1.1                          A bill for an act 
  1.2             relating to the operation of state government 
  1.3             services; appropriating money for the operation of the 
  1.4             departments of human services and health, the veterans 
  1.5             home board, the health related boards, the disability 
  1.6             council, the ombudsman for families, and the ombudsman 
  1.7             for mental health and mental retardation; including 
  1.8             provisions for agency management; children's programs; 
  1.9             basic health care programs; medical assistance and 
  1.10            general assistance medical care; long-term care; 
  1.11            state-operated services; mental health and 
  1.12            developmentally disabled; MinnesotaCare; child support 
  1.13            enforcement; assistance to families; health 
  1.14            department; amending Minnesota Statutes 1996, sections 
  1.15            13.99, by adding a subdivision; 16A.124, subdivision 
  1.16            4b; 62D.04, subdivision 5; 62E.02, subdivision 13; 
  1.17            62E.14, by adding a subdivision; 103I.101, subdivision 
  1.18            6; 103I.208; 103I.401, subdivision 1; 144.0721, 
  1.19            subdivision 3; 144.121, subdivision 1, and by adding 
  1.20            subdivisions; 144.125; 144.2215; 144.226, subdivision 
  1.21            1, and by adding a subdivision; 144.3351; 144.394; 
  1.22            144A.071, subdivisions 1, 2, and 4a; 144A.073, 
  1.23            subdivision 2; 145.925, subdivision 9; 153A.17; 
  1.24            157.15, by adding subdivisions; 157.16, subdivision 3; 
  1.25            245.03, subdivision 2; 245.4882, subdivision 5; 
  1.26            245.493, subdivision 1, and by adding a subdivision; 
  1.27            245.652, subdivisions 1 and 2; 245.98, by adding a 
  1.28            subdivision; 246.02, subdivision 2; 252.025, 
  1.29            subdivisions 1, 4, and by adding a subdivision; 
  1.30            252.28, by adding a subdivision; 252.32, subdivisions 
  1.31            1a, 3, 3a, 3c, and 5; 254.04; 254B.02, subdivisions 1 
  1.32            and 3; 254B.04, subdivision 1; 254B.09, subdivisions 
  1.33            4, 5, and 7; 256.01, subdivision 2, and by adding a 
  1.34            subdivision; 256.025, subdivisions 2 and 4; 256.045, 
  1.35            subdivisions 3, 3b, 4, 5, 7, 8, and 10; 256.476, 
  1.36            subdivisions 2, 3, 4, and 5; 256.82, subdivision 1, 
  1.37            and by adding a subdivision; 256.871, subdivision 6; 
  1.38            256.935; 256.969, subdivision 1; 256.9695, subdivision 
  1.39            1; 256B.037, subdivision 1a; 256B.04, by adding a 
  1.40            subdivision; 256B.056, subdivisions 4, 5, and 8; 
  1.41            256B.0625, subdivisions 13 and 15; 256B.0626; 
  1.42            256B.0627, subdivision 5, and by adding a subdivision; 
  1.43            256B.064, subdivisions 1a, 1c, and 2; 256B.0911, 
  1.44            subdivisions 2 and 7; 256B.0912, by adding a 
  1.45            subdivision; 256B.0913, subdivisions 10, 14, 15, and 
  1.46            by adding a subdivision; 256B.0915, subdivision 3, and 
  2.1             by adding a subdivision; 256B.19, subdivisions 1, 2a, 
  2.2             and 2b; 256B.421, subdivision 1; 256B.431, subdivision 
  2.3             25, and by adding a subdivision; 256B.433, by adding a 
  2.4             subdivision; 256B.434, subdivisions 2, 3, 4, 9, and 
  2.5             10; 256B.48, subdivision 6; 256B.49, subdivision 1, 
  2.6             and by adding a subdivision; 256B.69, subdivisions 2, 
  2.7             3a, 5, 5b, and by adding subdivisions; 256D.03, 
  2.8             subdivisions 2, 2a, 3b, and 6; 256D.36; 256F.11, 
  2.9             subdivision 2; 256G.02, subdivision 6; 256G.05, 
  2.10            subdivision 2; 256I.05, subdivision 1a, and by adding 
  2.11            a subdivision; 256J.50, by adding a subdivision; 
  2.12            326.37, subdivision 1; 393.07, subdivision 2; 466.01, 
  2.13            subdivision 1; 469.155, subdivision 4; 471.59, 
  2.14            subdivision 11; 626.556, subdivisions 10b, 10d, 10e, 
  2.15            10f, 11c, and by adding a subdivision; 626.558, 
  2.16            subdivisions 1 and 2; and 626.559, subdivision 5; Laws 
  2.17            1995, chapter 207, articles 6, section 115; and 8, 
  2.18            section 41, subdivision 2; proposing coding for new 
  2.19            law in Minnesota Statutes, chapters 144; 145A; 157; 
  2.20            252; 256B; and 257; repealing Minnesota Statutes 1996, 
  2.21            sections 145.9256; 256.026; 256.82, subdivision 1; 
  2.22            256B.041, subdivision 5; 256B.0625, subdivision 13b; 
  2.23            256B.19, subdivision 1a; and 469.154, subdivision 6; 
  2.24            Minnesota Rules, part 9505.1000. 
  2.25  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.26                             ARTICLE 1
  2.27                           APPROPRIATIONS 
  2.28  Section 1.  [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 
  2.29     The sums shown in the columns marked "APPROPRIATIONS" are 
  2.30  appropriated from the general fund, or any other fund named, to 
  2.31  the agencies and for the purposes specified in the following 
  2.32  sections of this article, to be available for the fiscal years 
  2.33  indicated for each purpose.  The figures "1998" and "1999" where 
  2.34  used in this article, mean that the appropriation or 
  2.35  appropriations listed under them are available for the fiscal 
  2.36  year ending June 30, 1998, or June 30, 1999, respectively.  
  2.37  Where a dollar amount appears in parentheses, it means a 
  2.38  reduction of an appropriation.  
  2.39                          SUMMARY BY FUND
  2.40  APPROPRIATIONS                                      BIENNIAL
  2.41                            1998          1999           TOTAL
  2.42  General          $2,613,932,000 $2,728,335,000 $5,342,267,000
  2.43  State Government
  2.44  Revenue      31,552,000     31,803,000     63,355,000
  2.45  Metropolitan Landfill 
  2.46  Contingency Action Fund 193,000        193,000        386,000
  2.47  Trunk Highway         1,652,000      1,678,000      3,330,000
  2.48  TOTAL             2,647,329,000  2,762,009,000  5,409,338,000
  2.49                                             APPROPRIATIONS 
  3.1                                          Available for the Year 
  3.2                                              Ending June 30 
  3.3                                             1998         1999 
  3.4   Sec. 2.  COMMISSIONER OF 
  3.5   HUMAN SERVICES 
  3.6   Subdivision 1.  Total 
  3.7   Appropriation                      2,536,934,000  2,652,318,000
  3.8                 Summary by Fund
  3.9   General           2,536,481,000 2,651,856,000
  3.10  State Government
  3.11  Special Revenue         453,000       462,000
  3.12  Subd. 2.  Agency Management 
  3.13  General              26,116,000    25,186,000
  3.14  State Government
  3.15  Special Revenue         342,000       350,000
  3.16  The amounts that may be spent from the 
  3.17  appropriation for each purpose are as 
  3.18  follows: 
  3.19  (a) Financial Operations 
  3.20  General               8,433,000     7,415,000
  3.21  [RECEIPTS FOR SYSTEMS PROJECTS.] 
  3.22  Appropriations and federal receipts for 
  3.23  information system projects for MAXIS, 
  3.24  electronic benefit system, social 
  3.25  services information system, child 
  3.26  support enforcement, and Minnesota 
  3.27  medicaid information system (MMIS II) 
  3.28  must be deposited in the state system 
  3.29  account authorized in Minnesota 
  3.30  Statutes, section 256.014.  Money 
  3.31  appropriated for computer projects 
  3.32  approved by the information policy 
  3.33  office, funded by the legislature, and 
  3.34  approved by the commissioner of finance 
  3.35  may be transferred from one project to 
  3.36  another and from development to 
  3.37  operations as the commissioner of human 
  3.38  services considers necessary.  Any 
  3.39  unexpended balance in the appropriation 
  3.40  for these projects does not cancel but 
  3.41  is available for ongoing development 
  3.42  and operations. 
  3.43  [STATE-OPERATED SERVICES BILLING 
  3.44  SYSTEMS.] Of this appropriation, 
  3.45  $500,000 in fiscal year 1998 is to 
  3.46  modify the current state-operated 
  3.47  services billing and receipting system 
  3.48  to accommodate cost-per-service 
  3.49  charging.  As part of this project, the 
  3.50  commissioner shall develop cost 
  3.51  accounting methods to ensure that 
  3.52  regional treatment center chemical 
  3.53  dependency program charges are based on 
  3.54  actual costs. 
  3.55  (b) Legal & Regulation Operations 
  3.56  General               6,203,000     6,041,000
  4.1   State Government
  4.2   Special Revenue         342,000       350,000
  4.3   (c) Management Operations 
  4.4   General              11,480,000    11,730,000
  4.5   [COMMUNICATION COSTS.] The commissioner 
  4.6   shall continue to operate the 
  4.7   department of human services 
  4.8   communication systems account 
  4.9   established in Laws 1993, First Special 
  4.10  Session chapter 1, article 1, section 
  4.11  2, subdivision 2, to manage shared 
  4.12  communication costs necessary for the 
  4.13  operation of the programs the 
  4.14  commissioner supervises.  A 
  4.15  communications account may also be 
  4.16  established for each regional treatment 
  4.17  center which operates communication 
  4.18  systems.  Each account shall be used to 
  4.19  manage shared communication costs 
  4.20  necessary for the operation of programs 
  4.21  the commissioner supervises.  The 
  4.22  commissioner may distribute the costs 
  4.23  of operating and maintaining 
  4.24  communication systems to participants 
  4.25  in a manner that reflects actual 
  4.26  usage.  Costs may include acquisition, 
  4.27  licensing, insurance, maintenance, 
  4.28  repair, staff time, and other costs as 
  4.29  determined by the commissioner.  State, 
  4.30  county, and local government agencies 
  4.31  and nonprofit organizations involved in 
  4.32  the operation of programs the 
  4.33  commissioner supervises may participate 
  4.34  in the use of the department's 
  4.35  communication technology and share in 
  4.36  the cost of operation.  The 
  4.37  commissioner may accept on behalf of 
  4.38  the state any gift, bequest, devise, or 
  4.39  personal property of any kind or money 
  4.40  tendered to the state for any lawful 
  4.41  purpose pertaining to the communication 
  4.42  activities of the department.  Any 
  4.43  money received for this purpose must be 
  4.44  deposited in the department of human 
  4.45  services communication systems 
  4.46  accounts.  Money collected by the 
  4.47  commissioner for the use of 
  4.48  communication systems must be deposited 
  4.49  in the state communication systems 
  4.50  account and is appropriated to the 
  4.51  commissioner for purposes of this 
  4.52  section. 
  4.53  [ISSUANCE OPERATIONS CENTER.] Payments 
  4.54  to the commissioner from other 
  4.55  governmental units and private 
  4.56  enterprises for (1) services performed 
  4.57  by the issuance operations center, or 
  4.58  (2) reports generated by the payment 
  4.59  and eligibility systems must be 
  4.60  deposited in the state systems account 
  4.61  authorized in Minnesota Statutes, 
  4.62  section 256.014.  These payments are 
  4.63  appropriated to the commissioner for 
  4.64  the operation of the issuance center or 
  4.65  system, in accordance with Minnesota 
  4.66  Statutes, section 256.014. 
  5.1   Subd. 3.  Children's Grants
  5.2   General              37,627,000    40,327,000
  5.3   [FAMILY VISITATION CENTER TRANSFER.] 
  5.4   Effective July 1, 1997, all duties and 
  5.5   funding related to family visitation 
  5.6   centers under Minnesota Statutes, 
  5.7   section 256F.09, are transferred to the 
  5.8   commissioner of children, families, and 
  5.9   learning. 
  5.10  [INDIAN CHILD WELFARE ACT.] Of this 
  5.11  appropriation, $90,000 each year is to 
  5.12  provide grants according to Minnesota 
  5.13  Statutes, section 257.3571, subdivision 
  5.14  2a, to the Indian child welfare defense 
  5.15  corporation to promote statewide 
  5.16  compliance with the Indian Child 
  5.17  Welfare Act. 
  5.18  Subd. 4.  Children's Services Management
  5.19  General               3,371,000     1,902,000
  5.20  [SOCIAL SERVICES INFORMATION SYSTEM.] 
  5.21  Of this appropriation, $1,500,000 in 
  5.22  fiscal year 1998 is for training and 
  5.23  implementation costs related to the 
  5.24  social services information system.  
  5.25  Any unexpended funds shall not cancel 
  5.26  but shall be available for fiscal year 
  5.27  1999.  This appropriation shall not 
  5.28  become part of the base for the 
  5.29  biennium beginning July 1, 1999. 
  5.30  Subd. 5.  Basic Health Care Grants
  5.31                Summary by Fund
  5.32  General             844,280,000   932,852,000
  5.33  The amounts that may be spent from this 
  5.34  appropriation for each purpose are as 
  5.35  follows: 
  5.36  (a) MA Basic Health Care Grants-
  5.37  Families and Children
  5.38  General             325,922,000   368,325,000
  5.39  (b) MA Basic Health Care Grants- 
  5.40  Elderly & Disabled
  5.41  General             346,436,000   397,987,000
  5.42  [PUBLIC HEALTH NURSE ASSESSMENT.] The 
  5.43  reimbursement for public health nurse 
  5.44  visits relating to the provision of 
  5.45  personal care services under Minnesota 
  5.46  Statutes, sections 256B.0625, 
  5.47  subdivision 19a, and 256B.0627, is 
  5.48  $204.36 for the initial assessment 
  5.49  visit and $102.18 for each reassessment 
  5.50  visit. 
  5.51  [AUGMENTATIVE COMMUNICATION DEVICES.] 
  5.52  Augmentative communication devices that 
  5.53  are prior authorized by pass through 
  5.54  vendors during the period from January 
  5.55  1, 1997, until the augmentative 
  6.1   communication system distribution 
  6.2   service is operational, and which have 
  6.3   not been delivered, shall be paid under 
  6.4   the medical assistance program at the 
  6.5   actual price charged the pass through 
  6.6   vendor for the device, except that 
  6.7   payment shall not exceed the suggested 
  6.8   retail price on March 1, 1997, plus 20 
  6.9   percent to cover administrative costs 
  6.10  of prior authorization and billing and 
  6.11  shipping charges. 
  6.12  [SURCHARGE COMPLIANCE.] In the event 
  6.13  that federal financial participation in 
  6.14  the Minnesota medical assistance 
  6.15  program is reduced as a result of a 
  6.16  determination that Minnesota is out of 
  6.17  compliance with Public Law Number 
  6.18  102-234 or its implementing regulations 
  6.19  or with any other federal law designed 
  6.20  to restrict provider tax programs or 
  6.21  intergovernmental transfers, the 
  6.22  commissioner shall appeal the 
  6.23  determination to the fullest extent 
  6.24  permitted by law and may ratably reduce 
  6.25  all medical assistance and general 
  6.26  assistance medical care payments to 
  6.27  providers other than the state of 
  6.28  Minnesota in order to eliminate any 
  6.29  shortfall resulting from the reduced 
  6.30  federal funding.  Any amount later 
  6.31  recovered through the appeals process 
  6.32  shall be used to reimburse providers 
  6.33  for any ratable reductions taken. 
  6.34  (c) General Assistance Medical Care
  6.35  General             171,922,000   166,540,000
  6.36  [HEALTH CARE ACCESS TRANSFERS TO 
  6.37  GENERAL FUND.] Funds shall be 
  6.38  transferred from the health care access 
  6.39  fund to the general fund in an amount 
  6.40  equal to the projected savings to 
  6.41  general assistance medical care (GAMC) 
  6.42  that would result from the transition 
  6.43  of GAMC parents and adults without 
  6.44  children to MinnesotaCare.  Based on 
  6.45  this projection, for state fiscal year 
  6.46  1998, the amount transferred from the 
  6.47  health care access fund to the general 
  6.48  fund shall be $13,700,000.  The amount 
  6.49  of transfer, if any, necessary for 
  6.50  state fiscal year 1999 shall be 
  6.51  determined on a pro rata basis. 
  6.52  Subd. 6.  Basic Health Care Management
  6.53  General              23,427,000    24,458,000
  6.54  (a) Health Care Policy Administration
  6.55  General               4,256,000     4,316,000
  6.56  [CONSUMER SATISFACTION SURVEY.] Any 
  6.57  federal matching money received through 
  6.58  the medical assistance program for the 
  6.59  consumer satisfaction survey is 
  6.60  appropriated to the commissioner for 
  6.61  this purpose.  The commissioner may 
  6.62  expend the federal money received for 
  7.1   the consumer satisfaction survey in 
  7.2   either year of the biennium. 
  7.3   (b) Health Care Operations
  7.4   General              19,171,000    20,142,000
  7.5   [SYSTEMS CONTINUITY.] In the event of 
  7.6   disruption of technical systems or 
  7.7   computer operations, the commissioner 
  7.8   may use available grant appropriations 
  7.9   to ensure continuity of payments for 
  7.10  maintaining the health, safety, and 
  7.11  well-being of clients served by 
  7.12  programs administered by the department 
  7.13  of human services.  Grant funds must be 
  7.14  used in a manner consistent with the 
  7.15  original intent of the appropriation. 
  7.16  [PREPAID MEDICAL PROGRAMS.] The 
  7.17  nonfederal share of the prepaid medical 
  7.18  assistance program fund, which has been 
  7.19  appropriated to fund county managed 
  7.20  care advocacy and enrollment operating 
  7.21  costs, shall be disbursed as grants 
  7.22  using either a reimbursement or block 
  7.23  grant mechanism and may also be 
  7.24  transferred between grants and nongrant 
  7.25  administration costs with approval of 
  7.26  the commissioner of finance. 
  7.27  Subd. 7.  State-Operated Services
  7.28  General             207,074,000   203,429,000
  7.29  The amounts that may be spent from this 
  7.30  appropriation for each purpose are as 
  7.31  follows: 
  7.32  (a) RTC Facilities
  7.33  General             193,547,000   188,883,000
  7.34  [MITIGATION RELATED TO DD DOWNSIZING 
  7.35  AND MH PILOTS.] Money appropriated to 
  7.36  finance mitigation expenses related to 
  7.37  the downsizing of regional treatment 
  7.38  center developmental disabilities 
  7.39  programs and the establishment of 
  7.40  mental health pilot projects may be 
  7.41  transferred between fiscal years within 
  7.42  the biennium. 
  7.43  [NAMES REQUIRED ON GRAVES.] Of this 
  7.44  appropriation, $100,000 in fiscal year 
  7.45  1998 shall be disbursed to replace 
  7.46  numbers with the names of the deceased 
  7.47  person on a marker at all individual 
  7.48  graves located at regional treatment 
  7.49  centers operated by the commissioner or 
  7.50  formerly operated by the commissioner.  
  7.51  Unless the individual's family 
  7.52  indicates otherwise to the appropriate 
  7.53  authority, the commissioner of human 
  7.54  services with assistance of the 
  7.55  communities in which regional treatment 
  7.56  centers are located and in consultation 
  7.57  with the state council on disability 
  7.58  shall replace numbers with the names of 
  7.59  individuals whose graves are located at 
  7.60  regional treatment centers operated by 
  8.1   the commissioner or formerly operated 
  8.2   by the commissioner.  The individual 
  8.3   names may be placed on a central marker 
  8.4   or memorial for a designated cemetery.  
  8.5   This appropriation is available only 
  8.6   after reasonable efforts have been made 
  8.7   to acquire funds from private sources 
  8.8   to fund the markers and after the 
  8.9   private funds collected, if any, have 
  8.10  been exhausted. Of the $100,000, $5,000 
  8.11  shall be transferred to Advocating 
  8.12  Change Together for a public awareness 
  8.13  campaign to increase public knowledge 
  8.14  of the issues surrounding developmental 
  8.15  disabilities and to encourage private 
  8.16  contributions to assist in the 
  8.17  completion of this project. 
  8.18  [RTC CHEMICAL DEPENDENCY PROGRAMS.] 
  8.19  When the operations of the regional 
  8.20  treatment center chemical dependency 
  8.21  fund created in Minnesota Statutes, 
  8.22  section 246.18, subdivision 2, are 
  8.23  impeded by projected cash deficiencies 
  8.24  resulting from delays in the receipt of 
  8.25  grants, dedicated income, or other 
  8.26  similar receivables, and when the 
  8.27  deficiencies would be corrected within 
  8.28  the budget period involved, the 
  8.29  commissioner of finance may transfer 
  8.30  general fund cash reserves into this 
  8.31  account as necessary to meet cash 
  8.32  demands.  The cash flow transfers must 
  8.33  be returned to the general fund in the 
  8.34  fiscal year that the transfer was 
  8.35  made.  Any interest earned on general 
  8.36  fund cash flow transfers accrues to the 
  8.37  general fund and not the regional 
  8.38  treatment center chemical dependency 
  8.39  fund. 
  8.40  [SHORT-TERM TREATMENT PROGRAM.] The 
  8.41  commissioner shall report to the 
  8.42  legislature by January 15, 1998, with 
  8.43  recommendations on the establishment of 
  8.44  a short-term treatment program of less 
  8.45  than 45 days to be administered by the 
  8.46  Anoka regional center to serve persons 
  8.47  with mental illness.  The report must 
  8.48  include a plan to qualify the program 
  8.49  for medical assistance reimbursement 
  8.50  and estimates of the capital bonding 
  8.51  and ongoing funding necessary to 
  8.52  operate the program. 
  8.53  [RTC PILOT PROJECTS.] The commissioner 
  8.54  may authorize regional treatment 
  8.55  centers to enter into contracts with 
  8.56  health plans that provide services to 
  8.57  publicly funded clients to provide 
  8.58  services within the diagnostic 
  8.59  categories related to mental illness 
  8.60  and chemical dependency, provided that 
  8.61  the revenue is sufficient to cover 
  8.62  actual costs.  Regional treatment 
  8.63  centers may establish revenue-based 
  8.64  acute care services to be provided 
  8.65  under these contracts, separate from 
  8.66  the appropriation-based services 
  8.67  otherwise provided at the regional 
  8.68  treatment center.  The appropriation to 
  9.1   regional treatment centers may be used 
  9.2   to cover start-up costs related to 
  9.3   these services, offset by revenue.  The 
  9.4   commissioner, in conjunction with the 
  9.5   commissioner of administration, is 
  9.6   authorized to modify state contract 
  9.7   procedures that would otherwise impede 
  9.8   pilot projects in order for the 
  9.9   facility to participate in managed care 
  9.10  activities.  The commissioner may 
  9.11  delegate the execution of these 
  9.12  contracts to the chief executive 
  9.13  officer of the regional center.  The 
  9.14  commissioner shall report to the 
  9.15  legislature by January 15, 1998, on 
  9.16  pilot project development and 
  9.17  implementation. 
  9.18  [RTC RESTRUCTURING.] For purposes of 
  9.19  restructuring the regional treatment 
  9.20  centers and state nursing homes, any 
  9.21  regional treatment center or state 
  9.22  nursing home employee whose position is 
  9.23  to be eliminated shall be afforded the 
  9.24  options provided in applicable 
  9.25  collective bargaining agreements.  All 
  9.26  salary and mitigation allocations from 
  9.27  fiscal year 1998 shall be carried 
  9.28  forward into fiscal year 1999.  
  9.29  Provided there is no conflict with any 
  9.30  collective bargaining agreement, any 
  9.31  regional treatment center or state 
  9.32  nursing home position reduction must 
  9.33  only be accomplished through 
  9.34  mitigation, attrition, transfer, and 
  9.35  other measures as provided in state or 
  9.36  applicable collective bargaining 
  9.37  agreements and in Minnesota Statutes, 
  9.38  section 252.50, subdivision 11, and not 
  9.39  through layoff. 
  9.40  [DEVELOPMENT OF ADULT MENTAL HEALTH 
  9.41  PILOT PROJECTS.] The commissioner shall 
  9.42  ensure that exclusive bargaining 
  9.43  representatives are informed about and 
  9.44  allowed to participate in all aspects 
  9.45  of the development of adult mental 
  9.46  health pilot projects.  Prior to 
  9.47  authorizing additional funding for any 
  9.48  county adult mental health pilot 
  9.49  project, the commissioner shall give 
  9.50  written assurance to the affected 
  9.51  exclusive bargaining representatives 
  9.52  that the mental health pilot project: 
  9.53  (1) does not infringe on existing 
  9.54  collective bargaining agreements or the 
  9.55  relationships between public employees 
  9.56  and their employers; 
  9.57  (2) will effectively use bargaining 
  9.58  unit employees; and 
  9.59  (3) will foster cooperative and 
  9.60  constructive labor and management 
  9.61  practices under Minnesota Statutes, 
  9.62  chapters 43A and 179A. 
  9.63  [CAMBRIDGE REGIONAL HUMAN SERVICES 
  9.64  CENTER.] (a) The commissioner shall 
  9.65  maintain capacity at Cambridge regional 
 10.1   human services center and shall 
 10.2   continue to provide residential and 
 10.3   crisis services at Cambridge for 
 10.4   persons with complex behavioral and 
 10.5   social problems committed by the courts 
 10.6   from the Faribault regional center and 
 10.7   Cambridge regional human services 
 10.8   center catchment areas.  Campus 
 10.9   programs shall operate with the aim of 
 10.10  facilitating the return of individuals 
 10.11  with clinically complex behavior and 
 10.12  social problems to community settings 
 10.13  and shall maintain sufficient support 
 10.14  services on campus as needed by the 
 10.15  programs. 
 10.16  (b) The commissioner shall develop and 
 10.17  present a plan and recommendations to 
 10.18  the legislature by January 15, 1998, 
 10.19  for the second phase of the Minnesota 
 10.20  extended treatment options (METO) 
 10.21  program at Cambridge regional human 
 10.22  services center to serve persons with 
 10.23  developmental disabilities who pose a 
 10.24  public risk.  Phase two shall increase 
 10.25  the on-campus program capacity of METO 
 10.26  by at least 36 additional beds. 
 10.27  [RTC STAFFING LEVELS.] In order to 
 10.28  maintain adequate staffing levels 
 10.29  during reallocations, downsizing, or 
 10.30  transfer of regional center nonfiscal 
 10.31  resources, the commissioner must ensure 
 10.32  that any reallocation of positions 
 10.33  between regional centers does not 
 10.34  reduce required staffing at regional 
 10.35  center programs for adults and 
 10.36  adolescents with mental illness. 
 10.37  Each regional treatment center serving 
 10.38  persons with mental illness must have a 
 10.39  written staffing plan based on program 
 10.40  services and treatment plans that are 
 10.41  required for individuals with mental 
 10.42  illness at the regional center using 
 10.43  standards established by the 
 10.44  commissioner.  The written plan must 
 10.45  include a detailed account of the 
 10.46  staffing needed at the regional center 
 10.47  for the following inpatient and other 
 10.48  psychiatric programs: 
 10.49  (1) acute inpatient; 
 10.50  (2) long-term inpatient; 
 10.51  (3) adolescent programs; and 
 10.52  (4) mobile and other crisis services 
 10.53  and transitional services. 
 10.54  If requested, the regional treatment 
 10.55  center chief executive officer must 
 10.56  provide the exclusive bargaining 
 10.57  representative or any other interested 
 10.58  party with a copy of the staffing plan. 
 10.59  If the exclusive bargaining 
 10.60  representative or another interested 
 10.61  party believes that actual staffing or 
 10.62  planned staffing for a regional 
 11.1   treatment center is not adequate to 
 11.2   provide necessary treatment, they may 
 11.3   request the ombudsman for mental health 
 11.4   and mental retardation to investigate, 
 11.5   report findings, and make 
 11.6   recommendations under Minnesota 
 11.7   Statutes, chapter 245.  If an 
 11.8   investigation is requested in light of 
 11.9   such circumstances, the report and 
 11.10  recommendations must be completed no 
 11.11  less than 30 days before an actual 
 11.12  reallocation, downsizing of staff, or 
 11.13  transfer of nonfiscal resources from a 
 11.14  regional treatment center. 
 11.15  By November 1, 1997, the commissioner 
 11.16  shall begin to develop regional 
 11.17  treatment center staffing plans for 
 11.18  inpatient and other psychiatric 
 11.19  programs.  The commissioner will 
 11.20  consult with representatives of 
 11.21  exclusive bargaining representatives 
 11.22  during the development of these plans.  
 11.23  By February 1, 1998, the commissioner 
 11.24  shall prepare and transmit to the 
 11.25  legislature a report of the staffing 
 11.26  level standards for regional treatment 
 11.27  centers.  The commissioner may also 
 11.28  recommend any changes in statute, 
 11.29  rules, and appropriations needed to 
 11.30  implement the recommendations. 
 11.31  [RTC POPULATION.] If the resident 
 11.32  population at the regional treatment 
 11.33  centers is projected to be higher than 
 11.34  the estimates upon which the medical 
 11.35  assistance forecast and budget 
 11.36  recommendations for the 1998-99 
 11.37  biennium is based, the amount of the 
 11.38  medical assistance appropriation that 
 11.39  is attributable to the cost of services 
 11.40  that would have been provided as an 
 11.41  alternative to regional treatment 
 11.42  center services, including resources 
 11.43  for community placements and waivered 
 11.44  services for persons with mental 
 11.45  retardation and related conditions, is 
 11.46  transferred to the residential 
 11.47  facilities appropriation. 
 11.48  [REPAIRS AND BETTERMENTS.] The 
 11.49  commissioner may transfer unencumbered 
 11.50  appropriation balances between fiscal 
 11.51  years for the state residential 
 11.52  facilities repairs and betterments 
 11.53  account and special equipment. 
 11.54  [PROJECT LABOR.] Wages for project 
 11.55  labor may be paid by the commissioner 
 11.56  of human services out of repairs and 
 11.57  betterments money if the individual is 
 11.58  to be engaged in a construction project 
 11.59  or a repair project of short-term and 
 11.60  nonrecurring nature.  Compensation for 
 11.61  project labor shall be based on the 
 11.62  prevailing wage rates, as defined in 
 11.63  Minnesota Statutes, section 177.42, 
 11.64  subdivision 6.  Project laborers are 
 11.65  excluded from the provisions of 
 11.66  Minnesota Statutes, sections 43A.22 to 
 11.67  43A.30, and shall not be eligible for 
 12.1   state-paid insurance and benefits. 
 12.2   (b) State-Operated Community
 12.3   Services - MI Adults 
 12.4   General               3,907,000     3,976,000
 12.5   (c) State-Operated Community 
 12.6   Services - DD
 12.7   General               9,620,000    10,570,000
 12.8   Subd. 8.  Continuing Care and 
 12.9   Community Support Grants
 12.10  General           1,114,122,000 1,156,630,000
 12.11  The amounts that may be spent from this 
 12.12  appropriation for each purpose are as 
 12.13  follows: 
 12.14  (a) Community Services Block Grants
 12.15      55,618,000     55,618,000 
 12.16  [CSSA TRADITIONAL APPROPRIATION.] 
 12.17  Notwithstanding Minnesota Statutes, 
 12.18  section 256E.06, the appropriations 
 12.19  available under that section in fiscal 
 12.20  years 1998 and 1999 must be distributed 
 12.21  to each county proportionately to the 
 12.22  aid received in calendar year 1996.  
 12.23  The commissioner, in consultation with 
 12.24  counties, shall study Minnesota 
 12.25  Statutes, section 256E.06, subdivision 
 12.26  2, and report findings and 
 12.27  recommendations to the legislature by 
 12.28  January 15, 1998. 
 12.29  (b) Consumer Support Grants
 12.30       1,757,000      1,757,000 
 12.31  (c) Aging Adult Service Grants
 12.32       7,605,000      7,608,000 
 12.33  [HOME CARE OMBUDSMAN PROGRAM.] Of this 
 12.34  appropriation, $100,000 each year of 
 12.35  the biennium shall be transferred to 
 12.36  the ombudsman for older Minnesotans to 
 12.37  assure statewide availability of home 
 12.38  care ombudsman services. 
 12.39  [HEALTH INSURANCE COUNSELING.] Of this 
 12.40  appropriation, $300,000 each year is 
 12.41  for the board on aging for the purpose 
 12.42  of health insurance counseling and 
 12.43  assistance grants to be awarded to the 
 12.44  area agencies on aging. 
 12.45  The board on aging shall award a grant 
 12.46  to each of the 14 area agencies on 
 12.47  aging to develop projects to provide 
 12.48  information about health coverage and 
 12.49  to provide assistance to individuals in 
 12.50  obtaining public and private health 
 12.51  care benefits.  Projects must: 
 12.52  (1) train and support staff and 
 12.53  volunteers to work in partnership to 
 13.1   provide one-on-one information and 
 13.2   assistance services; 
 13.3   (2) provide individual consumers with 
 13.4   assistance in understanding the terms 
 13.5   of a certificate, contract, or policy 
 13.6   of health coverage, including, but not 
 13.7   limited to, terms relating to covered 
 13.8   services, limitations on services, 
 13.9   limitations on access to providers, and 
 13.10  enrollee complaint and appeal 
 13.11  procedures; 
 13.12  (3) assist individuals to understand 
 13.13  medical bills and to process health 
 13.14  care claims and appeals to obtain 
 13.15  health care benefits; 
 13.16  (4) coordinate with existing health 
 13.17  insurance counseling programs serving 
 13.18  Medicare eligible individuals or 
 13.19  establish programs to serve all 
 13.20  consumers; and 
 13.21  (5) operate according to United States 
 13.22  Code, title 42, section 1395b-4, if 
 13.23  serving Medicare beneficiaries. 
 13.24  The board on aging shall allocate the 
 13.25  $300,000 each year to the 14 area 
 13.26  agencies on aging.  The Indian area 
 13.27  agency on aging shall receive a flat 
 13.28  grant of three percent of the annual 
 13.29  allocation.  All other area agencies 
 13.30  will receive a grant based on an age 
 13.31  60-plus population formula, except that 
 13.32  none of these area agencies on aging 
 13.33  shall receive less than a $15,000 base 
 13.34  allocation. 
 13.35  [CONGREGATE AND HOME-DELIVERED MEALS.] 
 13.36  The supplemental funding for nutrition 
 13.37  programs serving counties where 
 13.38  congregate and home-delivered meals 
 13.39  were locally financed prior to 
 13.40  participation in the nutrition program 
 13.41  of the Older Americans Act shall be 
 13.42  awarded at no less than the same levels 
 13.43  as in fiscal year 1997. 
 13.44  [INTRACTABLE EPILEPSY PROGRAM COLA.] Of 
 13.45  this appropriation, $10,000 each year 
 13.46  shall be disbursed for the purpose of 
 13.47  providing a cost of living adjustment 
 13.48  to the current base amount used as a 
 13.49  grant to provide a living skills 
 13.50  training program for persons with 
 13.51  intractable epilepsy who need 
 13.52  assistance in the transition to 
 13.53  independent living. 
 13.54  (d) Deaf and Hard-of-Hearing 
 13.55  Services Grants
 13.56       1,374,000      1,324,000 
 13.57  [SERVICES FOR DEAF AND HARD-OF-HEARING 
 13.58  ADULTS.] Of this appropriation, $50,000 
 13.59  each year shall be disbursed for a 
 13.60  grant to a nonprofit agency that serves 
 13.61  deaf and hard-of-hearing adults with 
 14.1   mental illness through residential 
 14.2   programs and supported housing outreach 
 14.3   activities.  The grant must be used to 
 14.4   expand community support services for 
 14.5   deaf and hard-of-hearing adults with 
 14.6   mental illness who use or wish to use 
 14.7   sign language as their primary means of 
 14.8   communication. 
 14.9   [SERVICE DOGS.] Of this appropriation, 
 14.10  $50,000 in fiscal year 1998 shall be 
 14.11  disbursed for grants to not-for-profit 
 14.12  organizations that train or provide 
 14.13  service dogs for persons with 
 14.14  disabilities.  The commissioner shall 
 14.15  report to the legislature by January 
 14.16  15, 1998, on the use of these grants. 
