Section 1.  Minnesota Statutes 2000, section 144.057, is 
121.36  amended to read: 
122.1      144.057 [BACKGROUND STUDIES ON LICENSEES AND SUPPLEMENTAL 
122.2   NURSING SERVICES AGENCY PERSONNEL.] 
122.3      Subdivision 1.  [BACKGROUND STUDIES REQUIRED.] The 
122.4   commissioner of health shall contract with the commissioner of 
122.5   human services to conduct background studies of: 
122.6      (1) individuals providing services which have direct 
122.7   contact, as defined under section 245A.04, subdivision 3, with 
122.8   patients and residents in hospitals, boarding care homes, 
122.9   outpatient surgical centers licensed under sections 144.50 to 
122.10  144.58; nursing homes and home care agencies licensed under 
122.11  chapter 144A; residential care homes licensed under chapter 
122.12  144B, and board and lodging establishments that are registered 
122.13  to provide supportive or health supervision services under 
122.14  section 157.17; ~~and~~ 
122.15     (2) beginning July 1, 1999, all other employees in nursing 
122.16  homes licensed under chapter 144A, and boarding care homes 
122.17  licensed under sections 144.50 to 144.58.  A disqualification of 
122.18  an individual in this section shall disqualify the individual 
122.19  from positions allowing direct contact or access to patients or 
122.20  residents receiving services; 
122.21     (3) individuals employed by a supplemental nursing services 
122.22  agency, as defined under section 144A.70, who are providing 
122.23  services in health care facilities; and 
122.24     (4) controlling persons of a supplemental nursing services 
122.25  agency, as defined under section 144A.70. 
122.26     If a facility or program is licensed by the department of 
122.27  human services and subject to the background study provisions of 
122.28  chapter 245A and is also licensed by the department of health, 
122.29  the department of human services is solely responsible for the 
122.30  background studies of individuals in the jointly licensed 
122.31  programs. 
122.32     Subd. 2.  [RESPONSIBILITIES OF DEPARTMENT OF HUMAN 
122.33  SERVICES.] The department of human services shall conduct the 
122.34  background studies required by subdivision 1 in compliance with 
122.35  the provisions of chapter 245A and Minnesota Rules, parts 
122.36  9543.3000 to 9543.3090.  For the purpose of this section, the 
123.1   term "residential program" shall include all facilities 
123.2   described in subdivision 1.  The department of human services 
123.3   shall provide necessary forms and instructions, shall conduct 
123.4   the necessary background studies of individuals, and shall 
123.5   provide notification of the results of the studies to the 
123.6   facilities, supplemental nursing services agencies, individuals, 
123.7   and the commissioner of health.  Individuals shall be 
123.8   disqualified under the provisions of chapter 245A and Minnesota 
123.9   Rules, parts 9543.3000 to 9543.3090.  If an individual is 
123.10  disqualified, the department of human services shall notify the 
123.11  facility, the supplemental nursing services agency, and the 
123.12  individual and shall inform the individual of the right to 
123.13  request a reconsideration of the disqualification by submitting 
123.14  the request to the department of health. 
123.15     Subd. 3.  [RECONSIDERATIONS.] The commissioner of health 
123.16  shall review and decide reconsideration requests, including the 
123.17  granting of variances, in accordance with the procedures and 
123.18  criteria contained in chapter 245A and Minnesota Rules, parts 
123.19  9543.3000 to 9543.3090.  The commissioner's decision shall be 
123.20  provided to the individual and to the department of human 
123.21  services.  The commissioner's decision to grant or deny a 
123.22  reconsideration of disqualification is the final administrative 
123.23  agency action. 
123.24     Subd. 4.  [RESPONSIBILITIES OF FACILITIES AND AGENCIES.] 
123.25  Facilities and agencies described in subdivision 1 shall be 
123.26  responsible for cooperating with the departments in implementing 
123.27  the provisions of this section.  The responsibilities imposed on 
123.28  applicants and licensees under chapter 245A and Minnesota Rules, 
123.29  parts 9543.3000 to 9543.3090, shall apply to these 
123.30  facilities and supplemental nursing services agencies.  The 
123.31  provision of section 245A.04, subdivision 3, paragraph (e), 
123.32  shall apply to applicants, licensees, registrants, or an 
123.33  individual's refusal to cooperate with the completion of the 
123.34  background studies.  Supplemental nursing services agencies 
123.35  subject to the registration requirements in section 144A.71 must 
123.36  maintain records verifying compliance with the background study 
124.1   requirements under this section. 
124.2      Sec. 2.  [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING 
124.3   SERVICES AGENCIES; DEFINITIONS.] 
124.4      Subdivision 1.  [SCOPE.] As used in sections 144A.70 to 
124.5   144A.74, the terms defined in this section have the meanings 
124.6   given them. 
124.7      Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
124.8   commissioner of health. 
124.9      Subd. 3.  [CONTROLLING PERSON.] "Controlling person" means 
124.10  a business entity, officer, program administrator, or director 
124.11  whose responsibilities include the direction of the management 
124.12  or policies of a supplemental nursing services agency.  
124.13  Controlling person also means an individual who, directly or 
124.14  indirectly, beneficially owns an interest in a corporation, 
124.15  partnership, or other business association that is a controlling 
124.16  person. 
124.17     Subd. 4.  [HEALTH CARE FACILITY.] "Health care facility" 
124.18  means a hospital, boarding care home, or outpatient surgical 
124.19  center licensed under sections 144.50 to 144.58; a nursing home 
124.20  or home care agency licensed under chapter 144A; a housing with 
124.21  services establishment registered under chapter 144D; or a board 
124.22  and lodging establishment that is registered to provide 
124.23  supportive or health supervision services under section 157.17. 
124.24     Subd. 5.  [PERSON.] "Person" includes an individual, firm, 
124.25  corporation, partnership, or association. 
124.26     Subd. 6.  [SUPPLEMENTAL NURSING SERVICES 
124.27  AGENCY.] "Supplemental nursing services agency" means a person, 
124.28  firm, corporation, partnership, or association engaged for hire 
124.29  in the business of providing or procuring temporary employment 
124.30  in health care facilities for nurses, nursing assistants, nurse 
124.31  aides, and orderlies.  Supplemental nursing services agency does 
124.32  not include an individual who only engages in providing the 
124.33  individual's services on a temporary basis to health care 
124.34  facilities.  Supplemental nursing services agency also does not 
124.35  include any nursing service agency that is limited to providing 
124.36  temporary nursing personnel solely to one or more health care 
125.1   facilities owned or operated by the same person, firm, 
125.2   corporation, or partnership. 
125.3      Sec. 3.  [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY 
125.4   REGISTRATION.] 
125.5      Subdivision 1.  [DUTY TO REGISTER.] A person who operates a 
125.6   supplemental nursing services agency shall register the agency 
125.7   with the commissioner.  Each separate location of the business 
125.8   of a supplemental nursing services agency shall register the 
125.9   agency with the commissioner.  Each separate location of the 
125.10  business of a supplemental nursing services agency shall have a 
125.11  separate registration. 
125.12     Subd. 2.  [APPLICATION INFORMATION AND FEE.] The 
125.13  commissioner shall establish forms and procedures for processing 
125.14  each supplemental nursing services agency registration 
125.15  application.  An application for a supplemental nursing services 
125.16  agency registration must include at least the following: 
125.17     (1) the names and addresses of the owner or owners of the 
125.18  supplemental nursing services agency; 
125.19     (2) if the owner is a corporation, copies of its articles 
125.20  of incorporation and current bylaws, together with the names and 
125.21  addresses of its officers and directors; 
125.22     (3) any other relevant information that the commissioner 
125.23  determines is necessary to properly evaluate an application for 
125.24  registration; and 
125.25     (4) the annual registration fee for a supplemental nursing 
125.26  services agency, which is $........ 
125.27     Subd. 3.  [REGISTRATION NOT TRANSFERABLE.] A registration 
125.28  issued by the commissioner according to this section is 
125.29  effective for a period of one year from the date of its issuance 
125.30  unless the registration is revoked or suspended under section 
125.31  144A.72, subdivision 2, or unless the supplemental nursing 
125.32  services agency is sold or ownership or management is 
125.33  transferred.  When a supplemental nursing services agency is 
125.34  sold or ownership or management is transferred, the registration 
125.35  of the agency must be voided and the new owner or operator may 
125.36  apply for a new registration. 
126.1      Sec. 4.  [144A.72] [REGISTRATION REQUIREMENTS; PENALTIES.] 
126.2      Subdivision 1.  [MINIMUM CRITERIA.] The commissioner shall 
126.3   require that, as a condition of registration: 
126.4      (1) the supplemental nursing services agency shall document 
126.5   that each temporary employee provided to health care facilities 
126.6   currently meets the minimum licensing, training, and continuing 
126.7   education standards for the position in which the employee will 
126.8   be working; 
126.9      (2) the supplemental nursing services agency shall comply 
126.10  with all pertinent requirements relating to the health and other 
126.11  qualifications of personnel employed in health care facilities; 
126.12     (3) the supplemental nursing services agency must not 
126.13  restrict in any manner the employment opportunities of its 
126.14  employees; 
126.15     (4) the supplemental nursing services agency, when 
126.16  supplying temporary employees to a health care facility, and 
126.17  when requested by the facility to do so, shall agree that at 
126.18  least 30 percent of the total personnel hours supplied are 
126.19  during night, holiday, or weekend shifts; 
126.20     (5) the supplemental nursing services agency shall carry 
126.21  medical malpractice insurance to insure against the loss, 
126.22  damage, or expense incident to a claim arising out of the death 
126.23  or injury of any person as the result of negligence or 
126.24  malpractice in the provision of health care services by the 
126.25  supplemental nursing services agency or by any employee of the 
126.26  agency; and 
126.27     (6) the supplemental nursing services agency must not, in 
126.28  any contract with any employee or health care facility, require 
126.29  the payment of liquidated damages, employment fees, or other 
126.30  compensation should the employee be hired as a permanent 
126.31  employee of a health care facility. 
126.32     Subd. 2.  [PENALTIES.] Violations of section 144A.74 are 
126.33  subject to a fine equal to 200 percent of the amount billed or 
126.34  received in excess of the maximum permitted under that section. 
126.35     Sec. 5.  [144A.73] [COMPLAINT SYSTEM.] 
126.36     The commissioner shall establish a system for reporting 
127.1   complaints against a supplemental nursing services agency or its 
127.2   employees.  Complaints may be made by any member of the public.  
127.3   Written complaints must be forwarded to the employer of each 
127.4   person against whom a complaint is made.  The employer shall 
127.5   promptly report to the commissioner any corrective action taken. 
127.6      Sec. 6.  [144A.74] [MAXIMUM CHARGES.] 
127.7      A supplemental nursing services agency must not bill or 
127.8   receive payments from a health care facility at a rate higher 
127.9   than 150 percent of the average wage rate by employee 
127.10  classification as identified by the commissioner of economic 
127.11  security.  The maximum rate must include all charges for 
127.12  administrative fees, contract fees, or other special charges in 
127.13  addition to the hourly rates for the temporary nursing pool 
127.14  personnel supplied to a nursing home. 