 14.17  [SERVICES TO DEAF-BLIND CHILDREN.] Of 
 14.18  this appropriation, $200,000 each year 
 14.19  shall be disbursed for deaf, 
 14.20  hard-of-hearing, and deaf blind 
 14.21  services described in clauses (1) and 
 14.22  (2): 
 14.23  (1) a grant to an organization that 
 14.24  provides services to deaf-blind persons 
 14.25  for purposes of providing additional 
 14.26  services to deaf-blind children and 
 14.27  their families, including the provision 
 14.28  of intervenors to assist deaf-blind 
 14.29  children in participating in their 
 14.30  community and family education 
 14.31  specialists to teach siblings and 
 14.32  parents skills to support the 
 14.33  deaf-blind child in the family, and a 
 14.34  grant to organizations that provide 
 14.35  services to deaf-blind persons for 
 14.36  purposes of providing assistance to 
 14.37  deaf-blind persons who are working 
 14.38  toward establishing and maintaining 
 14.39  independence.  The commissioner shall 
 14.40  use the request for proposal process to 
 14.41  award grants under this paragraph; and 
 14.42  (2) a grant for the deaf and 
 14.43  hard-of-hearing and deaf-blind 
 14.44  children.  The grant shall be used to 
 14.45  provide specialized statewide 
 14.46  psychological and social assessments, 
 14.47  family assessments, and school and 
 14.48  family consultation and training.  
 14.49  Services shall be provided in 
 14.50  cooperation with the Minnesota resource 
 14.51  center; the department of children, 
 14.52  families, and learning; the St. Paul 
 14.53  Ramsey health and wellness program 
 14.54  serving deaf and hard-of-hearing 
 14.55  people; and the Greater Minnesota 
 14.56  community mental health centers. 
 14.57  (e) Mental Health Grants
 14.58      48,128,000     49,428,000 
 14.59  [CHILDREN'S MENTAL HEALTH.] Of this 
 14.60  appropriation, $650,000 each year shall 
 14.61  be disbursed for the purpose of 
 14.62  awarding grants to counties for 
 14.63  children's mental health services.  In 
 14.64  awarding grants to counties, the 
 15.1   commissioner shall follow the process 
 15.2   in Minnesota Statutes, section 
 15.3   245.4886, subdivision 2.  The 
 15.4   commissioner shall ensure that grant 
 15.5   funds are not used to replace existing 
 15.6   funds. 
 15.7   [ADOLESCENT COMPULSIVE GAMBLING GRANT.] 
 15.8   $125,000 for fiscal year 1998 and 
 15.9   $125,000 for fiscal year 1999 shall be 
 15.10  transferred by the director of the 
 15.11  lottery from the lottery prize fund 
 15.12  created under Minnesota Statutes, 
 15.13  section 349A.10, subdivision 2, to the 
 15.14  general fund.  $125,000 for fiscal year 
 15.15  1998 and $125,000 for fiscal year 1999 
 15.16  is appropriated from the general fund 
 15.17  to the commissioner for the purposes of 
 15.18  a grant to a compulsive gambling 
 15.19  council located in St. Louis county for 
 15.20  a compulsive gambling prevention and 
 15.21  education project for adolescents. 
 15.22  (f) Developmental Disabilities
 15.23  Support Grants
 15.24       6,448,000      6,398,000 
 15.25  (g) Medical Assistance Long-Term 
 15.26  Care Waivers and Home Care
 15.27     255,540,000    297,609,000 
 15.28  [REIMBURSEMENT INCREASES.] Effective 
 15.29  for services rendered on or after July 
 15.30  1, 1997, the commissioner shall 
 15.31  increase reimbursement rates by five 
 15.32  percent for home- and community-based 
 15.33  waiver services for persons with mental 
 15.34  retardation or related conditions under 
 15.35  Minnesota Statutes, section 256B.501; 
 15.36  home- and community-based waiver 
 15.37  services for the elderly under 
 15.38  Minnesota Statutes, section 256B.0915; 
 15.39  community alternatives for disabled 
 15.40  individuals waiver services under 
 15.41  Minnesota Statutes, section 256B.49; 
 15.42  community alternative care waiver 
 15.43  services under Minnesota Statutes, 
 15.44  section 256B.49; traumatic brain injury 
 15.45  waiver services under Minnesota 
 15.46  Statutes, section 256B.49; nursing 
 15.47  services and home health services under 
 15.48  Minnesota Statutes, section 256B.0625, 
 15.49  subdivision 6a; personal care services 
 15.50  and nursing supervision of personal 
 15.51  care services under Minnesota Statutes, 
 15.52  section 256B.0625, subdivision 19a; 
 15.53  private duty nursing services under 
 15.54  Minnesota Statutes, section 256B.0625, 
 15.55  subdivision 7; day training and 
 15.56  habilitation services for adults with 
 15.57  mental retardation or related 
 15.58  conditions under Minnesota Statutes, 
 15.59  sections 252.40 to 252.47; physical 
 15.60  therapy services under Minnesota 
 15.61  Statutes, sections 256B.0625, 
 15.62  subdivision 8, and 256D.03, subdivision 
 15.63  4; occupational therapy services under 
 15.64  Minnesota Statutes, sections 256B.0625, 
 15.65  subdivision 8a, and 256D.03, 
 16.1   subdivision 4; speech-language therapy 
 16.2   services under Minnesota Statutes, 
 16.3   section 256D.03, subdivision 4, and 
 16.4   Minnesota Rules, part 9505.0390; 
 16.5   respiratory therapy services under 
 16.6   Minnesota Statutes, section 256D.03, 
 16.7   subdivision 4, and Minnesota Rules, 
 16.8   part 9505.0295; dental services under 
 16.9   Minnesota Statutes, sections 256B.0625, 
 16.10  subdivision 9, and 256D.03, subdivision 
 16.11  4; alternative care services under 
 16.12  Minnesota Statutes, section 256B.0913; 
 16.13  and semi-independent living services 
 16.14  under Minnesota Statutes, section 
 16.15  252.275.  The commissioner shall also 
 16.16  increase prepaid medical assistance 
 16.17  program capitation rates as appropriate 
 16.18  to reflect the rate increases in this 
 16.19  paragraph. 
 16.20  (h) Medical Assistance Long-Term
 16.21  Care Facilities
 16.22     582,688,000    591,859,000 
 16.23  [ICF/MR AND NURSING FACILITY 
 16.24  INFLATION.] The commissioner shall 
 16.25  grant inflation adjustments for nursing 
 16.26  facilities with rate years beginning 
 16.27  during the biennium according to 
 16.28  Minnesota Statutes, section 256B.431, 
 16.29  and shall grant inflation adjustments 
 16.30  for intermediate care facilities for 
 16.31  persons with mental retardation or 
 16.32  related conditions with rate years 
 16.33  beginning during the biennium according 
 16.34  to Minnesota Statutes, section 256B.501.
 16.35  [MORATORIUM EXCEPTIONS.] Of this 
 16.36  appropriation, $500,000 each year shall 
 16.37  be disbursed for the medical assistance 
 16.38  costs of moratorium exceptions approved 
 16.39  by the commissioner of health under 
 16.40  Minnesota Statutes, section 144A.073.  
 16.41  Unexpended money appropriated for 
 16.42  fiscal year 1998 does not cancel but is 
 16.43  available for fiscal year 1999.  This 
 16.44  appropriation shall not become part of 
 16.45  base-level funding for the biennium 
 16.46  beginning July 1, 1999. 
 16.47  [COUNTY WAIVERED SERVICES RESERVE.] 
 16.48  Notwithstanding the provisions of 
 16.49  Minnesota Statutes, section 256B.092, 
 16.50  subdivision 4, and Minnesota Rules, 
 16.51  part 9525.1830, subpart 2, the 
 16.52  commissioner may approve written 
 16.53  procedures and criteria for the 
 16.54  allocation of home- and community-based 
 16.55  waivered services funding for persons 
 16.56  with mental retardation or related 
 16.57  conditions which enables a county to 
 16.58  maintain a reserve resource account.  
 16.59  The reserve resource account may not 
 16.60  exceed five percent of the county 
 16.61  agency's total annual allocation of 
 16.62  home- and community-based waivered 
 16.63  services funds.  The reserve may be 
 16.64  utilized to ensure the county's ability 
 16.65  to meet the changing needs of current 
 16.66  recipients, to ensure the health and 
 17.1   safety needs of current recipients, or 
 17.2   to provide short-term emergency 
 17.3   intervention care to eligible waiver 
 17.4   recipients. 
 17.5   (i) Alternative Care Grants  
 17.6   General              48,257,000    32,147,000
 17.7   [PREADMISSION SCREENING TRANSFER.] 
 17.8   Effective the day following final 
 17.9   enactment, up to $40,000 of the 
 17.10  appropriation for preadmission 
 17.11  screening and alternative care for 
 17.12  fiscal year 1997 may be transferred to 
 17.13  the health care administration account 
 17.14  to pay the state's share of county 
 17.15  claims for conducting nursing home 
 17.16  assessments for persons with mental 
 17.17  illness or mental retardation as 
 17.18  required by Public Law Number 100-203. 
 17.19  [ALTERNATIVE CARE TRANSFER.] Any money 
 17.20  allocated to the alternative care 
 17.21  program that is not spent for the 
 17.22  purposes indicated does not cancel but 
 17.23  shall be transferred to the medical 
 17.24  assistance account. 
 17.25  [PREADMISSION SCREENING AMOUNT.] The 
 17.26  preadmission screening payment to all 
 17.27  counties shall continue at the payment 
 17.28  amount in effect for fiscal year 1997. 
 17.29  [PAS/AC APPROPRIATION.] The 
 17.30  commissioner may expend the money 
 17.31  appropriated for preadmission screening 
 17.32  and the alternative care program for 
 17.33  these purposes in either year of the 
 17.34  biennium. 
 17.35  (j) Group Residential Housing
 17.36  General              65,613,000    69,201,000
 17.37  [COUNTY SOCIAL SERVICE GRANTS FOR 
 17.38  FORMER GRH RECIPIENTS.] Notwithstanding 
 17.39  Laws 1995, chapter 207, article 1, 
 17.40  section 2, subdivision 3, section 13 of 
 17.41  this article, and Minnesota Statutes, 
 17.42  section 256E.06, effective July 1, 
 17.43  1995, the funds transferred under the 
 17.44  authority provided by Laws 1993, First 
 17.45  Special Session chapter 1, article 1, 
 17.46  section 2, subdivision 5, and Laws 
 17.47  1995, chapter 207, article 1, section 
 17.48  2, subdivision 3, to provide continuous 
 17.49  funding for persons no longer eligible 
 17.50  for group residential housing (GRH) 
 17.51  payments are added to the community 
 17.52  social services act funding for the 
 17.53  county in which the GRH setting was 
 17.54  located and must not be apportioned to 
 17.55  any other county or counties.  This 
 17.56  paragraph is effective the day 
 17.57  following final enactment. 
 17.58  (k) Chemical Dependency
 17.59  Entitlement Grants
 17.60  General              36,094,000    38,681,000
 18.1   [CHEMICAL DEPENDENCY FUNDS TRANSFER.] 
 18.2   $11,340,000 from the consolidated 
 18.3   chemical dependency general reserve 
 18.4   fund available in fiscal year 1998 is 
 18.5   transferred to the general fund. 
 18.6   (l) Chemical Dependency 
 18.7   Nonentitlement Grants
 18.8   General               5,000,000     5,000,000
 18.9   Subd. 9.  Continuing Care and
 18.10  Community Support Management
 18.11  General              19,129,000    18,754,000
 18.12  State Government
 18.13  Special Revenue         111,000       112,000
 18.14  [CONSUMER-OWNED HOUSING REVOLVING 
 18.15  ACCOUNT.] Effective the day following 
 18.16  final enactment, for the fiscal year 
 18.17  ending June 30, 1997, the commissioner 
 18.18  may transfer $25,000 of the 
 18.19  appropriation for health care to the 
 18.20  commissioner of the Minnesota housing 
 18.21  finance agency to establish an account 
 18.22  to finance the underwriting 
 18.23  requirements of the federal national 
 18.24  mortgage association pilot program for 
 18.25  persons with disabilities.  Any 
 18.26  unexpended balance in this account does 
 18.27  not cancel, but is available to the 
 18.28  commissioner of the Minnesota housing 
 18.29  finance agency for the ongoing purpose 
 18.30  of the account. 
 18.31  [REGION 10 QUALITY ASSURANCE 
 18.32  COMMISSION.] Of this appropriation, 
 18.33  $150,000 each year shall be transferred 
 18.34  to the region 10 quality assurance 
 18.35  commission for the costs associated 
 18.36  with the establishment and operation of 
 18.37  the quality assurance pilot project.  
 18.38  This appropriation shall not become 
 18.39  part of base-level funding for the 
 18.40  biennium beginning July 1, 1999. 
 18.41  [JOINT PURCHASER DEMONSTRATION 
 18.42  PROJECT.] Of this appropriation, 
 18.43  $50,000 in fiscal year 1998 is for a 
 18.44  grant to the Goodhue and Wabasha public 
 18.45  health service board to be used for the 
 18.46  development and start-up operational 
 18.47  costs for a joint purchaser 
 18.48  demonstration project described in Laws 
 18.49  1995, chapter 207, article 6, section 
 18.50  119, in Goodhue and Wabasha counties. 
 18.51  [PILOT PROJECT ON WOMEN'S MENTAL HEALTH 
 18.52  CRISIS SERVICES.] (a) Of this 
 18.53  appropriation, $100,000 in fiscal year 
 18.54  1998 is to develop a one-year pilot 
 18.55  project community-based crisis center 
 18.56  for women who are experiencing a mental 
 18.57  health crisis as a result of childhood 
 18.58  physical or sexual abuse.  The 
 18.59  commissioner shall provide pilot 
 18.60  project funding to Hennepin county to 
 18.61  contract with a four-bed adult foster 
 18.62  care facility to provide these services.
 19.1   (b) The commissioner shall apply to the 
 19.2   federal government for all necessary 
 19.3   waivers of medical assistance 
 19.4   requirements for funding of mental 
 19.5   health clinics so that the services in 
 19.6   paragraph (a) may be reimbursed by 
 19.7   medical assistance, upon legislative 
 19.8   approval, effective July 1, 1998. 
 19.9   [PILOT PROJECT FOR ASSISTED LIVING 
 19.10  SERVICES FOR SENIOR CITIZENS IN PUBLIC 
 19.11  HOUSING.] Of this appropriation, 
 19.12  $75,000 in fiscal year 1998 is for a 
 19.13  pilot project to provide assisted 
 19.14  living services for unserved and 
 19.15  underserved frail elderly and disabled 
 19.16  persons with a focus on those who 
 19.17  experience language and cultural 
 19.18  barriers.  The project shall offer 
 19.19  frail elderly persons an opportunity to 
 19.20  receive community-based support 
 19.21  services in a public housing setting to 
 19.22  enable them to remain in their homes.  
 19.23  The project shall also serve younger 
 19.24  disabled persons on waiver programs who 
 19.25  live in public housing and would 
 19.26  otherwise be in nursing homes.  The 
 19.27  commissioner shall provide pilot 
 19.28  project funding to Hennepin county to 
 19.29  contract with the Korean service center 
 19.30  at the Cedars high-rises.  The center 
 19.31  shall agree to do the following: 
 19.32  (1) facilitate or provide needed 
 19.33  community support services while taking 
 19.34  advantage of current local, state, and 
 19.35  federal programs that provide services 
 19.36  to senior citizens and handicapped 
 19.37  individuals; 
 19.38  (2) negotiate appropriate agreements 
 19.39  with the Minneapolis public housing 
 19.40  authority and Hennepin county; 
 19.41  (3) ensure that all participants are 
 19.42  screened for eligibility for services 
 19.43  by Hennepin county; 
 19.44  (4) become a licensed home care service 
 19.45  provider or subcontract with a licensed 
 19.46  provider to deliver needed services; 
 19.47  (5) contract for meals to be provided 
 19.48  through its congregate dining program; 
 19.49  and 
 19.50  (6) form other partnerships as needed 
 19.51  to ensure the development of a 
 19.52  successful, culturally sensitive 
 19.53  program for meeting the needs of 
 19.54  Korean, Southeast Asian, and other 
 19.55  frail elderly and disabled persons 
 19.56  living in public housing in southeast 
 19.57  Minneapolis. 
 19.58  [SNOW DAYS.] Of this appropriation, 
 19.59  $45,000 in fiscal year 1998 shall be 
 19.60  disbursed to reimburse day training and 
 19.61  habilitation providers for days during 
 19.62  which the provider was closed as a 
 19.63  result of severe weather conditions in 
 20.1   December 1996 to March 1997.  A day 
 20.2   training provider must request the aid 
 20.3   and provide relevant information to the 
 20.4   commissioner.  If the appropriation is 
 20.5   insufficient to reimburse for all 
 20.6   closed days reported by providers, the 
 20.7   commissioner shall make pro rata 
 20.8   reductions in the reimbursement 
 20.9   amount.  This money shall be 
 20.10  distributed no later than September 15, 
 20.11  1997. 
 20.12  Subd. 10.  Economic Support Grants
 20.13  General             222,159,000   210,836,000
 20.14  The amounts that may be spent from this 
 20.15  appropriation for each purpose are: 
 20.16  (a) Assistance to Families Grants
 20.17  General              92,253,000   110,688,000
 20.18  [GIFTS.] Notwithstanding Minnesota 
 20.19  Statutes, chapter 7, the commissioner 
 20.20  may accept on behalf of the state 
 20.21  additional funding from sources other 
 20.22  than state funds for the purpose of 
 20.23  financing the cost of assistance 
 20.24  program grants or administration of 
 20.25  them.  All additional funding is 
 20.26  appropriated to the commissioner for 
 20.27  use as designated by the grantee of 
 20.28  funding. 
 20.29  (b) Work Grants              
 20.30  General              13,786,000    13,792,000
 20.31  (c) Minnesota Family 
 20.32  Investment Program
 20.33  General              20,520,000       -0-    
 20.34  [WELFARE REFORM CARRYOVER.] Unexpended 
 20.35  grant funds for statewide 
 20.36  implementation of the Minnesota family 
 20.37  investment program-statewide, work 
 20.38  first, and employment and training 
 20.39  programs appropriated in fiscal year 
 20.40  1998 for the implementation of welfare 
 20.41  reform initiatives shall not cancel but 
 20.42  shall be available to the commissioner 
 20.43  for these purposes in fiscal year 1999. 
 20.44  (d) Aid to Families With     
 20.45  Dependent Children
 20.46  General               7,695,000       -0-
 20.47  [AFDC SUPPLEMENTARY GRANTS.] Of the 
 20.48  appropriation for AFDC, the 
 20.49  commissioner shall provide 
 20.50  supplementary grants not to exceed 
 20.51  $200,000 a year for AFDC until the AFDC 
 20.52  program no longer exists.  The 
 20.53  commissioner shall include the 
 20.54  following costs in determining the 
 20.55  amount of the supplementary grants:  
 20.56  major home repairs, repair of major 
 20.57  home appliances, utility recaps, 
 21.1   supplementary dietary needs not covered 
 21.2   by medical assistance, and replacements 
 21.3   of furnishings and essential major 
 21.4   appliances. 
 21.5   [CASH BENEFITS IN ADVANCE.] The 
 21.6   commissioner, with the advance approval 
 21.7   of the commissioner of finance, is 
 21.8   authorized to issue cash assistance 
 21.9   benefits up to three days before the 
 21.10  first day of each month, including 
 21.11  three days before the start of each 
 21.12  state fiscal year.  Three percent of 
 21.13  the money appropriated for assistance 
 21.14  to families grants for each fiscal year 
 21.15  is available to the commissioner in the 
 21.16  previous fiscal year.  If that amount 
 21.17  is insufficient for the costs incurred, 
 21.18  an additional amount of the 
 21.19  appropriation as needed may be 
 21.20  transferred with the advance approval 
 21.21  of the commissioner of finance.  This 
 21.22  paragraph is effective the day 
 21.23  following final enactment. 
 21.24  (f) Child Support Enforcement
 21.25  General               5,209,000     5,009,000
 21.26  [CHILD SUPPORT PAYMENT CENTER.] 
 21.27  Payments to the commissioner from other 
 21.28  governmental units, private 
 21.29  enterprises, and individuals for 
 21.30  services performed by the child support 
 21.31  payment center must be deposited in the 
 21.32  state systems account authorized under 
 21.33  Minnesota Statutes, section 256.014.  
 21.34  These payments are appropriated to the 
 21.35  commissioner for the operation of the 
 21.36  child support payment center or system, 
 21.37  according to Minnesota Statutes, 
 21.38  section 256.014. 
 21.39  [CHILD SUPPORT ENFORCEMENT PAYMENT 
 21.40  CENTER RECOUPMENT ACCOUNT.] The child 
 21.41  support enforcement payment center is 
 21.42  authorized to establish an account to 
 21.43  cover checks issued in error or in 
 21.44  cases where insufficient funds are 
 21.45  available to pay the checks.  All 
 21.46  recoupments against payments from the 
 21.47  account must be deposited in the child 
 21.48  support enforcement payment center 
 21.49  recoupment account and are appropriated 
 21.50  to the commissioner for the purposes of 
 21.51  the account.  Any unexpended balance in 
 21.52  the account does not cancel, but is 
 21.53  available until expended.  For the 
 21.54  period June 1, 1997, through June 30, 
 21.55  1997, the commissioner may transfer 
 21.56  fiscal year 1997 general fund 
 21.57  administrative money to the child 
 21.58  support enforcement payment center 
 21.59  recoupment account to cover 
 21.60  underfinanced and unfunded checks 
 21.61  during this period only.  This 
 21.62  paragraph is effective the day 
 21.63  following final enactment. 
 21.64  [CHILD SUPPORT ENFORCEMENT CARRYOVER.] 
 21.65  Unexpended funds for child support 
 22.1   enforcement grants and county 
 22.2   performance incentives for fiscal year 
 22.3   1998 do not cancel but are available to 
 22.4   the commissioner for these purposes for 
 22.5   fiscal year 1999. 
 22.6   (g) General Assistance
 22.7   General              55,019,000    51,583,000
 22.8   [GA STANDARD.] The commissioner shall 
 22.9   set the monthly standard of assistance 
 22.10  for general assistance units consisting 
 22.11  of an adult recipient who is childless 
 22.12  and unmarried or living apart from his 
 22.13  or her parents or a legal guardian at 
 22.14  $203, provided that if the policy 
 22.15  designed to make welfare benefits a 
 22.16  neutral factor in the decision to move 
 22.17  to Minnesota and to best manage the 
 22.18  benefit appropriation for needy 
 22.19  Minnesotans, while providing a safety 
 22.20  net for recent interstate migrants, is 
 22.21  enjoined or otherwise prevented from 
 22.22  being implemented, the standard is $94. 
 22.23  (h) Minnesota Supplemental Aid
 22.24  General              25,572,000    27,659,000
 22.25  (i) Refugee Services         
 22.26  General               2,105,000     2,105,000
 22.27  [CITIZENSHIP TRAINING.] The funds 
 22.28  appropriated for citizenship training 
 22.29  shall be awarded to nonprofit 
 22.30  organizations through a competitive 
 22.31  bidding process based on criteria 
 22.32  established by the commissioner.  
 22.33  Notice of the availability of funds 
 22.34  shall be published in the State 
 22.35  Register.  This appropriation shall not 
 22.36  become part of base-level funding for 
 22.37  the biennium beginning July 1, 1999. 
 22.38  Subd. 11.  Economic Support  
 22.39  Management
 22.40  General              39,176,000    37,482,000
 22.41  The amounts that may be spent from this 
 22.42  appropriation for each purpose are: 
 22.43  (a) Economic Support Policy  
 22.44  Administration
 22.45  General              10,234,000     8,626,000
 22.46  [PLAN FOR TRIBAL OPERATION OF FAMILY 
 22.47  ASSISTANCE PROGRAM.] Of this 
 22.48  appropriation, $75,000 each year is 
 22.49  appropriated to the commissioner to 
 22.50  assist tribes in the development and 
 22.51  implementation of a plan for providing 
 22.52  state funds in support of a family 
 22.53  assistance program and employment and 
 22.54  training programs administered by 
 22.55  Indian tribes that have a reservation 
 22.56  in Minnesota and that have federal 
 22.57  approval to operate a tribal program.  
 23.1   The commissioner and the tribes shall 
 23.2   collaborate in the development of the 
 23.3   plan.  The plan shall be reported to 
 23.4   the legislature no later than February 
 23.5   15, 1998.  This appropriation shall not 
 23.6   become part of base-level funding for 
 23.7   the biennium beginning July 1, 1999. 
 23.8   [NEW CHANCE PROGRAM.] Of this 
 23.9   appropriation, $140,000 each year is 
 23.10  for a grant to the "new chance" 
 23.11  program.  The new chance program shall 
 23.12  provide comprehensive services through 
 23.13  a private, nonprofit agency to young 
 23.14  parents in Hennepin county who have 
 23.15  dropped out of school and are receiving 
 23.16  public assistance.  The program 
 23.17  administrator shall report annually to 
 23.18  the commissioner on skills development, 
 23.19  education, job training, and job 
 23.20  placement outcomes for program 
 23.21  participants. 
 23.22  [TEMPORARY HUNGER PREVENTION AND 
 23.23  COMMUNITY DEVELOPMENT INITIATIVE.] (a) 
 23.24  The commissioner of human services, in 
 23.25  conjunction with the commissioner of 
 23.26  agriculture, shall create and 
 23.27  administer the "Minnesota grown" 
 23.28  component of the program called the 
 23.29  temporary hunger prevention and 
 23.30  community development initiative.  The 
 23.31  program shall consist of "Minnesota 
 23.32  grown" coupons.  The total benefit for 
 23.33  an individual or family shall be 35 
 23.34  percent of the actual amount of the 
 23.35  food stamp benefit for which the 
 23.36  individual or family would otherwise be 
 23.37  eligible, but for the individual or 
 23.38  family's noncitizen status.  The 
 23.39  program is intended to serve legal 
 23.40  noncitizens who are ineligible for the 
 23.41  federal food stamp program because of 
 23.42  changes in the citizenship requirements 
 23.43  made by Public Law Number 104-193.  The 
 23.44  commissioners of human services and 
 23.45  agriculture shall determine the most 
 23.46  effective way to administer the program 
 23.47  within the limit of the appropriation 
 23.48  for the program.  For purposes of 
 23.49  paragraphs (a) to (c), "legal 
 23.50  noncitizen" has the meaning given in 
 23.51  Minnesota Statutes, section 256J.11, if 
 23.52  enacted. 
 23.53  (b) The benefit for which the 
 23.54  individual or family is eligible shall 
 23.55  be issued by the commissioner of 
 23.56  agriculture through the "Minnesota 
 23.57  grown" coupon program, except that the 
 23.58  percentage issued as coupons must be 
 23.59  rounded to the nearest five dollars and 
 23.60  not exceed $100 nor be less than $20.  
 23.61  Each month the commissioner of human 
 23.62  services shall provide to the 
 23.63  commissioner of agriculture the names 
 23.64  of the heads of households who are 
 23.65  eligible for the "Minnesota grown" 
 23.66  coupon program, the addresses, and the 
 23.67  amount of coupons the household should 
 23.68  be issued.  The amount of the 
 24.1   "Minnesota grown" coupons must be 
 24.2   excluded as income under the AFDC, 
 24.3   refugee cash assistance, general 
 24.4   assistance, MFIP, MFIP-R, MFIP-S, and 
 24.5   food stamp programs.  
 24.6   (c) The temporary hunger prevention and 
 24.7   community development initiative 
 24.8   program shall serve otherwise eligible 
 24.9   legal noncitizens who reside in this 
 24.10  state as of March 1, 1997.  An 
 24.11  otherwise eligible legal noncitizen who 
 24.12  seeks assistance under the temporary 
 24.13  hunger prevention and community 
 24.14  development initiative program shall 
 24.15  receive assistance provided the legal 
 24.16  noncitizen: 
 24.17  (1) is enrolled in a literacy class, 
 24.18  English as a second language class, or 
 24.19  a citizenship class; 
 24.20  (2) is applying for admission to a 
 24.21  literacy class, English as a second 
 24.22  language class, or a citizenship class, 
 24.23  and is on a waiting list; 
 24.24  (3) is in the process of applying for a 
 24.25  waiver from the Immigration and 
 24.26  Naturalization Service of the English 
 24.27  language or civics requirement of the 
 24.28  citizenship test; 
 24.29  (4) has submitted an application for 
 24.30  citizenship to the Immigration and 
 24.31  Naturalization Service and is waiting 
 24.32  for a testing date or a subsequent 
 24.33  swearing in ceremony; or 
 24.34  (5) has been denied citizenship due to 
 24.35  a failure to pass the test after two 
 24.36  attempts or because of an inability to 
 24.37  understand the rights and 
 24.38  responsibilities of becoming a United 
 24.39  States citizen, as documented by the 
 24.40  Immigration and Naturalization Service 
 24.41  or the county. 
 24.42  [COMBINED MANUAL PRODUCTION COSTS.] The 
 24.43  commissioner may increase the fee 
 24.44  charged to, and may retain money 
 24.45  received from, individuals and private 
 24.46  entities in order to recover the 
 24.47  difference between the costs of 
 24.48  producing the department of human 
 24.49  services combined manual and the 
 24.50  subsidized price charged to individuals 
 24.51  and private entities on January 1, 
 24.52  1996.  The provision does not apply to 
 24.53  government agencies and nonprofit 
 24.54  agencies serving the legal or social 
 24.55  service needs of clients. 
 24.56  (b) Economic Support Policy  
 24.57  Operations
 24.58  General              28,942,000    28,856,000
 24.59  [ELECTRONIC BENEFIT TRANSFER (EBT) 
 24.60  COUNTY ALLOCATION.] Of the amount 
 24.61  appropriated for electronic benefit 
 25.1   transfer, an allocation shall be made 
 25.2   each year to counties for EBT-related 
 25.3   expenses.  One hundred percent of the 
 25.4   money shall be allocated to counties 
 25.5   based on each county's average monthly 
 25.6   number of food stamp households as a 
 25.7   proportion of statewide average monthly 
 25.8   food stamp households for the fiscal 
 25.9   year ending June 30, 1996. 
 25.10  Subd. 12.  Federal TANF Funds       
 25.11  [FEDERAL TANF FUNDS.] Federal Temporary 
 25.12  Assistance For Needy Families block 
 25.13  grant funds authorized under title I of 
 25.14  Public Law Number 104-193, the Personal 
 25.15  Responsibility and Work Opportunity Act 
 25.16  of 1996, are appropriated to the 
 25.17  department of human services in amounts 
 25.18  up to $278,400,000 in fiscal year 1998 
 25.19  and $277,244,000 in fiscal year 1999.  
 25.20  The Minnesota family investment 
 25.21  program-statewide/TANF reserve account 
 25.22  is created in the state treasury.  
 25.23  Funds designated by the legislature and 
 25.24  earnings available from the federal 
 25.25  TANF block grant appropriated to the 
 25.26  commissioner but not expended in the 
 25.27  biennium beginning July 1, 1997, shall 
 25.28  be retained in the reserve account to 
 25.29  be expended for the Minnesota family 
 25.30  investment program-statewide in fiscal 
 25.31  year 2000 and subsequent fiscal years. 
 25.32  [UNEXPENDED CHILD CARE FUNDS.] All 
 25.33  unexpended child care assistance grant 
 25.34  funds for the biennium ending June 30, 
 25.35  1999, must not cancel to the general 
 25.36  fund but shall be transferred to the 
 25.37  TANF reserve account. 
 25.38  Sec. 3.  COMMISSIONER OF HEALTH 
 25.39  Subdivision 1.  Total 
 25.40  Appropriation                         72,493,000    73,549,000
 25.41                Summary by Fund
 25.42  General              50,799,000    51,633,000
 25.43  Metropolitan Landfill
 25.44  Contingency Action Fund 193,000       193,000
 25.45  State Government
 25.46  Special Revenue      21,501,000    21,723,000
 25.47  [LANDFILL CONTINGENCY.] The 
 25.48  appropriation from the metropolitan 
 25.49  landfill contingency action fund shall 
 25.50  be disbursed for monitoring well water 
 25.51  supplies and conducting health 
 25.52  assessments in the metropolitan area. 
 25.53  Subd. 2.  Health Systems
 25.54  and Special Populations               48,143,000     49,266,000
 25.55                Summary by Fund
 25.56  General              39,280,000    40,373,000
 25.57  State Government
 26.1   Special Revenue       8,863,000     8,893,000
 26.2   [FEES FOR DRUG AND ALCOHOL COUNSELOR 
 26.3   LICENSE.] When setting fees for the 
 26.4   drug and alcohol counselor license, the 
 26.5   commissioner is exempt from Minnesota 
 26.6   Statutes, section 16A.1285, subdivision 
 26.7   2. 
 26.8   [FEES FOR HEARING INSTRUMENT DISPENSERS 
 26.9   LICENSE.] When setting fees for the 
 26.10  hearing instrument dispensers license, 
 26.11  the commissioner is exempt from 
 26.12  Minnesota Statutes, section 16A.1285, 
 26.13  subdivision 2. 
 26.14  [STATE VITAL STATISTICS REDESIGN 
 26.15  PROJECT ACCOUNT.] The amount 
 26.16  appropriated from the state government 
 26.17  special revenue fund for the vital 
 26.18  records redesign project shall be 
 26.19  available until expended for 
 26.20  development and implementation. 
 26.21  [COMPUTER PROJECTS] Money appropriated 
 26.22  for computer projects approved by the 
 26.23  information policy office, funded by 
 26.24  the legislature, and approved by the 
 26.25  commissioner of finance does not cancel 
 26.26  but is available for development and 
 26.27  implementation. 
 26.28  [COMPLEMENTARY MEDICINE STUDY.] (a) Of 
 26.29  the general fund appropriation, $20,000 
 26.30  in fiscal year 1998 shall be disbursed 
 26.31  for the commissioner of health, in 
 26.32  consultation with the commissioner of 
 26.33  commerce, to conduct a study based on 
 26.34  existing literature, information, and 
 26.35  data on the scope of complementary 
 26.36  medicine offered in this state.  The 
 26.37  commissioner shall: 
 26.38  (1) include the types of complementary 
 26.39  medicine therapies available in this 
 26.40  state; 
 26.41  (2) contact national and state 
 26.42  complementary medicine associations for 
 26.43  literature, information, and data; 
 26.44  (3) conduct a general literary review 
 26.45  for information and data on 
 26.46  complementary medicine; 
 26.47  (4) contact the departments of commerce 
 26.48  and human services for information on 
 26.49  existing registrations, licenses, 
 26.50  certificates, credentials, policies, 
 26.51  and regulations; and 
 26.52  (5) determine by sample, if 
 26.53  complementary medicine is currently 
 26.54  covered by health plan companies and 
 26.55  the extent of the coverage. 
 26.56  In conducting this review, the 
 26.57  commissioner shall consult with the 
 26.58  office of alternative medicine through 
 26.59  the National Institute of Health. 
 27.1   (b) The commissioner shall, in 
 27.2   consultation with the advisory 
 27.3   committee, report the study findings to 
 27.4   the legislature by January 15, 1998.  
 27.5   As part of the report, the commissioner 
 27.6   shall make recommendations on whether 
 27.7   the state should credential or regulate 
 27.8   any of the complementary medicine 
 27.9   providers. 
 27.10  (c) The commissioner shall appoint an 
 27.11  advisory committee to provide expertise 
 27.12  and advice on the study.  The committee 
 27.13  must include representation from the 
 27.14  following groups:  health care 
 27.15  providers, including providers of 
 27.16  complementary medicine; health plan 
 27.17  companies; and consumers.  The advisory 
 27.18  committee is governed by Minnesota 
 27.19  Statutes, section 15.059, for 
 27.20  membership terms and removal of members.
 27.21  (d) For purposes of this study, the 
 27.22  term "complementary medicine" includes, 
 27.23  but is not limited to, acupuncture, 
 27.24  homeopathy, manual healing, 
 27.25  macrobiotics, naturopathy, biofeedback, 
 27.26  mind/body control therapies, 
 27.27  traditional and ethnomedicine 
 27.28  therapies, structural manipulations and 
 27.29  energetic therapies, bioelectromagnetic 
 27.30  therapies, and herbal medicine. 
 27.31  [STUDY OF LICENSED PSYCHOLOGICAL 
 27.32  PRACTITIONERS.] The commissioner, in 
 27.33  cooperation with the board of 
 27.34  psychology, shall report to the 
 27.35  legislature by January 15, 1998, on the 
 27.36  impact on psychological practitioners 
 27.37  licensed under Minnesota Statutes, 
 27.38  section 148.908, and on consumers of 
 27.39  the limitations on third-party 
 27.40  reimbursement due to the requirement 
 27.41  for supervision under Minnesota 
 27.42  Statutes, section 148.925. 
 27.43  [DOWN SYNDROME.] Of the general fund 
 27.44  appropriation, $15,000 in fiscal year 
 27.45  1998 shall be disbursed for a grant to 
 27.46  a nonprofit organization that provides 
 27.47  support to individuals with Down 
 27.48  Syndrome and their families, for the 
 27.49  purpose of providing all obstetricians, 
 27.50  certified nurse-midwives, and family 
 27.51  physicians licensed to practice in this 
 27.52  state with informational packets on 
 27.53  Down Syndrome.  The packets must 
 27.54  include, at a minimum, a fact sheet on 
 27.55  Down Syndrome, a list of counseling and 
 27.56  support groups for families with 
 27.57  children with Down Syndrome, and a list 
 27.58  of special needs adoption resources.  
 27.59  The informational packets must be made 
 27.60  available to any pregnant patient who 
 27.61  has tested positive for Down Syndrome, 
 27.62  either through a screening test or 
 27.63  amniocentesis. 
 27.64  [NEWBORN SCREENING FOR HEARING LOSS 
 27.65  PROGRAM IMPLEMENTATION PLAN.] (a) Of 
 27.66  the general fund appropriation, $18,000 
 28.1   in fiscal year 1998 shall be disbursed 
 28.2   to pay the costs of coordinating with 
 28.3   hospitals, the medical community, 
 28.4   audiologists, insurance companies, 
 28.5   parents, and deaf and hard-of-hearing 
 28.6   citizens to establish and implement a 
 28.7   voluntary plan for hospitals and other 
 28.8   health care facilities to screen all 
 28.9   infants for hearing loss. 
 28.10  (b) The plan to achieve universal 
 28.11  screening of infants for hearing loss 
 28.12  on a voluntary basis shall be 
 28.13  formulated by a department work group, 
 28.14  including the following representatives:
 28.15  (1) a representative of the health 
 28.16  insurance industry designated by the 
 28.17  health insurance industry; 
 28.18  (2) a representative of the Minnesota 
 28.19  Hospital and Healthcare Partnership; 
 28.20  (3) a total of two representatives from 
 28.21  the following physician groups 
 28.22  designated by the Minnesota Medical 
 28.23  Association:  pediatrics, family 
 28.24  practice, and ENT; 
 28.25  (4) two audiologists designated by the 
 28.26  Minnesota Speech-Language-Hearing 
 28.27  Association and the Minnesota Academy 
 28.28  of Audiology; 
 28.29  (5) a representative of hospital 
 28.30  neonatal nurseries; 
 28.31  (6) a representative of part H (IDEA) 
 28.32  early childhood special education; 
 28.33  (7) the commissioner of health or a 
 28.34  designee; 
 28.35  (8) a representative of the department 
 28.36  of human services; 
 28.37  (9) a public health nurse; 
 28.38  (10) a parent of a deaf or 
 28.39  hard-of-hearing child; 
 28.40  (11) a deaf or hard-of-hearing person; 
 28.41  and 
 28.42  (12) a representative of the Minnesota 
 28.43  commission serving deaf and 
 28.44  hard-of-hearing people. 
 28.45  Members of the work group shall not 
 28.46  collect a per diem or compensation as 
 28.47  provided in Minnesota Statutes, section 
 28.48  15.0575. 
 28.49  (c) The plan shall include measurable 
 28.50  goals and timetables for the 
 28.51  achievement of universal screening of 
 28.52  infants for hearing loss throughout the 
 28.53  state and shall include the design and 
 28.54  implementation of needed training to 
 28.55  assist hospitals and other health care 
 28.56  facilities screen infants for hearing 
 29.1   loss according to recognized standards 
 29.2   of care. 
 29.3   (d) The work group shall report to the 
 29.4   legislature by January 15, 1998, 
 29.5   concerning progress toward the 
 29.6   achievement of universal screening of 
 29.7   infants in Minnesota for the purpose of 
 29.8   assisting the legislature to determine 
 29.9   whether this goal can be accomplished 
 29.10  on a voluntary basis. 
 29.11  [AMERICAN INDIAN DIABETES.] Of this 
 29.12  appropriation, $90,000 each year shall 
 29.13  be disbursed for a comprehensive 
 29.14  school-based intervention program 
 29.15  designed to reduce the risk factors 
 29.16  associated with diabetes among American 
 29.17  Indian school children in grades 1 
 29.18  through 4. The appropriation for fiscal 
 29.19  year 1999 is available only if matched 
 29.20  by $1 of nonstate money for each $1 of 
 29.21  the appropriation.  The commissioner 
 29.22  shall convene an American Indian 
 29.23  diabetes prevention advisory task 
 29.24  force.  The task force must include 
 29.25  representatives from the American 
 29.26  Indian tribes located in the state and 
 29.27  urban American Indian representatives.  
 29.28  The task force shall advise the 
 29.29  commissioner on the adaptation of 
 29.30  curricula and the dissemination of 
 29.31  information designed to reduce the risk 
 29.32  factors associated with diabetes among 
 29.33  American Indian school children in 
 29.34  grades 1 through 4.  The curricula and 
 29.35  information must be sensitive to 
 29.36  traditional American Indian values and 
 29.37  culture and must encourage full 
 29.38  participation by the American Indian 
 29.39  community. 
 29.40  [FETAL ALCOHOL SYNDROME.] Of the 
 29.41  general fund appropriation, $500,000 in 
 29.42  fiscal year 1998 shall be disbursed to 
 29.43  prevent and reduce harm from fetal 
 29.44  alcohol syndrome and fetal alcohol 
 29.45  effect.  Unexpended funds do not cancel 
 29.46  but are available for fiscal year 1999. 
 29.47  [MN ENABL.] Of the general fund 
 29.48  appropriation, $500,000 each year shall 
 29.49  be disbursed for the continuation and 
 29.50  expansion of the Minnesota education 
 29.51  now and babies later (MN ENABL) 
 29.52  program.  The appropriation shall 
 29.53  include the continuation of the 
 29.54  contract with the attorney general's 
 29.55  office for the development and 
 29.56  implementation of the media and public 
 29.57  relations campaign.  
 29.58  [BIRTH DEFECTS INFORMATION SYSTEM.] Of 
 29.59  the general fund appropriation, 
 29.60  $600,000 in fiscal year 1998 and 
 29.61  $1,000,000 in fiscal year 1999 shall be 
 29.62  disbursed to administer the birth 
 29.63  defects information system. 
 29.64  [IMMUNIZATION REGISTRIES.] Of this 
 29.65  appropriation, $525,000 each year shall 
 30.1   be disbursed for grants to local 
 30.2   communities for the central collection 
 30.3   of immunization registry data for all 
 30.4   persons of an age specified by the 
 30.5   registry within a geographic area, 
 30.6   beginning with the filing of their 
 30.7   birth registrations, provided that the 
 30.8   individual has consented to be included 
 30.9   in the central collection of 
 30.10  immunization registry data as required 
 30.11  by Minnesota Statutes, section 144.3351.
 30.12  [INFANT HEARING SCREENING PROGRAM.] Of 
 30.13  the general fund appropriation, $25,000 
 30.14  in fiscal year 1998 shall be disbursed 
 30.15  for a grant to a hospital in Staples, 
 30.16  Minnesota, for the infant hearing 
 30.17  screening program. 
 30.18  [WIC TRANSFERS.] General fund 
 30.19  appropriations for the women, infants, 
 30.20  and children food supplement program 
 30.21  (WIC) are available for either year of 
 30.22  the biennium.  Transfers of 
 30.23  appropriations between fiscal years 
 30.24  must be for the purpose of maximizing 
 30.25  federal funds or minimizing 
 30.26  fluctuations in the number of 
 30.27  participants.  
 30.28  [WIC APPROPRIATION.] Of the general 
 30.29  fund appropriation, $1,150,000 in 
 30.30  fiscal year 1998 and $1,000,000 in 
 30.31  fiscal year 1999 shall be disbursed for 
 30.32  the women, infants, and children food 
 30.33  supplement program (WIC).  This 
 30.34  appropriation shall not become part of 
 30.35  base-level funding for the biennium 
 30.36  beginning July 1, 1999. 
 30.37  [LOCAL PUBLIC HEALTH FINANCING.] Of the 
 30.38  general fund appropriation, $6,000,000 
 30.39  each year shall be disbursed for local 
 30.40  public health financing and shall be 
 30.41  distributed according to the community 
 30.42  health service subsidy formula in 
 30.43  Minnesota Statutes, section 145A.13.  
 30.44  [SERVICES FOR CHILDREN CARRYOVER.] 
 30.45  General fund appropriations for 
 30.46  treatment services in the services for 
 30.47  children with special health care needs 
 30.48  program are available for either year 
 30.49  of the biennium. 
 30.50  [NURSING HOMES DAMAGED BY FLOODS.] The 
 30.51  commissioner shall conduct an expedited 
 30.52  process under Minnesota Statutes, 
 30.53  section 144A.073, in order to review 
 30.54  nursing home moratorium exceptions 
 30.55  necessary to repair or replace nursing 
 30.56  facilities damaged by spring flooding 
 30.57  in 1997.  For facilities that require 
 30.58  total replacement and the relocation of 
 30.59  residents to other facilities during 
 30.60  construction, the operating cost 
 30.61  payment rates for the new facility 
 30.62  shall be determined using the interim 
 30.63  and settle-up payment provisions of 
 30.64  Minnesota Rules, part 9549.0057, and 
 30.65  the reimbursement provisions of 
 31.1   Minnesota Statutes, section 256B.431, 
 31.2   except that subdivision 25, paragraphs 
 31.3   (b), clause (3), and (d), shall not 
 31.4   apply until the second rate year after 
 31.5   the settle-up cost report is filed.  
 31.6   Property-related reimbursement rates 
 31.7   shall be determined under Minnesota 
 31.8   Rules, chapter 9549, taking into 
 31.9   account any federal or state 
 31.10  flood-related loans or grants provided 
 31.11  to a facility.  The medical assistance 
 31.12  property-related costs of this 
 31.13  paragraph shall be paid from the amount 
 31.14  made available in section 2 of this 
 31.15  article for moratorium exceptions.  The 
 31.16  medical assistance operating costs of 
 31.17  this paragraph shall be paid from any 
 31.18  flood-related disaster relief 
 31.19  appropriation made by the 1997 
 31.20  legislature.  This paragraph is 
 31.21  effective the day following final 
 31.22  enactment and is not subject to section 
 31.23  13 of this article. 
 31.24  Subd. 3.  Health Protection          21,300,000     21,108,000
 31.25                Summary by Fund
 31.26  General               8,627,000     8,243,000
 31.27  Metro Landfill
 31.28  Contingency             193,000       193,000
 31.29  State Government 
 31.30  Special Revenue      12,480,000    12,672,000
 31.31  [HIV/AIDS PREVENTION.] (a) Of the 
 31.32  general fund appropriation, $500,000 in 
 31.33  fiscal year 1998 shall be disbursed to 
 31.34  provide funding for HIV/AIDS prevention 
 31.35  grants under Minnesota Statutes, 
 31.36  section 145.924.  
 31.37  (b) Of the general fund appropriation, 
 31.38  $100,000 each year shall be disbursed 
 31.39  for activities related to prevention of 
 31.40  perinatal transmission of HIV, a 
 31.41  statewide education campaign for 
 31.42  pregnant women and their health care 
 31.43  providers, and demonstration grants to 
 31.44  providers to develop procedures for 
 31.45  incorporating HIV awareness and 
 31.46  education into perinatal care. 
 31.47  (c) The appropriations in paragraphs 
 31.48  (a) and (b) shall not become part of 
 31.49  base-level funding for the biennium 
 31.50  beginning July 1, 1999. 
 31.51  Subd. 4.  Management and
 31.52  Support Services                       3,050,000      3,175,000
 31.53                Summary by Fund
 31.54  General               2,892,000     3,017,000
 31.55  State Government
 31.56  Special Revenue         158,000       158,000
 31.57  Sec. 4.  VETERANS NURSING   
 31.58  HOMES BOARD                           23,721,000     22,172,000 
 32.1   [SPECIAL REVENUE ACCOUNT.] The general 
 32.2   fund appropriations made to the 
 32.3   veterans homes board shall be 
 32.4   transferred to a veterans homes special 
 32.5   revenue account in the special revenue 
 32.6   fund in the same manner as other 
 32.7   receipts are deposited according to 
 32.8   Minnesota Statutes, section 198.34, and 
 32.9   are appropriated to the veterans homes 
 32.10  board of directors for the operation of 
 32.11  board facilities and programs. 
 32.12  [SETTING THE COST OF CARE.] The 
 32.13  veterans homes board may set the cost 
 32.14  of care at the Fergus Falls facility 
 32.15  based on the cost of average skilled 
 32.16  nursing care provided to residents of 
 32.17  the Minneapolis veterans home for 
 32.18  fiscal years 1998 and 1999. 
 32.19  [LICENSED CAPACITY.] The department of 
 32.20  health shall not reduce the licensed 
 32.21  bed capacity for the Minneapolis 
 32.22  veterans home pending completion of the 
 32.23  project authorized by Laws 1990, 
 32.24  chapter 610, article 1, section 9, 
 32.25  subdivision 3.  
 32.26  [ALLOWANCE FOR FOOD.] The allowance for 
 32.27  food may be adjusted annually to 
 32.28  reflect changes in the producer price 
 32.29  index, as prepared by the United States 
 32.30  Bureau of Labor Statistics, with the 
 32.31  approval of the commissioner of 
 32.32  finance.  Adjustments for fiscal year 
 32.33  1998 and fiscal year 1999 must be based 
 32.34  on the June 1996 and June 1997 producer 
 32.35  price index respectively, but the 
 32.36  adjustment must be prorated if it would 
 32.37  require money in excess of the 
 32.38  appropriation. 
 32.39  Sec. 5.  HEALTH-RELATED BOARDS 
 32.40  Subdivision 1.  Total       
 32.41  Appropriation                          9,598,000      9,618,000 
 32.42  [STATE GOVERNMENT SPECIAL REVENUE 
 32.43  FUND.] The appropriations in this 
 32.44  section are from the state government 
 32.45  special revenue fund. 
 32.46  [NO SPENDING IN EXCESS OF REVENUES.] 
 32.47  The commissioner of finance shall not 
 32.48  permit the allotment, encumbrance, or 
 32.49  expenditure of money appropriated in 
 32.50  this section in excess of the 
 32.51  anticipated biennial revenues or 
 32.52  accumulated surplus revenues from fees 
 32.53  collected by the boards.  Neither this 
 32.54  provision nor Minnesota Statutes, 
 32.55  section 214.06, applies to transfers 
 32.56  from the general contingent account. 
 32.57  Subd. 2.  Board of Chiropractic 
 32.58  Examiners                                332,000        340,000
 32.59  Subd. 3.  Board of Dentistry             742,000        760,000
 32.60  Subd. 4.  Board of Dietetic
 33.1   and Nutrition Practice                    90,000         90,000
 33.2   Subd. 5.  Board of Marriage and 
 33.3   Family Therapy                           103,000        104,000
 33.4   Subd. 6.  Board of Medical  
 33.5   Practice                               3,672,000      3,711,000
 33.6   Of these appropriations, $109,000 the 
 33.7   first year and $110,000 the second year 
 33.8   are for the Health Professional 
 33.9   Services Activity. 
 33.10  Subd. 7.  Board of Nursing             2,067,000      2,106,000
 33.11  [DISCIPLINE AND LICENSING SYSTEMS 
 33.12  PROJECT.] Of this appropriation, 
 33.13  $235,000 the first year and $235,000 
 33.14  the second year shall be disbursed to 
 33.15  complete the implementation of the 
 33.16  discipline and licensing systems 
 33.17  project.  
 33.18  Subd. 8.  Board of Nursing 
 33.19  Home Administrators                      177,000        181,000
 33.20  Subd. 9.  Board of Optometry              82,000         85,000
 33.21  Subd. 10.  Board of Pharmacy           1,020,000      1,040,000
 33.22  Of this appropriation, $216,000 the 
 33.23  first year and $222,000 the second year 
 33.24  shall be disbursed for the health 
 33.25  boards administrative services unit.  
 33.26  The administrative services unit may 
 33.27  receive and expend reimbursements for 
 33.28  services performed for other agencies. 
 33.29  Subd. 11.  Board of Podiatry              33,000         33,000
 33.30  Subd. 12.  Board of Psychology           424,000        436,000
 33.31  Subd. 13.  Board of Social Work          715,000        588,000
 33.32  Subd. 14.  Board of Veterinary 
 33.33  Medicine                                 141,000        144,000
 33.34  Sec. 6.  EMERGENCY MEDICAL
 33.35  SERVICES BOARD                         2,436,000      2,262,000 
 33.36                Summary by Fund
 33.37  General                 784,000       584,000
 33.38  Trunk Highway         1,652,000     1,678,000
 33.39  [COMPREHENSIVE ADVANCED LIFE SUPPORT 
 33.40  (CALS).] Of this appropriation, 
 33.41  $194,000 in fiscal year 1998 shall be 
 33.42  disbursed to implement the 
 33.43  comprehensive advanced life support 
 33.44  (CALS) program or similar program and 
 33.45  $6,000 is for administrative costs of 
 33.46  implementing the CALS program. 
 33.47  Sec. 7.  COUNCIL ON DISABILITY           616,000        631,000
 33.48  Sec. 8.  OMBUDSMAN FOR MENTAL 
 33.49  HEALTH AND MENTAL RETARDATION          1,374,000      1,298,000
 33.50  [CARRYOVER.] $25,000 of the 
 34.1   appropriation from Laws 1995, chapter 
 34.2   207, article 1, section 7, does not 
 34.3   cancel but is available until June 30, 
 34.4   1999. 
 34.5   Sec. 9.  OMBUDSMAN
 34.6   FOR FAMILIES                             157,000        161,000
 34.7   Sec. 10.  TRANSFERS 
 34.8   Subdivision 1.  Entitlement programs
 34.9   Transfers of unencumbered 
 34.10  entitled grant and aid appropriations 
 34.11  for the biennium ending June 30, 1999.
 34.12  The commissioner of human services, 
 34.13  with the approval of the commissioner 
 34.14  of finance, and after notification of 
 34.15  the chair of the senate health and 
 34.16  family security budget division and the 
 34.17  chair of the house of representatives 
 34.18  health and human services finance 
 34.19  division, may transfer unencumbered 
 34.20  appropriation balances for the biennium 
 34.21  ending June 30, 1999, within fiscal 
 34.22  years among the aid to families with 
 34.23  dependent children, Minnesota family 
 34.24  investment plan, general assistance, 
 34.25  general assistance medical care, 
 34.26  medical assistance, Minnesota 
 34.27  supplemental aid, and group residential 
 34.28  housing programs, assistance to 
 34.29  families grants, and the entitlement 
 34.30  portion of the chemical dependency 
 34.31  consolidated treatment fund, and 
 34.32  between fiscal years of the biennium. 
 34.33  Subd. 2.  Approval required 
 34.34  Positions, salary money, and nonsalary 
 34.35  administrative money may be transferred 
 34.36  within the departments of human 
 34.37  services and health and within the 
 34.38  programs operated by the veterans 
 34.39  nursing homes board as the 
 34.40  commissioners and the board consider 
 34.41  necessary, with the advance approval of 
 34.42  the commissioner of finance.  The 
 34.43  commissioner of finance shall inform 
 34.44  the chairs of the health and human 
 34.45  services finance division of the house 
 34.46  of representatives and the health and 
 34.47  family security budget division of the 
 34.48  senate quarterly about transfers made 
 34.49  under this provision. 
 34.50  Subd. 3.  Transfer 
 34.51  Funding appropriated by the legislature 
 34.52  may not be transferred to a different 
 34.53  department than specified by the 
 34.54  legislature without legislative 
 34.55  authority. 
 34.56  Sec. 11.  PROVISIONS  
 34.57  (a) Money appropriated to the 
 34.58  commissioner of human services for the 
 34.59  purchase of provisions within the item 
 34.60  "current expense" must be used solely 
 35.1   for that purpose.  Money provided and 
 35.2   not used for the purchase of provisions 
 35.3   must be canceled into the fund from 
 35.4   which appropriated, except that money 
 35.5   provided and not used for the purchase 
 35.6   of provisions because of population 
 35.7   decreases may be transferred and used 
 35.8   for the purchase of drugs and medical 
 35.9   and hospital supplies and equipment 
 35.10  with written approval of the governor 
 35.11  after consultation with the legislative 
 35.12  advisory commission. 
 35.13  (b) For fiscal year 1998, the allowance 
 35.14  for food may be adjusted to the 
 35.15  equivalent of the 75th percentile of 
 35.16  the comparable raw food costs for 
 35.17  community nursing homes as reported to 
 35.18  the commissioner of human services.  
 35.19  For fiscal year 1999 an adjustment may 
 35.20  be made to reflect the annual change in 
 35.21  the United States Bureau of Labor 
 35.22  Statistics producer price index as of 
 35.23  June 1998 with the approval of the 
 35.24  commissioner of finance.  The 
 35.25  adjustments for either year must be 
 35.26  prorated if they would require money in 
 35.27  excess of this appropriation. 
 35.28  Sec. 12.  CARRYOVER LIMITATION
 35.29  None of the appropriations in this act 
 35.30  which are allowed to be carried forward 
 35.31  from fiscal year 1998 to fiscal year 
 35.32  1999 shall become part of the 
 35.33  base-level funding for the 2000-2001 
 35.34  biennial budget, unless specifically 
 35.35  directed by the legislature. 
 35.36  Sec. 13.  SUNSET OF UNCODIFIED LANGUAGE
 35.37  All uncodified language contained in 
 35.38  this article expires on June 30, 1999, 
 35.39  unless a different expiration date is 
 35.40  explicit. 
 35.41                             ARTICLE 2
 35.42           HEALTH DEPARTMENT AND HEALTH PLAN REGULATIONS
 35.43     Section 1.  Minnesota Statutes 1996, section 13.99, is 
 35.44  amended by adding a subdivision to read: 
 35.45     Subd. 32a.  [BIRTH DEFECTS INFORMATION SYSTEM.] Data on 
 35.46  individuals in the birth defects information system maintained 
 35.47  by the commissioner of health are classified in section 144.2217.
 35.48     Sec. 2.  Minnesota Statutes 1996, section 103I.101, 
 35.49  subdivision 6, is amended to read: 
 35.50     Subd. 6.  [FEES FOR VARIANCES.] The commissioner shall 
 35.51  charge a nonrefundable application fee of ~~$100~~ $120 to cover the 
 35.52  administrative cost of processing a request for a variance or 
 35.53  modification of rules adopted by the commissioner under this 
 36.1   chapter. 
 36.2      Sec. 3.  Minnesota Statutes 1996, section 103I.208, is 
 36.3   amended to read: 
 36.4      103I.208 [~~WELL~~ NOTIFICATION FILING FEES AND PERMIT FEES.] 
 36.5      Subdivision 1.  [WELL NOTIFICATION FEE.] The well 
 36.6   notification fee to be paid by a property owner is:  
 36.7      (1) for a new well, ~~$100~~ $120, which includes the state 
 36.8   core function fee; ~~and~~ 
 36.9      (2) for a well sealing, $20, which includes the state core 
 36.10  function fee; and 
 36.11     (3) for construction of a dewatering well, ~~$100~~ $120, which 
 36.12  includes the state core function fee, for each well except a 
 36.13  dewatering project comprising five or more wells shall be 
 36.14  assessed a single fee of ~~$500~~ $600 for the wells recorded on the 
 36.15  notification. 
 36.16     Subd. 1a.  [STATE CORE FUNCTION FEE.] The state core 
 36.17  function fee to be collected by the state and delegated boards 
 36.18  of health and used to support state core functions is: 
 36.19     (1) for a new well, $20; and 
 36.20     (2) for a well sealing, $5.  
 36.21     Subd. 2.  [PERMIT FEE.] The permit fee to be paid by a 
 36.22  property owner is:  
 36.23     (1) for a well that is not in use under a maintenance 
 36.24  permit, $100 annually; 
 36.25     (2) for construction of a monitoring well, ~~$100~~ $120, which 
 36.26  includes the state core function fee; 
 36.27     (3) for a monitoring well that is unsealed under a 
 36.28  maintenance permit, $100 annually; 
 36.29     (4) for monitoring wells used as a leak detection device at 
 36.30  a single motor fuel retail outlet or petroleum bulk storage site 
 36.31  excluding tank farms, the construction permit fee is ~~$100~~ $120, 
 36.32  which includes the state core function fee, per site regardless 
 36.33  of the number of wells constructed on the site, and the annual 
 36.34  fee for a maintenance permit for unsealed monitoring wells is 
 36.35  $100 per site regardless of the number of monitoring wells 
 36.36  located on site; 
 37.1      (5) for a groundwater thermal exchange device, in addition 
 37.2   to the notification fee for wells, ~~$100~~ $120, which includes the 
 37.3   state core function fee; 
 37.4      (6) for a vertical heat exchanger, ~~$100~~ $120; ~~and~~ 
 37.5      (7) for a dewatering well that is unsealed under a 
 37.6   maintenance permit, $100 annually for each well, except a 
 37.7   dewatering project comprising more than five wells shall be 
 37.8   issued a single permit for $500 annually for wells recorded on 
 37.9   the permit; and 
 37.10     (8) for excavating holes for the purpose of installing 
 37.11  elevator shafts, $120 for each hole. 
 37.12     Sec. 4.  Minnesota Statutes 1996, section 103I.401, 
 37.13  subdivision 1, is amended to read: 
 37.14     Subdivision 1.  [PERMIT REQUIRED.] (a) A person may not 
 37.15  construct an elevator shaft until a permit for the hole or 
 37.16  excavation is issued by the commissioner.  
 37.17     (b) ~~The fee for excavating holes for the purpose of~~ 
 37.18  ~~installing elevator shafts is $100 for each hole.~~ 
 37.19     ~~(c)~~ The elevator shaft permit preempts local permits except 
 37.20  local building permits, and counties and home rule charter or 
 37.21  statutory cities may not require a permit for elevator shaft 
 37.22  holes or excavations. 
 37.23     Sec. 5.  Minnesota Statutes 1996, section 144.121, 
 37.24  subdivision 1, is amended to read: 
 37.25     Subdivision 1.  [REGISTRATION; FEES.] The fee for the 
 37.26  registration for X-ray machines and ~~radium~~ other sources of 
 37.27  ionizing radiation required to be registered under rules adopted 
 37.28  by the state commissioner of health pursuant to section 144.12, 
 37.29  shall be in an amount ~~prescribed by the commissioner~~ as 
 37.30  described in subdivision 1a pursuant to section 144.122.  ~~The~~ 
 37.31  ~~first fee for registration shall be due on January 1, 1975.~~  The 
 37.32  registration shall expire and be renewed as prescribed by the 
 37.33  commissioner pursuant to section 144.122. 
 37.34     Sec. 6.  Minnesota Statutes 1996, section 144.121, is 
 37.35  amended by adding a subdivision to read: 
 37.36     Subd. 1a.  [FEES FOR X-RAY MACHINES AND OTHER SOURCES OF 
 38.1   IONIZING RADIATION.] After July 1, 1997, a facility with x-ray 
 38.2   machines or other sources of ionizing radiation must biennially 
 38.3   pay an initial or biennial renewal registration fee consisting 
 38.4   of a base facility fee of $132 and an additional fee for each 
 38.5   x-ray machine or other source of ionizing radiation as follows:  
 38.6     (1) medical or veterinary equipment                   $106
 38.7     (2) dental x-ray equipment                            $ 66
 38.8     (3) accelerator                                       $132
 38.9     (4) radiation therapy equipment                       $132
 38.10    (5) x-ray equipment not used on humans or animals     $106
 38.11    (6) devices with sources of ionizing radiation
 38.12        not used on humans or animals                     $106
 38.13    (7) sources of radium                                 $198
 38.14     Sec. 7.  Minnesota Statutes 1996, section 144.121, is 
 38.15  amended by adding a subdivision to read: 
 38.16     Subd. 1b.  [PENALTY FEE FOR LATE REGISTRATION.] 
 38.17  Applications for initial or renewal registrations submitted to 
 38.18  the commissioner after the time specified by the commissioner 
 38.19  shall be accompanied by a penalty fee of $20 in addition to the 
 38.20  fees prescribed in subdivision 1a. 
 38.21     Sec. 8.  Minnesota Statutes 1996, section 144.121, is 
 38.22  amended by adding a subdivision to read: 
 38.23     Subd. 1c.  [FEE FOR X-RAY MACHINES AND OTHER SOURCES OF 
 38.24  IONIZING RADIATION REGISTERED DURING LAST 12 MONTHS OF A 
 38.25  BIENNIAL REGISTRATION PERIOD.] The initial registration fee of 
 38.26  x-ray machines or other sources of radiation required to be 
 38.27  registered during the last 12 months of a biennial registration 
 38.28  period will be 50 percent of the applicable registration fee 
 38.29  prescribed in subdivision 1a. 
 38.30     Sec. 9.  Minnesota Statutes 1996, section 144.125, is 
 38.31  amended to read: 
 38.32     144.125 [TESTS OF INFANTS FOR INBORN METABOLIC ERRORS.] 
 38.33     It is the duty of (1) the administrative officer or other 
 38.34  person in charge of each institution caring for infants 28 days 
 38.35  or less of age and (2) the person required in pursuance of the 
 38.36  provisions of section 144.215, to register the birth of a child, 
 39.1   to cause to have administered to every infant or child in its 
 39.2   care tests for hemoglobinopathy, phenylketonuria, and other 
 39.3   inborn errors of metabolism in accordance with rules prescribed 
 39.4   by the state commissioner of health.  In determining which tests 
 39.5   must be administered, the commissioner shall take into 
 39.6   consideration the adequacy of laboratory methods to detect the 
 39.7   inborn metabolic error, the ability to treat or prevent medical 
 39.8   conditions caused by the inborn metabolic error, and the 
 39.9   severity of the medical conditions caused by the inborn 
 39.10  metabolic error.  Testing and the recording and reporting of the 
 39.11  results of the tests shall be performed at the times and in the 
 39.12  manner prescribed by the commissioner of health.  The 
 39.13  commissioner shall charge laboratory service fees for conducting 
 39.14  the tests of infants for inborn metabolic errors so that the 
 39.15  total of fees collected will approximate the costs of conducting 
 39.16  the tests and implementing and maintaining a system to follow-up 
 39.17  infants with inborn metabolic errors.  Costs associated with 
 39.18  capital expenditures and the development of new procedures may 
 39.19  be prorated over a three-year period when calculating the amount 
 39.20  of the fees. 
 39.21     Sec. 10.  Minnesota Statutes 1996, section 144.2215, is 
 39.22  amended to read: 
 39.23     144.2215 [BIRTH DEFECTS ~~REGISTRY~~ INFORMATION SYSTEM.] 
 39.24     Subdivision 1.  [ESTABLISHMENT.] The commissioner of health 
 39.25  shall ~~develop a statewide birth defects registry system to~~ 
 39.26  ~~provide for the collection, analysis, and dissemination of birth~~ 
 39.27  ~~defects information.  The commissioner shall consult with~~ 
 39.28  ~~representatives and experts in epidemiology, medicine,~~ 
 39.29  ~~insurance, health maintenance organizations, genetics,~~ 
 39.30  ~~consumers, and voluntary organizations in developing the system~~ 
 39.31  ~~and may phase in the implementation of the system~~ establish a 
 39.32  statewide population-based birth defects information system to 
 39.33  collect, analyze, and disseminate information regarding the risk 
 39.34  for and incidence of birth defects. 
 39.35     Subd. 2.  [DUTIES OF COMMISSIONER.] The commissioner of 
 39.36  health shall design the birth defects information system to 
 40.1   allow the commissioner to: 
 40.2      (1) monitor incidence trends of birth defects to detect 
 40.3   potential public health problems, predict risks, and assist in 
 40.4   responding to birth defects clusters; 
 40.5      (2) more accurately target intervention resources for 
 40.6   communities and individuals and their families; 
 40.7      (3) inform health professionals and the public of the 
 40.8   prevalence of and risks for birth defects; and 
 40.9      (4) promote high quality research to provide better 
 40.10  information for the prevention of birth defects. 
 40.11     Subd. 3.  [RULEMAKING.] The commissioner of health shall 
 40.12  adopt rules necessary to implement and administer the birth 
 40.13  defects information system.  The rules must address, but are not 
 40.14  limited to, the following: 
 40.15     (1) defining "case" for purposes of birth defects data 
 40.16  collection; 
 40.17     (2) establishing the type and scope of data to be collected 
 40.18  for each case; 
 40.19     (3) establishing a mechanism and assigning responsibility 
 40.20  for case ascertainment; and 
 40.21     (4) establishing criteria for contracts made with outside 
 40.22  entities to conduct studies using data collected by the birth 
 40.23  defects information system.  The criteria may include 
 40.24  requirements for a written protocol outlining the purpose and 
 40.25  public benefit of the study, peer review by other scientists, 
 40.26  methods and facilities to protect the privacy of the data, and 
 40.27  qualifications of the researcher proposing to undertake the 
 40.28  study.  
 40.29     Subd. 4.  [NOTICE.] (a) Within 30 days after making a 
 40.30  determination to enter a case into the birth defects information 
 40.31  system, the commissioner of health shall make a good faith 
 40.32  reasonable effort to notify the individual, or the parent or 
 40.33  guardian if the individual is a minor, of what data on the 
 40.34  individual has been entered into the system.  
 40.35     (b) Notice under this subdivision is not required if a 
 40.36  birth defect case was identified solely by prenatal diagnosis or 
 41.1   through fetal death or death certificate data. 
 41.2      Subd. 5.  [DEMONSTRATION PROJECTS.] The commissioner of 
 41.3   health shall evaluate and modify, as necessary, the birth 
 41.4   defects information system using demonstration projects.  The 
 41.5   commissioner shall use the results of the demonstration projects 
 41.6   to implement a refined birth defects information system 
 41.7   statewide. 
 41.8      Subd. 6.  [ADVISORY COMMITTEE.] The commissioner of health 
 41.9   shall appoint an advisory committee of 16 members to advise the 
 41.10  commissioner on the planning, implementation, evaluation, and 
 41.11  review of the birth defects information system.  The terms, 
 41.12  compensation, and removal of members are governed by section 
 41.13  15.059, except that the members do not receive per diem 
 41.14  compensation.  Members of the advisory committee shall represent 
 41.15  various geographical regions of the state.  Each of the 
 41.16  following professions must be represented in the advisory 
 41.17  committee:  epidemiologist, public health specialist, physician, 
 41.18  geneticist, health care provider, health information management 
 41.19  specialist, and health insurance provider.  The advisory 
 41.20  committee shall expire on June 30, 2001. 
 41.21     Subd. 7.  [REPORT.] The commissioner of health shall 
 41.22  prepare and transmit to the governor and the legislature a 
 41.23  report on the status and activities of the birth defects 
 41.24  information system no later than January 15 of every 
 41.25  odd-numbered year beginning in 1999. 
 41.26     Sec. 11.  [144.2216] [BIRTH DEFECTS RECORDS AND REPORTS 
 41.27  REQUIRED.] 
 41.28     Subdivision 1.  [PERSON PRACTICING HEALING 
 41.29  ARTS.] Notwithstanding section 144.335, a person licensed to 
 41.30  practice the healing arts in any form, upon request of the 
 41.31  commissioner of health, shall provide the commissioner with 
 41.32  access to information on each birth defect case in the manner 
 41.33  and at the times that the commissioner designates, subject to 
 41.34  the consent requirements of subdivision 4. 
 41.35     Subd. 2.  [HOSPITALS AND SIMILAR 
 41.36  INSTITUTIONS.] Notwithstanding section 144.335, a hospital, 
 42.1   medical clinic, medical laboratory, or other institution for the 
 42.2   hospitalization, clinical or laboratory diagnosis, or care of 
 42.3   human beings shall provide the commissioner of health with 
 42.4   access to information on each birth defect case in the manner 
 42.5   and at the times that the commissioner designates, subject to 
 42.6   the consent requirements of subdivision 4.  This subdivision 
 42.7   does not apply to institutions described in section 144A.09, 
 42.8   subdivision 1. 
 42.9      Subd. 3.  [OTHER DATA REPOSITORIES.] Notwithstanding 
 42.10  section 144.335, other repositories of data on the diagnosis or 
 42.11  care of human beings may provide the commissioner of health with 
 42.12  access to information on each case of birth defects in the 
 42.13  manner and at the times that the commissioner designates, 
 42.14  subject to the consent requirements of subdivision 4. 