127.15     Sec. 7.  Minnesota Statutes 2000, section 245A.04, 
127.16  subdivision 3, is amended to read: 
127.17     Subd. 3.  [BACKGROUND STUDY OF THE APPLICANT; DEFINITIONS.] 
127.18  (a) Before the commissioner issues a license, the commissioner 
127.19  shall conduct a study of the individuals specified in paragraph 
127.20  ~~(c)~~ (d), clauses (1) to (5), according to rules of the 
127.21  commissioner. 
127.22     Beginning January 1, 1997, the commissioner shall also 
127.23  conduct a study of employees providing direct contact services 
127.24  for nonlicensed personal care provider organizations described 
127.25  in paragraph ~~(c)~~ (d), clause (5). 
127.26     The commissioner shall recover the cost of these background 
127.27  studies through a fee of no more than $12 per study charged to 
127.28  the personal care provider organization.  
127.29     Beginning August 1, 1997, the commissioner shall conduct 
127.30  all background studies required under this chapter for adult 
127.31  foster care providers who are licensed by the commissioner of 
127.32  human services and registered under chapter 144D.  The 
127.33  commissioner shall conduct these background studies in 
127.34  accordance with this chapter.  The commissioner shall initiate a 
127.35  pilot project to conduct up to 5,000 background studies under 
127.36  this chapter in programs with joint licensure as home and 
128.1   community-based services and adult foster care for people with 
128.2   developmental disabilities when the license holder does not 
128.3   reside in the foster care residence. 
128.4      (b) Beginning July 1, 1998, the commissioner shall conduct 
128.5   a background study on individuals specified in 
128.6   paragraph ~~(c)~~ (d), clauses (1) to (5), who perform direct 
128.7   contact services in a nursing home or a home care agency 
128.8   licensed under chapter 144A or a boarding care home licensed 
128.9   under sections 144.50 to 144.58, when the subject of the study 
128.10  resides outside Minnesota; the study must be at least as 
128.11  comprehensive as that of a Minnesota resident and include a 
128.12  search of information from the criminal justice data 
128.13  communications network in the state where the subject of the 
128.14  study resides. 
128.15     (c) Beginning August 1, 2001, the commissioner shall 
128.16  conduct all background studies required under this chapter and 
128.17  initiated by supplemental nursing services agencies registered 
128.18  under chapter 144A.  Studies for the agencies must be initiated 
128.19  annually by each agency.  The commissioner shall conduct the 
128.20  background studies according to this chapter.  The commissioner 
128.21  shall recover the cost of the background studies through a fee 
128.22  of no more than $....... per study, charged to the supplemental 
128.23  nursing services agency. 
128.24     (d) The applicant, license holder, ~~the~~ registrant, bureau 
128.25  of criminal apprehension, ~~the~~ commissioner of health, and county 
128.26  agencies, after written notice to the individual who is the 
128.27  subject of the study, shall help with the study by giving the 
128.28  commissioner criminal conviction data and reports about the 
128.29  maltreatment of adults substantiated under section 626.557 and 
128.30  the maltreatment of minors in licensed programs substantiated 
128.31  under section 626.556.  The individuals to be studied shall 
128.32  include: 
128.33     (1) the applicant; 
128.34     (2) persons over the age of 13 living in the household 
128.35  where the licensed program will be provided; 
128.36     (3) current employees or contractors of the applicant who 
129.1   will have direct contact with persons served by the facility, 
129.2   agency, or program; 
129.3      (4) volunteers or student volunteers who have direct 
129.4   contact with persons served by the program to provide program 
129.5   services, if the contact is not directly supervised by the 
129.6   individuals listed in clause (1) or (3); and 
129.7      (5) any person who, as an individual or as a member of an 
129.8   organization, exclusively offers, provides, or arranges for 
129.9   personal care assistant services under the medical assistance 
129.10  program as authorized under sections 256B.04, subdivision 16, 
129.11  and 256B.0625, subdivision 19a. 
129.12     The juvenile courts shall also help with the study by 
129.13  giving the commissioner existing juvenile court records on 
129.14  individuals described in clause (2) relating to delinquency 
129.15  proceedings held within either the five years immediately 
129.16  preceding the application or the five years immediately 
129.17  preceding the individual's 18th birthday, whichever time period 
129.18  is longer.  The commissioner shall destroy juvenile records 
129.19  obtained pursuant to this subdivision when the subject of the 
129.20  records reaches age 23.  
129.21     For purposes of this section and Minnesota Rules, part 
129.22  9543.3070, a finding that a delinquency petition is proven in 
129.23  juvenile court shall be considered a conviction in state 
129.24  district court. 
129.25     For purposes of this subdivision, "direct contact" means 
129.26  providing face-to-face care, training, supervision, counseling, 
129.27  consultation, or medication assistance to persons served by a 
129.28  program.  For purposes of this subdivision, "directly supervised"
129.29  means an individual listed in clause (1), (3), or (5) is within 
129.30  sight or hearing of a volunteer to the extent that the 
129.31  individual listed in clause (1), (3), or (5) is capable at all 
129.32  times of intervening to protect the health and safety of the 
129.33  persons served by the program who have direct contact with the 
129.34  volunteer. 
129.35     A study of an individual in clauses (1) to (5) shall be 
129.36  conducted at least upon application for initial license or 
130.1   registration and reapplication for a license or registration.  
130.2   The commissioner is not required to conduct a study of an 
130.3   individual at the time of reapplication for a license or if the 
130.4   individual has been continuously affiliated with a foster care 
130.5   provider licensed by the commissioner of human services and 
130.6   registered under chapter 144D, other than a family day care or 
130.7   foster care license, if:  (i) a study of the individual was 
130.8   conducted either at the time of initial licensure or when the 
130.9   individual became affiliated with the license holder; (ii) the 
130.10  individual has been continuously affiliated with the license 
130.11  holder since the last study was conducted; and (iii) the 
130.12  procedure described in paragraph ~~(d)~~ (e) has been implemented 
130.13  and was in effect continuously since the last study was 
130.14  conducted.  For the purposes of this section, a physician 
130.15  licensed under chapter 147 is considered to be continuously 
130.16  affiliated upon the license holder's receipt from the 
130.17  commissioner of health or human services of the physician's 
130.18  background study results.  For individuals who are required to 
130.19  have background studies under clauses (1) to (5) and who have 
130.20  been continuously affiliated with a foster care provider that is 
130.21  licensed in more than one county, criminal conviction data may 
130.22  be shared among those counties in which the foster care programs 
130.23  are licensed.  A county agency's receipt of criminal conviction 
130.24  data from another county agency shall meet the criminal data 
130.25  background study requirements of this section. 
130.26     The commissioner may also conduct studies on individuals 
130.27  specified in clauses (3) and (4) when the studies are initiated 
130.28  by: 
130.29     (i) personnel pool agencies; 
130.30     (ii) temporary personnel agencies; 
130.31     (iii) educational programs that train persons by providing 
130.32  direct contact services in licensed programs; and 
130.33     (iv) professional services agencies that are not licensed 
130.34  and which contract with licensed programs to provide direct 
130.35  contact services or individuals who provide direct contact 
130.36  services. 
131.1      Studies on individuals in items (i) to (iv) must be 
131.2   initiated annually by these agencies, programs, and 
131.3   individuals.  Except for personal care provider 
131.4   organizations and supplemental nursing services agencies, no 
131.5   applicant, license holder, or individual who is the subject of 
131.6   the study shall pay any fees required to conduct the study. 
131.7      (1) At the option of the licensed facility, rather than 
131.8   initiating another background study on an individual required to 
131.9   be studied who has indicated to the licensed facility that a 
131.10  background study by the commissioner was previously completed, 
131.11  the facility may make a request to the commissioner for 
131.12  documentation of the individual's background study status, 
131.13  provided that: 
131.14     (i) the facility makes this request using a form provided 
131.15  by the commissioner; 
131.16     (ii) in making the request the facility informs the 
131.17  commissioner that either: 
131.18     (A) the individual has been continuously affiliated with a 
131.19  licensed facility since the individual's previous background 
131.20  study was completed, or since October 1, 1995, whichever is 
131.21  shorter; or 
131.22     (B) the individual is affiliated only with a personnel pool 
131.23  agency, a temporary personnel agency, an educational program 
131.24  that trains persons by providing direct contact services in 
131.25  licensed programs, or a professional services agency that is not 
131.26  licensed and which contracts with licensed programs to provide 
131.27  direct contact services or individuals who provide direct 
131.28  contact services; and 
131.29     (iii) the facility provides notices to the individual as 
131.30  required in paragraphs (a) to ~~(d)~~ (e), and that the facility is 
131.31  requesting written notification of the individual's background 
131.32  study status from the commissioner.  
131.33     (2) The commissioner shall respond to each request under 
131.34  paragraph (1) with a written or electronic notice to the 
131.35  facility and the study subject.  If the commissioner determines 
131.36  that a background study is necessary, the study shall be 
132.1   completed without further request from a licensed agency or 
132.2   notifications to the study subject.  
132.3      (3) When a background study is being initiated by a 
132.4   licensed facility or a foster care provider that is also 
132.5   registered under chapter 144D, a study subject affiliated with 
132.6   multiple licensed facilities may attach to the background study 
132.7   form a cover letter indicating the additional facilities' names, 
132.8   addresses, and background study identification numbers.  When 
132.9   the commissioner receives such notices, each facility identified 
132.10  by the background study subject shall be notified of the study 
132.11  results.  The background study notice sent to the subsequent 
132.12  agencies shall satisfy those facilities' responsibilities for 
132.13  initiating a background study on that individual. 
132.14     ~~(d)~~ (e) If an individual who is affiliated with a program 
132.15  or facility regulated by the department of human services or 
132.16  department of health or who is affiliated with a nonlicensed 
132.17  personal care provider organization, is convicted of a crime 
132.18  constituting a disqualification under subdivision 3d, the 
132.19  probation officer or corrections agent shall notify the 
132.20  commissioner of the conviction.  The commissioner, in 
132.21  consultation with the commissioner of corrections, shall develop 
132.22  forms and information necessary to implement this paragraph and 
132.23  shall provide the forms and information to the commissioner of 
132.24  corrections for distribution to local probation officers and 
132.25  corrections agents.  The commissioner shall inform individuals 
132.26  subject to a background study that criminal convictions for 
132.27  disqualifying crimes will be reported to the commissioner by the 
132.28  corrections system.  A probation officer, corrections agent, or 
132.29  corrections agency is not civilly or criminally liable for 
132.30  disclosing or failing to disclose the information required by 
132.31  this paragraph.  Upon receipt of disqualifying information, the 
132.32  commissioner shall provide the notifications required in 
132.33  subdivision 3a, as appropriate to agencies on record as having 
132.34  initiated a background study or making a request for 
132.35  documentation of the background study status of the individual.  
132.36  This paragraph does not apply to family day care and child 
133.1   foster care programs. 