 42.15     Subd. 4.  [CONSENT.] A person may not release information 
 42.16  on a patient under this subdivision without the consent of the 
 42.17  patient, as provided in section 144.335, subdivision 3a, 
 42.18  paragraph (a) or (d). 
 42.19     Subd. 5.  [REPORTING WITHOUT LIABILITY.] Furnishing 
 42.20  information under this section in good faith shall not subject a 
 42.21  person, hospital, medical clinic, medical laboratory, data 
 42.22  repository, or other institution to an action for damages or 
 42.23  other relief. 
 42.24     Sec. 12.  [144.2217] [CLASSIFICATION OF BIRTH DEFECTS 
 42.25  INFORMATION SYSTEM DATA.] 
 42.26     Data collected, received, or maintained on individuals and 
 42.27  nonindividuals with regard to the birth defects information 
 42.28  system are private data on individuals and nonpublic data on 
 42.29  nonindividuals, respectively, and may be used only for the 
 42.30  purposes specified in sections 144.2215 to 144.2218.  
 42.31  Notwithstanding section 13.03, subdivisions 6 to 8; 13.10, 
 42.32  subdivisions 1 to 4; 138.17, or any other law to the contrary, 
 42.33  all data collected, received, or maintained by the commissioner 
 42.34  of health with regard to the birth defects information system 
 42.35  retains the classification designated under this section and 
 42.36  section 13.384 and may not be disclosed other than according to 
 43.1   this section and section 144.2218. 
 43.2      Sec. 13.  [144.2218] [TRANSFERS OF BIRTH DEFECTS 
 43.3   INFORMATION SYSTEM DATA TO OTHER GOVERNMENT AGENCIES.] 
 43.4      Subdivision 1.  [INTERSTATE TRANSFERS OF DATA.] Data 
 43.5   collected by the birth defects information system may be 
 43.6   disseminated to a state government agency in another state 
 43.7   solely for purposes consistent with sections 144.2215 to 
 43.8   144.2218, provided that the state government agency agrees to 
 43.9   maintain the data as provided by section 144.2217 and the prior 
 43.10  consent of the individual has been obtained. 
 43.11     Subd. 2.  [INTRASTATE TRANSFERS OF DATA.] Data collected by 
 43.12  the birth defects information system may be disseminated to 
 43.13  another state government agency in this state upon determination 
 43.14  by the commissioner of health that another state government 
 43.15  agency could help an individual registered in the system gain 
 43.16  access to social, educational, or medical services for which the 
 43.17  individual is eligible, if the commissioner of health obtains 
 43.18  the prior consent of the individual. 
 43.19     Sec. 14.  Minnesota Statutes 1996, section 144.226, 
 43.20  subdivision 1, is amended to read: 
 43.21     Subdivision 1.  [WHICH SERVICES ARE FOR FEE.] The fees 
 43.22  for ~~any of~~ the following services shall be ~~in~~ the following or 
 43.23  an amount prescribed by rule of the commissioner: 
 43.24     (a) The fee for the issuance of a certified copy or 
 43.25  certification of a vital record, or a certification that the 
 43.26  record cannot be found~~;~~ is $8.  No fee shall be charged for a 
 43.27  certified birth or death record that is reissued within one year 
 43.28  of the original issue, if the previously issued record is 
 43.29  surrendered. 
 43.30     (b) The fee for the replacement of a birth ~~certificate;~~ 
 43.31  record for all events except adoption is $20. 
 43.32     (c) The fee for the filing of a delayed registration of 
 43.33  birth or death~~;~~ is $20. 
 43.34     (d) The ~~alteration, correction, or completion~~ fee for the 
 43.35  amendment of any vital record~~, provided that~~ when requested more 
 43.36  than one year after the filing of the record is $20.  No fee 
 44.1   shall be charged for an ~~alteration, correction, or~~ 
 44.2   ~~completion~~ amendment requested within one year after the filing 
 44.3   of the certificate~~; and~~. 
 44.4      (e) The fee for the verification of information from ~~or~~ 
 44.5   ~~noncertified copies of~~ vital records is $8 when the applicant 
 44.6   furnishes the specific information to locate the record.  When 
 44.7   the applicant does not furnish specific information, the fee is 
 44.8   $20 per hour for staff time expended.  Specific information 
 44.9   shall include the correct date of the event and the correct name 
 44.10  of the registrant.  Fees charged shall approximate the costs 
 44.11  incurred in searching and copying the records.  The fee shall be 
 44.12  payable at time of application. 
 44.13     (f) The fee for issuance of a certified or noncertified 
 44.14  copy of any document on file pertaining to a vital record or a 
 44.15  certification that the record cannot be found is $8. 
 44.16     Sec. 15.  Minnesota Statutes 1996, section 144.226, is 
 44.17  amended by adding a subdivision to read: 
 44.18     Subd. 4.  [VITAL RECORDS SURCHARGE.] In addition to any fee 
 44.19  prescribed under subdivision 1, there is a nonrefundable 
 44.20  surcharge of $3 for each certified and noncertified birth or 
 44.21  death record.  The local or state registrar shall forward this 
 44.22  amount to the state treasurer to be deposited into the state 
 44.23  government special revenue fund.  This surcharge shall not be 
 44.24  charged under those circumstances in which no fee for a birth or 
 44.25  death record is permitted under subdivision 1, paragraph (a).  
 44.26  This surcharge requirement expires June 30, 2002. 
 44.27     Sec. 16.  Minnesota Statutes 1996, section 144.3351, is 
 44.28  amended to read: 
 44.29     144.3351 [IMMUNIZATION DATA.] 
 44.30     (a) Subject to paragraph (b), providers as defined in 
 44.31  section 144.335, subdivision 1, group purchasers as defined in 
 44.32  section 62J.03, subdivision 6, elementary or secondary schools 
 44.33  or child care facilities as defined in section 123.70, 
 44.34  subdivision 9, public or private post-secondary educational 
 44.35  institutions as defined in section 135A.14, subdivision 1, 
 44.36  paragraph (b), a board of health as defined in section 145A.02, 
 45.1   subdivision 2, community action agencies as defined in section 
 45.2   268.53, subdivision 1, and the commissioner of health may 
 45.3   exchange immunization data with one another, without the 
 45.4   patient's consent, if the person requesting access provides 
 45.5   services on behalf of the patient.  For purposes of this section 
 45.6   immunization data includes:  
 45.7      (1) patient's name, address, date of birth, gender, parent 
 45.8   or guardian's name; and 
 45.9      (2) date vaccine was received, vaccine type, lot number, 
 45.10  and manufacturer of all immunizations received by the patient, 
 45.11  and whether there is a contraindication or an adverse reaction 
 45.12  indication. 
 45.13     This ~~section~~ paragraph applies to all immunization data, 
 45.14  regardless of when the immunization occurred. 
 45.15     (b) Notwithstanding paragraph (a), immunization data may 
 45.16  not be included in a centralized registry for collection of 
 45.17  immunization data without the patient's consent.  This paragraph 
 45.18  applies to data collected on and after July 1, 1997. 
 45.19     Sec. 17.  Minnesota Statutes 1996, section 144.394, is 
 45.20  amended to read: 
 45.21     144.394 [~~SMOKING PREVENTION~~ HEALTH PROMOTION AND 
 45.22  EDUCATION.] 
 45.23     The commissioner may sell at market value~~,~~ all ~~nonsmoking~~ 
 45.24  ~~or tobacco use prevention advertising~~ health promotion and 
 45.25  health education materials.  Proceeds from the sale of the 
 45.26  ~~advertising~~ materials are appropriated to the department of 
 45.27  health for ~~its nonsmoking~~ the program that developed the 
 45.28  material. 
 45.29     Sec. 18.  Minnesota Statutes 1996, section 145.925, 
 45.30  subdivision 9, is amended to read: 
 45.31     Subd. 9.  [RULES; REGIONAL FUNDING.] Notwithstanding any 
 45.32  rules to the contrary, including rules proposed in the State 
 45.33  Register on April 1, 1991, the commissioner, in allocating grant 
 45.34  funds for family planning special projects, shall not limit the 
 45.35  total amount of funds that can be allocated to an organization 
 45.36  ~~that has submitted applications from more than one region,~~ 
 46.1   ~~except that no more than $75,000 may be allocated to any grantee~~ 
 46.2   ~~within a single region.  For two or more organizations who have~~ 
 46.3   ~~submitted a joint application, that limit is $75,000 for each~~ 
 46.4   ~~organization~~.  This subdivision does not affect any procedure 
 46.5   established in rule for allocating special project money to the 
 46.6   different regions.  The commissioner shall revise the rules for 
 46.7   family planning special project grants so that they conform to 
 46.8   the requirements of this subdivision.  In adopting these 
 46.9   revisions, the commissioner is not subject to the rulemaking 
 46.10  provisions of chapter 14, but is bound by section 14.38, 
 46.11  subdivision 7. 
 46.12     Sec. 19.  [145A.16] [HOME VISITING PROGRAMS FOR INFANT 
 46.13  CARE.] 
 46.14     Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
 46.15  establish a grant program to fund universal home visiting 
 46.16  programs designed to serve all live births in designated 
 46.17  geographic areas.  The commissioner shall designate the 
 46.18  geographic area to be served by each program.  At least one 
 46.19  program must provide home visiting services to families within 
 46.20  the seven-county metropolitan area, and at least one program 
 46.21  must provide home visiting services to families outside the 
 46.22  metropolitan area.  The purpose of the program is to strengthen 
 46.23  families and to promote positive parenting and healthy child 
 46.24  development.  
 46.25     Subd. 2.  [STEERING COMMITTEE.] The commissioner shall 
 46.26  establish an ad hoc steering committee to develop and implement 
 46.27  a comprehensive plan for the universal home visiting programs.  
 46.28  The members of the ad hoc steering committee shall include, at a 
 46.29  minimum, representatives of local public health departments, 
 46.30  public health nurses, other health care providers, 
 46.31  paraprofessionals, community-based family workers, 
 46.32  representatives of the state councils of color, representatives 
 46.33  of health insurance plans, and other individuals with expertise 
 46.34  in the field of home visiting, early childhood health and 
 46.35  development, and child abuse prevention.  
 46.36     Subd. 3.  [PROGRAM REQUIREMENTS.] The commissioner shall 
 47.1   award grants using a request for proposal system.  Existing home 
 47.2   visiting programs or a family services collaborative established 
 47.3   under section 256F.13 may apply for the grants.  Health 
 47.4   information and assessment, counseling, social support, 
 47.5   educational services, and referral to community resources must 
 47.6   be offered to all families, regardless of need or risk, 
 47.7   beginning prenatally or as soon after birth as possible, and 
 47.8   continuing as needed.  Each program applying for a grant must 
 47.9   have access to adequate community resources to complement the 
 47.10  home visiting services and must be designed to: 
 47.11     (1) identify all newborn infants within the geographic area 
 47.12  served by the program.  Identification may be made prenatally or 
 47.13  at the time of birth; 
 47.14     (2) offer a home visit by a trained home visitor.  The 
 47.15  offer of a home visit must be made in a way that guarantees that 
 47.16  the existence of the pregnancy is not revealed to any other 
 47.17  individual without the written consent of the pregnant female.  
 47.18  If home visiting is accepted, the first visit must occur 
 47.19  prenatally or as soon after birth as possible and must include 
 47.20  an assessment by a public health nurse; 
 47.21     (3) offer, at a minimum, information on infant care, child 
 47.22  growth and development, positive parenting, the prevention of 
 47.23  disease and exposure to environmental hazards, and support 
 47.24  services available in the community; 
 47.25     (4) provide information on and referral to health care 
 47.26  services, if needed, including information on health care 
 47.27  coverage for which the individual or family may be eligible and 
 47.28  information on family planning, pediatric preventive services, 
 47.29  immunizations, and developmental assessments, and provide 
 47.30  information on the availability of public assistance programs as 
 47.31  appropriate; 
 47.32     (5) recruit home visit workers who will represent all the 
 47.33  races, cultures, and languages spoken by eligible families in 
 47.34  the designated geographic areas; and 
 47.35     (6) train and supervise home visitors in accordance with 
 47.36  the requirements established under subdivision 5.  
 48.1      Subd. 4.  [COORDINATION.] To minimize duplication, a 
 48.2   program receiving a grant must establish a coalition that 
 48.3   includes parents, health care providers that provide services to 
 48.4   families with young children in the service area, and 
 48.5   representatives of local schools, governmental and nonprofit 
 48.6   agencies, community-based organizations, health insurance plans, 
 48.7   and local hospitals.  A program may use the family services 
 48.8   collaborative as the coalition if a collaborative is established 
 48.9   in the area served by the program.  The coalition must designate 
 48.10  the roles of all provider agencies, family identification 
 48.11  methods, referral mechanisms, and payment responsibilities 
 48.12  appropriate for the existing systems in the program's service 
 48.13  area.  The coalition must also coordinate with other programs 
 48.14  offered by school boards under section 121.882, subdivision 2b, 
 48.15  and programs offered under section 145A.15.  
 48.16     Subd. 5.  [TRAINING.] The commissioner shall establish 
 48.17  training requirements for home visitors and minimum requirements 
 48.18  for supervision by a public health nurse.  The requirements for 
 48.19  nurses must be consistent with chapter 148.  Training must 
 48.20  include child development, positive parenting techniques, and 
 48.21  diverse cultural practices in child rearing and family systems.  
 48.22  A program may use grant money to train home visitors. 
 48.23     Subd. 6.  [EVALUATION.] (a) The commissioner shall evaluate 
 48.24  the effectiveness of the home visiting programs, taking into 
 48.25  consideration the following goals:  
 48.26     (1) appropriate child growth, development, and access to 
 48.27  health care; 
 48.28     (2) appropriate utilization of preventive health care and 
 48.29  medical care for acute illnesses; 
 48.30     (3) lower rates of substantiated child abuse and neglect; 
 48.31     (4) up-to-date immunizations; 
 48.32     (5) a reduction in unintended pregnancies; 
 48.33     (6) increasing families' understanding of lead poisoning 
 48.34  prevention; 
 48.35     (7) lower rates of unintentional injuries; and 
 48.36     (8) fewer hospitalizations and emergency room visits.  
 49.1      (b) The commissioner shall compare overall outcomes of 
 49.2   universal home visiting programs with targeted home visiting 
 49.3   programs and report the findings to the legislature.  The report 
 49.4   must also include information on how home visiting programs will 
 49.5   coordinate activities and preventive services provided by health 
 49.6   plans and other organizations. 
 49.7      (c) The commissioner shall report to the legislature by 
 49.8   February 15, 1998, on the comprehensive plan for the universal 
 49.9   home visiting programs and recommend any draft legislation 
 49.10  needed to implement the plan.  The commissioner shall report to 
 49.11  the legislature biennially beginning December 15, 2001, on the 
 49.12  effectiveness of the universal home visiting programs.  In the 
 49.13  report due December 15, 2001, the commissioner shall include 
 49.14  recommendations on the feasibility and cost of expanding the 
 49.15  program statewide.  
 49.16     Subd. 7.  [TECHNICAL ASSISTANCE.] The commissioner shall 
 49.17  provide administrative and technical assistance to each program, 
 49.18  including assistance conducting short- and long-term evaluations 
 49.19  of the home visiting program required under subdivision 6.  The 
 49.20  commissioner may request research and evaluation support from 
 49.21  the University of Minnesota.  
 49.22     Subd. 8.  [MATCHING FUNDS.] The commissioner and the grant 
 49.23  programs shall seek to supplement any state funding with private 
 49.24  and other nonstate funding sources, including other grants and 
 49.25  insurance coverage for services provided.  Program funding may 
 49.26  be used only to supplement, not to replace, existing funds being 
 49.27  used for home visiting.  
 49.28     Subd. 9.  [PAYMENT FOR HOME VISITING SERVICES.] Any health 
 49.29  plan that provides services to families or individuals enrolled 
 49.30  in medical assistance, general assistance medical care, or the 
 49.31  MinnesotaCare program must contract with the programs receiving 
 49.32  grants under this section and the programs established under 
 49.33  section 145A.15 that are providing home visiting services in the 
 49.34  area served by the health plan to provide home visiting services 
 49.35  covered under medical assistance, general assistance medical 
 49.36  care, or the MinnesotaCare program to their enrollees.  A health 
 50.1   plan may require a home visiting program to comply with the 
 50.2   health plan's requirements on the same basis as the health 
 50.3   plan's other participating providers. 
 50.4      Sec. 20.  Minnesota Statutes 1996, section 153A.17, is 
 50.5   amended to read: 
 50.6      153A.17 [EXPENSES; FEES.] 
 50.7      (a) The expenses for administering the certification 
 50.8   requirements including the complaint handling system for hearing 
 50.9   aid dispensers in sections 153A.14 and 153A.15 and the consumer 
 50.10  information center under section 153A.18 must be paid from 
 50.11  initial application and examination fees, renewal fees, 
 50.12  penalties, and fines.  All fees are nonrefundable.  The 
 50.13  certificate application fee is ~~$280~~ $650, the examination fee is 
 50.14  $200 for the written portion and $200 for the practical portion 
 50.15  each time one or the other is taken, and the trainee application 
 50.16  fee is ~~$100, except that the certification application fee for a~~ 
 50.17  ~~registered audiologist is $280 minus the audiologist~~ 
 50.18  ~~registration fee of $101~~ $300.  ~~In addition, both certification~~ 
 50.19  ~~and examination fees are subject to~~ Notwithstanding the policy 
 50.20  set forth in section 16A.1285, subdivision 2, a surcharge of 
 50.21  ~~$60~~ $63 shall be paid at the time of application or renewal 
 50.22  until June 30, 2007 to recover~~, over a five-year period,~~ $88,000 
 50.23  of the commissioner's accumulated direct expenditures for 
 50.24  administering the requirements of this chapter~~, but not~~ 
 50.25  ~~registration of hearing instrument dispensers under section~~ 
 50.26  ~~214.13, before November 1, 1994~~ between July 1, 1994, and June 
 50.27  30, 1997.  The penalty fee for late submission of a renewal 
 50.28  application is ~~$70~~ $200.  All fees, penalties, and fines 
 50.29  received must be deposited in the state government special 
 50.30  revenue fund.  The commissioner may prorate the certification 
 50.31  fee for new applicants based on the number of quarters remaining 
 50.32  in the annual certification period. 
 50.33     (b) Notwithstanding the policy set forth in section 
 50.34  16A.1285, subdivision 2, audiologists registered under chapter 
 50.35  148 shall pay a surcharge of $74 at the time of initial 
 50.36  registration or registration renewal, under section 148.5191.  
 51.1   The surcharge on registered audiologists shall remain in effect 
 51.2   until June 30, 2007, to recover $88,000 of the commissioner's 
 51.3   accumulated direct expenditures for administering the 
 51.4   requirements of this chapter between July 1, 1994, and June 30, 
 51.5   1997. 
 51.6      Sec. 21.  Minnesota Statutes 1996, section 157.15, is 
 51.7   amended by adding a subdivision to read: 
 51.8      Subd. 16.  [CRITICAL CONTROL POINT.] "Critical control 
 51.9   point" means a point or procedure in a specific food system 
 51.10  where loss of control may result in an unacceptable health risk. 
 51.11     Sec. 22.  Minnesota Statutes 1996, section 157.15, is 
 51.12  amended by adding a subdivision to read: 
 51.13     Subd. 17.  [HACCP PLAN.] "Hazard analysis critical control 
 51.14  point (HACCP) plan" means a written document that delineates the 
 51.15  formal procedures for following the HACCP principles developed 
 51.16  by the National Advisory Committee on Microbiological Criteria 
 51.17  for Foods. 
 51.18     Sec. 23.  Minnesota Statutes 1996, section 157.15, is 
 51.19  amended by adding a subdivision to read: 
 51.20     Subd. 18.  [HAZARD.] "Hazard" means any biological, 
 51.21  chemical, or physical property that may cause an unacceptable 
 51.22  consumer health risk.  
 51.23     Sec. 24.  Minnesota Statutes 1996, section 157.16, 
 51.24  subdivision 3, is amended to read: 
 51.25     Subd. 3.  [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 
 51.26  following fees are required for food and beverage service 
 51.27  establishments, hotels, motels, lodging establishments, and 
 51.28  resorts licensed under this chapter.  Food and beverage service 
 51.29  establishments must pay the highest applicable fee under 
 51.30  paragraph (e), clause (1), (2), (3), or (4), and establishments 
 51.31  serving alcohol must pay the highest applicable fee under 
 51.32  paragraph (e), clause (6) or (7). 
 51.33     (b) All food and beverage service establishments, except 
 51.34  special event food stands, and all hotels, motels, lodging 
 51.35  establishments, and resorts shall pay an annual base fee of $100.
 51.36     (c) A special event food stand shall pay a flat fee of $60 
 52.1   annually.  "Special event food stand" means a fee category where 
 52.2   food is prepared or served in conjunction with celebrations, 
 52.3   county fairs, or special events from a special event food stand 
 52.4   as defined in section 157.15. 
 52.5      (d) A special event food stand-limited shall pay a flat fee 
 52.6   of $30. 
 52.7      (e) In addition to the base fee in paragraph (b), each food 
 52.8   and beverage service establishment, other than a special event 
 52.9   food stand, and each hotel, motel, lodging establishment, and 
 52.10  resort shall pay an additional annual fee for each fee category 
 52.11  as specified in this paragraph: 
 52.12     (1) Limited food menu selection, $30.  "Limited food menu 
 52.13  selection" means a fee category that provides one or more of the 
 52.14  following: 
 52.15     (i) prepackaged food that receives heat treatment and is 
 52.16  served in the package; 
 52.17     (ii) frozen pizza that is heated and served; 
 52.18     (iii) a continental breakfast such as rolls, coffee, juice, 
 52.19  milk, and cold cereal; 
 52.20     (iv) soft drinks, coffee, or nonalcoholic beverages; or 
 52.21     (v) cleaning for eating, drinking, or cooking utensils, 
 52.22  when the only food served is prepared off site. 
 52.23     (2) Small ~~menu selection with limited equipment~~ 
 52.24  establishment, including boarding establishments, $55.  
 52.25  "Small ~~menu selection with limited equipment~~ establishment" 
 52.26  means a fee category that has no salad bar and meets one or more 
 52.27  of the following: 
 52.28     (i) possesses food service equipment that consists of no 
 52.29  more than a deep fat fryer, a grill, two hot holding containers, 
 52.30  and one or more microwave ovens; 
 52.31     (ii) serves dipped ice cream or soft serve frozen desserts; 
 52.32     (iii) serves breakfast in an owner-occupied bed and 
 52.33  breakfast establishment; ~~or~~ 
 52.34     (iv) is a boarding establishment; or 
 52.35     (v) meets the equipment criteria in clause (3), item (i) or 
 52.36  (ii), and has a maximum patron seating capacity of not more than 
 53.1   50.  
 53.2      (3) ~~Small~~ Medium establishment ~~with full menu selection~~, 
 53.3   $150.  "~~Small~~ Medium establishment ~~with full menu selection~~" 
 53.4   means a fee category that meets one or more of the following: 
 53.5      (i) possesses food service equipment that includes a range, 
 53.6   oven, steam table, salad bar, or salad preparation area; 
 53.7      (ii) possesses food service equipment that includes more 
 53.8   than one deep fat fryer, one grill, or two hot holding 
 53.9   containers; or 
 53.10     (iii) is an establishment where food is prepared at one 
 53.11  location and served at one or more separate locations. 
 53.12     Establishments meeting criteria in clause (2), item (v), 
 53.13  are not included in this fee category.  
 53.14     (4) Large establishment ~~with full menu selection~~, $250.  
 53.15  "Large establishment ~~with full menu selection~~" means either: 
 53.16     (i) a fee category that (A) meets the criteria in clause 
 53.17  (3), items (i) or (ii), for a ~~small~~ medium establishment ~~with~~ 
 53.18  ~~full menu selection~~, (B) seats more than 175 people, and (C) 
 53.19  offers the full menu selection an average of five or more days a 
 53.20  week during the weeks of operation; or 
 53.21     (ii) a fee category that (A) meets the criteria in clause 
 53.22  (3), item (iii), for a ~~small~~ medium establishment ~~with full menu~~ 
 53.23  ~~selection~~, and (B) prepares and serves 500 or more meals per day.
 53.24     (5) Other food and beverage service, including food carts, 
 53.25  mobile food units, seasonal temporary food stands, and seasonal 
 53.26  permanent food stands, $30. 
 53.27     (6) Beer or wine table service, $30.  "Beer or wine table 
 53.28  service" means a fee category where the only alcoholic beverage 
 53.29  service is beer or wine, served to customers seated at tables. 
 53.30     (7) Alcoholic beverage service, other than beer or wine 
 53.31  table service, $75. 
 53.32     "Alcohol beverage service, other than beer or wine table 
 53.33  service" means a fee category where alcoholic mixed drinks are 
 53.34  served or where beer or wine are served from a bar. 
 53.35     (8) Lodging per sleeping accommodation unit, $4, including 
 53.36  hotels, motels, lodging establishments, and resorts, up to a 
 54.1   maximum of $400.  "Lodging per sleeping accommodation unit" 
 54.2   means a fee category including the number of guest rooms, 
 54.3   cottages, or other rental units of a hotel, motel, lodging 
 54.4   establishment, or resort; or the number of beds in a dormitory. 
 54.5      (9) First public swimming pool, $100; each additional 
 54.6   public swimming pool, $50.  "Public swimming pool" means a fee 
 54.7   category that has the meaning given in Minnesota Rules, part 
 54.8   4717.0250, subpart 8. 
 54.9      (10) First spa, $50; each additional spa, $25.  "Spa pool" 
 54.10  means a fee category that has the meaning given in Minnesota 
 54.11  Rules, part 4717.0250, subpart 9. 
 54.12     (11) Private sewer or water, $30.  "Individual private 
 54.13  water" means a fee category with a water supply other than a 
 54.14  community public water supply as defined in Minnesota Rules, 
 54.15  chapter 4720.  "Individual private sewer" means a fee category 
 54.16  with an individual sewage treatment system which uses subsurface 
 54.17  treatment and disposal. 
 54.18     (f) A fee is not required for a food and beverage service 
 54.19  establishment operated by a school as defined in sections 120.05 
 54.20  and 120.101. 
 54.21     (g) A fee of $150 for review of the construction plans must 
 54.22  accompany the initial license application for food and beverage 
 54.23  service establishments, hotels, motels, lodging establishments, 
 54.24  or resorts. 
 54.25     (h) When existing food and beverage service establishments, 
 54.26  hotels, motels, lodging establishments, or resorts are 
 54.27  extensively remodeled, a fee of $150 must be submitted with the 
 54.28  remodeling plans. 
 54.29     (i) Seasonal temporary food stands, special event food 
 54.30  stands, and special event food stands-limited are not required 
 54.31  to submit construction or remodeling plans for review. 
 54.32     Sec. 25.  [157.215] [PILOT PROJECT.] 
 54.33     The commissioner of health is authorized to issue a request 
 54.34  for participation to the regulated food and beverage service 
 54.35  establishment industry and to select up to 25 pilot projects 
 54.36  utilizing HACCP quality assurance principles for monitoring risk.
 55.1      Sec. 26.  Minnesota Statutes 1996, section 326.37, 
 55.2   subdivision 1, is amended to read: 
 55.3      Subdivision 1.  [RULES.] The state commissioner of health 
 55.4   may, by rule, prescribe minimum standards which shall be 
 55.5   uniform, and which standards shall thereafter be effective for 
 55.6   all new plumbing installations, including additions, extensions, 
 55.7   alterations, and replacements connected with any water or sewage 
 55.8   disposal system owned or operated by or for any municipality, 
 55.9   institution, factory, office building, hotel, apartment 
 55.10  building, or any other place of business regardless of location 
 55.11  or the population of the city or town in which located.  
 55.12  Notwithstanding the provisions of Minnesota Rules, part 
 55.13  4715.3130, as they apply to plan review, the commissioner may 
 55.14  allow plumbing construction, alteration, or extension to proceed.
 55.15     The commissioner shall administer the provisions of 
 55.16  sections 326.37 to 326.45 and for such purposes may employ 
 55.17  plumbing inspectors and other assistants. 
 55.18     Sec. 27.  [GRANT PROGRAM FOR JUVENILE ASSESSMENT CENTERS.] 
 55.19     Subdivision 1.  [PROGRAM DESCRIBED.] The commissioner of 
 55.20  health through the office of drug policy and violence 
 55.21  prevention, shall administer a pilot project grant program to 
 55.22  award grants to no more than three judicial districts to develop 
 55.23  and implement plans to create juvenile assessment centers.  A 
 55.24  juvenile assessment center is a 24-hour centralized receiving, 
 55.25  processing, and intervention facility for children who are 
 55.26  accused of committing delinquent acts or status offenses or who 
 55.27  are alleged to have been victims of abuse or neglect. 
 55.28     Subd. 2.  [WORKING GROUPS AUTHORIZED; PLANS REQUIRED.] The 
 55.29  chief judge of a judicial district or the judge's designee may 
 55.30  convene a working group consisting of individuals experienced in 
 55.31  providing services to children.  A working group shall consist 
 55.32  of, but is not limited to, representatives from substance abuse 
 55.33  programs, domestic abuse programs, child protection agencies, 
 55.34  mental health providers, mental health collaboratives, law 
 55.35  enforcement agencies, schools, health service providers, and 
 55.36  higher education institutions.  The working group shall 
 56.1   cooperatively develop a plan to create a juvenile assessment 
 56.2   center in the judicial district.  Juvenile assessment centers 
 56.3   must provide initial screening for children, including intake 
 56.4   and needs assessments, substance abuse screening, physical and 
 56.5   mental health screening, fetal alcohol syndrome and fetal 
 56.6   alcohol exposure screening, and diagnostic educational testing, 
 56.7   as appropriate.  The entities involved in the assessment center 
 56.8   shall make the resources for the provision of these assessments 
 56.9   available at the same level to which they are available to the 
 56.10  general public.  The plan must include, but is not limited to, 
 56.11  recommended screening tools to assess children to determine 
 56.12  their needs and assets; protocols to determine how children 
 56.13  should enter the center, what will happen at the center, and 
 56.14  what will happen after the child leaves the center; methods to 
 56.15  share information in a manner consistent with existing law; and 
 56.16  information on how the center will collaborate with a higher 
 56.17  educational institution that has expertise in the research, 
 56.18  programming, and evaluation of children's services.  The plan 
 56.19  may also address the provision of services to children. 
 56.20     Subd. 3.  [COOPERATION WITH WORKING GROUPS.] The 
 56.21  commissioner may provide technical assistance to the working 
 56.22  groups and judicial districts.  If the working groups identify 
 56.23  any necessary changes in data privacy laws that would facilitate 
 56.24  the operation of the assessment centers, the commissioner may 
 56.25  recommend these changes to the legislature. 
 56.26     Subd. 4.  [AWARDING OF GRANTS.] By January 1, 1998, the 
 56.27  commissioner shall award grants under this section to judicial 
 56.28  districts to develop plans to create juvenile assessment 
 56.29  centers.  Each district awarded a planning grant shall submit 
 56.30  its plan to the commissioner.  The commissioner shall review the 
 56.31  plans and award grants to districts whose plans have been 
 56.32  approved to develop an assessment center. 
 56.33     Subd. 5.  [REPORT.] By January 15, 1999, the commissioner 
 56.34  shall report to the legislature on the planning and 
 56.35  implementation grants awarded under this section. 
 56.36     Sec. 28.  [RULE CHANGE; RADIOGRAPHIC ABSORPTIONMETRY.] 
 57.1      Upon review and recommendation by the health technology 
 57.2   advisory committee regarding the impact on patients the 
 57.3   commissioner of health may amend Minnesota Rules, part 
 57.4   4730.1210, subpart 2, item G, to permit the use of direct 
 57.5   exposure x-ray film in radiographic absorptionmetry for the 
 57.6   diagnosis and management of osteoporosis.  The commissioner may 
 57.7   use the rulemaking procedures under Minnesota Statutes, section 
 57.8   14.388. 
 57.9      Sec. 29.  [REPEALER.] 
 57.10     Minnesota Statutes 1996, section 145.9256, is repealed. 
 57.11     Sec. 30.  [EFFECTIVE DATE.] 
 57.12     Sections 2, 3, and 4 amending the well management program 
 57.13  are effective July 1, 1998. 
 57.14                             ARTICLE 3
 57.15                           LONG-TERM CARE
 57.16     Section 1.  Minnesota Statutes 1996, section 144A.071, 
 57.17  subdivision 1, is amended to read: 
 57.18     Subdivision 1.  [FINDINGS.] The legislature declares that a 
 57.19  moratorium on the licensure and medical assistance certification 
 57.20  of new nursing home beds and construction projects that exceed 
 57.21  ~~the lesser of $500,000 or 25 percent of a facility's appraised~~ 
 57.22  ~~value~~ $750,000 is necessary to control nursing home expenditure 
 57.23  growth and enable the state to meet the needs of its elderly by 
 57.24  providing high quality services in the most appropriate manner 
 57.25  along a continuum of care.  
 57.26     Sec. 2.  Minnesota Statutes 1996, section 144A.071, 
 57.27  subdivision 2, is amended to read: 
 57.28     Subd. 2.  [MORATORIUM.] The commissioner of health, in 
 57.29  coordination with the commissioner of human services, shall deny 
 57.30  each request for new licensed or certified nursing home or 
 57.31  certified boarding care beds except as provided in subdivision 3 
 57.32  or 4a, or section 144A.073.  "Certified bed" means a nursing 
 57.33  home bed or a boarding care bed certified by the commissioner of 
 57.34  health for the purposes of the medical assistance program, under 
 57.35  United States Code, title 42, sections 1396 et seq.  
 57.36     The commissioner of human services, in coordination with 
 58.1   the commissioner of health, shall deny any request to issue a 
 58.2   license under section 252.28 and chapter 245A to a nursing home 
 58.3   or boarding care home, if that license would result in an 
 58.4   increase in the medical assistance reimbursement amount.  
 58.5      In addition, the commissioner of health must not approve 
 58.6   any construction project whose cost exceeds ~~$500,000, or 25~~ 
 58.7   ~~percent of the facility's appraised value, whichever is less,~~ 
 58.8   $750,000 unless: 
 58.9      (a) any construction costs exceeding ~~the lesser of $500,000~~ 
 58.10  ~~or 25 percent of the facility's appraised value~~ $750,000 are not 
 58.11  added to the facility's appraised value and are not included in 
 58.12  the facility's payment rate for reimbursement under the medical 
 58.13  assistance program; or 
 58.14     (b) the project: 
 58.15     (1) has been approved through the process described in 
 58.16  section 144A.073; 
 58.17     (2) meets an exception in subdivision 3 or 4a; 
 58.18     (3) is necessary to correct violations of state or federal 
 58.19  law issued by the commissioner of health; 
 58.20     (4) is necessary to repair or replace a portion of the 
 58.21  facility that was damaged by fire, lightning, groundshifts, or 
 58.22  other such hazards, including environmental hazards, provided 
 58.23  that the provisions of subdivision 4a, clause (a), are met; 
 58.24     (5) as of May 1, 1992, the facility has submitted to the 
 58.25  commissioner of health written documentation evidencing that the 
 58.26  facility meets the "commenced construction" definition as 
 58.27  specified in subdivision 1a, clause (d), or that substantial 
 58.28  steps have been taken prior to April 1, 1992, relating to the 
 58.29  construction project.  "Substantial steps" require that the 
 58.30  facility has made arrangements with outside parties relating to 
 58.31  the construction project and include the hiring of an architect 
 58.32  or construction firm, submission of preliminary plans to the 
 58.33  department of health or documentation from a financial 
 58.34  institution that financing arrangements for the construction 
 58.35  project have been made; or 
 58.36     (6) is being proposed by a licensed nursing facility that 
 59.1   is not certified to participate in the medical assistance 
 59.2   program and will not result in new licensed or certified beds. 
 59.3      Prior to the final plan approval of any construction 
 59.4   project, the commissioner of health shall be provided with an 
 59.5   itemized cost estimate for the project construction costs.  If a 
 59.6   construction project is anticipated to be completed in phases, 
 59.7   the total estimated cost of all phases of the project shall be 
 59.8   submitted to the commissioner and shall be considered as one 
 59.9   construction project.  Once the construction project is 
 59.10  completed and prior to the final clearance by the commissioner, 
 59.11  the total project construction costs for the construction 
 59.12  project shall be submitted to the commissioner.  If the final 
 59.13  project construction cost exceeds the dollar threshold in this 
 59.14  subdivision, the commissioner of human services shall not 
 59.15  recognize any of the project construction costs or the related 
 59.16  financing costs in excess of this threshold in establishing the 
 59.17  facility's property-related payment rate. 