133.2      ~~(e)~~ (f) The individual who is the subject of the study must 
133.3   provide the applicant or license holder with sufficient 
133.4   information to ensure an accurate study including the 
133.5   individual's first, middle, and last name; home address, city, 
133.6   county, and state of residence for the past five years; zip 
133.7   code; sex; date of birth; and driver's license number.  The 
133.8   applicant or license holder shall provide this information about 
133.9   an individual in paragraph ~~(c)~~ (d), clauses (1) to (5), on forms 
133.10  prescribed by the commissioner.  By January 1, 2000, for 
133.11  background studies conducted by the department of human 
133.12  services, the commissioner shall implement a system for the 
133.13  electronic transmission of:  (1) background study information to 
133.14  the commissioner; and (2) background study results to the 
133.15  license holder.  The commissioner may request additional 
133.16  information of the individual, which shall be optional for the 
133.17  individual to provide, such as the individual's social security 
133.18  number or race. 
133.19     ~~(f)~~ (g) Except for child foster care, adult foster care, 
133.20  and family day care homes, a study must include information 
133.21  related to names of substantiated perpetrators of maltreatment 
133.22  of vulnerable adults that has been received by the commissioner 
133.23  as required under section 626.557, subdivision 9c, paragraph 
133.24  (i), and the commissioner's records relating to the maltreatment 
133.25  of minors in licensed programs, information from juvenile courts 
133.26  as required in paragraph ~~(c)~~ (d) for persons listed in paragraph 
133.27  ~~(c)~~ (d), clause (2), and information from the bureau of criminal 
133.28  apprehension.  For child foster care, adult foster care, and 
133.29  family day care homes, the study must include information from 
133.30  the county agency's record of substantiated maltreatment of 
133.31  adults, and the maltreatment of minors, information from 
133.32  juvenile courts as required in paragraph ~~(c)~~ (d) for persons 
133.33  listed in paragraph ~~(c)~~ (d), clause (2), and information from 
133.34  the bureau of criminal apprehension.  The commissioner may also 
133.35  review arrest and investigative information from the bureau of 
133.36  criminal apprehension, the commissioner of health, a county 
134.1   attorney, county sheriff, county agency, local chief of police, 
134.2   other states, the courts, or the Federal Bureau of Investigation 
134.3   if the commissioner has reasonable cause to believe the 
134.4   information is pertinent to the disqualification of an 
134.5   individual listed in paragraph ~~(c)~~ (d), clauses (1) to (5).  The 
134.6   commissioner is not required to conduct more than one review of 
134.7   a subject's records from the Federal Bureau of Investigation if 
134.8   a review of the subject's criminal history with the Federal 
134.9   Bureau of Investigation has already been completed by the 
134.10  commissioner and there has been no break in the subject's 
134.11  affiliation with the license holder who initiated the background 
134.12  studies. 
134.13     When the commissioner has reasonable cause to believe that 
134.14  further pertinent information may exist on the subject, the 
134.15  subject shall provide a set of classifiable fingerprints 
134.16  obtained from an authorized law enforcement agency.  For 
134.17  purposes of requiring fingerprints, the commissioner shall be 
134.18  considered to have reasonable cause under, but not limited to, 
134.19  the following circumstances: 
134.20     (1) information from the bureau of criminal apprehension 
134.21  indicates that the subject is a multistate offender; 
134.22     (2) information from the bureau of criminal apprehension 
134.23  indicates that multistate offender status is undetermined; or 
134.24     (3) the commissioner has received a report from the subject 
134.25  or a third party indicating that the subject has a criminal 
134.26  history in a jurisdiction other than Minnesota. 
134.27     ~~(g)~~ (h) An applicant's ~~or~~, license holder's, or 
134.28  registrant's failure or refusal to cooperate with the 
134.29  commissioner is reasonable cause to disqualify a subject, deny a 
134.30  license application or immediately suspend, suspend, or revoke a 
134.31  license or registration.  Failure or refusal of an individual to 
134.32  cooperate with the study is just cause for denying or 
134.33  terminating employment of the individual if the individual's 
134.34  failure or refusal to cooperate could cause the applicant's 
134.35  application to be denied or the license holder's license to be 
134.36  immediately suspended, suspended, or revoked. 
135.1      ~~(h)~~ (i) The commissioner shall not consider an application 
135.2   to be complete until all of the information required to be 
135.3   provided under this subdivision has been received.  
135.4      ~~(i)~~ (j) No person in paragraph ~~(c)~~ (d), clause (1), (2), 
135.5   (3), (4), or (5), who is disqualified as a result of this 
135.6   section may be retained by the agency in a position involving 
135.7   direct contact with persons served by the program. 
135.8      ~~(j)~~ (k) Termination of persons in paragraph ~~(c)~~ (d), clause 
135.9   (1), (2), (3), (4), or (5), made in good faith reliance on a 
135.10  notice of disqualification provided by the commissioner shall 
135.11  not subject the applicant or license holder to civil liability. 
135.12     ~~(k)~~ (l) The commissioner may establish records to fulfill 
135.13  the requirements of this section. 
135.14     ~~(l)~~ (m) The commissioner may not disqualify an individual 
135.15  subject to a study under this section because that person has, 
135.16  or has had, a mental illness as defined in section 245.462, 
135.17  subdivision 20. 
135.18     ~~(m)~~ (n) An individual subject to disqualification under 
135.19  this subdivision has the applicable rights in subdivision 3a, 
135.20  3b, or 3c. 
135.21     ~~(n)~~ (o) For the purposes of background studies completed by 
135.22  tribal organizations performing licensing activities otherwise 
135.23  required of the commissioner under this chapter, after obtaining 
135.24  consent from the background study subject, tribal licensing 
135.25  agencies shall have access to criminal history data in the same 
135.26  manner as county licensing agencies and private licensing 
135.27  agencies under this chapter. 
135.28     Sec. 8.  Minnesota Statutes 2000, section 245A.04, 
135.29  subdivision 3a, is amended to read: 
135.30     Subd. 3a.  [NOTIFICATION TO SUBJECT AND LICENSE HOLDER OF 
135.31  STUDY RESULTS; DETERMINATION OF RISK OF HARM.] (a) The 
135.32  commissioner shall notify the applicant ~~or~~, license holder, or 
135.33  registrant and the individual who is the subject of the study, 
135.34  in writing or by electronic transmission, of the results of the 
135.35  study.  When the study is completed, a notice that the study was 
135.36  undertaken and completed shall be maintained in the personnel 
136.1   files of the program.  For studies on individuals pertaining to 
136.2   a license to provide family day care or group family day care, 
136.3   foster care for children in the provider's own home, or foster 
136.4   care or day care services for adults in the provider's own home, 
136.5   the commissioner is not required to provide a separate notice of 
136.6   the background study results to the individual who is the 
136.7   subject of the study unless the study results in a 
136.8   disqualification of the individual. 
136.9      The commissioner shall notify the individual studied if the 
136.10  information in the study indicates the individual is 
136.11  disqualified from direct contact with persons served by the 
136.12  program.  The commissioner shall disclose the information 
136.13  causing disqualification and instructions on how to request a 
136.14  reconsideration of the disqualification to the individual 
136.15  studied.  An applicant or license holder who is not the subject 
136.16  of the study shall be informed that the commissioner has found 
136.17  information that disqualifies the subject from direct contact 
136.18  with persons served by the program.  However, only the 
136.19  individual studied must be informed of the information contained 
136.20  in the subject's background study unless the only basis for the 
136.21  disqualification is failure to cooperate, the Data Practices Act 
136.22  provides for release of the information, or the individual 
136.23  studied authorizes the release of the information. 
136.24     (b) If the commissioner determines that the individual 
136.25  studied has a disqualifying characteristic, the commissioner 
136.26  shall review the information immediately available and make a 
136.27  determination as to the subject's immediate risk of harm to 
136.28  persons served by the program where the individual studied will 
136.29  have direct contact.  The commissioner shall consider all 
136.30  relevant information available, including the following factors 
136.31  in determining the immediate risk of harm:  the recency of the 
136.32  disqualifying characteristic; the recency of discharge from 
136.33  probation for the crimes; the number of disqualifying 
136.34  characteristics; the intrusiveness or violence of the 
136.35  disqualifying characteristic; the vulnerability of the victim 
136.36  involved in the disqualifying characteristic; and the similarity 
137.1   of the victim to the persons served by the program where the 
137.2   individual studied will have direct contact.  The commissioner 
137.3   may determine that the evaluation of the information immediately 
137.4   available gives the commissioner reason to believe one of the 
137.5   following: 
137.6      (1) The individual poses an imminent risk of harm to 
137.7   persons served by the program where the individual studied will 
137.8   have direct contact.  If the commissioner determines that an 
137.9   individual studied poses an imminent risk of harm to persons 
137.10  served by the program where the individual studied will have 
137.11  direct contact, the individual and the license holder must be 
137.12  sent a notice of disqualification.  The commissioner shall order 
137.13  the license holder to immediately remove the individual studied 
137.14  from direct contact.  The notice to the individual studied must 
137.15  include an explanation of the basis of this determination. 
137.16     (2) The individual poses a risk of harm requiring 
137.17  continuous supervision while providing direct contact services 
137.18  during the period in which the subject may request a 
137.19  reconsideration.  If the commissioner determines that an 
137.20  individual studied poses a risk of harm that requires continuous 
137.21  supervision, the individual and the license holder must be sent 
137.22  a notice of disqualification.  The commissioner shall order the 
137.23  license holder to immediately remove the individual studied from 
137.24  direct contact services or assure that the individual studied is 
137.25  within sight or hearing of another staff person when providing 
137.26  direct contact services during the period in which the 
137.27  individual may request a reconsideration of the 
137.28  disqualification.  If the individual studied does not submit a 
137.29  timely request for reconsideration, or the individual submits a 
137.30  timely request for reconsideration, but the disqualification is 
137.31  not set aside for that license holder, the license holder will 
137.32  be notified of the disqualification and ordered to immediately 
137.33  remove the individual from any position allowing direct contact 
137.34  with persons receiving services from the license holder. 
137.35     (3) The individual does not pose an imminent risk of harm 
137.36  or a risk of harm requiring continuous supervision while 
138.1   providing direct contact services during the period in which the 
138.2   subject may request a reconsideration.  If the commissioner 
138.3   determines that an individual studied does not pose a risk of 
138.4   harm that requires continuous supervision, only the individual 
138.5   must be sent a notice of disqualification.  The license holder 
138.6   must be sent a notice that more time is needed to complete the 
138.7   individual's background study.  If the individual studied 
138.8   submits a timely request for reconsideration, and if the 
138.9   disqualification is set aside for that license holder, the 
138.10  license holder will receive the same notification received by 
138.11  license holders in cases where the individual studied has no 
138.12  disqualifying characteristic.  If the individual studied does 
138.13  not submit a timely request for reconsideration, or the 
138.14  individual submits a timely request for reconsideration, but the 
138.15  disqualification is not set aside for that license holder, the 
138.16  license holder will be notified of the disqualification and 
138.17  ordered to immediately remove the individual from any position 
138.18  allowing direct contact with persons receiving services from the 
138.19  license holder.  
138.20     (c) County licensing agencies performing duties under this 
138.21  subdivision may develop an alternative system for determining 
138.22  the subject's immediate risk of harm to persons served by the 
138.23  program, providing the notices under paragraph (b), and 
138.24  documenting the action taken by the county licensing agency.  
138.25  Each county licensing agency's implementation of the alternative 
138.26  system is subject to approval by the commissioner.  
138.27  Notwithstanding this alternative system, county licensing 
138.28  agencies shall complete the requirements of paragraph (a). 
138.29     Sec. 9.  Minnesota Statutes 2000, section 245A.04, 
138.30  subdivision 3b, is amended to read: 
138.31     Subd. 3b.  [RECONSIDERATION OF DISQUALIFICATION.] (a) The 
138.32  individual who is the subject of the disqualification may 
138.33  request a reconsideration of the disqualification.  
138.34     The individual must submit the request for reconsideration 
138.35  to the commissioner in writing.  A request for reconsideration 
138.36  for an individual who has been sent a notice of disqualification 
139.1   under subdivision 3a, paragraph (b), clause (1) or (2), must be 
139.2   submitted within 30 calendar days of the disqualified 
139.3   individual's receipt of the notice of disqualification.  A 
139.4   request for reconsideration for an individual who has been sent 
139.5   a notice of disqualification under subdivision 3a, paragraph 
139.6   (b), clause (3), must be submitted within 15 calendar days of 
139.7   the disqualified individual's receipt of the notice of 
139.8   disqualification.  Removal of a disqualified individual from 
139.9   direct contact shall be ordered if the individual does not 
139.10  request reconsideration within the prescribed time, and for an 
139.11  individual who submits a timely request for reconsideration, if 
139.12  the disqualification is not set aside.  The individual must 
139.13  present information showing that: 
139.14     (1) the information the commissioner relied upon is 
139.15  incorrect or inaccurate.  If the basis of a reconsideration 
139.16  request is that a maltreatment determination or disposition 
139.17  under section 626.556 or 626.557 is incorrect, and the 
139.18  commissioner has issued a final order in an appeal of that 
139.19  determination or disposition under section 256.045, the 
139.20  commissioner's order is conclusive on the issue of maltreatment; 
139.21  or 
139.22     (2) the subject of the study does not pose a risk of harm 
139.23  to any person served by the applicant ~~or~~, license holder, or 
139.24  registrant. 
139.25     (b) The commissioner may set aside the disqualification 
139.26  under this section if the commissioner finds that the 
139.27  information the commissioner relied upon is incorrect or the 
139.28  individual does not pose a risk of harm to any person served by 
139.29  the applicant ~~or~~, license holder, or registrant.  In determining 
139.30  that an individual does not pose a risk of harm, the 
139.31  commissioner shall consider the consequences of the event or 
139.32  events that lead to disqualification, whether there is more than 
139.33  one disqualifying event, the vulnerability of the victim at the 
139.34  time of the event, the time elapsed without a repeat of the same 
139.35  or similar event, documentation of successful completion by the 
139.36  individual studied of training or rehabilitation pertinent to 
140.1   the event, and any other information relevant to 
140.2   reconsideration.  In reviewing a disqualification under this 
140.3   section, the commissioner shall give preeminent weight to the 
140.4   safety of each person to be served by the license holder ~~or~~, 
140.5   applicant, or registrant over the interests of the license 
140.6   holder ~~or~~, applicant, or registrant. 
140.7      (c) Unless the information the commissioner relied on in 
140.8   disqualifying an individual is incorrect, the commissioner may 
140.9   not set aside the disqualification of an individual in 
140.10  connection with a license to provide family day care for 
140.11  children, foster care for children in the provider's own home, 
140.12  or foster care or day care services for adults in the provider's 
140.13  own home if: 
140.14     (1) less than ten years have passed since the discharge of 
140.15  the sentence imposed for the offense; and the individual has 
140.16  been convicted of a violation of any offense listed in sections 
140.17  609.20 (manslaughter in the first degree), 609.205 (manslaughter 
140.18  in the second degree), criminal vehicular homicide under 609.21 
140.19  (criminal vehicular homicide and injury), 609.215 (aiding 
140.20  suicide or aiding attempted suicide), felony violations under 
140.21  609.221 to 609.2231 (assault in the first, second, third, or 
140.22  fourth degree), 609.713 (terroristic threats), 609.235 (use of 
140.23  drugs to injure or to facilitate crime), 609.24 (simple 
140.24  robbery), 609.245 (aggravated robbery), 609.25 (kidnapping), 
140.25  609.255 (false imprisonment), 609.561 or 609.562 (arson in the 
140.26  first or second degree), 609.71 (riot), burglary in the first or 
140.27  second degree under 609.582 (burglary), 609.66 (dangerous 
140.28  weapon), 609.665 (spring guns), 609.67 (machine guns and 
140.29  short-barreled shotguns), 609.749 (harassment; stalking), 
140.30  152.021 or 152.022 (controlled substance crime in the first or 
140.31  second degree), 152.023, subdivision 1, clause (3) or (4), or 
140.32  subdivision 2, clause (4) (controlled substance crime in the 
140.33  third degree), 152.024, subdivision 1, clause (2), (3), or (4) 
140.34  (controlled substance crime in the fourth degree), 609.224, 
140.35  subdivision 2, paragraph (c) (fifth-degree assault by a 
140.36  caregiver against a vulnerable adult), 609.228 (great bodily 
141.1   harm caused by distribution of drugs), 609.23 (mistreatment of 
141.2   persons confined), 609.231 (mistreatment of residents or 
141.3   patients), 609.2325 (criminal abuse of a vulnerable adult), 
141.4   609.233 (criminal neglect of a vulnerable adult), 609.2335 
141.5   (financial exploitation of a vulnerable adult), 609.234 (failure 
141.6   to report), 609.265 (abduction), 609.2664 to 609.2665 
141.7   (manslaughter of an unborn child in the first or second degree), 
141.8   609.267 to 609.2672 (assault of an unborn child in the first, 
141.9   second, or third degree), 609.268 (injury or death of an unborn 
141.10  child in the commission of a crime), 617.293 (disseminating or 
141.11  displaying harmful material to minors), a gross misdemeanor 
141.12  offense under 609.324, subdivision 1 (other prohibited acts), a 
141.13  gross misdemeanor offense under 609.378 (neglect or endangerment 
141.14  of a child), a gross misdemeanor offense under 609.377 
141.15  (malicious punishment of a child), 609.72, subdivision 3 
141.16  (disorderly conduct against a vulnerable adult); or an attempt 
141.17  or conspiracy to commit any of these offenses, as each of these 
141.18  offenses is defined in Minnesota Statutes; or an offense in any 
141.19  other state, the elements of which are substantially similar to 
141.20  the elements of any of the foregoing offenses; 
141.21     (2) regardless of how much time has passed since the 
141.22  discharge of the sentence imposed for the offense, the 
141.23  individual was convicted of a violation of any offense listed in 
141.24  sections 609.185 to 609.195 (murder in the first, second, or 
141.25  third degree), 609.2661 to 609.2663 (murder of an unborn child 
141.26  in the first, second, or third degree), a felony offense under 
141.27  609.377 (malicious punishment of a child), a felony offense 
141.28  under 609.324, subdivision 1 (other prohibited acts), a felony 
141.29  offense under 609.378 (neglect or endangerment of a child), 
141.30  609.322 (solicitation, inducement, and promotion of 
141.31  prostitution), 609.342 to 609.345 (criminal sexual conduct in 
141.32  the first, second, third, or fourth degree), 609.352 
141.33  (solicitation of children to engage in sexual conduct), 617.246 
141.34  (use of minors in a sexual performance), 617.247 (possession of 
141.35  pictorial representations of a minor), 609.365 (incest), a 
141.36  felony offense under sections 609.2242 and 609.2243 (domestic 
142.1   assault), a felony offense of spousal abuse, a felony offense of 
142.2   child abuse or neglect, a felony offense of a crime against 
142.3   children, or an attempt or conspiracy to commit any of these 
142.4   offenses as defined in Minnesota Statutes, or an offense in any 
142.5   other state, the elements of which are substantially similar to 
142.6   any of the foregoing offenses; 
142.7      (3) within the seven years preceding the study, the 
142.8   individual committed an act that constitutes maltreatment of a 
142.9   child under section 626.556, subdivision 10e, and that resulted 
142.10  in substantial bodily harm as defined in section 609.02, 
142.11  subdivision 7a, or substantial mental or emotional harm as 
142.12  supported by competent psychological or psychiatric evidence; or 
142.13     (4) within the seven years preceding the study, the 
142.14  individual was determined under section 626.557 to be the 
142.15  perpetrator of a substantiated incident of maltreatment of a 
142.16  vulnerable adult that resulted in substantial bodily harm as 
142.17  defined in section 609.02, subdivision 7a, or substantial mental 
142.18  or emotional harm as supported by competent psychological or 
142.19  psychiatric evidence. 
142.20     In the case of any ground for disqualification under 
142.21  clauses (1) to (4), if the act was committed by an individual 
142.22  other than the applicant ~~or~~, license holder, or registrant 
142.23  residing in the applicant's ~~or~~, license holder's, or 
142.24  registrant's home, the applicant ~~or~~, license holder, or 
142.25  registrant may seek reconsideration when the individual who 
142.26  committed the act no longer resides in the home.  
142.27     The disqualification periods provided under clauses (1), 
142.28  (3), and (4) are the minimum applicable disqualification 
142.29  periods.  The commissioner may determine that an individual 
142.30  should continue to be disqualified from licensure or 
142.31  registration because the license holder ~~or~~, registrant, or 
142.32  applicant poses a risk of harm to a person served by that 
142.33  individual after the minimum disqualification period has passed. 
142.34     (d) The commissioner shall respond in writing or by 
142.35  electronic transmission to all reconsideration requests for 
142.36  which the basis for the request is that the information relied 
143.1   upon by the commissioner to disqualify is incorrect or 
143.2   inaccurate within 30 working days of receipt of a request and 
143.3   all relevant information.  If the basis for the request is that 
143.4   the individual does not pose a risk of harm, the commissioner 
143.5   shall respond to the request within 15 working days after 
143.6   receiving the request for reconsideration and all relevant 
143.7   information.  If the disqualification is set aside, the 
143.8   commissioner shall notify the applicant or license holder in 
143.9   writing or by electronic transmission of the decision. 
143.10     (e) Except as provided in subdivision 3c, the 
143.11  commissioner's decision to disqualify an individual, including 
143.12  the decision to grant or deny a rescission or set aside a 
143.13  disqualification under this section, is the final administrative 
143.14  agency action and shall not be subject to further review in a 
143.15  contested case under chapter 14 involving a negative licensing 
143.16  appeal taken in response to the disqualification or involving an 
143.17  accuracy and completeness appeal under section 13.04. 