 59.18     The dollar thresholds for construction projects are as 
 59.19  follows:  for construction projects other than those authorized 
 59.20  in clauses (1) to (6), the dollar threshold is ~~$500,000 or 25~~ 
 59.21  ~~percent of appraised value, whichever is less~~ $750,000.  For 
 59.22  projects authorized after July 1, 1993, under clause (1), the 
 59.23  dollar threshold is the cost estimate submitted with a proposal 
 59.24  for an exception under section 144A.073, plus inflation as 
 59.25  calculated according to section 256B.431, subdivision 3f, 
 59.26  paragraph (a).  For projects authorized under clauses (2) to 
 59.27  (4), the dollar threshold is the itemized estimate project 
 59.28  construction costs submitted to the commissioner of health at 
 59.29  the time of final plan approval, plus inflation as calculated 
 59.30  according to section 256B.431, subdivision 3f, paragraph (a). 
 59.31     The commissioner of health shall adopt rules to implement 
 59.32  this section or to amend the emergency rules for granting 
 59.33  exceptions to the moratorium on nursing homes under section 
 59.34  144A.073.  
 59.35     Sec. 3.  Minnesota Statutes 1996, section 144A.071, 
 59.36  subdivision 4a, is amended to read: 
 60.1      Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
 60.2   best interest of the state to ensure that nursing homes and 
 60.3   boarding care homes continue to meet the physical plant 
 60.4   licensing and certification requirements by permitting certain 
 60.5   construction projects.  Facilities should be maintained in 
 60.6   condition to satisfy the physical and emotional needs of 
 60.7   residents while allowing the state to maintain control over 
 60.8   nursing home expenditure growth. 
 60.9      The commissioner of health in coordination with the 
 60.10  commissioner of human services, may approve the renovation, 
 60.11  replacement, upgrading, or relocation of a nursing home or 
 60.12  boarding care home, under the following conditions: 
 60.13     (a) to license or certify beds in a new facility 
 60.14  constructed to replace a facility or to make repairs in an 
 60.15  existing facility that was destroyed or damaged after June 30, 
 60.16  1987, by fire, lightning, or other hazard provided:  
 60.17     (i) destruction was not caused by the intentional act of or 
 60.18  at the direction of a controlling person of the facility; 
 60.19     (ii) at the time the facility was destroyed or damaged the 
 60.20  controlling persons of the facility maintained insurance 
 60.21  coverage for the type of hazard that occurred in an amount that 
 60.22  a reasonable person would conclude was adequate; 
 60.23     (iii) the net proceeds from an insurance settlement for the 
 60.24  damages caused by the hazard are applied to the cost of the new 
 60.25  facility or repairs; 
 60.26     (iv) the new facility is constructed on the same site as 
 60.27  the destroyed facility or on another site subject to the 
 60.28  restrictions in section 144A.073, subdivision 5; 
 60.29     (v) the number of licensed and certified beds in the new 
 60.30  facility does not exceed the number of licensed and certified 
 60.31  beds in the destroyed facility; and 
 60.32     (vi) the commissioner determines that the replacement beds 
 60.33  are needed to prevent an inadequate supply of beds. 
 60.34  Project construction costs incurred for repairs authorized under 
 60.35  this clause shall not be considered in the dollar threshold 
 60.36  amount defined in subdivision 2; 
 61.1      (b) to license or certify beds that are moved from one 
 61.2   location to another within a nursing home facility, provided the 
 61.3   total costs of remodeling performed in conjunction with the 
 61.4   relocation of beds does not exceed ~~25 percent of the appraised~~ 
 61.5   ~~value of the facility or $500,000, whichever is less~~ $750,000; 
 61.6      (c) to license or certify beds in a project recommended for 
 61.7   approval under section 144A.073; 
 61.8      (d) to license or certify beds that are moved from an 
 61.9   existing state nursing home to a different state facility, 
 61.10  provided there is no net increase in the number of state nursing 
 61.11  home beds; 
 61.12     (e) to certify and license as nursing home beds boarding 
 61.13  care beds in a certified boarding care facility if the beds meet 
 61.14  the standards for nursing home licensure, or in a facility that 
 61.15  was granted an exception to the moratorium under section 
 61.16  144A.073, and if the cost of any remodeling of the facility does 
 61.17  not exceed ~~25 percent of the appraised value of the facility or~~ 
 61.18  ~~$500,000, whichever is less~~ $750,000.  If boarding care beds are 
 61.19  licensed as nursing home beds, the number of boarding care beds 
 61.20  in the facility must not increase beyond the number remaining at 
 61.21  the time of the upgrade in licensure.  The provisions contained 
 61.22  in section 144A.073 regarding the upgrading of the facilities do 
 61.23  not apply to facilities that satisfy these requirements; 
 61.24     (f) to license and certify up to 40 beds transferred from 
 61.25  an existing facility owned and operated by the Amherst H. Wilder 
 61.26  Foundation in the city of St. Paul to a new unit at the same 
 61.27  location as the existing facility that will serve persons with 
 61.28  Alzheimer's disease and other related disorders.  The transfer 
 61.29  of beds may occur gradually or in stages, provided the total 
 61.30  number of beds transferred does not exceed 40.  At the time of 
 61.31  licensure and certification of a bed or beds in the new unit, 
 61.32  the commissioner of health shall delicense and decertify the 
 61.33  same number of beds in the existing facility.  As a condition of 
 61.34  receiving a license or certification under this clause, the 
 61.35  facility must make a written commitment to the commissioner of 
 61.36  human services that it will not seek to receive an increase in 
 62.1   its property-related payment rate as a result of the transfers 
 62.2   allowed under this paragraph; 
 62.3      (g) to license and certify nursing home beds to replace 
 62.4   currently licensed and certified boarding care beds which may be 
 62.5   located either in a remodeled or renovated boarding care or 
 62.6   nursing home facility or in a remodeled, renovated, newly 
 62.7   constructed, or replacement nursing home facility within the 
 62.8   identifiable complex of health care facilities in which the 
 62.9   currently licensed boarding care beds are presently located, 
 62.10  provided that the number of boarding care beds in the facility 
 62.11  or complex are decreased by the number to be licensed as nursing 
 62.12  home beds and further provided that, if the total costs of new 
 62.13  construction, replacement, remodeling, or renovation exceed ten 
 62.14  percent of the appraised value of the facility or $200,000, 
 62.15  whichever is less, the facility makes a written commitment to 
 62.16  the commissioner of human services that it will not seek to 
 62.17  receive an increase in its property-related payment rate by 
 62.18  reason of the new construction, replacement, remodeling, or 
 62.19  renovation.  The provisions contained in section 144A.073 
 62.20  regarding the upgrading of facilities do not apply to facilities 
 62.21  that satisfy these requirements; 
 62.22     (h) to license as a nursing home and certify as a nursing 
 62.23  facility a facility that is licensed as a boarding care facility 
 62.24  but not certified under the medical assistance program, but only 
 62.25  if the commissioner of human services certifies to the 
 62.26  commissioner of health that licensing the facility as a nursing 
 62.27  home and certifying the facility as a nursing facility will 
 62.28  result in a net annual savings to the state general fund of 
 62.29  $200,000 or more; 
 62.30     (i) to certify, after September 30, 1992, and prior to July 
 62.31  1, 1993, existing nursing home beds in a facility that was 
 62.32  licensed and in operation prior to January 1, 1992; 
 62.33     (j) to license and certify new nursing home beds to replace 
 62.34  beds in a facility condemned as part of an economic 
 62.35  redevelopment plan in a city of the first class, provided the 
 62.36  new facility is located within one mile of the site of the old 
 63.1   facility.  Operating and property costs for the new facility 
 63.2   must be determined and allowed under existing reimbursement 
 63.3   rules; 
 63.4      (k) to license and certify up to 20 new nursing home beds 
 63.5   in a community-operated hospital and attached convalescent and 
 63.6   nursing care facility with 40 beds on April 21, 1991, that 
 63.7   suspended operation of the hospital in April 1986.  The 
 63.8   commissioner of human services shall provide the facility with 
 63.9   the same per diem property-related payment rate for each 
 63.10  additional licensed and certified bed as it will receive for its 
 63.11  existing 40 beds; 
 63.12     (l) to license or certify beds in renovation, replacement, 
 63.13  or upgrading projects as defined in section 144A.073, 
 63.14  subdivision 1, so long as the cumulative total costs of the 
 63.15  facility's remodeling projects do not exceed ~~25 percent of the~~ 
 63.16  ~~appraised value of the facility or $500,000, whichever is less~~ 
 63.17  $750,000; 
 63.18     (m) to license and certify beds that are moved from one 
 63.19  location to another for the purposes of converting up to five 
 63.20  four-bed wards to single or double occupancy rooms in a nursing 
 63.21  home that, as of January 1, 1993, was county-owned and had a 
 63.22  licensed capacity of 115 beds; 
 63.23     (n) to allow a facility that on April 16, 1993, was a 
 63.24  106-bed licensed and certified nursing facility located in 
 63.25  Minneapolis to layaway all of its licensed and certified nursing 
 63.26  home beds.  These beds may be relicensed and recertified in a 
 63.27  newly-constructed teaching nursing home facility affiliated with 
 63.28  a teaching hospital upon approval by the legislature.  The 
 63.29  proposal must be developed in consultation with the interagency 
 63.30  committee on long-term care planning.  The beds on layaway 
 63.31  status shall have the same status as voluntarily delicensed and 
 63.32  decertified beds, except that beds on layaway status remain 
 63.33  subject to the surcharge in section 256.9657.  This layaway 
 63.34  provision expires ~~July 1, 1997~~ January 15, 1998; 
 63.35     (o) to allow a project which will be completed in 
 63.36  conjunction with an approved moratorium exception project for a 
 64.1   nursing home in southern Cass county and which is directly 
 64.2   related to that portion of the facility that must be repaired, 
 64.3   renovated, or replaced, to correct an emergency plumbing problem 
 64.4   for which a state correction order has been issued and which 
 64.5   must be corrected by August 31, 1993; 
 64.6      (p) to allow a facility that on April 16, 1993, was a 
 64.7   368-bed licensed and certified nursing facility located in 
 64.8   Minneapolis to layaway, upon 30 days prior written notice to the 
 64.9   commissioner, up to 30 of the facility's licensed and certified 
 64.10  beds by converting three-bed wards to single or double 
 64.11  occupancy.  Beds on layaway status shall have the same status as 
 64.12  voluntarily delicensed and decertified beds except that beds on 
 64.13  layaway status remain subject to the surcharge in section 
 64.14  256.9657, remain subject to the license application and renewal 
 64.15  fees under section 144A.07 and shall be subject to a $100 per 
 64.16  bed reactivation fee.  In addition, at any time within three 
 64.17  years of the effective date of the layaway, the beds on layaway 
 64.18  status may be: 
 64.19     (1) relicensed and recertified upon relocation and 
 64.20  reactivation of some or all of the beds to an existing licensed 
 64.21  and certified facility or facilities located in Pine River, 
 64.22  Brainerd, or International Falls; provided that the total 
 64.23  project construction costs related to the relocation of beds 
 64.24  from layaway status for any facility receiving relocated beds 
 64.25  may not exceed the dollar threshold provided in subdivision 2 
 64.26  unless the construction project has been approved through the 
 64.27  moratorium exception process under section 144A.073; 
 64.28     (2) relicensed and recertified, upon reactivation of some 
 64.29  or all of the beds within the facility which placed the beds in 
 64.30  layaway status, if the commissioner has determined a need for 
 64.31  the reactivation of the beds on layaway status. 
 64.32     The property-related payment rate of a facility placing 
 64.33  beds on layaway status must be adjusted by the incremental 
 64.34  change in its rental per diem after recalculating the rental per 
 64.35  diem as provided in section 256B.431, subdivision 3a, paragraph 
 64.36  (d).  The property-related payment rate for a facility 
 65.1   relicensing and recertifying beds from layaway status must be 
 65.2   adjusted by the incremental change in its rental per diem after 
 65.3   recalculating its rental per diem using the number of beds after 
 65.4   the relicensing to establish the facility's capacity day 
 65.5   divisor, which shall be effective the first day of the month 
 65.6   following the month in which the relicensing and recertification 
 65.7   became effective.  Any beds remaining on layaway status more 
 65.8   than three years after the date the layaway status became 
 65.9   effective must be removed from layaway status and immediately 
 65.10  delicensed and decertified; 
 65.11     (q) ~~to license and certify beds in a renovation and~~ 
 65.12  ~~remodeling project to convert 13 three-bed wards into 13 two-bed~~ 
 65.13  ~~rooms and 13 single-bed rooms, expand space, and add~~ 
 65.14  ~~improvements in a nursing home that, as of January 1, 1994, met~~ 
 65.15  ~~the following conditions:  the nursing home was located in~~ 
 65.16  ~~Ramsey county; was not owned by a hospital corporation; had a~~ 
 65.17  ~~licensed capacity of 64 beds; and had been ranked among the top~~ 
 65.18  ~~15 applicants by the 1993 moratorium exceptions advisory review~~ 
 65.19  ~~panel.  The total project construction cost estimate for this~~ 
 65.20  ~~project must not exceed the cost estimate submitted in~~ 
 65.21  ~~connection with the 1993 moratorium exception process;~~ 
 65.22     ~~(r)~~ to license and certify beds in a renovation and 
 65.23  remodeling project to convert 12 four-bed wards into 24 two-bed 
 65.24  rooms, expand space, and add improvements in a nursing home 
 65.25  that, as of January 1, 1994, met the following conditions:  the 
 65.26  nursing home was located in Ramsey county; had a licensed 
 65.27  capacity of 154 beds; and had been ranked among the top 15 
 65.28  applicants by the 1993 moratorium exceptions advisory review 
 65.29  panel.  The total project construction cost estimate for this 
 65.30  project must not exceed the cost estimate submitted in 
 65.31  connection with the 1993 moratorium exception process; 
 65.32     ~~(s)~~ (r) to license and certify up to 117 beds that are 
 65.33  relocated from a licensed and certified 138-bed nursing facility 
 65.34  located in St. Paul to a hospital with 130 licensed hospital 
 65.35  beds located in South St. Paul, provided that the nursing 
 65.36  facility and hospital are owned by the same or a related 
 66.1   organization and that prior to the date the relocation is 
 66.2   completed the hospital ceases operation of its inpatient 
 66.3   hospital services at that hospital.  After relocation, the 
 66.4   nursing facility's status under section 256B.431, subdivision 
 66.5   2j, shall be the same as it was prior to relocation.  The 
 66.6   nursing facility's property-related payment rate resulting from 
 66.7   the project authorized in this paragraph shall become effective 
 66.8   no earlier than April 1, 1996.  For purposes of calculating the 
 66.9   incremental change in the facility's rental per diem resulting 
 66.10  from this project, the allowable appraised value of the nursing 
 66.11  facility portion of the existing health care facility physical 
 66.12  plant prior to the renovation and relocation may not exceed 
 66.13  $2,490,000; 
 66.14     ~~(t)~~ (s) to license and certify two beds in a facility to 
 66.15  replace beds that were voluntarily delicensed and decertified on 
 66.16  June 28, 1991; 
 66.17     ~~(u)~~ (t) to allow 16 licensed and certified beds located on 
 66.18  July 1, 1994, in a 142-bed nursing home and 21-bed boarding care 
 66.19  home facility in Minneapolis, notwithstanding the licensure and 
 66.20  certification after July 1, 1995, of the Minneapolis facility as 
 66.21  a 147-bed nursing home facility after completion of a 
 66.22  construction project approved in 1993 under section 144A.073, to 
 66.23  be laid away upon 30 days' prior written notice to the 
 66.24  commissioner.  Beds on layaway status shall have the same status 
 66.25  as voluntarily delicensed or decertified beds except that they 
 66.26  shall remain subject to the surcharge in section 256.9657.  The 
 66.27  16 beds on layaway status may be relicensed as nursing home beds 
 66.28  and recertified at any time within five years of the effective 
 66.29  date of the layaway upon relocation of some or all of the beds 
 66.30  to a licensed and certified facility located in Watertown, 
 66.31  provided that the total project construction costs related to 
 66.32  the relocation of beds from layaway status for the Watertown 
 66.33  facility may not exceed the dollar threshold provided in 
 66.34  subdivision 2 unless the construction project has been approved 
 66.35  through the moratorium exception process under section 144A.073. 
 66.36     The property-related payment rate of the facility placing 
 67.1   beds on layaway status must be adjusted by the incremental 
 67.2   change in its rental per diem after recalculating the rental per 
 67.3   diem as provided in section 256B.431, subdivision 3a, paragraph 
 67.4   (d).  The property-related payment rate for the facility 
 67.5   relicensing and recertifying beds from layaway status must be 
 67.6   adjusted by the incremental change in its rental per diem after 
 67.7   recalculating its rental per diem using the number of beds after 
 67.8   the relicensing to establish the facility's capacity day 
 67.9   divisor, which shall be effective the first day of the month 
 67.10  following the month in which the relicensing and recertification 
 67.11  became effective.  Any beds remaining on layaway status more 
 67.12  than five years after the date the layaway status became 
 67.13  effective must be removed from layaway status and immediately 
 67.14  delicensed and decertified; 
 67.15     ~~(v)~~ (u) to license and certify beds that are moved within 
 67.16  an existing area of a facility or to a newly-constructed 
 67.17  addition which is built for the purpose of eliminating three- 
 67.18  and four-bed rooms and adding space for dining, lounge areas, 
 67.19  bathing rooms, and ancillary service areas in a nursing home 
 67.20  that, as of January 1, 1995, was located in Fridley and had a 
 67.21  licensed capacity of 129 beds; ~~or~~ 
 67.22     ~~(w)~~ (v) to relocate 36 beds in Crow Wing county and four 
 67.23  beds from Hennepin county to a 160-bed facility in Crow Wing 
 67.24  county, provided all the affected beds are under common 
 67.25  ownership; or 
 67.26     (w) to license and certify beds in a renovation and 
 67.27  remodeling project to convert 13 three-bed wards into 13 two-bed 
 67.28  rooms and 13 single-bed rooms, expand space, and add 
 67.29  improvements in a nursing home that, as of January 1, 1994, met 
 67.30  the following conditions:  the nursing home was located in 
 67.31  Ramsey county, was not owned by a hospital corporation, had a 
 67.32  licensed capacity of 64 beds, and had been ranked among the top 
 67.33  15 applicants by the 1993 moratorium exceptions advisory review 
 67.34  panel.  The total project construction cost estimate for this 
 67.35  project must not exceed the cost estimate submitted in 
 67.36  connection with the 1993 moratorium exception process. 
 68.1      Sec. 4.  Minnesota Statutes 1996, section 144A.073, 
 68.2   subdivision 2, is amended to read: 
 68.3      Subd. 2.  [REQUEST FOR PROPOSALS.] At the authorization by 
 68.4   the legislature of additional medical assistance expenditures 
 68.5   for exceptions to the moratorium on nursing homes, the 
 68.6   interagency committee shall publish in the State Register a 
 68.7   request for proposals for nursing home projects to be licensed 
 68.8   or certified under section 144A.071, subdivision 4a, clause 
 68.9   (c).  The public notice of this funding and the request for 
 68.10  proposals must specify how the approval criteria will be 
 68.11  prioritized by the advisory review panel, the interagency 
 68.12  long-term care planning committee, and the commissioner.  The 
 68.13  notice must describe the information that must accompany a 
 68.14  request and state that proposals must be submitted to the 
 68.15  interagency committee within 90 days of the date of 
 68.16  publication.  The notice must include the amount of the 
 68.17  legislative appropriation available for the additional costs to 
 68.18  the medical assistance program of projects approved under this 
 68.19  section.  If no money is appropriated for a year, the 
 68.20  interagency committee shall publish a notice to that effect, and 
 68.21  no proposals shall be requested.  If money is appropriated, the 
 68.22  interagency committee shall initiate the application and review 
 68.23  process described in this section at least twice each biennium 
 68.24  and up to four times each biennium, according to dates 
 68.25  established by rule.  Authorized funds shall be allocated 
 68.26  proportionally to the number of processes.  Funds not encumbered 
 68.27  by an earlier process within a biennium shall carry forward to 
 68.28  subsequent iterations of the process.  Authorization for 
 68.29  expenditures does not carry forward into the following 
 68.30  biennium.  To be considered for approval, a proposal must 
 68.31  include the following information: 
 68.32     (1) whether the request is for renovation, replacement, 
 68.33  upgrading, conversion, or relocation; 
 68.34     (2) a description of the problem the project is designed to 
 68.35  address; 
 68.36     (3) a description of the proposed project; 
 69.1      (4) an analysis of projected costs of the nursing facility 
 69.2   proposal, which are not required to exceed the cost threshold 
 69.3   referred to in section 144A.071, subdivision 1, to be considered 
 69.4   under this section, including initial construction and 
 69.5   remodeling costs; site preparation costs; financing costs, 
 69.6   including the current estimated long-term financing costs of the 
 69.7   proposal, which consists of estimates of the amount and sources 
 69.8   of money, reserves if required under the proposed funding 
 69.9   mechanism, annual payments schedule, interest rates, length of 
 69.10  term, closing costs and fees, insurance costs, and any completed 
 69.11  marketing study or underwriting review; and estimated operating 
 69.12  costs during the first two years after completion of the 
 69.13  project; 
 69.14     (5) for proposals involving replacement of all or part of a 
 69.15  facility, the proposed location of the replacement facility and 
 69.16  an estimate of the cost of addressing the problem through 
 69.17  renovation; 
 69.18     (6) for proposals involving renovation, an estimate of the 
 69.19  cost of addressing the problem through replacement; 
 69.20     (7) the proposed timetable for commencing construction and 
 69.21  completing the project; 
 69.22     (8) a statement of any licensure or certification issues, 
 69.23  such as certification survey deficiencies; 
 69.24     (9) the proposed relocation plan for current residents if 
 69.25  beds are to be closed so that the department of human services 
 69.26  can estimate the total costs of a proposal; and 
 69.27     (10) other information required by permanent rule of the 
 69.28  commissioner of health in accordance with subdivisions 4 and 8. 
 69.29     Sec. 5.  Minnesota Statutes 1996, section 252.28, is 
 69.30  amended by adding a subdivision to read: 
 69.31     Subd. 3a.  [LICENSING EXCEPTION.] Notwithstanding the 
 69.32  provisions of subdivision 3, the commissioner may license 
 69.33  service sites, each accommodating up to six residents moving 
 69.34  from a 48-bed intermediate care facility for persons with mental 
 69.35  retardation or related conditions located in Dakota county that 
 69.36  is closing under section 252.292. 
 70.1      Sec. 6.  Minnesota Statutes 1996, section 256B.431, 
 70.2   subdivision 25, is amended to read: 
 70.3      Subd. 25.  [CHANGES TO NURSING FACILITY REIMBURSEMENT 
 70.4   BEGINNING JULY 1, 1995.] The nursing facility reimbursement 
 70.5   changes in paragraphs (a) to (h) shall apply in the sequence 
 70.6   specified to Minnesota Rules, parts 9549.0010 to 9549.0080, and 
 70.7   this section, beginning July 1, 1995. 
 70.8      (a) The eight-cent adjustment to care-related rates in 
 70.9   subdivision 22, paragraph (e), shall no longer apply. 
 70.10     (b) For rate years beginning on or after July 1, 1995, the 
 70.11  commissioner shall limit a nursing facility's allowable 
 70.12  operating per diem for each case mix category for each rate year 
 70.13  as in clauses (1) to (3). 
 70.14     (1) For the rate year beginning July 1, 1995, the 
 70.15  commissioner shall group nursing facilities into two groups, 
 70.16  freestanding and nonfreestanding, within each geographic group, 
 70.17  using their operating cost per diem for the case mix A 
 70.18  classification.  A nonfreestanding nursing facility is a nursing 
 70.19  facility whose other operating cost per diem is subject to the 
 70.20  hospital attached, short length of stay, or the rule 80 limits.  
 70.21  All other nursing facilities shall be considered freestanding 
 70.22  nursing facilities.  The commissioner shall then array all 
 70.23  nursing facilities in each grouping by their allowable case mix 
 70.24  A operating cost per diem.  In calculating a nursing facility's 
 70.25  operating cost per diem for this purpose, the commissioner shall 
 70.26  exclude the raw food cost per diem related to providing special 
 70.27  diets that are based on religious beliefs, as determined in 
 70.28  subdivision 2b, paragraph (h).  For those nursing facilities in 
 70.29  each grouping whose case mix A operating cost per diem: 
 70.30     (i) is at or below the median minus 1.0 standard deviation 
 70.31  of the array, the commissioner shall limit the nursing 
 70.32  facility's allowable operating cost per diem for each case mix 
 70.33  category to the lesser of the prior reporting year's allowable 
 70.34  operating cost per diems plus the inflation factor as 
 70.35  established in paragraph (f), clause (2), increased by six 
 70.36  percentage points, or the current reporting year's corresponding 
 71.1   allowable operating cost per diem; 
 71.2      (ii) is between minus .5 standard deviation and minus 1.0 
 71.3   standard deviation below the median of the array, the 
 71.4   commissioner shall limit the nursing facility's allowable 
 71.5   operating cost per diem for each case mix category to the lesser 
 71.6   of the prior reporting year's allowable operating cost per diems 
 71.7   plus the inflation factor as established in paragraph (f), 
 71.8   clause (2), increased by four percentage points, or the current 
 71.9   reporting year's corresponding allowable operating cost per 
 71.10  diem; or 
 71.11     (iii) is equal to or above minus .5 standard deviation 
 71.12  below the median of the array, the commissioner shall limit the 
 71.13  nursing facility's allowable operating cost per diem for each 
 71.14  case mix category to the lesser of the prior reporting year's 
 71.15  allowable operating cost per diems plus the inflation factor as 
 71.16  established in paragraph (f), clause (2), increased by three 
 71.17  percentage points, or the current reporting year's corresponding 
 71.18  allowable operating cost per diem. 
 71.19     (2) For the rate year beginning on July 1, 1996, the 
 71.20  commissioner shall limit the nursing facility's allowable 
 71.21  operating cost per diem for each case mix category to the lesser 
 71.22  of the prior reporting year's allowable operating cost per diems 
 71.23  plus the inflation factor as established in paragraph (f), 
 71.24  clause (2), increased by one percentage point or the current 
 71.25  reporting year's corresponding allowable operating cost per 
 71.26  diems; and 
 71.27     (3) For rate years beginning on or after July 1, 1997, the 
 71.28  commissioner shall limit the nursing facility's allowable 
 71.29  operating cost per diem for each case mix category to the lesser 
 71.30  of the reporting year prior to the current reporting year's 
 71.31  allowable operating cost per diems plus the inflation factor as 
 71.32  established in paragraph (f), clause (2), or the current 
 71.33  reporting year's corresponding allowable operating cost per 
 71.34  diems. 
 71.35     (c) For rate years beginning on July 1, 1995, the 
 71.36  commissioner shall limit the allowable operating cost per diems 
 72.1   for high cost nursing facilities.  After application of the 
 72.2   limits in paragraph (b) to each nursing facility's operating 
 72.3   cost per diems, the commissioner shall group nursing facilities 
 72.4   into two groups, freestanding or nonfreestanding, within each 
 72.5   geographic group.  A nonfreestanding nursing facility is a 
 72.6   nursing facility whose other operating cost per diems are 
 72.7   subject to hospital attached, short length of stay, or rule 80 
 72.8   limits.  All other nursing facilities shall be considered 
 72.9   freestanding nursing facilities.  The commissioner shall then 
 72.10  array all nursing facilities within each grouping by their 
 72.11  allowable case mix A operating cost per diems.  In calculating a 
 72.12  nursing facility's operating cost per diem for this purpose, the 
 72.13  commissioner shall exclude the raw food cost per diem related to 
 72.14  providing special diets that are based on religious beliefs, as 
 72.15  determined in subdivision 2b, paragraph (h).  For those nursing 
 72.16  facilities in each grouping whose case mix A operating cost per 
 72.17  diem exceeds 1.0 standard deviation above the median, the 
 72.18  commissioner shall reduce their allowable operating cost per 
 72.19  diems by two percent.  For those nursing facilities in each 
 72.20  grouping whose case mix A operating cost per diem exceeds 0.5 
 72.21  standard deviation above the median but is less than or equal to 
 72.22  1.0 standard deviation above the median, the commissioner shall 
 72.23  reduce their allowable operating cost per diems by one percent. 
 72.24     (d) For rate years beginning on or after July 1, 1996, the 
 72.25  commissioner shall limit the allowable operating cost per diems 
 72.26  for high cost nursing facilities.  After application of the 
 72.27  limits in paragraph (b) to each nursing facility's operating 
 72.28  cost per diems, the commissioner shall group nursing facilities 
 72.29  into two groups, freestanding or nonfreestanding, within each 
 72.30  geographic group.  A nonfreestanding nursing facility is a 
 72.31  nursing facility whose other operating cost per diems are 
 72.32  subject to hospital attached, short length of stay, or rule 80 
 72.33  limits.  All other nursing facilities shall be considered 
 72.34  freestanding nursing facilities.  The commissioner shall then 
 72.35  array all nursing facilities within each grouping by their 
 72.36  allowable case mix A operating cost per diems.  In calculating a 
 73.1   nursing facility's operating cost per diem for this purpose, the 
 73.2   commissioner shall exclude the raw food cost per diem related to 
 73.3   providing special diets that are based on religious beliefs, as 
 73.4   determined in subdivision 2b, paragraph (h).  In those nursing 
 73.5   facilities in each grouping whose case mix A operating cost per 
 73.6   diem exceeds 1.0 standard deviation above the median, the 
 73.7   commissioner shall reduce their allowable operating cost per 
 73.8   diems by three percent.  For those nursing facilities in each 
 73.9   grouping whose case mix A operating cost per diem exceeds 0.5 
 73.10  standard deviation above the median but is less than or equal to 
 73.11  1.0 standard deviation above the median, the commissioner shall 
 73.12  reduce their allowable operating cost per diems by two percent. 
 73.13     (e) For rate years beginning on or after July 1, 1995, the 
 73.14  commissioner shall determine a nursing facility's efficiency 
 73.15  incentive by first computing the allowable difference, which is 
 73.16  the lesser of $4.50 or the amount by which the facility's other 
 73.17  operating cost limit exceeds its nonadjusted other operating 
 73.18  cost per diem for that rate year.  The commissioner shall 
 73.19  compute the efficiency incentive by: 
 73.20     (1) subtracting the allowable difference from $4.50 and 
 73.21  dividing the result by $4.50; 
 73.22     (2) multiplying 0.20 by the ratio resulting from clause 
 73.23  (1), and then; 
 73.24     (3) adding 0.50 to the result from clause (2); and 
 73.25     (4) multiplying the result from clause (3) times the 
 73.26  allowable difference. 
 73.27     The nursing facility's efficiency incentive payment shall 
 73.28  be the lesser of $2.25 or the product obtained in clause (4). 
 73.29     (f) For rate years beginning on or after July 1, 1995, the 
 73.30  forecasted price index for a nursing facility's allowable 
 73.31  operating cost per diems shall be determined under clauses (1) 
 73.32  to (3) using the change in the Consumer Price Index-All Items 
 73.33  (United States city average) (CPI-U) or the change in the 
 73.34  Nursing Home Market Basket, both as forecasted by Data Resources 
 73.35  Inc., whichever is applicable.  The commissioner shall use the 
 73.36  indices as forecasted in the fourth quarter of the calendar year 
 74.1   preceding the rate year, subject to subdivision 2l, paragraph 
 74.2   (c).  If, as a result of federal legislative or administrative 
 74.3   action, the methodology used to calculate the Consumer Price 
 74.4   Index-All Items (United States city average) (CPI-U) changes, 
 74.5   the commissioner shall develop a conversion factor or other 
 74.6   methodology to convert the CPI-U index factor that results from 
 74.7   the new methodology to an index factor that approximates, as 
 74.8   closely as possible, the index factor that would have resulted 
 74.9   from application of the original CPI-U methodology prior to any 
 74.10  changes in methodology.  The commissioner shall use the 
 74.11  conversion factor or other methodology to calculate an adjusted 
 74.12  inflation index.  The adjusted inflation index must be used to 
 74.13  calculate payment rates under this section instead of the CPI-U 
 74.14  index specified in paragraph (d).  If the commissioner is 
 74.15  required to develop an adjusted inflation index, the 
 74.16  commissioner shall report to the legislature as part of the next 
 74.17  budget submission the fiscal impact of applying this index. 
 74.18     (1) The CPI-U forecasted index for allowable operating cost 
 74.19  per diems shall be based on the 21-month period from the 
 74.20  midpoint of the nursing facility's reporting year to the 
 74.21  midpoint of the rate year following the reporting year. 
 74.22     (2) The Nursing Home Market Basket forecasted index for 
 74.23  allowable operating costs and per diem limits shall be based on 
 74.24  the 12-month period between the midpoints of the two reporting 
 74.25  years preceding the rate year. 
 74.26     (3) For rate years beginning on or after July 1, 1996, the 
 74.27  forecasted index for operating cost limits referred to in 
 74.28  subdivision 21, paragraph (b), shall be based on the CPI-U for 
 74.29  the 12-month period between the midpoints of the two reporting 
 74.30  years preceding the rate year. 
 74.31     (g) After applying these provisions for the respective rate 
 74.32  years, the commissioner shall index these allowable operating 
 74.33  costs per diems by the inflation factor provided for in 
 74.34  paragraph (f), clause (1), and add the nursing facility's 
 74.35  efficiency incentive as computed in paragraph (e). 
 74.36     (h) (1) A nursing facility licensed for 302 beds on 
 75.1   September 30, 1993, that was approved under the moratorium 
 75.2   exception process in section 144A.073 for a partial replacement, 
 75.3   and completed the replacement project in December 1994, is 
 75.4   exempt from paragraphs (b) to (d) for rate years beginning on or 
 75.5   after July 1, 1995. 
 75.6      (2) For the rate year beginning July 1, 1997, after 
 75.7   computing this nursing facility's payment rate according to 
 75.8   section 256B.434, the commissioner shall make a one-year rate 
 75.9   adjustment of $8.62 to the facility's contract payment rate for 
 75.10  the rate effect of operating cost changes associated with the 
 75.11  facility's 1994 downsizing project. 
 75.12     (3) For rate years beginning on or after July 1, 1997, the 
 75.13  commissioner shall add 35 cents to the facility's base property 
 75.14  related payment rate for the rate effect of reducing its 
 75.15  licensed capacity to 290 beds from 302 beds and shall add 83 
 75.16  cents to the facility's real estate tax and special assessment 
 75.17  payment rate for payments in lieu of real estate taxes.  The 
 75.18  adjustments in this clause shall remain in effect for the 
 75.19  duration of the facility's contract under section 256B.434. 
 75.20     (i) Notwithstanding Laws 1996, chapter 451, article 3, 
 75.21  section 11, paragraph (h), for the rate years beginning on July 
 75.22  1, 1996, July 1, 1997, and July 1, 1998, a nursing facility 
 75.23  licensed for 40 beds effective May 1, 1992, with a subsequent 
 75.24  increase of 20 Medicare/Medicaid certified beds, effective 
 75.25  January 26, 1993, in accordance with an increase in licensure is 
 75.26  exempt from paragraphs (b) to (d). 
 75.27     (j) For the rate year beginning July 1, 1997, the 
 75.28  commissioner shall compute the payment rate for a nursing 
 75.29  facility licensed for 94 beds on September 30, 1996, that 
 75.30  applied in October 1993 for approval of a total replacement 
 75.31  under the moratorium exception process in section 144A.073, and 
 75.32  completed the approved replacement in June 1995, with an 
 75.33  aggregate spend-up limit under paragraph (b) or Laws 1996, 
 75.34  chapter 451, article 3, section 11, increased by $3.98, and 
 75.35  after computing the facility's payment rate according to this 
 75.36  section, the commissioner shall make a one year positive rate 
 76.1   adjustment of $3.19 for operating costs related to the newly 
 76.2   constructed total replacement, without application of paragraphs 
 76.3   (b) to (d) or Laws 1996, chapter 451, article 3, section 11.  
 76.4   The facility's per diems, before the $3.19 adjustment, shall be 
 76.5   used as the prior reporting year's allowable operating cost per 
 76.6   diems for payment rate calculation for the rate year beginning 
 76.7   July 1, 1998. 
 76.8      (k) For the purpose of applying the limit under paragraph 
 76.9   (b), clause (3), a nursing facility in Hibbing licensed for 192 
 76.10  beds shall have the prior year's allowable other operating cost 
 76.11  per diems increased by $2.67 before adding the inflation in 
 76.12  paragraph (f), clause (2), for the rate year beginning July 1, 
 76.13  1997. 