143.18     Sec. 10.  Minnesota Statutes 2000, section 245A.04, 
143.19  subdivision 3d, is amended to read: 
143.20     Subd. 3d.  [DISQUALIFICATION.] (a) Except as provided in 
143.21  paragraph (b), when a background study completed under 
143.22  subdivision 3 shows any of the following:  a conviction of one 
143.23  or more crimes listed in clauses (1) to (4); the individual has 
143.24  admitted to or a preponderance of the evidence indicates the 
143.25  individual has committed an act or acts that meet the definition 
143.26  of any of the crimes listed in clauses (1) to (4); or an 
143.27  administrative determination listed under clause (4), the 
143.28  individual shall be disqualified from any position allowing 
143.29  direct contact with persons receiving services from the license 
143.30  holder or registrant: 
143.31     (1) regardless of how much time has passed since the 
143.32  discharge of the sentence imposed for the offense, and unless 
143.33  otherwise specified, regardless of the level of the conviction, 
143.34  the individual was convicted of any of the following offenses:  
143.35  sections 609.185 (murder in the first degree); 609.19 (murder in 
143.36  the second degree); 609.195 (murder in the third degree); 
144.1   609.2661 (murder of an unborn child in the first degree); 
144.2   609.2662 (murder of an unborn child in the second degree); 
144.3   609.2663 (murder of an unborn child in the third degree); 
144.4   609.322 (solicitation, inducement, and promotion of 
144.5   prostitution); 609.342 (criminal sexual conduct in the first 
144.6   degree); 609.343 (criminal sexual conduct in the second degree); 
144.7   609.344 (criminal sexual conduct in the third degree); 609.345 
144.8   (criminal sexual conduct in the fourth degree); 609.352 
144.9   (solicitation of children to engage in sexual conduct); 609.365 
144.10  (incest); felony offense under 609.377 (malicious punishment of 
144.11  a child); a felony offense under 609.378 (neglect or 
144.12  endangerment of a child); a felony offense under 609.324, 
144.13  subdivision 1 (other prohibited acts); 617.246 (use of minors in 
144.14  sexual performance prohibited); 617.247 (possession of pictorial 
144.15  representations of minors); a felony offense under sections 
144.16  609.2242 and 609.2243 (domestic assault), a felony offense of 
144.17  spousal abuse, a felony offense of child abuse or neglect, a 
144.18  felony offense of a crime against children; or attempt or 
144.19  conspiracy to commit any of these offenses as defined in 
144.20  Minnesota Statutes, or an offense in any other state or country, 
144.21  where the elements are substantially similar to any of the 
144.22  offenses listed in this clause; 
144.23     (2) if less than 15 years have passed since the discharge 
144.24  of the sentence imposed for the offense; and the individual has 
144.25  received a felony conviction for a violation of any of these 
144.26  offenses:  sections 609.20 (manslaughter in the first degree); 
144.27  609.205 (manslaughter in the second degree); 609.21 (criminal 
144.28  vehicular homicide and injury); 609.215 (suicide); 609.221 to 
144.29  609.2231 (assault in the first, second, third, or fourth 
144.30  degree); repeat offenses under 609.224 (assault in the fifth 
144.31  degree); repeat offenses under 609.3451 (criminal sexual conduct 
144.32  in the fifth degree); 609.713 (terroristic threats); 609.235 
144.33  (use of drugs to injure or facilitate crime); 609.24 (simple 
144.34  robbery); 609.245 (aggravated robbery); 609.25 (kidnapping); 
144.35  609.255 (false imprisonment); 609.561 (arson in the first 
144.36  degree); 609.562 (arson in the second degree); 609.563 (arson in 
145.1   the third degree); repeat offenses under 617.23 (indecent 
145.2   exposure; penalties); repeat offenses under 617.241 (obscene 
145.3   materials and performances; distribution and exhibition 
145.4   prohibited; penalty); 609.71 (riot); 609.66 (dangerous weapons); 
145.5   609.67 (machine guns and short-barreled shotguns); 609.749 
145.6   (harassment; stalking; penalties); 609.228 (great bodily harm 
145.7   caused by distribution of drugs); 609.2325 (criminal abuse of a 
145.8   vulnerable adult); 609.2664 (manslaughter of an unborn child in 
145.9   the first degree); 609.2665 (manslaughter of an unborn child in 
145.10  the second degree); 609.267 (assault of an unborn child in the 
145.11  first degree); 609.2671 (assault of an unborn child in the 
145.12  second degree); 609.268 (injury or death of an unborn child in 
145.13  the commission of a crime); 609.52 (theft); 609.2335 (financial 
145.14  exploitation of a vulnerable adult); 609.521 (possession of 
145.15  shoplifting gear); 609.582 (burglary); 609.625 (aggravated 
145.16  forgery); 609.63 (forgery); 609.631 (check forgery; offering a 
145.17  forged check); 609.635 (obtaining signature by false pretense); 
145.18  609.27 (coercion); 609.275 (attempt to coerce); 609.687 
145.19  (adulteration); 260C.301 (grounds for termination of parental 
145.20  rights); and chapter 152 (drugs; controlled substance).  An 
145.21  attempt or conspiracy to commit any of these offenses, as each 
145.22  of these offenses is defined in Minnesota Statutes; or an 
145.23  offense in any other state or country, the elements of which are 
145.24  substantially similar to the elements of the offenses in this 
145.25  clause.  If the individual studied is convicted of one of the 
145.26  felonies listed in this clause, but the sentence is a gross 
145.27  misdemeanor or misdemeanor disposition, the lookback period for 
145.28  the conviction is the period applicable to the disposition, that 
145.29  is the period for gross misdemeanors or misdemeanors; 
145.30     (3) if less than ten years have passed since the discharge 
145.31  of the sentence imposed for the offense; and the individual has 
145.32  received a gross misdemeanor conviction for a violation of any 
145.33  of the following offenses:  sections 609.224 (assault in the 
145.34  fifth degree); 609.2242 and 609.2243 (domestic assault); 
145.35  violation of an order for protection under 518B.01, subdivision 
145.36  14; 609.3451 (criminal sexual conduct in the fifth degree); 
146.1   repeat offenses under 609.746 (interference with privacy); 
146.2   repeat offenses under 617.23 (indecent exposure); 617.241 
146.3   (obscene materials and performances); 617.243 (indecent 
146.4   literature, distribution); 617.293 (harmful materials; 
146.5   dissemination and display to minors prohibited); 609.71 (riot); 
146.6   609.66 (dangerous weapons); 609.749 (harassment; stalking; 
146.7   penalties); 609.224, subdivision 2, paragraph (c) (assault in 
146.8   the fifth degree by a caregiver against a vulnerable adult); 
146.9   609.23 (mistreatment of persons confined); 609.231 (mistreatment 
146.10  of residents or patients); 609.2325 (criminal abuse of a 
146.11  vulnerable adult); 609.233 (criminal neglect of a vulnerable 
146.12  adult); 609.2335 (financial exploitation of a vulnerable adult); 
146.13  609.234 (failure to report maltreatment of a vulnerable adult); 
146.14  609.72, subdivision 3 (disorderly conduct against a vulnerable 
146.15  adult); 609.265 (abduction); 609.378 (neglect or endangerment of 
146.16  a child); 609.377 (malicious punishment of a child); 609.324, 
146.17  subdivision 1a (other prohibited acts; minor engaged in 
146.18  prostitution); 609.33 (disorderly house); 609.52 (theft); 
146.19  609.582 (burglary); 609.631 (check forgery; offering a forged 
146.20  check); 609.275 (attempt to coerce); or an attempt or conspiracy 
146.21  to commit any of these offenses, as each of these offenses is 
146.22  defined in Minnesota Statutes; or an offense in any other state 
146.23  or country, the elements of which are substantially similar to 
146.24  the elements of any of the offenses listed in this clause.  If 
146.25  the defendant is convicted of one of the gross misdemeanors 
146.26  listed in this clause, but the sentence is a misdemeanor 
146.27  disposition, the lookback period for the conviction is the 
146.28  period applicable to misdemeanors; or 
146.29     (4) if less than seven years have passed since the 
146.30  discharge of the sentence imposed for the offense; and the 
146.31  individual has received a misdemeanor conviction for a violation 
146.32  of any of the following offenses:  sections 609.224 (assault in 
146.33  the fifth degree); 609.2242 (domestic assault); violation of an 
146.34  order for protection under 518B.01 (Domestic Abuse Act); 
146.35  violation of an order for protection under 609.3232 (protective 
146.36  order authorized; procedures; penalties); 609.746 (interference 
147.1   with privacy); 609.79 (obscene or harassing phone calls); 
147.2   609.795 (letter, telegram, or package; opening; harassment); 
147.3   617.23 (indecent exposure; penalties); 609.2672 (assault of an 
147.4   unborn child in the third degree); 617.293 (harmful materials; 
147.5   dissemination and display to minors prohibited); 609.66 
147.6   (dangerous weapons); 609.665 (spring guns); 609.2335 (financial 
147.7   exploitation of a vulnerable adult); 609.234 (failure to report 
147.8   maltreatment of a vulnerable adult); 609.52 (theft); 609.27 
147.9   (coercion); or an attempt or conspiracy to commit any of these 
147.10  offenses, as each of these offenses is defined in Minnesota 
147.11  Statutes; or an offense in any other state or country, the 
147.12  elements of which are substantially similar to the elements of 
147.13  any of the offenses listed in this clause; failure to make 
147.14  required reports under section 626.556, subdivision 3, or 
147.15  626.557, subdivision 3, for incidents in which:  (i) the final 
147.16  disposition under section 626.556 or 626.557 was substantiated 
147.17  maltreatment, and (ii) the maltreatment was recurring or 
147.18  serious; or substantiated serious or recurring maltreatment of a 
147.19  minor under section 626.556 or of a vulnerable adult under 
147.20  section 626.557 for which there is a preponderance of evidence 
147.21  that the maltreatment occurred, and that the subject was 
147.22  responsible for the maltreatment. 
147.23     For the purposes of this section, "serious maltreatment" 
147.24  means sexual abuse; maltreatment resulting in death; or 
147.25  maltreatment resulting in serious injury which reasonably 
147.26  requires the care of a physician whether or not the care of a 
147.27  physician was sought; or abuse resulting in serious injury.  For 
147.28  purposes of this section, "abuse resulting in serious injury" 
147.29  means:  bruises, bites, skin laceration or tissue damage; 
147.30  fractures; dislocations; evidence of internal injuries; head 
147.31  injuries with loss of consciousness; extensive second-degree or 
147.32  third-degree burns and other burns for which complications are 
147.33  present; extensive second-degree or third-degree frostbite, and 
147.34  others for which complications are present; irreversible 
147.35  mobility or avulsion of teeth; injuries to the eyeball; 
147.36  ingestion of foreign substances and objects that are harmful; 
148.1   near drowning; and heat exhaustion or sunstroke.  For purposes 
148.2   of this section, "care of a physician" is treatment received or 
148.3   ordered by a physician, but does not include diagnostic testing, 
148.4   assessment, or observation.  For the purposes of this section, 
148.5   "recurring maltreatment" means more than one incident of 
148.6   maltreatment for which there is a preponderance of evidence that 
148.7   the maltreatment occurred, and that the subject was responsible 
148.8   for the maltreatment. 
148.9      (b) If the subject of a background study is licensed by a 
148.10  health-related licensing board, the board shall make the 
148.11  determination regarding a disqualification under this 
148.12  subdivision based on a finding of substantiated maltreatment 
148.13  under section 626.556 or 626.557.  The commissioner shall notify 
148.14  the health-related licensing board if a background study shows 
148.15  that a licensee would be disqualified because of substantiated 
148.16  maltreatment and the board shall make a determination under 
148.17  section 214.104. 
148.18     Sec. 11.  [256B.039] [REPORTING OF SUPPLEMENTAL NURSING 
148.19  SERVICES AGENCY USE.] 
148.20     Beginning July 1, 2001, the commissioner shall require 
148.21  health care facilities, as defined in section 144A.70, 
148.22  subdivision 4, to report semiannually the following information 
148.23  on the use of supplemental nursing services, in the form and 
148.24  manner specified by the commissioner: 
148.25     (1) number of hours worked by supplemental nursing services 
148.26  agency personnel, by job classification, for each month; 
148.27     (2) payments to supplemental nursing services agencies, on 
148.28  a per-hour worked basis, by job classification, for each month; 
148.29  and 
148.30     (3) percentage of total monthly work hours provided by 
148.31  supplemental nursing services agency personnel, by job 
148.32  classification, for each shift and for weekdays and weekends. 
148.33     Sec. 12.  [APPROPRIATION.] 
148.34     $....... is appropriated from the general fund to the 
148.35  commissioner of health for the biennium beginning July 1, 2001, 
148.36  to regulate supplemental nursing services agencies. 
149.1                              ARTICLE 5
149.2                       LONG-TERM CARE INSURANCE
149.3      Section 1.  Minnesota Statutes 2000, section 62A.02, is 
149.4   amended by adding a subdivision to read: 
149.5      Subd. 8.  [LONG-TERM CARE INSURANCE; INITIAL FILING.] (a) 
149.6   This subdivision applies to any long-term care policy issued in 
149.7   this state on or after January 1, 2002, under sections 62A.46 to 
149.8   62A.56 or under chapter 62S. 
149.9      (b) An insurer shall provide the following information to 
149.10  the commissioner 30 days prior to making a long-term care 
149.11  insurance form available for sale: 
149.12     (1) a copy of the disclosure documents required in section 
149.13  62S.081; and 
149.14     (2) an actuarial certification consisting of at least the 
149.15  following: 
149.16     (i) a statement that the initial premium rate schedule is 
149.17  sufficient to cover anticipated costs under moderately adverse 
149.18  experience and that the premium rate schedule is reasonably 
149.19  expected to be sustainable over the life of the form with no 
149.20  future premium increases anticipated; 
149.21     (ii) a statement that the policy design and coverage 
149.22  provided have been reviewed and taken into consideration; 
149.23     (iii) a statement that the underwriting and claims 
149.24  adjudication processes have been reviewed and taken into 
149.25  consideration; 
149.26     (iv) a complete description of the basis for contract 
149.27  reserves that are anticipated to be held under the form, to 
149.28  include: 
149.29     (A) sufficient detail or sample calculations provided so as 
149.30  to have a complete depiction of the reserve amounts to be held; 
149.31     (B) a statement that the assumptions used for reserves 
149.32  contain reasonable margins for adverse experience; 
149.33     (C) a statement that the net valuation premium for renewal 
149.34  years does not increase, except for attained-age rating where 
149.35  permitted; 
149.36     (D) a statement that the difference between the gross 
150.1   premium and the net valuation premium for renewal years is 
150.2   sufficient to cover expected renewal expenses, or if such a 
150.3   statement cannot be made, a complete description of the 
150.4   situations where this does not occur.  An aggregate distribution 
150.5   of anticipated issues may be used as long as the underlying 
150.6   gross premiums maintain a reasonably consistent relationship.  
150.7   If the gross premiums for certain age groups appear to be 
150.8   inconsistent with this requirement, the commissioner may request 
150.9   a demonstration under item (i) based on a standard age 
150.10  distribution; and 
150.11     (E) either a statement that the premium rate schedule is 
150.12  not less than the premium rate schedule for existing similar 
150.13  policy forms also available from the insurer except for 
150.14  reasonable differences attributable to benefits, or a comparison 
150.15  of the premium schedules for similar policy forms that are 
150.16  currently available from the insurer with an explanation of the 
150.17  differences. 
150.18     (c) The commissioner may request an actuarial demonstration 
150.19  that benefits are reasonable in relation to premiums.  The 
150.20  actuarial demonstration shall include either premium and claim 
150.21  experience on similar policy forms, adjusted for any premium or 
150.22  benefit differences, relevant and credible data from other 
150.23  studies, or both.  If the commissioner asks for additional 
150.24  information under this paragraph, the period in paragraph (b) 
150.25  does not include the period during which the insurer is 
150.26  preparing the requested information. 
150.27     Sec. 2.  Minnesota Statutes 2000, section 62A.48, is 
150.28  amended by adding a subdivision to read: 
150.29     Subd. 10.  [REGULATION OF PREMIUM INCREASES.] Policies 
150.30  issued under sections 62A.46 to 62A.56 must comply with sections 
150.31  62S.081, 62S.265, and 62S.266. 
150.32     Sec. 3.  Minnesota Statutes 2000, section 62A.48, is 
150.33  amended by adding a subdivision to read: 
150.34     Subd. 11.  [NONFORFEITURE BENEFITS.] Policies issued under 
150.35  sections 62A.46 to 62A.56 must comply with section 62S.02, 
150.36  subdivision 2. 
151.1      Sec. 4.  Minnesota Statutes 2000, section 62S.01, is 
151.2   amended by adding a subdivision to read: 
151.3      Subd. 13a.  [EXCEPTIONAL INCREASE.] "Exceptional increase" 
151.4   means only those increases filed by an insurer as exceptional 
151.5   for which the commissioner determines the need for the premium 
151.6   rate increase is justified due to changes in laws or rules 
151.7   applicable to long-term care coverage in this state, or due to 
151.8   increased and unexpected utilization that affects the majority 
151.9   of insurers of similar products. 
151.10     Except as provided in section 62S.265, exceptional 
151.11  increases are subject to the same requirements as other premium 
151.12  rate schedule increases.  The commissioner may request a review 
151.13  by an independent actuary or a professional actuarial body of 
151.14  the basis for a request that an increase be considered an 
151.15  exceptional increase.  The commissioner, in determining that the 
151.16  necessary basis for an exceptional increase exists, shall also 
151.17  determine any potential offsets to higher claims costs. 
151.18     Sec. 5.  [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES 
151.19  TO CONSUMERS.] 
151.20     Subdivision 1.  [APPLICATION.] This section shall apply as 
151.21  follows: 
151.22     (a) Except as provided in paragraph (b), this section 
151.23  applies to any long-term care policy or certificate issued in 
151.24  this state on or after January 1, 2002. 
151.25     (b) For certificates issued on or after the effective date 
151.26  of this section under a policy of group long-term care insurance 
151.27  as defined in section 62S.01, subdivision 15, that was in force 
151.28  on the effective date of this section, this section applies on 
151.29  the policy anniversary following June 30, 2002. 
151.30     Subd. 2.  [REQUIRED DISCLOSURES.] Other than policies for 
151.31  which no applicable premium rate or rate schedule increases can 
151.32  be made, insurers shall provide all of the information listed in 
151.33  this subdivision to the applicant at the time of application or 
151.34  enrollment, unless the method of application does not allow for 
151.35  delivery at that time.  In such a case, an insurer shall provide 
151.36  all of the information listed in this subdivision to the 
152.1   applicant no later than at the time of delivery of the policy or 
152.2   certificate: 
152.3      (1) a statement that the policy may be subject to rate 
152.4   increases in the future; 
152.5      (2) an explanation of potential future premium rate 
152.6   revisions and the policyholder's or certificate holder's option 
152.7   in the event of a premium rate revision; 
152.8      (3) the premium rate or rate schedules applicable to the 
152.9   applicant that will be in effect until a request is made for an 
152.10  increase; 
152.11     (4) a general explanation for applying premium rate or rate 
152.12  schedule adjustments that must include: 
152.13     (i) a description of when premium rate or rate schedule 
152.14  adjustments will be effective, for example the next anniversary 
152.15  date or the next billing date; and 
152.16     (ii) the right to a revised premium rate or rate schedule 
152.17  as provided in clause (3) if the premium rate or rate schedule 
152.18  is changed; 
152.19     (5)(i) information regarding each premium rate increase on 
152.20  this policy form or similar policy forms over the past ten years 
152.21  for this state or any other state that, at a minimum, identifies:
152.22     (A) the policy forms for which premium rates have been 
152.23  increased; 
152.24     (B) the calendar years when the form was available for 
152.25  purchase; and 
152.26     (C) the amount or percent of each increase.  The percentage 
152.27  may be expressed as a percentage of the premium rate prior to 
152.28  the increase and may also be expressed as minimum and maximum 
152.29  percentages if the rate increase is variable by rating 
152.30  characteristics; 
152.31     (ii) the insurer may, in a fair manner, provide additional 
152.32  explanatory information related to the rate increases; 
152.33     (iii) an insurer has the right to exclude from the 
152.34  disclosure premium rate increases that apply only to blocks of 
152.35  business acquired from other nonaffiliated insurers or the 
152.36  long-term care policies acquired from other nonaffiliated 
153.1   insurers when those increases occurred prior to the acquisition; 
153.2      (iv) if an acquiring insurer files for a rate increase on a 
153.3   long-term care policy form acquired from nonaffiliated insurers 
153.4   or a block of policy forms acquired from nonaffiliated insurers 
153.5   on or before the later of the effective date of this section, or 
153.6   the end of a 24-month period following the acquisition of the 
153.7   block or policies, the acquiring insurer may exclude that rate 
153.8   increase from the disclosure.  However, the nonaffiliated 
153.9   selling company must include the disclosure of that rate 
153.10  increase in accordance with item (i); and 
153.11     (v) if the acquiring insurer in item (iv) files for a 
153.12  subsequent rate increase, even within the 24-month period, on 
153.13  the same policy form acquired from nonaffiliated insurers or 
153.14  block of policy forms acquired from nonaffiliated insurers 
153.15  referenced in item (iv), the acquiring insurer shall make all 
153.16  disclosures required by this paragraph, including disclosure of 
153.17  the earlier rate increase referenced in item (iv). 
153.18     Subd. 3.  [ACKNOWLEDGMENT.] An applicant shall sign an 
153.19  acknowledgment at the time of application, unless the method of 
153.20  application does not allow for signature at that time, that the 
153.21  insurer made the disclosure required under subdivision 2.  If, 
153.22  due to the method of application, the applicant cannot sign an 
153.23  acknowledgment at the time of application, the applicant shall 
153.24  sign no later than at the time of delivery of the policy or 
153.25  certificate. 
153.26     Subd. 4.  [FORMS.] An insurer shall use the forms in 
153.27  Appendices B and F of the Long-term Care Insurance Model 
153.28  Regulation adopted by the National Association of Insurance 
153.29  Commissioners to comply with the requirements of subdivisions 1 
153.30  and 2. 