 76.14     (l) For the purpose of applying the limit under paragraph 
 76.15  (b), clause (3), a nursing facility in Kandiyohi county licensed 
 76.16  for 86 beds that was granted hospital-attached status on 
 76.17  December 1, 1994, shall have the prior year's allowable 
 76.18  operating cost per diems increased by $7.984 before adding the 
 76.19  inflation in paragraph (f), clause (2), for the rate year 
 76.20  beginning on July 1, 1997. 
 76.21     Sec. 7.  Minnesota Statutes 1996, section 256B.431, is 
 76.22  amended by adding a subdivision to read: 
 76.23     Subd. 26.  [NURSING FACILITY REIMBURSEMENT BEGINNING JULY 
 76.24  1, 1997.] For rate years beginning on or after July 1, 1997, the 
 76.25  total operating cost payment rates for a nursing facility shall 
 76.26  be the greater of the total operating cost payment rates 
 76.27  determined under this section or the total operating cost 
 76.28  payment rates in effect on June 30, 1997, subject to rate 
 76.29  adjustments due to field audit or rate appeal resolution.  This 
 76.30  provision shall not apply to subsequent field audit adjustments 
 76.31  of the nursing facility's operating cost rates for rate years 
 76.32  beginning on or after July 1, 1997. 
 76.33     Sec. 8.  Minnesota Statutes 1996, section 256B.433, is 
 76.34  amended by adding a subdivision to read: 
 76.35     Subd. 3a.  [EXEMPTION FROM REQUIREMENT FOR SEPARATE THERAPY 
 76.36  BILLING.] The provisions of subdivision 3 do not apply to 
 77.1   nursing facilities that are reimbursed according to the 
 77.2   provisions of section 256B.431 and are located in a county 
 77.3   participating in the prepaid medical assistance program. 
 77.4      Sec. 9.  Minnesota Statutes 1996, section 256B.434, 
 77.5   subdivision 9, is amended to read: 
 77.6      Subd. 9.  [MANAGED CARE CONTRACTS FOR OTHER SERVICES.] 
 77.7   Beginning July 1, 1995, the commissioner may contract with 
 77.8   nursing facilities that have entered into alternative payment 
 77.9   demonstration project contracts under this section to provide 
 77.10  medical assistance services other than nursing facility care to 
 77.11  residents of the facility under a prepaid, managed care payment 
 77.12  system.  ~~For purposes of contracts entered into under this~~ 
 77.13  ~~subdivision, the commissioner may waive one or more of the~~ 
 77.14  ~~requirements for payment for ancillary services in section~~ 
 77.15  ~~256B.433.~~  Managed care contracts for other services may be 
 77.16  entered into at any time during the duration of a nursing 
 77.17  facility's alternative payment demonstration project contract, 
 77.18  and the terms of the managed care contracts need not coincide 
 77.19  with the terms of the alternative payment demonstration project 
 77.20  contract. 
 77.21     Sec. 10.  Minnesota Statutes 1996, section 256B.434, 
 77.22  subdivision 10, is amended to read: 
 77.23     Subd. 10.  [EXEMPTIONS.] (a) To the extent permitted by 
 77.24  federal law, (1) a facility that has entered into a contract 
 77.25  under this section is not required to file a cost report, as 
 77.26  defined in Minnesota Rules, part 9549.0020, subpart 13, for any 
 77.27  year after the base year that is the basis for the calculation 
 77.28  of the contract payment rate for the first rate year of the 
 77.29  alternative payment demonstration project contract; and (2) a 
 77.30  facility under contract is not subject to audits of historical 
 77.31  costs or revenues, or paybacks or retroactive adjustments based 
 77.32  on these costs or revenues, except audits, paybacks, or 
 77.33  adjustments relating to the cost report that is the basis for 
 77.34  calculation of the first rate year under the contract. 
 77.35     (b) A facility that is under contract with the commissioner 
 77.36  under this section is not subject to the moratorium on licensure 
 78.1   or certification of new nursing home beds in section 144A.071, 
 78.2   unless the project results in a net increase in bed capacity or 
 78.3   involves relocation of beds from one site to another.  Contract 
 78.4   payment rates must not be adjusted to reflect any additional 
 78.5   costs that a nursing facility incurs as a result of a 
 78.6   construction project undertaken under this paragraph.  In 
 78.7   addition, as a condition of entering into a contract under this 
 78.8   section, a nursing facility must agree that any future medical 
 78.9   assistance payments for nursing facility services will not 
 78.10  reflect any additional costs attributable to the sale of a 
 78.11  nursing facility under this section and to construction 
 78.12  undertaken under this paragraph that otherwise would not be 
 78.13  authorized under the moratorium in section 144A.073.  Nothing in 
 78.14  this section prevents a nursing facility participating in the 
 78.15  alternative payment demonstration project under this section 
 78.16  from seeking approval of an exception to the moratorium through 
 78.17  the process established in section 144A.073, and if approved the 
 78.18  facility's rates shall be adjusted to reflect the cost of the 
 78.19  project. 
 78.20     (c) Notwithstanding section 256B.48, subdivision 6, 
 78.21  paragraphs (c), (d), and (e), and pursuant to any terms and 
 78.22  conditions contained in the facility's contract, a nursing 
 78.23  facility that is under contract with the commissioner under this 
 78.24  section is in compliance with section 256B.48, subdivision 6, 
 78.25  paragraph (b), if the facility is Medicare certified. 
 78.26     (d) Notwithstanding paragraph (a), if by April 1, 1996, the 
 78.27  health care financing administration has not approved a required 
 78.28  waiver, or the health care financing administration otherwise 
 78.29  requires cost reports to be filed prior to the waiver's 
 78.30  approval, the commissioner shall require a cost report for the 
 78.31  rate year. 
 78.32     (e) A facility that is under contract with the commissioner 
 78.33  under this section shall be allowed to change therapy 
 78.34  arrangements from an unrelated vendor to a related vendor during 
 78.35  the term of the contract.  The commissioner may develop 
 78.36  reasonable requirements designed to prevent an increase in 
 79.1   therapy utilization for residents enrolled in the medical 
 79.2   assistance program. 
 79.3      Sec. 11.  Minnesota Statutes 1996, section 256I.05, 
 79.4   subdivision 1a, is amended to read: 
 79.5      Subd. 1a.  [SUPPLEMENTARY RATES.] (a) In addition to the 
 79.6   room and board rate specified in subdivision 1, the county 
 79.7   agency may negotiate a payment not to exceed $426.37 for other 
 79.8   services necessary to provide room and board provided by the 
 79.9   group residence if the residence is licensed by or registered by 
 79.10  the department of health, or licensed by the department of human 
 79.11  services to provide services in addition to room and board, and 
 79.12  if the provider of services is not also concurrently receiving 
 79.13  funding for services for a recipient under a home and 
 79.14  community-based waiver under title XIX of the Social Security 
 79.15  Act; or funding from the medical assistance program under 
 79.16  section 256B.0627, subdivision 4, for personal care services for 
 79.17  residents in the setting; or residing in a setting which 
 79.18  receives funding under Minnesota Rules, parts 9535.2000 to 
 79.19  9535.3000.  If funding is available for other necessary services 
 79.20  through a home and community-based waiver, or personal care 
 79.21  services under section 256B.0627, subdivision 4, then the GRH 
 79.22  rate is limited to the rate set in subdivision 1.  The 
 79.23  registration and licensure requirement does not apply to 
 79.24  establishments which are exempt from state licensure because 
 79.25  they are located on Indian reservations and for which the tribe 
 79.26  has prescribed health and safety requirements.  Service payments 
 79.27  under this section may be prohibited under rules to prevent the 
 79.28  supplanting of federal funds with state funds.  The commissioner 
 79.29  shall pursue the feasibility of obtaining the approval of the 
 79.30  Secretary of Health and Human Services to provide home and 
 79.31  community-based waiver services under title XIX of the Social 
 79.32  Security Act for residents who are not eligible for an existing 
 79.33  home and community-based waiver due to a primary diagnosis of 
 79.34  mental illness or chemical dependency and shall apply for a 
 79.35  waiver if it is determined to be cost-effective.  
 79.36     (b) The commissioner is authorized to make cost-neutral 
 80.1   transfers from the GRH fund for beds under this section to other 
 80.2   funding programs administered by the department after 
 80.3   consultation with the county or counties in which the affected 
 80.4   beds are located.  The commissioner may also make cost-neutral 
 80.5   transfers from the GRH fund to county human service agencies for 
 80.6   beds permanently removed from the GRH census under a plan 
 80.7   submitted by the county agency and approved by the 
 80.8   commissioner.  The commissioner shall report the amount of any 
 80.9   transfers under this provision annually to the legislature. 
 80.10     (c) The provisions of paragraph (b) do not apply to a 
 80.11  facility that has its reimbursement rate established under 
 80.12  section 256B.431, subdivision 4, paragraph (c). 
 80.13     Sec. 12.  Minnesota Statutes 1996, section 256I.05, is 
 80.14  amended by adding a subdivision to read: 
 80.15     Subd. 1d.  [SUPPLEMENTARY SERVICE RATES FOR CERTAIN 
 80.16  FACILITIES SERVING PERSONS WITH MENTAL ILLNESS OR CHEMICAL 
 80.17  DEPENDENCY.] Notwithstanding the provisions of subdivisions 1a 
 80.18  and 1c for the fiscal year ending June 30, 1998, a county agency 
 80.19  may negotiate a supplementary service rate in addition to the 
 80.20  board and lodging rate for facilities licensed and registered by 
 80.21  the Minnesota department of health under section 157.17 prior to 
 80.22  December 31, 1994, if the facility meets the following criteria: 
 80.23     (1) at least 75 percent of the residents have a primary 
 80.24  diagnosis of mental illness, chemical dependency, or both, and 
 80.25  have related special needs; 
 80.26     (2) the facility provides 24-hour, on-site, year-round 
 80.27  supportive services by qualified staff capable of intervention 
 80.28  in a crisis of persons with late-state inebriety or mental 
 80.29  illness who are vulnerable to abuse or neglect; 
 80.30     (3) the services at the facility include, but are not 
 80.31  limited to: 
 80.32     (i) secure central storage of medication; 
 80.33     (ii) reminders and monitoring of medication for 
 80.34  self-administration; 
 80.35     (iii) support for developing an individual medical and 
 80.36  social service plan, updating the plan, and monitoring 
 81.1   compliance with the plan; and 
 81.2      (iv) assistance with setting up meetings, appointments, and 
 81.3   transportation to access medical, chemical health, and mental 
 81.4   health service providers; 
 81.5      (4) each resident has a documented need for at least one of 
 81.6   the services provided; 
 81.7      (5) each resident has been offered an opportunity to apply 
 81.8   for admission to a licensed residential treatment program for 
 81.9   mental illness, chemical dependency, or both, have refused that 
 81.10  offer, and the offer and their refusal has been documented to 
 81.11  writing; and 
 81.12     (6) the residents are not eligible for home- and 
 81.13  community-based services waivers because of their unique need 
 81.14  for community support. 
 81.15     The total supplementary service rate must not exceed $500. 
 81.16     Sec. 13.  [RATE CLARIFICATION.] 
 81.17     For the rate years beginning October 1, 1997, and October 
 81.18  1, 1998, the commissioner of human services shall exempt 
 81.19  intermediate care facilities for persons with mental retardation 
 81.20  (ICF/MR) from reductions to the payment rates under Minnesota 
 81.21  Statutes, section 256B.501, subdivision 5b, paragraph (d), 
 81.22  clause (6), if the facility: 
 81.23     (1) has had a settle-up payment rate established in the 
 81.24  reporting year preceding the rate year for the one-time rate 
 81.25  adjustment; 
 81.26     (2) is a newly established facility; 
 81.27     (3) is an A to B conversion that has been converted under 
 81.28  Minnesota Statutes, section 252.292, since rate year 1990; 
 81.29     (4) has a payment rate subject to a community conversion 
 81.30  project under Minnesota Statutes, section 252.292; 
 81.31     (5) has a payment rate established under Minnesota 
 81.32  Statutes, section 245A.12 or 245A.13; 
 81.33     (6) is a facility created by the relocation of more than 25 
 81.34  percent of the capacity of a related facility during the 
 81.35  reporting year; or 
 81.36     (7) is a downsizing project that was authorized by 
 82.1   Minnesota Statutes, section 252.291, subdivision 3, in the 
 82.2   reporting year preceding the rate year. 
 82.3      Sec. 14.  [ICF/MR REIMBURSEMENT OCTOBER 1, 1997, TO OCTOBER 
 82.4   1, 1999.] 
 82.5      (a) Notwithstanding any contrary provision in Minnesota 
 82.6   Statutes, section 256B.501, for the rate years beginning October 
 82.7   1, 1997, and October 1, 1998, the commissioner of human services 
 82.8   shall, for purposes of the spend-up limit, array facilities 
 82.9   within each grouping established under Minnesota Statutes, 
 82.10  section 256B.501, subdivision 5b, paragraph (d), clause (4), by 
 82.11  each facility's cost per resident day.  A facility's cost per 
 82.12  resident day shall be determined by dividing its allowable 
 82.13  historical general operating cost for the reporting year by the 
 82.14  facility's resident days for the reporting year.  Facilities 
 82.15  with a cost per resident day at or above the median shall be 
 82.16  limited to the lesser of: 
 82.17     (1) the current reporting year's cost per resident day; or 
 82.18     (2) the prior report year's cost per resident day plus the 
 82.19  inflation factor established under Minnesota Statutes, section 
 82.20  256B.501, subdivision 3c, clause (2), increased by three 
 82.21  percentage points. 
 82.22  In no case shall the amount of this reduction exceed:  three 
 82.23  percent for a facility with a licensed capacity greater than 16 
 82.24  beds; two percent for a facility with a licensed capacity of 
 82.25  nine to 16 beds; and one percent for a facility with a licensed 
 82.26  capacity of eight or fewer beds. 
 82.27     (b) The commissioner shall not apply the limits established 
 82.28  under Minnesota Statutes, section 256B.501, subdivision 5b, 
 82.29  paragraph (d), clause (8), for the rate years beginning October 
 82.30  1, 1997, and October 1, 1998. 
 82.31                             ARTICLE 4
 82.32        MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE,
 82.33                  AND CHEMICAL DEPENDENCY SERVICES
 82.34     Section 1.  Minnesota Statutes 1996, section 62E.02, 
 82.35  subdivision 13, is amended to read: 
 82.36     Subd. 13.  [ELIGIBLE PERSON.] (a) "Eligible person" means 
 83.1   an individual who: 
 83.2      (1) is currently and has been a resident of Minnesota for 
 83.3   the six months immediately preceding the date of receipt by the 
 83.4   association or its writing carrier of a completed certificate of 
 83.5   eligibility ~~and who~~; 
 83.6      (2) meets the enrollment requirements of section 62E.14; 
 83.7   and 
 83.8      (3) is not otherwise ineligible under this subdivision. 
 83.9      (b) No individual is eligible for coverage under a 
 83.10  qualified or a Medicare supplement plan issued by the 
 83.11  association for whom a premium is paid or reimbursed by medical 
 83.12  assistance or general assistance medical care as of the first 
 83.13  day of any term for which a premium amount is paid or reimbursed.
 83.14     Sec. 2.  Minnesota Statutes 1996, section 62E.14, is 
 83.15  amended by adding a subdivision to read: 
 83.16     Subd. 4e.  [WAIVER OF PREEXISTING CONDITIONS; PERSONS 
 83.17  COVERED BY PUBLICLY FUNDED HEALTH PROGRAMS.] A person may enroll 
 83.18  in the comprehensive plan with a waiver of the preexisting 
 83.19  condition limitation in subdivision 3, provided that:  
 83.20     (1) the person was formerly enrolled in the medical 
 83.21  assistance, general assistance medical care, or MinnesotaCare 
 83.22  program; 
 83.23     (2) the person is a Minnesota resident; and 
 83.24     (3) the person applies within 90 days of termination from 
 83.25  medical assistance, general assistance medical care, or 
 83.26  MinnesotaCare program. 
 83.27     Sec. 3.  Minnesota Statutes 1996, section 254B.02, 
 83.28  subdivision 3, is amended to read: 
 83.29     Subd. 3.  [RESERVE ACCOUNT.] The commissioner shall 
 83.30  allocate money from the reserve account to counties that, during 
 83.31  the current fiscal year, have met or exceeded the base level of 
 83.32  expenditures for eligible chemical dependency services from 
 83.33  local money.  The commissioner shall establish the base level 
 83.34  for fiscal year 1988 as the amount of local money used for 
 83.35  eligible services in calendar year 1986.  In later years, the 
 83.36  base level must be increased in the same proportion as state 
 84.1   appropriations to implement Laws 1986, chapter 394, sections 8 
 84.2   to 20, are increased.  The base level must be decreased if the 
 84.3   fund balance from which allocations are made under section 
 84.4   254B.02, subdivision 1, is decreased in later years.  The local 
 84.5   match rate for the reserve account is the same rate as applied 
 84.6   to the initial allocation.  Reserve account payments must not be 
 84.7   included when calculating the county adjustments made according 
 84.8   to subdivision 2.  For counties providing medical assistance or 
 84.9   general assistance medical care through managed care plans on 
 84.10  January 1, 1996, the base year is fiscal year 1995.  For 
 84.11  counties beginning provision of managed care after January 1, 
 84.12  1996, the base year is the most recent fiscal year before 
 84.13  enrollment in managed care begins.  For counties providing 
 84.14  managed care, the base level will be increased or decreased in 
 84.15  proportion to changes in the fund balance from which allocations 
 84.16  are made under subdivision 2, but will be additionally increased 
 84.17  or decreased in proportion to the change in county adjusted 
 84.18  population made in subdivision 1, paragraphs (b) and (c). 
 84.19     Sec. 4. Minnesota Statutes 1996, section 254B.04, 
 84.20  subdivision 1, is amended to read: 
 84.21     Subdivision 1.  [ELIGIBILITY.] (a) Persons eligible for 
 84.22  benefits under Code of Federal Regulations, title 25, part 20, 
 84.23  persons eligible for medical assistance benefits under sections 
 84.24  256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, 
 84.25  or who meet the income standards of section 256B.056, 
 84.26  subdivision 4, and persons eligible for general assistance 
 84.27  medical care under section 256D.03, subdivision 3, are entitled 
 84.28  to chemical dependency fund services.  State money appropriated 
 84.29  for this paragraph must be placed in a separate account 
 84.30  established for this purpose. 
 84.31     (b) A person not entitled to services under paragraph (a), 
 84.32  but with family income that is less than 60 percent of the state 
 84.33  median income for a family of like size and composition, shall 
 84.34  be eligible to receive chemical dependency fund services within 
 84.35  the limit of funds available after persons entitled to services 
 84.36  under paragraph (a) have been served.  A county may spend money 
 85.1   from its own sources to serve persons under this paragraph.  
 85.2   State money appropriated for this paragraph must be placed in a 
 85.3   separate account established for this purpose. 
 85.4      (c) Persons whose income is between 60 percent and 115 
 85.5   percent of the state median income shall be eligible for 
 85.6   chemical dependency services on a sliding fee basis, within the 
 85.7   limit of funds available, after persons entitled to services 
 85.8   under paragraph (a) and persons eligible for services under 
 85.9   paragraph (b) have been served.  Persons eligible under this 
 85.10  paragraph must contribute to the cost of services according to 
 85.11  the sliding fee scale established under subdivision 3.  A county 
 85.12  may spend money from its own sources to provide services to 
 85.13  persons under this paragraph.  State money appropriated for this 
 85.14  paragraph must be placed in a separate account established for 
 85.15  this purpose. 
 85.16     ~~(d) Notwithstanding the provisions of paragraphs (b) and~~ 
 85.17  ~~(c), state funds appropriated to serve persons who are not~~ 
 85.18  ~~entitled under the provisions of paragraph (a), shall be~~ 
 85.19  ~~expended for chemical dependency treatment services for~~ 
 85.20  ~~nonentitled but eligible persons who have children in their~~ 
 85.21  ~~household, are pregnant, or are younger than 18 years old.~~  
 85.22  ~~These persons may have household incomes up to 60 percent of the~~ 
 85.23  ~~state median income.  Any funds in addition to the amounts~~ 
 85.24  ~~necessary to serve the persons identified in this paragraph~~ 
 85.25  ~~shall be expended according to the provisions of paragraphs (b)~~ 
 85.26  ~~and (c).~~  
 85.27     Sec. 5.  Minnesota Statutes 1996, section 256.969, 
 85.28  subdivision 1, is amended to read: 
 85.29     Subdivision 1.  [HOSPITAL COST INDEX.] (a) The hospital 
 85.30  cost index shall be the change in the Consumer Price Index-All 
 85.31  Items (United States city average) (CPI-U) forecasted by Data 
 85.32  Resources, Inc.  The commissioner shall use the indices as 
 85.33  forecasted in the third quarter of the calendar year prior to 
 85.34  the rate year.  The hospital cost index may be used to adjust 
 85.35  the base year operating payment rate through the rate year on an 
 85.36  annually compounded basis.  
 86.1      (b) For fiscal years beginning on or after July 1, 1993, 
 86.2   the commissioner of human services shall not provide automatic 
 86.3   annual inflation adjustments for hospital payment rates under 
 86.4   medical assistance, nor under general assistance medical care, 
 86.5   except that the inflation adjustments under paragraph (a) for 
 86.6   medical assistance, excluding general assistance medical care, 
 86.7   shall apply through calendar year ~~1997~~ 1999.  The commissioner 
 86.8   of finance shall include as a budget change request in each 
 86.9   biennial detailed expenditure budget submitted to the 
 86.10  legislature under section 16A.11 annual adjustments in hospital 
 86.11  payment rates under medical assistance and general assistance 
 86.12  medical care, based upon the hospital cost index. 
 86.13     Sec. 6.  Minnesota Statutes 1996, section 256.9695, 
 86.14  subdivision 1, is amended to read: 
 86.15     Subdivision 1.  [APPEALS.] A hospital may appeal a decision 
 86.16  arising from the application of standards or methods under 
 86.17  section 256.9685, 256.9686, or 256.969, if an appeal would 
 86.18  result in a change to the hospital's payment rate or payments.  
 86.19  Both overpayments and underpayments that result from the 
 86.20  submission of appeals shall be implemented.  Regardless of any 
 86.21  appeal outcome, relative values shall not be recalculated.  The 
 86.22  appeal shall be heard by an administrative law judge according 
 86.23  to sections 14.57 to 14.62, or upon agreement by both parties, 
 86.24  according to a modified appeals procedure established by the 
 86.25  commissioner and the office of administrative hearings.  In any 
 86.26  proceeding under this section, the appealing party must 
 86.27  demonstrate by a preponderance of the evidence that the 
 86.28  commissioner's determination is incorrect or not according to 
 86.29  law. 
 86.30     (a) To appeal a payment rate or payment determination or a 
 86.31  determination made from base year information, the hospital 
 86.32  shall file a written appeal request to the commissioner within 
 86.33  60 days of the date the payment rate determination was mailed.  
 86.34  The appeal request shall specify:  (i) the disputed items; (ii) 
 86.35  the authority in federal or state statute or rule upon which the 
 86.36  hospital relies for each disputed item; and (iii) the name and 
 87.1   address of the person to contact regarding the appeal.  Facts to 
 87.2   be considered in any appeal of base year information are limited 
 87.3   to those in existence at the time the payment rates of the first 
 87.4   rate year were established from the base year information.  In 
 87.5   the case of Medicare settled appeals, the 60-day appeal period 
 87.6   shall begin on the mailing date of the notice by the Medicare 
 87.7   program or the date the medical assistance payment rate 
 87.8   determination notice is mailed, whichever is later. 
 87.9      (b) To appeal a payment rate or payment change that results 
 87.10  from a difference in case mix between the base year and a rate 
 87.11  year, the procedures and requirements of paragraph (a) apply.  
 87.12  However, the appeal must be filed with the commissioner within 
 87.13  120 days after the end of a rate year.  A case mix appeal must 
 87.14  apply to the cost of services to all medical assistance patients 
 87.15  that received inpatient services from the hospital during the 
 87.16  rate year appealed.  For case mix appeals filed after January 1, 
 87.17  1997, the difference in case mix and the corresponding payment 
 87.18  adjustment must exceed a threshold of ten percent. 
 87.19     Sec. 7.  Minnesota Statutes 1996, section 256B.04, is 
 87.20  amended by adding a subdivision to read: 
 87.21     Subd. 1a.  [COMPREHENSIVE HEALTH SERVICES SYSTEM.] The 
 87.22  commissioner shall carry out the duties in this section with the 
 87.23  participation of the boards of county commissioners, and with 
 87.24  full consideration for the interests of counties, to plan and 
 87.25  implement a unified, accountable, comprehensive health services 
 87.26  system that: 
 87.27     (1) promotes accessible and quality health care for all 
 87.28  Minnesotans; 
 87.29     (2) assures provision of adequate health care within 
 87.30  limited state and county resources; 
 87.31     (3) avoids shifting funding burdens to county tax 
 87.32  resources; 
 87.33     (4) provides statewide eligibility, benefit, and service 
 87.34  expectations; 
 87.35     (5) manages care, develops risk management strategies, and 
 87.36  contains cost in all health and human services; and 
 88.1      (6) supports effective implementation of publicly funded 
 88.2   health and human services for all areas of the state. 
 88.3      Sec. 8.  Minnesota Statutes 1996, section 256B.056, 
 88.4   subdivision 8, is amended to read: 
 88.5      Subd. 8.  [COOPERATION.] To be eligible for medical 
 88.6   assistance, applicants and recipients must cooperate with the 
 88.7   state and local agency to identify potentially liable 
 88.8   third-party payers and assist the state in obtaining third party 
 88.9   payments, unless good cause for noncooperation is determined 
 88.10  according to Code of Federal Regulations, title 42, part 
 88.11  433.147.  "Cooperation" includes identifying any third party who 
 88.12  may be liable for care and services provided under this chapter 
 88.13  to the applicant, recipient, or any other family member for whom 
 88.14  application is made and providing relevant information to assist 
 88.15  the state in pursuing a potentially liable third party.  
 88.16  Cooperation also includes providing information about a group 
 88.17  health plan for which the person may be eligible and if the plan 
 88.18  is determined cost-effective by the state agency and premiums 
 88.19  are paid by the local agency or there is no cost to the 
 88.20  recipient, they must enroll or remain enrolled with the group.  
 88.21  For purposes of this subdivision, coverage provided by the 
 88.22  Minnesota comprehensive health association under chapter 62E 
 88.23  shall not be considered group health plan coverage or 
 88.24  cost-effective by the state and local agency.  Cost-effective 
 88.25  insurance premiums approved for payment by the state agency and 
 88.26  paid by the local agency are eligible for reimbursement 
 88.27  according to section 256B.19. 
 88.28     Sec. 9.  Minnesota Statutes 1996, section 256B.0625, 
 88.29  subdivision 13, is amended to read: 
 88.30     Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
 88.31  except for fertility drugs when specifically used to enhance 
 88.32  fertility, if prescribed by a licensed practitioner and 
 88.33  dispensed by a licensed pharmacist, by a physician enrolled in 
 88.34  the medical assistance program as a dispensing physician, or by 
 88.35  a physician or a nurse practitioner employed by or under 
 88.36  contract with a community health board as defined in section 
 89.1   145A.02, subdivision 5, for the purposes of communicable disease 
 89.2   control.  The commissioner, after receiving recommendations from 
 89.3   professional medical associations and professional pharmacist 
 89.4   associations, shall designate a formulary committee to advise 
 89.5   the commissioner on the names of drugs for which payment is 
 89.6   made, recommend a system for reimbursing providers on a set fee 
 89.7   or charge basis rather than the present system, and develop 
 89.8   methods encouraging use of generic drugs when they are less 
 89.9   expensive and equally effective as trademark drugs.  The 
 89.10  formulary committee shall consist of nine members, four of whom 
 89.11  shall be physicians who are not employed by the department of 
 89.12  human services, and a majority of whose practice is for persons 
 89.13  paying privately or through health insurance, three of whom 
 89.14  shall be pharmacists who are not employed by the department of 
 89.15  human services, and a majority of whose practice is for persons 
 89.16  paying privately or through health insurance, a consumer 
 89.17  representative, and a nursing home representative.  Committee 
 89.18  members shall serve three-year terms and shall serve without 
 89.19  compensation.  Members may be reappointed once.  
 89.20     (b) The commissioner shall establish a drug formulary.  Its 
 89.21  establishment and publication shall not be subject to the 
 89.22  requirements of the administrative procedure act, but the 
 89.23  formulary committee shall review and comment on the formulary 
 89.24  contents.  The formulary committee shall review and recommend 
 89.25  drugs which require prior authorization.  The formulary 
 89.26  committee may recommend drugs for prior authorization directly 
 89.27  to the commissioner, as long as opportunity for public input is 
 89.28  provided.  Prior authorization may be requested by the 
 89.29  commissioner based on medical and clinical criteria before 
 89.30  certain drugs are eligible for payment.  Before a drug may be 
 89.31  considered for prior authorization at the request of the 
 89.32  commissioner:  
 89.33     (1) the drug formulary committee must develop criteria to 
 89.34  be used for identifying drugs; the development of these criteria 
 89.35  is not subject to the requirements of chapter 14, but the 
 89.36  formulary committee shall provide opportunity for public input 
 90.1   in developing criteria; 
 90.2      (2) the drug formulary committee must hold a public forum 
 90.3   and receive public comment for an additional 15 days; and 
 90.4      (3) the commissioner must provide information to the 
 90.5   formulary committee on the impact that placing the drug on prior 
 90.6   authorization will have on the quality of patient care and 
 90.7   information regarding whether the drug is subject to clinical 
 90.8   abuse or misuse.  Prior authorization may be required by the 
 90.9   commissioner before certain formulary drugs are eligible for 
 90.10  payment.  The formulary shall not include:  
 90.11     (i) drugs or products for which there is no federal 
 90.12  funding; 
 90.13     (ii) over-the-counter drugs, except for antacids, 
 90.14  acetaminophen, family planning products, aspirin, insulin, 
 90.15  products for the treatment of lice, vitamins for adults with 
 90.16  documented vitamin deficiencies, ~~and~~ vitamins for children under 
 90.17  the age of seven and pregnant or nursing women~~;~~, and 
 90.18     ~~(iii)~~ any other over-the-counter drug identified by the 
 90.19  commissioner, in consultation with the drug formulary committee, 
 90.20  as necessary, appropriate, and cost-effective for the treatment 
 90.21  of certain specified chronic diseases, conditions or disorders, 
 90.22  and this determination shall not be subject to the requirements 
 90.23  of chapter 14; 
 90.24     ~~(iv)~~ (iii) anorectics; and 
 90.25     ~~(v)~~ (iv) drugs for which medical value has not been 
 90.26  established. 
 90.27     The commissioner shall publish conditions for prohibiting 
 90.28  payment for specific drugs after considering the formulary 
 90.29  committee's recommendations.  
 90.30     (c) The basis for determining the amount of payment shall 
 90.31  be the lower of the actual acquisition costs of the drugs plus a 
 90.32  fixed dispensing fee; the maximum allowable cost set by the 
 90.33  federal government or by the commissioner plus the fixed 
 90.34  dispensing fee; or the usual and customary price charged to the 
 90.35  public.  The pharmacy dispensing fee shall be ~~$3.85~~ $3.45.  
 90.36  Actual acquisition cost includes quantity and other special 
 91.1   discounts except time and cash discounts.  The actual 
 91.2   acquisition cost of a drug shall be estimated by the 
 91.3   commissioner, at average wholesale price minus nine percent.  
 91.4   The maximum allowable cost of a multisource drug may be set by 
 91.5   the commissioner and it shall be comparable to, but no higher 
 91.6   than, the maximum amount paid by other third-party payors in 
 91.7   this state who have maximum allowable cost programs.  
 91.8   Establishment of the amount of payment for drugs shall not be 
 91.9   subject to the requirements of the administrative procedure 
 91.10  act.  An additional dispensing fee of $.30 may be added to the 
 91.11  dispensing fee paid to pharmacists for legend drug prescriptions 
 91.12  dispensed to residents of long-term care facilities when a unit 
 91.13  dose blister card system, approved by the department, is used.  
 91.14  Under this type of dispensing system, the pharmacist must 
 91.15  dispense a 30-day supply of drug.  The National Drug Code (NDC) 
 91.16  from the drug container used to fill the blister card must be 
 91.17  identified on the claim to the department.  The unit dose 
 91.18  blister card containing the drug must meet the packaging 
 91.19  standards set forth in Minnesota Rules, part 6800.2700, that 
 91.20  govern the return of unused drugs to the pharmacy for reuse.  
 91.21  The pharmacy provider will be required to credit the department 
 91.22  for the actual acquisition cost of all unused drugs that are 
 91.23  eligible for reuse.  Over-the-counter medications must be 
 91.24  dispensed in the manufacturer's unopened package.  The 
 91.25  commissioner may permit the drug clozapine to be dispensed in a 
 91.26  quantity that is less than a 30-day supply.  Whenever a 
 91.27  generically equivalent product is available, payment shall be on 
 91.28  the basis of the actual acquisition cost of the generic drug, 
 91.29  unless the prescriber specifically indicates "dispense as 
 91.30  written - brand necessary" on the prescription as required by 
 91.31  section 151.21, subdivision 2.  
 91.32     Sec. 10.  Minnesota Statutes 1996, section 256B.0625, 
 91.33  subdivision 15, is amended to read: 
 91.34     Subd. 15.  [HEALTH PLAN PREMIUMS AND COPAYMENTS.] Medical 
 91.35  assistance covers health care prepayment plan premiums, 
 91.36  insurance premiums, and copayments if determined to be 
 92.1   cost-effective by the commissioner.  Effective for all premium 
 92.2   payments due on or after June 30, 1997, medical assistance does 
 92.3   not cover premiums that a recipient is required to pay under a 
 92.4   qualified or Medicare supplement plan issued by the Minnesota 
 92.5   comprehensive health association.  Medical assistance will 
 92.6   continue to cover premiums for recipients who are covered under 
 92.7   a plan issued by the Minnesota comprehensive health association 
 92.8   on June 30, 1997, for a period of six months following receipt 
 92.9   of the notice of termination or January 1, 1998, whichever is 
 92.10  later. For purposes of obtaining Medicare part A and part B, and 
 92.11  copayments, expenditures may be made even if federal funding is 
 92.12  not available. 
 92.13     Sec. 11.  Minnesota Statutes 1996, section 256B.0627, is 
 92.14  amended by adding a subdivision to read: 
 92.15     Subd. 8.  [PERSONAL CARE ASSISTANT SERVICES.] Recipients of 
 92.16  personal care assistant services may share staff and the 
 92.17  commissioner shall provide a rate system for shared personal 
 92.18  care assistant services.  The rate system shall not exceed 1-1/2 
 92.19  the amount paid for providing services to one person, and shall 
 92.20  increase incrementally by one-half the cost of serving a single 
 92.21  person, for each person served.  A personal care assistant may 
 92.22  not serve more than three children in a single setting. 
 92.23     Nothing in this subdivision shall be construed to reduce 
 92.24  the total number of hours authorized for an individual recipient.
 92.25     Sec. 12.  Minnesota Statutes 1996, section 256B.0912, is 
 92.26  amended by adding a subdivision to read: 
 92.27     Subd. 3.  [RATE CONSOLIDATION AND EQUALIZATION.] (a) The 
 92.28  commissioner of human services shall use one maximum 
 92.29  reimbursement rate for personal care services rendered after 
 92.30  June 30, 1997, regardless of whether the services are provided 
 92.31  through the medical assistance program, the alternative care 
 92.32  program, and the elderly, the community alternatives for 
 92.33  disabled individuals, the community alternative care, and the 
 92.34  traumatic brain injury waiver programs.  The maximum 
 92.35  reimbursement rate to be paid must be the reimbursement rate 
 92.36  paid for personal care services received under the medical 
 93.1   assistance program on June 30, 1997. 
 93.2      (b) The maximum reimbursement rates for behavior 
 93.3   programming and cognitive therapy services provided through the 
 93.4   traumatic brain injury waiver must be equivalent to the medical 
 93.5   assistance reimbursement rates for mental health services. 
 93.6      Sec. 13.  Minnesota Statutes 1996, section 256B.0913, is 
 93.7   amended by adding a subdivision to read: 
 93.8      Subd. 16.  [CONVERSION OF ENROLLMENT.] Upon approval of the 
 93.9   elderly waiver amendments described in section 14, persons 
 93.10  currently receiving services shall have their eligibility for 
 93.11  the elderly waiver program determined under section 256B.0915.  