153.31     An insurer shall provide notice of an upcoming premium rate 
153.32  schedule increase to all policyholders or certificate holders, 
153.33  if applicable, at least 45 days prior to the implementation of 
153.34  the premium rate schedule increase by the insurer.  The notice 
153.35  shall include the information required by subdivision 2 when the 
153.36  rate increase is implemented. 
154.1      Sec. 6.  [62S.265] [PREMIUM RATE SCHEDULE INCREASES.] 
154.2      Subdivision 1.  [APPLICABILITY.] (a) Except as provided in 
154.3   paragraph (b), this section applies to any long-term care policy 
154.4   or certificate issued in this state on or after January 1, 2002, 
154.5   under this chapter or sections 62A.46 to 62A.56. 
154.6      (b) For certificates issued on or after the effective date 
154.7   of this section under a group long-term care insurance policy as 
154.8   defined in section 62S.01, subdivision 15, or as described in 
154.9   the second paragraph of section 62A.46, subdivision 2, that was 
154.10  in force on the effective date of this section, this section 
154.11  applies on the policy anniversary following June 30, 2002. 
154.12     Subd. 2.  [NOTICE.] An insurer shall provide notice of a 
154.13  pending premium rate schedule increase, including an exceptional 
154.14  increase, to the commissioner at least 30 days prior to the 
154.15  notice to the policyholders and shall include: 
154.16     (1) all information required by section 62S.081; 
154.17     (2) certification by a qualified actuary that: 
154.18     (i) if the requested premium rate schedule increase is 
154.19  implemented and the underlying assumptions, which reflect 
154.20  moderately adverse conditions, are realized, no further premium 
154.21  rate schedule increases are anticipated; and 
154.22     (ii) the premium rate filing complies with this section; 
154.23     (3) an actuarial memorandum justifying the rate schedule 
154.24  change request that includes: 
154.25     (i) lifetime projections of earned premiums and incurred 
154.26  claims based on the filed premium rate schedule increase and the 
154.27  method and assumptions used in determining the projected values, 
154.28  including reflection of any assumptions that deviate from those 
154.29  used for pricing other forms currently available for sale; 
154.30     (A) annual values for the five years preceding and the 
154.31  three years following the valuation date shall be provided 
154.32  separately; 
154.33     (B) the projections shall include the development of the 
154.34  lifetime loss ratio, unless the rate increase is an exceptional 
154.35  increase; 
154.36     (C) the projections shall demonstrate compliance with 
155.1   subdivision 3; and 
155.2      (D) for exceptional increases, the projected experience 
155.3   must be limited to the increases in claims expenses attributable 
155.4   to the approved reasons for the exceptional increase and, if the 
155.5   commissioner determines that offsets to higher claim costs may 
155.6   exist, the insurer shall use appropriate net projected 
155.7   experience; 
155.8      (ii) disclosure of how reserves have been incorporated in 
155.9   this rate increase whenever the rate increase will trigger 
155.10  contingent benefit upon lapse; 
155.11     (iii) disclosure of the analysis performed to determine why 
155.12  a rate adjustment is necessary, which pricing assumptions were 
155.13  not realized and why, and what other actions taken by the 
155.14  company have been relied upon by the actuary; 
155.15     (iv) a statement that policy design, underwriting, and 
155.16  claims adjudication practices have been taken into 
155.17  consideration; and 
155.18     (v) if it is necessary to maintain consistent premium rates 
155.19  for new certificates and certificates receiving a rate increase, 
155.20  the insurer shall file composite rates reflecting projections of 
155.21  new certificates; 
155.22     (4) a statement that renewal premium rate schedules are not 
155.23  greater than new business premium rate schedules except for 
155.24  differences attributable to benefits, unless sufficient 
155.25  justification is provided to the commissioner; and 
155.26     (5) sufficient information for review and approval of the 
155.27  premium rate schedule increase by the commissioner. 
155.28     Subd. 3.  [REQUIREMENTS PERTAINING TO RATE INCREASES.] All 
155.29  premium rate schedule increases must be determined in accordance 
155.30  with the following requirements: 
155.31     (1) exceptional increases shall provide that 70 percent of 
155.32  the present value of projected additional premiums from the 
155.33  exceptional increase will be returned to policyholders in 
155.34  benefits; 
155.35     (2) premium rate schedule increases must be calculated such 
155.36  that the sum of the accumulated value of incurred claims, 
156.1   without the inclusion of active life reserves, and the present 
156.2   value of future projected incurred claims, without the inclusion 
156.3   of active life reserves, will not be less than the sum of the 
156.4   following: 
156.5      (i) the accumulated value of the initial earned premium 
156.6   times 58 percent; 
156.7      (ii) 85 percent of the accumulated value of prior premium 
156.8   rate schedule increases on an earned basis; 
156.9      (iii) the present value of future projected initial earned 
156.10  premiums times 58 percent; and 
156.11     (iv) 85 percent of the present value of future projected 
156.12  premiums not in item (iii) on an earned basis; 
156.13     (3) if a policy form has both exceptional and other 
156.14  increases, the values in clause (2), items (ii) and (iv), must 
156.15  also include 70 percent for exceptional rate increase amounts; 
156.16  and 
156.17     (4) all present and accumulated values used to determine 
156.18  rate increases must use the maximum valuation interest rate for 
156.19  contract reserves permitted for valuation of whole life 
156.20  insurance policies issued in this state on the same date.  The 
156.21  actuary shall disclose as part of the actuarial memorandum the 
156.22  use of any appropriate averages. 
156.23     Subd. 4.  [PROJECTIONS.] For each rate increase that is 
156.24  implemented, the insurer shall file for approval by the 
156.25  commissioner updated projections, as defined in subdivision 2, 
156.26  clause (3), item (i), annually for the next three years and 
156.27  include a comparison of actual results to projected values.  The 
156.28  commissioner may extend the period to greater than three years 
156.29  if actual results are not consistent with projected values from 
156.30  prior projections.  For group insurance policies that meet the 
156.31  conditions in subdivision 10, the projections required by this 
156.32  subdivision must be provided to the policyholder in lieu of 
156.33  filing with the commissioner. 
156.34     Subd. 5.  [LIFETIME PROJECTIONS.] If any premium rate in 
156.35  the revised premium rate schedule is greater than 200 percent of 
156.36  the comparable rate in the initial premium schedule, lifetime 
157.1   projections, as defined in subdivision 2, clause (3), item (i), 
157.2   must be filed for approval by the commissioner every five years 
157.3   following the end of the required period in subdivision 4.  For 
157.4   group insurance policies that meet the conditions in subdivision 
157.5   10, the projections required by this subdivision must be 
157.6   provided to the policyholder in lieu of filing with the 
157.7   commissioner. 
157.8      Subd. 6.  [EFFECT OF ACTUAL EXPERIENCE.] (a) If the 
157.9   commissioner has determined that the actual experience following 
157.10  a rate increase does not adequately match the projected 
157.11  experience and that the current projections under moderately 
157.12  adverse conditions demonstrate that incurred claims will not 
157.13  exceed proportions of premiums specified in subdivision 3, the 
157.14  commissioner may require the insurer to implement any of the 
157.15  following: 
157.16     (1) premium rate schedule adjustments; or 
157.17     (2) other measures to reduce the difference between the 
157.18  projected and actual experience. 
157.19     (b) In determining whether the actual experience adequately 
157.20  matches the projected experience, consideration should be given 
157.21  to subdivision 2, clause (3), item (v), if applicable. 
157.22     Subd. 7.  [CONTINGENT BENEFIT UPON LAPSE.] If the majority 
157.23  of the policies or certificates to which the increase is 
157.24  applicable are eligible for the contingent benefit upon lapse, 
157.25  the insurer shall file: 
157.26     (1) a plan, subject to commissioner approval, for improved 
157.27  administration or claims processing designed to eliminate the 
157.28  potential for further deterioration of the policy form requiring 
157.29  further premium rate schedule increases, or both, or a 
157.30  demonstration that appropriate administration and claims 
157.31  processing have been implemented or are in effect, otherwise the 
157.32  commissioner may impose the condition in subdivision 8, 
157.33  paragraph (b); and 
157.34     (2) the original anticipated lifetime loss ratio, and the 
157.35  premium rate schedule increase that would have been calculated 
157.36  according to subdivision 3 had the greater of the original 
158.1   anticipated lifetime loss ratio or 58 percent been used in the 
158.2   calculations described in subdivision 3, clause (1), items (i) 
158.3   and (iii). 
158.4      Subd. 8.  [PROJECTED LAPSE RATES.] (a) For a rate increase 
158.5   filing that meets the following criteria, the commissioner shall 
158.6   review, for all policies included in the filing, the projected 
158.7   lapse rates and past lapse rates during the 12 months following 
158.8   each increase to determine if significant adverse lapsation has 
158.9   occurred or is anticipated: 
158.10     (1) the rate increase is not the first rate increase 
158.11  requested for the specific policy form or forms; 
158.12     (2) the rate increase is not an exceptional increase; and 
158.13     (3) the majority of the policies or certificates to which 
158.14  the increase is applicable are eligible for the contingent 
158.15  benefit upon lapse. 
158.16     (b) If significant adverse lapsation has occurred, is 
158.17  anticipated in the filing, or is evidenced in the actual results 
158.18  as presented in the updated projections provided by the insurer 
158.19  following the requested rate increase, the commissioner may 
158.20  determine that a rate spiral exists.  Following the 
158.21  determination that a rate spiral exists, the commissioner may 
158.22  require the insurer to offer, without underwriting, to all 
158.23  in-force insureds subject to the rate increase, the option to 
158.24  replace existing coverage with one or more reasonably comparable 
158.25  products being offered by the insurer or its affiliates.  The 
158.26  offer must: 
158.27     (1) be subject to the approval of the commissioner; 
158.28     (2) be based on actuarially sound principles, but not be 
158.29  based on attained age; and 
158.30     (3) provide that maximum benefits under any new policy 
158.31  accepted by an insured shall be reduced by comparable benefits 
158.32  already paid under the existing policy. 
158.33     (c) The insurer shall maintain the experience of all the 
158.34  replacement insureds separate from the experience of insureds 
158.35  originally issued the policy forms.  In the event of a request 
158.36  for a rate increase on the policy form, the rate increase must 
159.1   be limited to the lesser of the maximum rate increase determined 
159.2   based on the combined experience and the maximum rate increase 
159.3   determined based only on the experience of the insureds 
159.4   originally issued the form plus ten percent. 
159.5      Subd. 9.  [PERSISTENT PRACTICE OF INADEQUATE INITIAL 
159.6   RATES.] If the commissioner determines that the insurer has 
159.7   exhibited a persistent practice of filing inadequate initial 
159.8   premium rates for long-term care insurance, the commissioner 
159.9   may, in addition to the provisions of subdivision 8, prohibit 
159.10  the insurer from either of the following: 
159.11     (1) filing and marketing comparable coverage for a period 
159.12  of up to five years; or 
159.13     (2) offering all other similar coverages and limiting 
159.14  marketing of new applications to the products subject to recent 
159.15  premium rate schedule increases. 