 93.12  Persons currently receiving alternative care services whose 
 93.13  income is under the special income standard according to Code of 
 93.14  Federal Regulations, title 42, section 435.236, who are eligible 
 93.15  for the elderly waiver program shall be transferred to that 
 93.16  program and shall receive priority access to elderly waiver 
 93.17  slots for six months after implementation of this subdivision.  
 93.18  Persons currently enrolled in the alternative care program who 
 93.19  are not eligible for the elderly waiver program shall continue 
 93.20  to be eligible for the alternative care program as long as 
 93.21  continuous eligibility is maintained.  Continued eligibility for 
 93.22  the alternative care program shall be reviewed every six 
 93.23  months.  Persons who apply for the alternative care program 
 93.24  after approval of the elderly waiver amendments in section 14 
 93.25  are not eligible for alternative care if they would qualify for 
 93.26  the elderly waiver, with or without a spenddown.  
 93.27     Sec. 14.  Minnesota Statutes 1996, section 256B.0915, is 
 93.28  amended by adding a subdivision to read: 
 93.29     Subd. 1d.  [POST-ELIGIBILITY TREATMENT OF INCOME AND 
 93.30  RESOURCES FOR ELDERLY WAIVER.] (a) Notwithstanding the 
 93.31  provisions of section 256B.056, the commissioner shall make the 
 93.32  following amendment to the medical assistance elderly waiver 
 93.33  program effective July 1, 1997, or upon federal approval, 
 93.34  whichever is later. 
 93.35     A recipient's maintenance needs will be an amount equal to 
 93.36  the Minnesota supplemental aid equivalent rate as defined in 
 94.1   section 256I.03, subdivision 5, plus the medical assistance 
 94.2   personal needs allowance as defined in section 256B.35, 
 94.3   subdivision 1, paragraph (a), when applying posteligibility 
 94.4   treatment of income rules to the gross income of elderly waiver 
 94.5   recipients, except for individuals whose income is in excess of 
 94.6   the special income standard according to Code of Federal 
 94.7   Regulations, title 42, section 435.236. 
 94.8      (b) The commissioner of human services shall secure 
 94.9   approval of additional elderly waiver slots sufficient to serve 
 94.10  persons who will qualify under the revised income standard 
 94.11  described in paragraph (a) before implementing section 
 94.12  256B.0913, subdivision 16. 
 94.13     Sec. 15.  Minnesota Statutes 1996, section 256B.0915, 
 94.14  subdivision 3, is amended to read: 
 94.15     Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT, AND 
 94.16  FORECASTING.] (a) The number of medical assistance waiver 
 94.17  recipients that a county may serve must be allocated according 
 94.18  to the number of medical assistance waiver cases open on July 1 
 94.19  of each fiscal year.  Additional recipients may be served with 
 94.20  the approval of the commissioner. 
 94.21     (b) The monthly limit for the cost of waivered services to 
 94.22  an individual waiver client shall be the statewide average 
 94.23  payment rate of the case mix resident class to which the waiver 
 94.24  client would be assigned under the medical assistance case mix 
 94.25  reimbursement system.  If medical supplies and equipment or 
 94.26  adaptations are or will be purchased for an elderly waiver 
 94.27  services recipient, the costs may be prorated on a monthly basis 
 94.28  throughout the year in which they are purchased.  If the monthly 
 94.29  cost of a recipient's other waivered services exceeds the 
 94.30  monthly limit established in this paragraph, the annual cost of 
 94.31  the waivered services shall be determined.  In this event, the 
 94.32  annual cost of waivered services shall not exceed 12 times the 
 94.33  monthly limit calculated in this paragraph.  The statewide 
 94.34  average payment rate is calculated by determining the statewide 
 94.35  average monthly nursing home rate, effective July 1 of the 
 94.36  fiscal year in which the cost is incurred, less the statewide 
 95.1   average monthly income of nursing home residents who are age 65 
 95.2   or older, and who are medical assistance recipients in the month 
 95.3   of March of the previous state fiscal year.  The annual cost 
 95.4   divided by 12 of elderly or disabled waivered services for a 
 95.5   person who is a nursing facility resident at the time of 
 95.6   requesting a determination of eligibility for elderly or 
 95.7   disabled waivered services shall ~~not exceed~~ be the greater of 
 95.8   the monthly payment for:  (i) the resident class assigned under 
 95.9   Minnesota Rules, parts 9549.0050 to 9549.0059, for that resident 
 95.10  in the nursing facility where the resident currently resides; or 
 95.11  (ii) the statewide average payment of the case mix resident 
 95.12  class to which the resident would be assigned under the medical 
 95.13  assistance case mix reimbursement system, provided that the 
 95.14  limit under this clause only applies to persons discharged from 
 95.15  a nursing facility and found eligible for waivered services on 
 95.16  or after July 1, 1997.  The following costs must be included in 
 95.17  determining the total monthly costs for the waiver client: 
 95.18     (1) cost of all waivered services, including extended 
 95.19  medical supplies and equipment; and 
 95.20     (2) cost of skilled nursing, home health aide, and personal 
 95.21  care services reimbursable by medical assistance.  
 95.22     (c) Medical assistance funding for skilled nursing 
 95.23  services, private duty nursing, home health aide, and personal 
 95.24  care services for waiver recipients must be approved by the case 
 95.25  manager and included in the individual care plan. 
 95.26     (d) For both the elderly waiver and the nursing facility 
 95.27  disabled waiver, a county may purchase extended supplies and 
 95.28  equipment without prior approval from the commissioner when 
 95.29  there is no other funding source and the supplies and equipment 
 95.30  are specified in the individual's care plan as medically 
 95.31  necessary to enable the individual to remain in the community 
 95.32  according to the criteria in Minnesota Rules, part 9505.0210, 
 95.33  items A and B.  A county is not required to contract with a 
 95.34  provider of supplies and equipment if the monthly cost of the 
 95.35  supplies and equipment is less than $250.  
 95.36     (e) For the fiscal year beginning on July 1, 1993, and for 
 96.1   subsequent fiscal years, the commissioner of human services 
 96.2   shall not provide automatic annual inflation adjustments for 
 96.3   home and community-based waivered services.  The commissioner of 
 96.4   finance shall include as a budget change request in each 
 96.5   biennial detailed expenditure budget submitted to the 
 96.6   legislature under section 16A.11, annual adjustments in 
 96.7   reimbursement rates for home and community-based waivered 
 96.8   services, based on the forecasted percentage change in the Home 
 96.9   Health Agency Market Basket of Operating Costs, for the fiscal 
 96.10  year beginning July 1, compared to the previous fiscal year, 
 96.11  unless otherwise adjusted by statute.  The Home Health Agency 
 96.12  Market Basket of Operating Costs is published by Data Resources, 
 96.13  Inc.  The forecast to be used is the one published for the 
 96.14  calendar quarter beginning January 1, six months prior to the 
 96.15  beginning of the fiscal year for which rates are set.  The adult 
 96.16  foster care rate shall be considered a difficulty of care 
 96.17  payment and shall not include room and board. 
 96.18     (f) The adult foster care daily rate for the elderly and 
 96.19  disabled waivers shall be negotiated between the county agency 
 96.20  and the foster care provider.  The rate established under this 
 96.21  section shall not exceed the state average monthly nursing home 
 96.22  payment for the case mix classification to which the individual 
 96.23  receiving foster care is assigned; the rate must allow for other 
 96.24  waiver and medical assistance home care services to be 
 96.25  authorized by the case manager. 
 96.26     (g) The assisted living and residential care service rates 
 96.27  for elderly and community alternatives for disabled individuals 
 96.28  (CADI) waivers shall be made to the vendor as a monthly rate 
 96.29  negotiated with the county agency.  The rate shall not exceed 
 96.30  the nonfederal share of the greater of either the statewide or 
 96.31  any of the geographic groups' weighted average monthly medical 
 96.32  assistance nursing facility payment rate of the case mix 
 96.33  resident class to which the elderly or disabled client would be 
 96.34  assigned under Minnesota Rules, parts 9549.0050 to 9549.0059.  
 96.35  For alternative care assisted living projects established under 
 96.36  Laws 1988, chapter 689, article 2, section 256, monthly rates 
 97.1   may not exceed 65 percent of the greater of either the statewide 
 97.2   or any of the geographic groups' weighted average monthly 
 97.3   medical assistance nursing facility payment rate for the case 
 97.4   mix resident class to which the elderly or disabled client would 
 97.5   be assigned under Minnesota Rules, parts 9549.0050 to 
 97.6   9549.0059.  The rate may not cover direct rent or food costs. 
 97.7      (h) The county shall negotiate individual rates with 
 97.8   vendors and may be reimbursed for actual costs up to the greater 
 97.9   of the county's current approved rate or 60 percent of the 
 97.10  maximum rate in fiscal year 1994 and 65 percent of the maximum 
 97.11  rate in fiscal year 1995 for each service within each program. 
 97.12     (i) On July 1, 1993, the commissioner shall increase the 
 97.13  maximum rate for home-delivered meals to $4.50 per meal. 
 97.14     (j) Reimbursement for the medical assistance recipients 
 97.15  under the approved waiver shall be made from the medical 
 97.16  assistance account through the invoice processing procedures of 
 97.17  the department's Medicaid Management Information System (MMIS), 
 97.18  only with the approval of the client's case manager.  The budget 
 97.19  for the state share of the Medicaid expenditures shall be 
 97.20  forecasted with the medical assistance budget, and shall be 
 97.21  consistent with the approved waiver.  
 97.22     (k) Beginning July 1, 1991, the state shall reimburse 
 97.23  counties according to the payment schedule in section 256.025 
 97.24  for the county share of costs incurred under this subdivision on 
 97.25  or after January 1, 1991, for individuals who are receiving 
 97.26  medical assistance. 
 97.27     (l) For the community alternatives for disabled individuals 
 97.28  waiver, and nursing facility disabled waivers, county may use 
 97.29  waiver funds for the cost of minor adaptations to a client's 
 97.30  residence or vehicle without prior approval from the 
 97.31  commissioner if there is no other source of funding and the 
 97.32  adaptation: 
 97.33     (1) is necessary to avoid institutionalization; 
 97.34     (2) has no utility apart from the needs of the client; and 
 97.35     (3) meets the criteria in Minnesota Rules, part 9505.0210, 
 97.36  items A and B.  
 98.1   For purposes of this subdivision, "residence" means the client's 
 98.2   own home, the client's family residence, or a family foster 
 98.3   home.  For purposes of this subdivision, "vehicle" means the 
 98.4   client's vehicle, the client's family vehicle, or the client's 
 98.5   family foster home vehicle. 
 98.6      (m) The commissioner shall establish a maximum rate unit 
 98.7   for baths provided by an adult day care provider that are not 
 98.8   included in the provider's contractual daily or hourly rate.  
 98.9   This maximum rate must equal the home health aide extended rate 
 98.10  and shall be paid for baths provided to clients served under the 
 98.11  elderly and disabled waivers. 
 98.12     Sec. 16.  Minnesota Statutes 1996, section 256B.49, is 
 98.13  amended by adding a subdivision to read: 
 98.14     Subd. 9.  [PREVOCATIONAL AND SUPPORT EMPLOYMENT 
 98.15  SERVICES.] The commissioner shall seek to amend the community 
 98.16  alternatives for disabled individuals waivers and the traumatic 
 98.17  brain injury waivers to include prevocational and supported 
 98.18  employment services. 
 98.19     Sec. 17.  Minnesota Statutes 1996, section 256B.69, 
 98.20  subdivision 2, is amended to read: 
 98.21     Subd. 2.  [DEFINITIONS.] For the purposes of this section, 
 98.22  the following terms have the meanings given.  
 98.23     (a) "Commissioner" means the commissioner of human services.
 98.24  For the remainder of this section, the commissioner's 
 98.25  responsibilities for methods and policies for implementing the 
 98.26  project will be proposed by the project advisory committees and 
 98.27  approved by the commissioner.  
 98.28     (b) "Demonstration provider" means ~~an individual, agency,~~ 
 98.29  ~~organization, or group of these entities~~ a health maintenance 
 98.30  organization or community integrated service network authorized 
 98.31  and operating under chapter 62D or 62N that participates in the 
 98.32  demonstration project according to criteria, standards, methods, 
 98.33  and other requirements established for the project and approved 
 98.34  by the commissioner.  Notwithstanding the above, Itasca county 
 98.35  may continue to participate as a demonstration provider until 
 98.36  July 1, 2000. 
 99.1      (c) "Eligible individuals" means those persons eligible for 
 99.2   medical assistance benefits as defined in sections 256B.055, 
 99.3   256B.056, and 256B.06. 
 99.4      (d) "Limitation of choice" means suspending freedom of 
 99.5   choice while allowing eligible individuals to choose among the 
 99.6   demonstration providers.  
 99.7      (e) This paragraph supersedes paragraph (c) as long as the 
 99.8   Minnesota health care reform waiver remains in effect.  When the 
 99.9   waiver expires, this paragraph expires and the commissioner of 
 99.10  human services shall publish a notice in the State Register and 
 99.11  notify the revisor of statutes.  "Eligible individuals" means 
 99.12  those persons eligible for medical assistance benefits as 
 99.13  defined in sections 256B.055, 256B.056, and 256B.06.  
 99.14  Notwithstanding sections 256B.055, 256B.056, and 256B.06, an 
 99.15  individual who becomes ineligible for the program because of 
 99.16  failure to submit income reports or recertification forms in a 
 99.17  timely manner, shall remain enrolled in the prepaid health plan 
 99.18  and shall remain eligible to receive medical assistance coverage 
 99.19  through the last day of the month following the month in which 
 99.20  the enrollee became ineligible for the medical assistance 
 99.21  program. 
 99.22     Sec. 18.  Minnesota Statutes 1996, section 256B.69, 
 99.23  subdivision 3a, is amended to read: 
 99.24     Subd. 3a.  [COUNTY AUTHORITY.] (a) The commissioner, when 
 99.25  implementing the general assistance medical care, or medical 
 99.26  assistance prepayment program within a county, must include the 
 99.27  county board in the process of development, approval, and 
 99.28  issuance of the request for proposals to provide services to 
 99.29  eligible individuals within the proposed county.  County boards 
 99.30  must be given reasonable opportunity to make recommendations 
 99.31  regarding the development, issuance, review of responses, and 
 99.32  changes needed in the request for proposals.  The commissioner 
 99.33  must provide county boards the opportunity to review each 
 99.34  proposal based on the identification of community needs under 
 99.35  chapters 145A and 256E and county advocacy activities.  If a 
 99.36  county board finds that a proposal does not address certain 
100.1   community needs, the county board and commissioner shall 
100.2   continue efforts for improving the proposal and network prior to 
100.3   the approval of the contract.  The county board shall make 
100.4   recommendations regarding the approval of local networks and 
100.5   their operations to ensure adequate availability and access to 
100.6   covered services.  The provider or health plan must respond 
100.7   directly to county advocates and the state prepaid medical 
100.8   assistance ombudsperson regarding service delivery and must be 
100.9   accountable to the state regarding contracts with medical 
100.10  assistance and general assistance medical care funds.  The 
100.11  county board may recommend a maximum number of participating 
100.12  health plans after considering the size of the enrolling 
100.13  population; ensuring adequate access and capacity; considering 
100.14  the client and county administrative complexity; and considering 
100.15  the need to promote the viability of locally developed health 
100.16  plans.  The county board or a single entity representing a group 
100.17  of county boards and the commissioner shall mutually select 
100.18  health plans for participation at the time of initial 
100.19  implementation of the prepaid medical assistance program in that 
100.20  county or group of counties and at the time of contract renewal. 
100.21  The commissioner shall also seek input for contract requirements 
100.22  from the county or single entity representing a group of county 
100.23  boards at each contract renewal and incorporate those 
100.24  recommendations into the contract negotiation process.  The 
100.25  commissioner, in conjunction with the county board, shall 
100.26  actively seek to develop a mutually agreeable timetable prior to 
100.27  the development of the request for proposal, but counties must 
100.28  agree to initial enrollment beginning on or before January 1, 
100.29  1999, in either the prepaid medical assistance and general 
100.30  assistance medical care programs or county-based purchasing 
100.31  under section 256B.692.  At least 90 days before enrollment in 
100.32  the medical assistance and general assistance medical care 
100.33  prepaid programs begins in a county in which the prepaid 
100.34  programs have not been established, the commissioner shall 
100.35  provide a report to the chairs of senate and house committees 
100.36  having jurisdiction over state health care programs which 
101.1   verifies that the commissioner complied with the requirements 
101.2   for county involvement that are specified in this subdivision. 
101.3      (b) The commissioner shall seek a federal waiver to allow a 
101.4   fee-for-service plan option to MinnesotaCare enrollees.  The 
101.5   commissioner shall develop an increase of the premium fees 
101.6   required under section 256.9356 up to 20 percent of the premium 
101.7   fees for the enrollees who elect the fee-for-service option.  
101.8   Prior to implementation, the commissioner shall submit this fee 
101.9   schedule to the chair and ranking minority member of the senate 
101.10  health care committee, the senate health care and family 
101.11  services funding division, the house of representatives health 
101.12  and human services committee, and the house of representatives 
101.13  health and human services finance division. 
101.14     (c) At the option of the county board, the board may 
101.15  develop contract requirements related to the achievement of 
101.16  local public health goals to meet the health needs of medical 
101.17  assistance and general assistance medical care enrollees.  These 
101.18  requirements must be reasonably related to the performance of 
101.19  health plan functions and within the scope of the medical 
101.20  assistance and general assistance medical care benefit sets.  If 
101.21  the county board and the commissioner mutually agree to such 
101.22  requirements, the department shall include such requirements in 
101.23  all health plan contracts governing the prepaid medical 
101.24  assistance and general assistance medical care programs in that 
101.25  county at initial implementation of the program in that county 
101.26  and at the time of contract renewal.  The county board may 
101.27  participate in the enforcement of the contract provisions 
101.28  related to local public health goals. 
101.29     (d) For counties in which prepaid medical assistance and 
101.30  general assistance medical care programs have not been 
101.31  established, the commissioner shall not implement those programs 
101.32  if a county board submits acceptable and timely preliminary and 
101.33  final proposals under section 256B.692, until county-based 
101.34  purchasing is no longer operational in that county.  For 
101.35  counties in which prepaid medical assistance and general 
101.36  assistance medical care programs are in existence on or after 
102.1   September 1, 1997, the commissioner must terminate contracts 
102.2   with health plans according to section 256B.692, subdivision 5, 
102.3   if the county board submits and the commissioner accepts 
102.4   preliminary and final proposals according to that subdivision. 
102.5      (e) In the event that a county board or a single entity 
102.6   representing a group of county boards and the commissioner 
102.7   cannot reach agreement regarding:  (i) the selection of 
102.8   participating health plans in that county; (ii) contract 
102.9   requirements; or (iii) implementation and enforcement of county 
102.10  requirements including provisions regarding local public health 
102.11  goals, the commissioner shall resolve all disputes after taking 
102.12  into account the recommendations of a three-person mediation 
102.13  panel.  The panel shall be composed of one designee of the 
102.14  president of the association of Minnesota counties, one designee 
102.15  of the commissioner of human services, and one designee of the 
102.16  commissioner of health. 
102.17     Sec. 19.  Minnesota Statutes 1996, section 256B.69, 
102.18  subdivision 5, is amended to read: 
102.19     Subd. 5.  [PROSPECTIVE PER CAPITA PAYMENT.] The 
102.20  commissioner shall establish the method and amount of payments 
102.21  for services.  The commissioner shall annually contract with 
102.22  demonstration providers to provide services consistent with 
102.23  these established methods and amounts for payment.  
102.24  ~~Notwithstanding section 62D.02, subdivision 1, payments for~~ 
102.25  ~~services rendered as part of the project may be made to~~ 
102.26  ~~providers that are not licensed health maintenance organizations~~ 
102.27  ~~on a risk-based, prepaid capitation basis.~~  
102.28     If allowed by the commissioner, a demonstration provider 
102.29  may contract with an insurer, health care provider, nonprofit 
102.30  health service plan corporation, or the commissioner, to provide 
102.31  insurance or similar protection against the cost of care 
102.32  provided by the demonstration provider or to provide coverage 
102.33  against the risks incurred by demonstration providers under this 
102.34  section.  The recipients enrolled with a demonstration provider 
102.35  are a permissible group under group insurance laws and chapter 
102.36  62C, the Nonprofit Health Service Plan Corporations Act.  Under 
103.1   this type of contract, the insurer or corporation may make 
103.2   benefit payments to a demonstration provider for services 
103.3   rendered or to be rendered to a recipient.  Any insurer or 
103.4   nonprofit health service plan corporation licensed to do 
103.5   business in this state is authorized to provide this insurance 
103.6   or similar protection.  
103.7      Payments to providers participating in the project are 
103.8   exempt from the requirements of sections 256.966 and 256B.03, 
103.9   subdivision 2.  The commissioner shall complete development of 
103.10  capitation rates for payments before delivery of services under 
103.11  this section is begun.  For payments made during calendar year 
103.12  1990 and later years, the commissioner shall contract with an 
103.13  independent actuary to establish prepayment rates. 
103.14     By January 15, 1996, the commissioner shall report to the 
103.15  legislature on the methodology used to allocate to participating 
103.16  counties available administrative reimbursement for advocacy and 
103.17  enrollment costs.  The report shall reflect the commissioner's 
103.18  judgment as to the adequacy of the funds made available and of 
103.19  the methodology for equitable distribution of the funds.  The 
103.20  commissioner must involve participating counties in the 
103.21  development of the report. 
103.22     Sec. 20.  Minnesota Statutes 1996, section 256B.69, 
103.23  subdivision 5b, is amended to read: 
103.24     Subd. 5b.  [PROSPECTIVE REIMBURSEMENT RATES.] For prepaid 
103.25  medical assistance and general assistance medical care program 
103.26  contract rates set by the commissioner under subdivision 5 and 
103.27  effective on or after January 1, ~~1997, through December 31,~~ 
103.28  1998, capitation rates for nonmetropolitan counties shall on a 
103.29  weighted average be no less than ~~85~~ 90 percent of the capitation 
103.30  rates for metropolitan counties, excluding Hennepin county.  The 
103.31  commissioner shall make a pro rata adjustment in capitation 
103.32  rates paid to counties other than nonmetropolitan counties in 
103.33  order to make this provision budget neutral, except that pro 
103.34  rata adjustments shall not be applied to payments to a health 
103.35  maintenance organization that is operated by a county and is 
103.36  affiliated with a hospital with over 900 licensed beds that is 
104.1   operated by the same county. 
104.2      Sec. 21.  Minnesota Statutes 1996, section 256B.69, is 
104.3   amended by adding a subdivision to read: 
104.4      Subd. 5c.  [MEDICAL EDUCATION AND RESEARCH TRUST 
104.5   FUND.] Beginning January 1998 and each month after: 
104.6      (a) The commissioner of human services shall transfer 4.2 
104.7   percent of the prepaid medical assistance and prepaid general 
104.8   assistance medical care payment, excluding nursing facility and 
104.9   elderly waiver payments, and 2.2 percent of the MinnesotaCare 
104.10  payment made for the same month to the medical education and 
104.11  research trust fund established under section 62J.69.  
104.12     (b) The county medical assistance and general assistance 
104.13  medical care capitation base rate prior to plan specific 
104.14  adjustments shall be reduced 6.3 percent for Hennepin county, 
104.15  two percent for the remaining metropolitan counties, and 1.6 
104.16  percent for the nonmetropolitan Minnesota counties, and 2.2 
104.17  percent for MinnesotaCare in all counties.  
104.18     (c) The amount calculated under paragraph (a) shall not be 
104.19  adjusted for subsequent changes to the capitation payments for 
104.20  periods already paid.  This subdivision shall be effective each 
104.21  month a federal waiver allows federal financial participation in 
104.22  the medical education and research fund.  If the waiver delays 
104.23  implementation beyond January 1998, the transfer shall include 
104.24  all payments that would have been made under this subdivision if 
104.25  approved in the waiver. 
104.26     Sec. 22.  Minnesota Statutes 1996, section 256B.69, is 
104.27  amended by adding a subdivision to read: 
104.28     Subd. 24.  [ENROLLMENT EXEMPTION.] Persons eligible for 
104.29  services under section 256B.0915 who have income in excess of 
104.30  the level permitted under section 256B.056 without a spenddown 
104.31  but below the MSA equivalent rate as defined in section 256I.03, 
104.32  subdivision 5, plus the medical assistance personal needs 
104.33  allowance as defined in section 256B.35, subdivision 1, 
104.34  paragraph (a), shall be exempt from mandatory enrollment in the 
104.35  prepaid medical assistance program under this section unless 
104.36  otherwise directed by the legislature, except for those persons 
105.1   who were initially enrolled in the prepaid medical assistance 
105.2   program while residing in a nursing home or whose income changed 
105.3   after initial enrollment in the prepaid medical assistance 
105.4   program.  Nothing in this subdivision shall require persons who 
105.5   are required to enroll in the prepaid medical assistance program 
105.6   to disenroll from that program or from the Minnesota senior 
105.7   health options project after initial enrollment. 
105.8      Sec. 23.  [256B.692] [COUNTY-BASED PURCHASING.] 
105.9      Subdivision 1.  [IN GENERAL.] County boards or groups of 
105.10  county boards may elect to purchase or provide health care 
105.11  services on behalf of persons eligible for medical assistance 
105.12  and general assistance medical care who would otherwise be 
105.13  required to or may elect to participate in the prepaid medical 
105.14  assistance or prepaid general assistance medical care programs 
105.15  according to sections 256B.69 and 256D.03.  Counties that elect 
105.16  to purchase or provide health care under this section must 
105.17  provide all services included in prepaid managed care programs 
105.18  according to sections 256B.69, subdivisions 1 to 22, and 
105.19  256D.03.  County-based purchasing under this section is governed 
105.20  by section 256B.69, unless otherwise provided for under this 
105.21  section. 
105.22     Subd. 2.  [DUTIES OF THE COMMISSIONER OF HEALTH.] 
105.23  Notwithstanding chapters 62D and 62N, a county that elects to 
105.24  purchase medical assistance and general assistance medical care 
105.25  in return for a fixed sum without regard to the frequency or 
105.26  extent of services furnished to any particular enrollee is not 
105.27  required to obtain a certificate of authority under chapter 62D 
105.28  or 62N.  A county that elects to purchase medical assistance and 
105.29  general assistance medical care services under this section must 
105.30  satisfy the commissioner of health that the requirements of 
105.31  chapter 62D, applicable to health maintenance organizations, or 
105.32  chapter 62N, applicable to community integrated service 
105.33  networks, will be met.  A county must also ensure the 
105.34  commissioner of health that the requirements of section 72A.201 
105.35  will be met.  All enforcement and rulemaking powers available 
105.36  under chapters 62D and 62N are hereby granted to the 
106.1   commissioner of health with respect to counties that purchase 
106.2   medical assistance and general assistance medical care services 
106.3   under this section. 
106.4      Subd. 3.  [REQUIREMENTS OF THE COUNTY BOARD.] A county 
106.5   board that intends to purchase or provide health care under this 
106.6   section, which may include purchasing all or part of these 
106.7   services from health plans or individual providers on a 
106.8   fee-for-service basis, or providing these services directly, 
106.9   must demonstrate the ability to follow and agree to the 
106.10  following requirements: 
106.11     (1) purchase all covered services for a fixed payment from 
106.12  the state that does not exceed the estimated state and federal 
106.13  cost that would have occurred under the prepaid medical 
106.14  assistance and general assistance medical care programs; 
106.15     (2) ensure that covered services are accessible to all 
106.16  enrollees and that enrollees have a reasonable choice of 
106.17  providers, health plans, or networks when possible.  If the 
106.18  county is also a provider of service, the county board shall 
106.19  develop a process to ensure that providers employed by the 
106.20  county are not the sole referral source and are not the sole 
106.21  provider of health care services if other providers, which meet 
106.22  the same quality and cost requirements are available; 
106.23     (3) issue payments to participating vendors or networks in 
106.24  a timely manner; 
106.25     (4) establish a process to ensure and improve the quality 
106.26  of care provided; 
106.27     (5) provide appropriate quality and other required data in 
106.28  a format required by the state; 
106.29     (6) provide a system for advocacy, enrollee protection, and 
106.30  complaints and appeals that is independent of care providers or 
106.31  other risk bearers and complies with section 256B.69; 
106.32     (7) for counties within the seven-county metropolitan area, 
106.33  ensure that the implementation and operation of the Minnesota 
106.34  senior health options demonstration project, authorized under 
106.35  section 256B.69, subdivision 23, will not be impeded; 
106.36     (8) ensure that all recipients that are enrolled in the 
107.1   prepaid medical assistance or general assistance medical care 
107.2   program will be transferred to county-based purchasing without 
107.3   utilizing the department's fee-for-service claims payment 
107.4   system; 
107.5      (9) ensure that all recipients who are required to 
107.6   participate in county-based purchasing are given sufficient 
107.7   information prior to enrollment in order to make informed 
107.8   decisions; and 
107.9      (10) ensure that the state and the medical assistance and 
107.10  general assistance medical care recipients will be held harmless 
107.11  for the payment of obligations incurred by the county if the 
107.12  county, or a health plan providing services on behalf of the 
107.13  county, or a provider participating in county-based purchasing 
107.14  becomes insolvent, and the state has made the payments due to 
107.15  the county under this section. 
107.16     Subd. 4.  [PAYMENTS TO COUNTIES.] The commissioner shall 
107.17  pay counties that are purchasing or providing health care under 
107.18  this section a per capita payment for all enrolled recipients.  
107.19  Payments shall not exceed payments that otherwise would have 
107.20  been paid to health plans under medical assistance and general 
107.21  assistance medical care for that county or region.  This payment 
107.22  is in addition to any administrative allocation to counties for 
107.23  education, enrollment, and advocacy.  The state of Minnesota and 
107.24  the United States Department of Health and Human Services are 
107.25  not liable for any costs incurred by a county that exceed the 
107.26  payments to the county made under this subdivision.  A county 
107.27  may assign risk for the cost of care to a third party. 
107.28     Subd. 5.  [COUNTY PROPOSALS.] (a) On or before September 1, 
107.29  1997, a county board that wishes to purchase or provide health 
107.30  care under this section must submit a preliminary proposal that 
107.31  substantially demonstrates the county's ability to meet all the 
107.32  requirements of this section in response to criteria for 
107.33  proposals issued by the department on or before July 1, 1997.  
107.34  Counties submitting preliminary proposals must establish a local 
107.35  planning process that involves input from medical assistance and 
107.36  general assistance medical care recipients, recipient advocates, 
108.1   providers and representatives of local school districts, labor, 
108.2   and tribal government to advise on the development of a final 
108.3   proposal and its implementation.  
108.4      (b) The county board must submit a final proposal on or 
108.5   before July 1, 1998, that demonstrates the ability to meet all 
108.6   the requirements of this section, including beginning enrollment 
108.7   on January 1, 1999.  
108.8      (c) After January 1, 1999, for a county in which the 
108.9   prepaid medical assistance program is in existence, the county 
108.10  board must submit a preliminary proposal at least 15 months 
108.11  prior to termination of health plan contracts in that county and 
108.12  a final proposal six months prior to the health plan contract 
108.13  termination date in order to begin enrollment after the 
108.14  termination.  Nothing in this section shall impede or delay 
108.15  implementation or continuation of the prepaid medical assistance 
108.16  and general assistance medical care programs in counties for 
108.17  which the board does not submit a proposal, or submits a 
108.18  proposal that is not in compliance with this section. 
108.19     Subd. 6.  [COMMISSIONER'S AUTHORITY.] The commissioner may: 
108.20     (1) reject any preliminary or final proposal that 
108.21  substantially fails to meet the requirements of this section, or 
108.22  that the commissioner determines would substantially impair the 
108.23  state's ability to purchase health care services in other areas 
108.24  of the state, or would substantially impair an enrollee's choice 
108.25  of care systems when reasonable choice is possible, or would 
108.26  substantially impair the implementation and operation of the 
108.27  Minnesota senior health options demonstration project authorized 
108.28  under section 256B.69, subdivision 23; and 
108.29     (2) assume operation of a county's purchasing of health 
108.30  care for enrollees in medical assistance and general assistance 
108.31  medical care in the event that the contract with the county is 
108.32  terminated. 
108.33     Subd. 7.  [DISPUTE RESOLUTION.] In the event the 
108.34  commissioner rejects a proposal under subdivision 6, the county 
108.35  board may request the recommendation of a three-person mediation 
108.36  panel.  The commissioner shall resolve all disputes after taking 
109.1   into account the recommendations of the mediation panel.  The 
109.2   panel shall be composed of one designee of the president of the 
109.3   association of Minnesota counties, one designee of the 
109.4   commissioner of human services, and one designee of the 
109.5   commissioner of health. 
109.6      Subd. 8.  [APPEALS.] A county that conducts county-based 
109.7   purchasing shall be considered to be a prepaid health plan for 
109.8   purposes of section 256.045. 
109.9      Subd. 9.  [FEDERAL APPROVAL.] The commissioner shall 
109.10  request any federal waivers and federal approval required to 
109.11  implement this section.  County-based purchasing shall not be 
109.12  implemented without obtaining all federal approval required to 
109.13  maintain federal matching funds in the medical assistance 
109.14  program. 
109.15     Subd. 10.  [REPORT TO THE LEGISLATURE.] The commissioner 
109.16  shall submit a report to the legislature by February 1, 1998, on 
109.17  the preliminary proposals submitted on or before September 1, 
109.18  1997. 
109.19     Sec. 24.  Minnesota Statutes 1996, section 256D.03, 
109.20  subdivision 3b, is amended to read: 
109.21     Subd. 3b.  [COOPERATION.] General assistance or general 
109.22  assistance medical care applicants and recipients must cooperate 
109.23  with the state and local agency to identify potentially liable 
109.24  third-party payors and assist the state in obtaining third-party 
109.25  payments.  Cooperation includes identifying any third party who 
109.26  may be liable for care and services provided under this chapter 
109.27  to the applicant, recipient, or any other family member for whom 
109.28  application is made and providing relevant information to assist 
109.29  the state in pursuing a potentially liable third party.  General 
109.30  assistance medical care applicants and recipients must cooperate 
109.31  by providing information about any group health plan in which 
109.32  they may be eligible to enroll.  They must cooperate with the 
109.33  state and local agency in determining if the plan is 
109.34  cost-effective.  For purposes of this subdivision, coverage 
109.35  provided by the Minnesota comprehensive health association under 
109.36  chapter 62E shall not be considered group health plan coverage 
110.1   or cost-effective by the state and local agency.  If the plan is 
110.2   determined cost-effective and the premium will be paid by the 
110.3   state or local agency or is available at no cost to the person, 
110.4   they must enroll or remain enrolled in the group health 
110.5   plan.  Effective for all premium payments due on or after June 
110.6   30, 1997, general assistance medical care does not cover 
110.7   premiums that a recipient is required to pay under a qualified 
110.8   or Medicare supplement plan issued by the Minnesota 
110.9   comprehensive health association.  General assistance medical 
110.10  care will continue to cover premiums for recipients who are 
110.11  covered under a plan issued by the Minnesota comprehensive 
110.12  health association on June 30, 1997, for a period of six months 
110.13  following receipt of the notice of termination or January 1, 
110.14  1998, whichever is later.  Cost-effective insurance premiums 
110.15  approved for payment by the state agency and paid by the local 
110.16  agency are eligible for reimbursement according to subdivision 6.
110.17     Sec. 25.  Minnesota Statutes 1996, section 256G.05, 
110.18  subdivision 2, is amended to read: 
110.19     Subd. 2.  [NON-MINNESOTA RESIDENTS.] State residence is not 
110.20  required for receiving emergency assistance in the general 
110.21  assistance~~, general assistance medical care,~~ and Minnesota 
110.22  supplemental aid programs only.  The receipt of emergency 
110.23  assistance must not be used as a factor in determining county or 
110.24  state residence. 