159.16     Subd. 10.  [LARGE GROUP POLICIES.] Subdivisions 6 and 9 do 
159.17  not apply to group long-term care insurance policies as defined 
159.18  in section 62S.01, subdivision 15, where: 
159.19     (1) the policies insure 250 or more persons, and the 
159.20  policyholder has 5,000 or more eligible employees of a single 
159.21  employer; or 
159.22     (2) the policyholder, and not the certificate holders, pays 
159.23  a material portion of the premium, which is not less than 20 
159.24  percent of the total premium for the group in the calendar year 
159.25  prior to the year in which a rate increase is filed. 
159.26     Sec. 7.  [62S.266] [NONFORFEITURE BENEFIT REQUIREMENT.] 
159.27     Subdivision 1.  [APPLICABILITY.] This section does not 
159.28  apply to life insurance policies or riders containing 
159.29  accelerated long-term care benefits. 
159.30     Subd. 2.  [REQUIREMENT.] An insurer must offer each 
159.31  prospective policyholder a nonforfeiture benefit in compliance 
159.32  with the following requirements: 
159.33     (1) a policy or certificate offered with nonforfeiture 
159.34  benefits must have coverage elements, eligibility, benefit 
159.35  triggers, and benefit length that are the same as coverage to be 
159.36  issued without nonforfeiture benefits.  The nonforfeiture 
160.1   benefit included in the offer must be the benefit described in 
160.2   subdivision 5; and 
160.3      (2) the offer must be in writing if the nonforfeiture 
160.4   benefit is not otherwise described in the outline of coverage or 
160.5   other materials given to the prospective policyholder. 
160.6      Subd. 3.  [EFFECT OF REJECTION OF OFFER.] If the offer 
160.7   required to be made under subdivision 2 is rejected, the insurer 
160.8   shall provide the contingent benefit upon lapse described in 
160.9   this section. 
160.10     Subd. 4.  [CONTINGENT BENEFIT UPON LAPSE.] (a) After 
160.11  rejection of the offer required under subdivision 2, for 
160.12  individual and group policies without nonforfeiture benefits 
160.13  issued after the effective date of this section, the insurer 
160.14  shall provide a contingent benefit upon lapse. 
160.15     (b) If a group policyholder elects to make the 
160.16  nonforfeiture benefit an option to the certificate holder, a 
160.17  certificate shall provide either the nonforfeiture benefit or 
160.18  the contingent benefit upon lapse. 
160.19     (c) The contingent benefit on lapse shall be triggered 
160.20  every time an insurer increases the premium rates to a level 
160.21  which results in a cumulative increase of the annual premium 
160.22  equal to or exceeding the percentage of the insured's initial 
160.23  annual premium set forth below based on the insured's issue age, 
160.24  and the policy or certificate lapses within 120 days of the due 
160.25  date of the premium so increased.  Unless otherwise required, 
160.26  policyholders shall be notified at least 30 days prior to the 
160.27  due date of the premium reflecting the rate increase. 
160.28           Triggers for a Substantial Premium Increase 
160.29                      Percent Increase
160.30       Issue Age      Over Initial Premium
160.31       29 and Under            200
160.32          30-34                190
160.33          35-39                170
160.34          40-44                150
160.35          45-49                130
160.36          50-54                110
161.1           55-59                 90
161.2              60                 70
161.3              61                 66
161.4              62                 62
161.5              63                 58
161.6              64                 54
161.7              65                 50
161.8              66                 48
161.9              67                 46
161.10             68                 44
161.11             69                 42
161.12             70                 40
161.13             71                 38
161.14             72                 36
161.15             73                 34
161.16             74                 32
161.17             75                 30
161.18             76                 28
161.19             77                 26
161.20             78                 24
161.21             79                 22
161.22             80                 20
161.23             81                 19
161.24             82                 18
161.25             83                 17
161.26             84                 16
161.27             85                 15
161.28             86                 14
161.29             87                 13
161.30             88                 12
161.31             89                 11
161.32         90 and over            10
161.33     (d) On or before the effective date of a substantial 
161.34  premium increase as defined in paragraph (c), the insurer shall: 
161.35     (1) offer to reduce policy benefits provided by the current 
161.36  coverage without the requirement of additional underwriting so 
162.1   that required premium payments are not increased; 
162.2      (2) offer to convert the coverage to a paid-up status with 
162.3   a shortened benefit period in accordance with the terms of 
162.4   subdivision 5.  This option may be elected at any time during 
162.5   the 120-day period referenced in paragraph (c); and 
162.6      (3) notify the policyholder or certificate holder that a 
162.7   default or lapse at any time during the 120-day period 
162.8   referenced in paragraph (c) shall be deemed to be the election 
162.9   of the offer to convert in clause (2). 
162.10     Subd. 5.  [NONFORFEITURE BENEFITS; REQUIREMENTS.] (a) 
162.11  Benefits continued as nonforfeiture benefits, including 
162.12  contingent benefits upon lapse, must be as described in this 
162.13  subdivision. 
162.14     (b) For purposes of this subdivision, "attained age rating" 
162.15  is defined as a schedule of premiums starting from the issue 
162.16  date which increases age at least one percent per year prior to 
162.17  age 50, and at least three percent per year beyond age 50. 
162.18     (c) For purposes of this subdivision, the nonforfeiture 
162.19  benefit shall be of a shortened benefit period providing paid-up 
162.20  long-term care insurance coverage after lapse.  The same 
162.21  benefits, amounts and frequency in effect at the time of lapse 
162.22  but not increased thereafter, will be payable for a qualifying 
162.23  claim, but the lifetime maximum dollars or days of benefits 
162.24  shall be determined as specified in paragraph (d). 
162.25     (d) The standard nonforfeiture credit will be equal to 100 
162.26  percent of the sum of all premiums paid, including the premiums 
162.27  paid prior to any changes in benefits.  The insurer may offer 
162.28  additional shortened benefit period options, as long as the 
162.29  benefits for each duration equal or exceed the standard 
162.30  nonforfeiture credit for that duration.  However, the minimum 
162.31  nonforfeiture credit shall not be less than 30 times the daily 
162.32  nursing home benefit at the time of lapse.  In either event, the 
162.33  calculation of the nonforfeiture credit is subject to the 
162.34  limitation of this subdivision. 
162.35     (e) The nonforfeiture benefit shall begin not later than 
162.36  the end of the third year following the policy or certificate 
163.1   issue date.  The contingent benefit, upon lapse, shall be 
163.2   effective during the first three years as well as thereafter. 
163.3      (f) Notwithstanding paragraph (e), for a policy or 
163.4   certificate with attained age rating, the nonforfeiture benefit 
163.5   shall begin on the earlier of: 
163.6      (1) the end of the tenth year following the policy or 
163.7   certificate issue date; or 
163.8      (2) the end of the second year following the date the 
163.9   policy or certificate is no longer subject to attained age 
163.10  rating. 
163.11     (g) Nonforfeiture credits may be used for all care and 
163.12  services qualifying for benefits under the terms of the policy 
163.13  or certificate, up to the limits specified in the policy or 
163.14  certificate. 
163.15     Subd. 6.  [BENEFIT LIMIT.] All benefits paid by the insurer 
163.16  while the policy or certificate is in premium-paying status and 
163.17  in the paid-up status will not exceed the maximum benefits which 
163.18  would be payable if the policy or certificate had remained in 
163.19  premium-paying status. 
163.20     Subd. 7.  [MINIMUM BENEFITS; INDIVIDUAL AND GROUP 
163.21  POLICIES.] There shall be no difference in the minimum 
163.22  nonforfeiture benefits as required under this section for group 
163.23  and individual policies. 
163.24     Subd. 8.  [APPLICATION; EFFECTIVE DATES.] This section 
163.25  becomes effective January 1, 2002, and applies as follows: 
163.26     (a) Except as provided in paragraph (b), this section 
163.27  applies to any long-term care policy issued in this state on or 
163.28  after the effective date of this section. 
163.29     (b) For certificates issued on or after the effective date 
163.30  of this section, under a group long-term care insurance policy 
163.31  that was in force on the effective date of this section, the 
163.32  provisions of this section shall not apply. 
163.33     Subd. 9.  [EFFECT ON LOSS RATIO.] Premiums charged for a 
163.34  policy or certificate containing nonforfeiture benefits or a 
163.35  contingent benefit on lapse shall be subject to the loss ratio 
163.36  requirements of section 62A.48, subdivision 4, or 62S.26, 
164.1   treating the policy as a whole. 
164.2      Subd. 10.  [PURCHASED BLOCKS OF BUSINESS.] To determine 
164.3   whether contingent nonforfeiture upon lapse provisions are 
164.4   triggered under subdivision 4, paragraph (c), a replacing 
164.5   insurer that purchased or otherwise assumed a block or blocks of 
164.6   long-term care insurance policies from another insurer shall 
164.7   calculate the percentage increase based on the initial annual 
164.8   premium paid by the insured when the policy was first purchased 
164.9   from the original insurer. 
164.10     Subd. 11.  [LEVEL PREMIUM CONTRACTS.] A nonforfeiture 
164.11  benefit for qualified long-term care insurance contracts that 
164.12  are level premium contracts shall be offered that meets the 
164.13  following requirements: 
164.14     (1) the nonforfeiture provision shall be appropriately 
164.15  captioned; 
164.16     (2) the nonforfeiture provision shall provide a benefit 
164.17  available in the event of a default in the payment of any 
164.18  premiums and shall state that the amount of the benefit may be 
164.19  adjusted subsequent to being initially granted only as necessary 
164.20  to reflect changes in claims, persistency, and interest as 
164.21  reflected in changes in rates for premium paying contracts 
164.22  approved by the commissioner for the same contract form; and 
164.23     (3) the nonforfeiture provision shall provide at least one 
164.24  of the following: 
164.25     (i) reduced paid-up insurance; 
164.26     (ii) extended term insurance; 
164.27     (iii) shortened benefit period; or 
164.28     (iv) other similar offerings approved by the commissioner. 
164.29     Sec. 8.  Minnesota Statutes 2000, section 256.975, is 
164.30  amended by adding a subdivision to read: 
164.31     Subd. 8.  [PROMOTION OF LONG-TERM CARE INSURANCE.] The 
164.32  Minnesota board on aging, either directly or through contract, 
164.33  shall promote the provision of employer-sponsored long-term care 
164.34  insurance.  The board shall encourage private- and public-sector 
164.35  employers to make long-term care insurance available to 
164.36  employees, provide interested employers with information on the 
165.1   long-term care insurance product offered to state employees, and 
165.2   provide technical assistance to employers in designing long-term 
165.3   care insurance products and contacting health plan companies 
165.4   offering long-term care insurance products. 
165.5      Sec. 9.  [APPROPRIATION.] 
165.6      $....... is appropriated from the general fund to the 
165.7   commissioner of human services for the biennium ending June 30, 
165.8   2003, for the board on aging to promote employer-sponsored 
165.9   long-term care insurance.