110.25     Sec. 26.  Laws 1995, chapter 207, article 6, section 115, 
110.26  is amended to read: 
110.27     Sec. 115.  [CONTINUATION OF PILOT PROJECTS.] 
110.28     The alternative care pilot projects authorized in Laws 
110.29  1993, First Special Session chapter 1, article 5, section 133, 
110.30  shall not expire on June 30, 1995, but shall continue until June 
110.31  30, ~~1997~~ 2001, except that the three percent rate increases 
110.32  authorized in Laws 1993, First Special Session chapter 1, 
110.33  article 1, section 2, subdivision 4, and any subsequent rate 
110.34  increases shall be incorporated in average monthly cost 
110.35  effective July 1, 1995.  Beginning July 1, 1997, a county may 
110.36  spend up to ten percent of grant funds for needed client 
111.1   services that are not listed under Minnesota Statutes, section 
111.2   256B.0913, subdivision 5.  The commissioner shall allow 
111.3   additional counties at their option to implement the alternative 
111.4   care program within the parameters established in Laws 1993, 
111.5   First Special Session chapter 1, article 5, section 133.  If 
111.6   more than five counties exercise this option, the commissioner 
111.7   may require counties to make this change on a phased schedule if 
111.8   necessary in order to implement this provision within the limit 
111.9   of available resources.  For newly participating counties, the 
111.10  previous fiscal year shall be the base year. 
111.11     Sec. 27.  [STUDY OF ELDERLY WAIVER EXPANSION.] 
111.12     The commissioner of human services shall appoint a task 
111.13  force that includes representatives of counties, health plans, 
111.14  consumers, and legislators to study the impact of the expansion 
111.15  of the elderly waiver program under section 4 and to make 
111.16  recommendations for any changes in law necessary to facilitate 
111.17  an efficient and equitable relationship between the elderly 
111.18  waiver program and the Minnesota senior health options project.  
111.19  Based on the results of the task force study, the commissioner 
111.20  may seek any federal waivers needed to improve the relationship 
111.21  between the elderly waiver and the Minnesota senior health 
111.22  options project.  The commissioner shall report the results of 
111.23  the task force study to the legislature by January 15, 1998. 
111.24     Sec. 28.  [MCHA TERMINATION NOTICE.] 
111.25     (a) The Minnesota comprehensive health association, in 
111.26  consultation with the commissioner of human services, shall 
111.27  provide written notice to all persons whose coverage under the 
111.28  comprehensive health insurance plan terminates due to the change 
111.29  in policy described in Minnesota Statutes, sections 256B.0625, 
111.30  subdivision 19, and 256D.03, subdivision 3b. 
111.31     The notice must include the following information: 
111.32     (1) the reason for termination; 
111.33     (2) a description of the eligibility requirements for the 
111.34  comprehensive health insurance plan; 
111.35     (3) a description of medical assistance and general 
111.36  assistance medical care eligibility categories; 
112.1      (4) a description of the participation requirements to the 
112.2   prepaid medical assistance program, prepaid general assistance 
112.3   medical care, and exemptions from participation due to 
112.4   disability as determined by the social security administration; 
112.5   and 
112.6      (5) a telephone number for the department of human services 
112.7   for specific questions regarding the medical assistance and 
112.8   general assistance medical care program. 
112.9   Notice must be given at least six months before coverage is 
112.10  terminated. 
112.11     (b) The commissioner of human services shall release to the 
112.12  association any data necessary to provide the notice required in 
112.13  paragraph (a). 
112.14     Sec. 29.  [PERSONAL CARE SERVICES STUDY.] 
112.15     The commissioner of human services shall formulate 
112.16  recommendations on how to allow recipients of medical assistance 
112.17  who have been diagnosed with autism or other disabilities to use 
112.18  personal care services with more flexibility to meet individual 
112.19  client needs and preferences.  The commissioner may convene an 
112.20  advisory task force as authorized under Minnesota Statutes, 
112.21  section 15.014, subdivision 2, to assist in formulating these 
112.22  recommendations.  If a task force is convened, it shall be 
112.23  comprised of department of human services staff from the adult 
112.24  mental health, children's mental health, home- and 
112.25  community-based services, and developmental disabilities 
112.26  divisions, as well as consumers of personal care services, 
112.27  advocates, and providers of personal care attendant services.  A 
112.28  report with recommendations that outlines how consumer-centered 
112.29  planning and flexible use of funds can be implemented by July 1, 
112.30  1998, must be presented to the legislature by December 15, 1997. 
112.31     Sec. 30.  [INTEGRATION OF MINNESOTACARE WITH COUNTY-BASED 
112.32  PURCHASING.] 
112.33     The commissioner of human services shall develop a plan to 
112.34  integrate the MinnesotaCare program with county-based 
112.35  purchasing.  The plan must permit a county that elects to 
112.36  implement county-based purchasing to elect to purchase or 
113.1   provide health services on behalf of persons eligible for the 
113.2   MinnesotaCare program.  The commissioner shall submit the plan 
113.3   to the legislature by February 1, 1998. 
113.4      Sec. 31.  [OMBUDSPERSON SERVICES.] 
113.5      The commissioner of human services shall make 
113.6   recommendations to the legislature by January 15, 1998, on how 
113.7   the ombudsperson services and prepayment coordinator services 
113.8   established in Minnesota Statutes, section 256B.69, subdivisions 
113.9   20 and 21, could be reorganized to ensure that the ombudsman and 
113.10  county prepayment coordinator are independent of the department 
113.11  of human services, county authorities, health plans, or other 
113.12  health care providers.  The commissioner must seek input from 
113.13  recipients, advocates, and counties in reorganizing the 
113.14  ombudsman and county advocate system. 
113.15     Sec. 32.  [REPEALER.] 
113.16     (a) Minnesota Statutes 1996, section 256B.0625, subdivision 
113.17  13b, is repealed the day following final enactment. 
113.18     (b) Minnesota Rules, part 9505.1000, is repealed July 1, 
113.19  1997. 
113.20     Sec. 33.  [EFFECTIVE DATE.] 
113.21     Section 1 is effective January 1, 1998.  
113.22     Sections 8, 17, and 24 are effective the day following 
113.23  final enactment. 
113.24                             ARTICLE 5
113.25                        CHILDREN'S PROGRAMS
113.26     Section 1.  Minnesota Statutes 1996, section 245.4882, 
113.27  subdivision 5, is amended to read: 
113.28     Subd. 5.  [SPECIALIZED RESIDENTIAL TREATMENT SERVICES.] The 
113.29  commissioner of human services shall continue efforts to further 
113.30  interagency collaboration to develop a comprehensive system of 
113.31  services, including family community support and specialized 
113.32  residential treatment services for children.  The services shall 
113.33  be designed for children with emotional disturbance who exhibit 
113.34  violent or destructive behavior and for whom local treatment 
113.35  services are not feasible due to the small number of children 
113.36  statewide who need the services and the specialized nature of 
114.1   the services required.  The services shall be located in 
114.2   community settings.  ~~If no appropriate services are available in~~ 
114.3   ~~Minnesota or within the geographical area in which the residents~~ 
114.4   ~~of the county normally do business, the commissioner is~~ 
114.5   ~~responsible, effective July 1, 1997, for 50 percent of the~~ 
114.6   ~~nonfederal costs of out-of-state treatment of children for whom~~ 
114.7   ~~no appropriate resources are available in Minnesota.  Counties~~ 
114.8   ~~are eligible to receive enhanced state funding under this~~ 
114.9   ~~section only if they have established juvenile screening teams~~ 
114.10  ~~under section 260.151, subdivision 3, and if the out-of-state~~ 
114.11  ~~treatment has been approved by the commissioner.  By January 1,~~ 
114.12  ~~1995, the commissioners of human services and corrections shall~~ 
114.13  ~~jointly develop a plan, including a financing strategy, for~~ 
114.14  ~~increasing the in-state availability of treatment within a~~ 
114.15  ~~secure setting.  By July 1, 1994, the commissioner of human~~ 
114.16  ~~services shall also:~~ 
114.17     ~~(1) conduct a study and develop a plan to meet the needs of~~ 
114.18  ~~children with both a developmental disability and severe~~ 
114.19  ~~emotional disturbance; and~~ 
114.20     ~~(2) study the feasibility of expanding medical assistance~~ 
114.21  ~~coverage to include specialized residential treatment for the~~ 
114.22  ~~children described in this subdivision.~~  
114.23     Sec. 2.  Minnesota Statutes 1996, section 245.493, 
114.24  subdivision 1, is amended to read: 
114.25     Subdivision 1.  [REQUIREMENTS TO QUALIFY AS A LOCAL 
114.26  CHILDREN'S MENTAL HEALTH COLLABORATIVE.] In order to qualify as 
114.27  a local children's mental health collaborative and be eligible 
114.28  to receive start-up funds, the representatives of the local 
114.29  system of care, including entities provided under section 
114.30  245.4875, subdivision 6, and nongovernmental entities such as 
114.31  parents of children in the target population; parent and 
114.32  consumer organizations; community, civic, and religious 
114.33  organizations; private and nonprofit mental and physical health 
114.34  care providers; culturally specific organizations; local 
114.35  foundations; and businesses, or at a minimum one county, one 
114.36  school district or special education cooperative, ~~and~~ one mental 
115.1   health entity, and, by July 1, 1998, one juvenile justice or 
115.2   corrections entity, must agree to the following: 
115.3      (1) to establish a local children's mental health 
115.4   collaborative and develop an integrated service system; and 
115.5      (2) to commit resources to providing services through the 
115.6   local children's mental health collaborative. 
115.7      Sec. 3.  Minnesota Statutes 1996, section 245.493, is 
115.8   amended by adding a subdivision to read: 
115.9      Subd. 1a.  [DUTIES OF CERTAIN COORDINATING BODIES.] By 
115.10  mutual agreement of the collaborative and a coordinating body 
115.11  listed in this subdivision, a children's mental health 
115.12  collaborative or a collaborative established by the merger of a 
115.13  children's mental health collaborative and a family services 
115.14  collaborative under section 121.8355, may assume the duties of a 
115.15  community transition interagency committee established under 
115.16  section 120.17, subdivision 16; an interagency early 
115.17  intervention committee established under 120.1701, subdivision 
115.18  5; a local advisory council established under section 245.4875, 
115.19  subdivision 5; or a local coordinating council established under 
115.20  section 245.4875, subdivision 6. 
115.21     Sec. 4.  Minnesota Statutes 1996, section 256.01, 
115.22  subdivision 2, is amended to read: 
115.23     Subd. 2.  [SPECIFIC POWERS.] Subject to the provisions of 
115.24  section 241.021, subdivision 2, the commissioner of human 
115.25  services shall: 
115.26     (1) Administer and supervise all forms of public assistance 
115.27  provided for by state law and other welfare activities or 
115.28  services as are vested in the commissioner.  Administration and 
115.29  supervision of human services activities or services includes, 
115.30  but is not limited to, assuring timely and accurate distribution 
115.31  of benefits, completeness of service, and quality program 
115.32  management.  In addition to administering and supervising human 
115.33  services activities vested by law in the department, the 
115.34  commissioner shall have the authority to: 
115.35     (a) require county agency participation in training and 
115.36  technical assistance programs to promote compliance with 
116.1   statutes, rules, federal laws, regulations, and policies 
116.2   governing human services; 
116.3      (b) monitor, on an ongoing basis, the performance of county 
116.4   agencies in the operation and administration of human services, 
116.5   enforce compliance with statutes, rules, federal laws, 
116.6   regulations, and policies governing welfare services and promote 
116.7   excellence of administration and program operation; 
116.8      (c) develop a quality control program or other monitoring 
116.9   program to review county performance and accuracy of benefit 
116.10  determinations; 
116.11     (d) require county agencies to make an adjustment to the 
116.12  public assistance benefits issued to any individual consistent 
116.13  with federal law and regulation and state law and rule and to 
116.14  issue or recover benefits as appropriate; 
116.15     (e) delay or deny payment of all or part of the state and 
116.16  federal share of benefits and administrative reimbursement 
116.17  according to the procedures set forth in section 256.017; and 
116.18     (f) make contracts with and grants to public and private 
116.19  agencies and organizations, both profit and nonprofit, and 
116.20  individuals, using appropriated funds. 
116.21     (2) Inform county agencies, on a timely basis, of changes 
116.22  in statute, rule, federal law, regulation, and policy necessary 
116.23  to county agency administration of the programs. 
116.24     (3) Administer and supervise all child welfare activities; 
116.25  promote the enforcement of laws protecting handicapped, 
116.26  dependent, neglected and delinquent children, and children born 
116.27  to mothers who were not married to the children's fathers at the 
116.28  times of the conception nor at the births of the children; 
116.29  license and supervise child-caring and child-placing agencies 
116.30  and institutions; supervise the care of children in boarding and 
116.31  foster homes or in private institutions; and generally perform 
116.32  all functions relating to the field of child welfare now vested 
116.33  in the state board of control. 
116.34     (4) Administer and supervise all noninstitutional service 
116.35  to handicapped persons, including those who are visually 
116.36  impaired, hearing impaired, or physically impaired or otherwise 
117.1   handicapped.  The commissioner may provide and contract for the 
117.2   care and treatment of qualified indigent children in facilities 
117.3   other than those located and available at state hospitals when 
117.4   it is not feasible to provide the service in state hospitals. 
117.5      (5) Assist and actively cooperate with other departments, 
117.6   agencies and institutions, local, state, and federal, by 
117.7   performing services in conformity with the purposes of Laws 
117.8   1939, chapter 431. 
117.9      (6) Act as the agent of and cooperate with the federal 
117.10  government in matters of mutual concern relative to and in 
117.11  conformity with the provisions of Laws 1939, chapter 431, 
117.12  including the administration of any federal funds granted to the 
117.13  state to aid in the performance of any functions of the 
117.14  commissioner as specified in Laws 1939, chapter 431, and 
117.15  including the promulgation of rules making uniformly available 
117.16  medical care benefits to all recipients of public assistance, at 
117.17  such times as the federal government increases its participation 
117.18  in assistance expenditures for medical care to recipients of 
117.19  public assistance, the cost thereof to be borne in the same 
117.20  proportion as are grants of aid to said recipients. 
117.21     (7) Establish and maintain any administrative units 
117.22  reasonably necessary for the performance of administrative 
117.23  functions common to all divisions of the department. 
117.24     (8) Act as designated guardian of both the estate and the 
117.25  person of all the wards of the state of Minnesota, whether by 
117.26  operation of law or by an order of court, without any further 
117.27  act or proceeding whatever, except as to persons committed as 
117.28  mentally retarded.  For children under the guardianship of the 
117.29  commissioner whose interests would be best served by adoptive 
117.30  placement, the commissioner may contract with a licensed 
117.31  child-placing agency to provide adoption services.  A contract 
117.32  with a licensed child-placing agency must be designed to 
117.33  supplement existing county efforts and may not replace existing 
117.34  county programs, unless the replacement is agreed to by the 
117.35  county board and the appropriate exclusive bargaining 
117.36  representative or the commissioner has evidence that child 
118.1   placements of the county continue to be substantially below that 
118.2   of other counties. 
118.3      (9) Act as coordinating referral and informational center 
118.4   on requests for service for newly arrived immigrants coming to 
118.5   Minnesota. 
118.6      (10) The specific enumeration of powers and duties as 
118.7   hereinabove set forth shall in no way be construed to be a 
118.8   limitation upon the general transfer of powers herein contained. 
118.9      (11) Establish county, regional, or statewide schedules of 
118.10  maximum fees and charges which may be paid by county agencies 
118.11  for medical, dental, surgical, hospital, nursing and nursing 
118.12  home care and medicine and medical supplies under all programs 
118.13  of medical care provided by the state and for congregate living 
118.14  care under the income maintenance programs. 
118.15     (12) Have the authority to conduct and administer 
118.16  experimental projects to test methods and procedures of 
118.17  administering assistance and services to recipients or potential 
118.18  recipients of public welfare.  To carry out such experimental 
118.19  projects, it is further provided that the commissioner of human 
118.20  services is authorized to waive the enforcement of existing 
118.21  specific statutory program requirements, rules, and standards in 
118.22  one or more counties.  The order establishing the waiver shall 
118.23  provide alternative methods and procedures of administration, 
118.24  shall not be in conflict with the basic purposes, coverage, or 
118.25  benefits provided by law, and in no event shall the duration of 
118.26  a project exceed four years.  It is further provided that no 
118.27  order establishing an experimental project as authorized by the 
118.28  provisions of this section shall become effective until the 
118.29  following conditions have been met: 
118.30     (a) The proposed comprehensive plan, including estimated 
118.31  project costs and the proposed order establishing the waiver, 
118.32  shall be filed with the secretary of the senate and chief clerk 
118.33  of the house of representatives at least 60 days prior to its 
118.34  effective date. 
118.35     (b) The secretary of health, education, and welfare of the 
118.36  United States has agreed, for the same project, to waive state 
119.1   plan requirements relative to statewide uniformity. 
119.2      (c) A comprehensive plan, including estimated project 
119.3   costs, shall be approved by the legislative advisory commission 
119.4   and filed with the commissioner of administration.  
119.5      (13) In accordance with federal requirements, establish 
119.6   procedures to be followed by local welfare boards in creating 
119.7   citizen advisory committees, including procedures for selection 
119.8   of committee members. 
119.9      (14) Allocate federal fiscal disallowances or sanctions 
119.10  which are based on quality control error rates for the aid to 
119.11  families with dependent children, medical assistance, or food 
119.12  stamp program in the following manner:  
119.13     (a) One-half of the total amount of the disallowance shall 
119.14  be borne by the county boards responsible for administering the 
119.15  programs.  For the medical assistance and AFDC programs, 
119.16  disallowances shall be shared by each county board in the same 
119.17  proportion as that county's expenditures for the sanctioned 
119.18  program are to the total of all counties' expenditures for the 
119.19  AFDC and medical assistance programs.  For the food stamp 
119.20  program, sanctions shall be shared by each county board, with 50 
119.21  percent of the sanction being distributed to each county in the 
119.22  same proportion as that county's administrative costs for food 
119.23  stamps are to the total of all food stamp administrative costs 
119.24  for all counties, and 50 percent of the sanctions being 
119.25  distributed to each county in the same proportion as that 
119.26  county's value of food stamp benefits issued are to the total of 
119.27  all benefits issued for all counties.  Each county shall pay its 
119.28  share of the disallowance to the state of Minnesota.  When a 
119.29  county fails to pay the amount due hereunder, the commissioner 
119.30  may deduct the amount from reimbursement otherwise due the 
119.31  county, or the attorney general, upon the request of the 
119.32  commissioner, may institute civil action to recover the amount 
119.33  due. 
119.34     (b) Notwithstanding the provisions of paragraph (a), if the 
119.35  disallowance results from knowing noncompliance by one or more 
119.36  counties with a specific program instruction, and that knowing 
120.1   noncompliance is a matter of official county board record, the 
120.2   commissioner may require payment or recover from the county or 
120.3   counties, in the manner prescribed in paragraph (a), an amount 
120.4   equal to the portion of the total disallowance which resulted 
120.5   from the noncompliance, and may distribute the balance of the 
120.6   disallowance according to paragraph (a).  
120.7      (15) Develop and implement special projects that maximize 
120.8   reimbursements and result in the recovery of money to the 
120.9   state.  For the purpose of recovering state money, the 
120.10  commissioner may enter into contracts with third parties.  Any 
120.11  recoveries that result from projects or contracts entered into 
120.12  under this paragraph shall be deposited in the state treasury 
120.13  and credited to a special account until the balance in the 
120.14  account reaches $1,000,000.  When the balance in the account 
120.15  exceeds $1,000,000, the excess shall be transferred and credited 
120.16  to the general fund.  All money in the account is appropriated 
120.17  to the commissioner for the purposes of this paragraph. 
120.18     (16) Have the authority to make direct payments to 
120.19  facilities providing shelter to women and their children 
120.20  pursuant to section 256D.05, subdivision 3.  Upon the written 
120.21  request of a shelter facility that has been denied payments 
120.22  under section 256D.05, subdivision 3, the commissioner shall 
120.23  review all relevant evidence and make a determination within 30 
120.24  days of the request for review regarding issuance of direct 
120.25  payments to the shelter facility.  Failure to act within 30 days 
120.26  shall be considered a determination not to issue direct payments.
120.27     (17) Have the authority to establish and enforce the 
120.28  following county reporting requirements:  
120.29     (a) The commissioner shall establish fiscal and statistical 
120.30  reporting requirements necessary to account for the expenditure 
120.31  of funds allocated to counties for human services programs.  
120.32  When establishing financial and statistical reporting 
120.33  requirements, the commissioner shall evaluate all reports, in 
120.34  consultation with the counties, to determine if the reports can 
120.35  be simplified or the number of reports can be reduced. 
120.36     (b) The county board shall submit monthly or quarterly 
121.1   reports to the department as required by the commissioner.  
121.2   Monthly reports are due no later than 15 working days after the 
121.3   end of the month.  Quarterly reports are due no later than 30 
121.4   calendar days after the end of the quarter, unless the 
121.5   commissioner determines that the deadline must be shortened to 
121.6   20 calendar days to avoid jeopardizing compliance with federal 
121.7   deadlines or risking a loss of federal funding.  Only reports 
121.8   that are complete, legible, and in the required format shall be 
121.9   accepted by the commissioner.  
121.10     (c) If the required reports are not received by the 
121.11  deadlines established in clause (b), the commissioner may delay 
121.12  payments and withhold funds from the county board until the next 
121.13  reporting period.  When the report is needed to account for the 
121.14  use of federal funds and the late report results in a reduction 
121.15  in federal funding, the commissioner shall withhold from the 
121.16  county boards with late reports an amount equal to the reduction 
121.17  in federal funding until full federal funding is received.  
121.18     (d) A county board that submits reports that are late, 
121.19  illegible, incomplete, or not in the required format for two out 
121.20  of three consecutive reporting periods is considered 
121.21  noncompliant.  When a county board is found to be noncompliant, 
121.22  the commissioner shall notify the county board of the reason the 
121.23  county board is considered noncompliant and request that the 
121.24  county board develop a corrective action plan stating how the 
121.25  county board plans to correct the problem.  The corrective 
121.26  action plan must be submitted to the commissioner within 45 days 
121.27  after the date the county board received notice of noncompliance.
121.28     (e) The final deadline for fiscal reports or amendments to 
121.29  fiscal reports is one year after the date the report was 
121.30  originally due.  If the commissioner does not receive a report 
121.31  by the final deadline, the county board forfeits the funding 
121.32  associated with the report for that reporting period and the 
121.33  county board must repay any funds associated with the report 
121.34  received for that reporting period. 
121.35     (f) The commissioner may not delay payments, withhold 
121.36  funds, or require repayment under paragraph (c) or (e) if the 
122.1   county demonstrates that the commissioner failed to provide 
122.2   appropriate forms, guidelines, and technical assistance to 
122.3   enable the county to comply with the requirements.  If the 
122.4   county board disagrees with an action taken by the commissioner 
122.5   under paragraph (c) or (e), the county board may appeal the 
122.6   action according to sections 14.57 to 14.69. 
122.7      (g) Counties subject to withholding of funds under 
122.8   paragraph (c) or forfeiture or repayment of funds under 
122.9   paragraph (e) shall not reduce or withhold benefits or services 
122.10  to clients to cover costs incurred due to actions taken by the 
122.11  commissioner under paragraph (c) or (e). 
122.12     (18) Allocate federal fiscal disallowances or sanctions for 
122.13  audit exceptions when federal fiscal disallowances or sanctions 
122.14  are based on a statewide random sample for the foster care 
122.15  program under title IV-E of the Social Security Act, United 
122.16  States Code, title 42, in direct proportion to each county's 
122.17  title IV-E foster care maintenance claim for that period. 
122.18     Sec. 5.  Minnesota Statutes 1996, section 256.01, is 
122.19  amended by adding a subdivision to read: 
122.20     Subd. 14.  [CHILD WELFARE REFORM PILOTS.] The commissioner 
122.21  of human services shall encourage local reforms in the delivery 
122.22  of child welfare services and is authorized to approve local 
122.23  pilot programs which focus on reforming the child protection and 
122.24  child welfare systems in Minnesota.  Authority to approve pilots 
122.25  includes authority to waive existing state rules as needed to 
122.26  accomplish reform efforts.  Notwithstanding section 626.556, 
122.27  subdivision 10, 10b, or 10d, the commissioner may authorize 
122.28  programs to use alternative methods of investigating and 
122.29  assessing reports of child maltreatment, provided that the 
122.30  programs comply with the provisions of section 626.556 dealing 
122.31  with the rights of individuals who are subjects of reports or 
122.32  investigations, including notice and appeal rights and data 
122.33  practices requirements.  Pilot programs must be required to 
122.34  address responsibility for safety and protection of children, be 
122.35  time limited, and include evaluation of the pilot program. 
122.36     Sec. 6.  Minnesota Statutes 1996, section 256.045, 
123.1   subdivision 3, is amended to read: 
123.2      Subd. 3.  [STATE AGENCY HEARINGS.] (a) State agency 
123.3   hearings are available for the following:  (1) any person 
123.4   applying for, receiving or having received public assistance or 
123.5   a program of social services granted by the state agency or a 
123.6   county agency under sections 252.32, 256.031 to 256.036, and 
123.7   256.72 to 256.879, chapters 256B, 256D, 256E, 261, or the 
123.8   federal Food Stamp Act whose application for assistance is 
123.9   denied, not acted upon with reasonable promptness, or whose 
123.10  assistance is suspended, reduced, terminated, or claimed to have 
123.11  been incorrectly paid; (2) any patient or relative aggrieved by 
123.12  an order of the commissioner under section 252.27; (3) a party 
123.13  aggrieved by a ruling of a prepaid health plan; (4) any 
123.14  individual or facility determined by a lead agency to have 
123.15  maltreated a vulnerable adult under section 626.557 after they 
123.16  have exercised their right to administrative reconsideration 
123.17  under section 626.557; (5) any person whose claim for foster 
123.18  care payment pursuant to a placement of the child resulting from 
123.19  a child protection assessment under section 626.556 is denied or 
123.20  not acted upon with reasonable promptness, regardless of funding 
123.21  source; (6) any person to whom a right of appeal pursuant to 
123.22  this section is given by other provision of law; ~~or~~ (7) an 
123.23  applicant aggrieved by an adverse decision to an application for 
123.24  a hardship waiver under section 256B.15; or (8) an individual or 
123.25  facility determined to have maltreated a minor under section 
123.26  626.556 after they have exercised their right to administrative 
123.27  reconsideration under section 626.556.  The failure to exercise 
123.28  the right to an administrative reconsideration shall not be a 
123.29  bar to a hearing under this section if federal law provides an 
123.30  individual the right to a hearing to dispute a finding of 
123.31  maltreatment.  Individuals and organizations specified in this 
123.32  section may contest the specified action, decision, or final 
123.33  disposition before the state agency by submitting a written 
123.34  request for a hearing to the state agency within 30 days after 
123.35  receiving written notice of the action, decision, or final 
123.36  disposition, or within 90 days of such written notice if the 
124.1   applicant, recipient, patient, or relative shows good cause why 
124.2   the request was not submitted within the 30-day time limit. 
124.3      The hearing for an individual or facility under clause (4) 
124.4   or (8) is the only administrative appeal to the final ~~lead~~ 
124.5   agency ~~disposition~~ determination specifically, including a 
124.6   challenge to the accuracy and completeness of data under section 
124.7   13.04.  Hearings requested under clause (4) apply only to 
124.8   incidents of maltreatment that occur on or after October 1, 
124.9   1995.  Hearings requested by nursing assistants in nursing homes 
124.10  alleged to have maltreated a resident prior to October 1, 1995, 
124.11  shall be held as a contested case proceeding under the 
124.12  provisions of chapter 14.  Hearings requested under clause (8) 
124.13  apply only to incidents of maltreatment that occur on or after 
124.14  July 1, 1997.  A hearing for an individual or facility under 
124.15  clause (8) is only available when there is no juvenile court or 
124.16  adult criminal action pending.  If such action is filed in 
124.17  either court while an administrative review is pending, the 
124.18  administrative review must be suspended until the judicial 
124.19  actions are completed.  If the juvenile court action or criminal 
124.20  charge is dismissed or the criminal action overturned, the 
124.21  matter may be considered in an administrative hearing. 
124.22     For purposes of this section, bargaining unit grievance 
124.23  procedures are not an administrative appeal. 
124.24     The scope of hearings involving claims to foster care 
124.25  payments under clause (5) shall be limited to the issue of 
124.26  whether the county is legally responsible for a child's 
124.27  placement under court order or voluntary placement agreement 
124.28  and, if so, the correct amount of foster care payment to be made 
124.29  on the child's behalf and shall not include review of the 
124.30  propriety of the county's child protection determination or 
124.31  child placement decision. 
124.32     (b) ~~Except for a prepaid health plan,~~ A vendor of medical 
124.33  care as defined in section 256B.02, subdivision 7, or a vendor 
124.34  under contract with a county agency to provide social services 
124.35  under section 256E.08, subdivision 4, is not a party and may not 
124.36  request a hearing under this section, except if assisting a 
125.1   recipient as provided in subdivision 4. 
125.2      (c) An applicant or recipient is not entitled to receive 
125.3   social services beyond the services included in the amended 
125.4   community social services plan developed under section 256E.081, 
125.5   subdivision 3, if the county agency has met the requirements in 
125.6   section 256E.081. 
125.7      Sec. 7.  Minnesota Statutes 1996, section 256.045, 
125.8   subdivision 3b, is amended to read: 
125.9      Subd. 3b.  [STANDARD OF EVIDENCE FOR MALTREATMENT 
125.10  HEARINGS.] The state human services referee shall determine that 
125.11  maltreatment has occurred if a preponderance of evidence exists 
125.12  to support the final disposition under ~~section~~ sections 626.556 
125.13  and 626.557. 
125.14     The state human services referee shall recommend an order 
125.15  to the commissioner of health or human services, as applicable, 
125.16  who shall issue a final order.  The commissioner shall affirm, 
125.17  reverse, or modify the final disposition.  Any order of the 
125.18  commissioner issued in accordance with this subdivision is 
125.19  conclusive upon the parties unless appeal is taken in the manner 
125.20  provided in subdivision 7.  In any licensing appeal under 
125.21  chapter 245A and sections 144.50 to 144.58 and 144A.02 to 
125.22  144A.46, the commissioner's ~~findings~~ determination as to ~~whether~~ 
125.23  maltreatment ~~occurred~~ is conclusive. 
125.24     Sec. 8.  Minnesota Statutes 1996, section 256.045, 
125.25  subdivision 4, is amended to read: 
125.26     Subd. 4.  [CONDUCT OF HEARINGS.] (a) All hearings held 
125.27  pursuant to subdivision 3, 3a, 3b, or 4a shall be conducted 
125.28  according to the provisions of the federal Social Security Act 
125.29  and the regulations implemented in accordance with that act to 
125.30  enable this state to qualify for federal grants-in-aid, and 
125.31  according to the rules and written policies of the commissioner 
125.32  of human services.  County agencies shall install equipment 
125.33  necessary to conduct telephone hearings.  A state human services 
125.34  referee may schedule a telephone conference hearing when the 
125.35  distance or time required to travel to the county agency offices 
125.36  will cause a delay in the issuance of an order, or to promote 
126.1   efficiency, or at the mutual request of the parties.  Hearings 
126.2   may be conducted by telephone conferences unless the applicant, 
126.3   recipient, former recipient, person, or facility contesting 
126.4   maltreatment objects.  The hearing shall not be held earlier 
126.5   than five days after filing of the required notice with the 
126.6   county or state agency.  The state human services referee shall 
126.7   notify all interested persons of the time, date, and location of 
126.8   the hearing at least five days before the date of the hearing.  
126.9   Interested persons may be represented by legal counsel or other 
126.10  representative of their choice, including a provider of therapy 
126.11  services, at the hearing and may appear personally, testify and 
126.12  offer evidence, and examine and cross-examine witnesses.  The 
126.13  applicant, recipient, former recipient, person, or facility 
126.14  contesting maltreatment shall have the opportunity to examine 
126.15  the contents of the case file and all documents and records to 
126.16  be used by the county or state agency at the hearing at a 
126.17  reasonable time before the date of the hearing and during the 
126.18  hearing.  ~~In cases alleging discharge for maltreatment,~~ In 
126.19  hearings under subdivision 3, paragraph (a), clause (4) or (8), 
126.20  either party may subpoena the private data relating to the 
126.21  investigation ~~memorandum~~ prepared by the ~~lead~~ agency under 
126.22  section 626.556 or 626.557 that is not otherwise accessible 
126.23  under section 13.04, provided the ~~name~~ identity of the reporter 
126.24  may not be disclosed. 
126.25     (b) The private data obtained according to a subpoena in a 
126.26  hearing under subdivision 3, paragraph (a), clause (4) or (8), 
126.27  must be subject to a protective order which prohibits its 
126.28  disclosure for any other purpose outside the hearing provided 
126.29  for in this section without prior order of the district court.  
126.30  Disclosure without court order is punishable by a sentence of 
126.31  not more than 90 days imprisonment or a fine of not more than 
126.32  $700, or both.  These restrictions on the use of private data do 
126.33  not prohibit access to the data under section 13.03, subdivision 
126.34  6.  Except for appeals under subdivision 3, paragraph (a), 
126.35  clauses (4), (5), and (8), upon request, the county agency shall 
126.36  provide reimbursement for transportation, child care, 
127.1   photocopying, medical assessment, witness fee, and other 
127.2   necessary and reasonable costs incurred by the applicant, 
127.3   recipient, or former recipient in connection with the appeal~~,~~ 
127.4   ~~except in appeals brought under subdivision 3b~~.  All evidence, 
127.5   except that privileged by law, commonly accepted by reasonable 
127.6   people in the conduct of their affairs as having probative value 
127.7   with respect to the issues shall be submitted at the hearing and 
127.8   such hearing shall not be "a contested case" within the meaning 
127.9   of section 14.02, subdivision 3.  The agency must present its 
127.10  evidence prior to or at the hearing, and may not submit evidence 
127.11  after the hearing except by agreement of the parties at the 
127.12  hearing, provided the ~~recipient~~ petitioner has the opportunity 
127.13  to respond. 
127.14     Sec. 9.  Minnesota Statutes 1996, section 256.045, 
127.15  subdivision 5, is amended to read: 
127.16     Subd. 5.  [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] 
127.17  ~~This subdivision does not apply to appeals under subdivision~~ 
127.18  ~~3b.~~  A state human services referee shall conduct a hearing on 
127.19  the appeal and shall recommend an order to the commissioner of 
127.20  human services.  The recommended order must be based on all 
127.21  relevant evidence and must not be limited to a review of the 
127.22  propriety of the state or county agency's action.  A referee may 
127.23  take official notice of adjudicative facts.  The commissioner of 
127.24  human services may accept the recommended order of a state human 
127.25  services referee and issue the order to the county agency and 
127.26  the applicant, recipient, former recipient, or prepaid health 
127.27  plan.  The commissioner on refusing to accept the recommended 
127.28  order of the state human services referee, shall notify the 
127.29  ~~county~~ petitioner, the agency ~~and the applicant, recipient,~~ 
127.30  ~~former recipient~~, or prepaid health plan of that fact and shall 
127.31  state reasons therefor and shall allow each party ten days' time 
127.32  to submit additional written argument on the matter.  After the 
127.33  expiration of the ten-day period, the commissioner shall issue 
127.34  an order on the matter to the ~~county~~ petitioner, the agency ~~and~~ 
127.35  ~~the applicant, recipient, former recipient~~, or prepaid health 
127.36  plan. 
128.1      A party aggrieved by an order of the commissioner may 
128.2   appeal under subdivision 7, or request reconsideration by the 
128.3   commissioner within 30 days after the date the commissioner 
128.4   issues the order.  The commissioner may reconsider an order upon 
128.5   request of any party or on the commissioner's own motion.  A 
128.6   request for reconsideration does not stay implementation of the 
128.7   commissioner's order.  Upon reconsideration, the commissioner 
128.8   may issue an amended order or an order affirming the original 
128.9   order. 
128.10     Any order of the commissioner issued under this subdivision 
128.11  shall be conclusive upon the parties unless appeal is taken in 
128.12  the manner provided by subdivision 7.  Any order of the 
128.13  commissioner is binding on the parties and must be implemented 
128.14  by the state agency ~~or~~, a county agency, or a prepaid health 
128.15  plan according to subdivision 3a, until the order is reversed by 
128.16  the district court, or unless the commissioner or a district 
128.17  court orders monthly assistance or aid or services paid or 
128.18  provided under subdivision 10. 
128.19     ~~Except for a prepaid health plan,~~ A vendor of medical care 
128.20  as defined in section 256B.02, subdivision 7, or a vendor under 
128.21  contract with a county agency to provide social services under 
128.22  section 256E.08, subdivision 4, is not a party and may not 
128.23  request a hearing or seek judicial review of an order issued 
128.24  under this section, unless assisting a recipient as provided in 
128.25  subdivision 4.  A prepaid health plan is a party to an appeal 
128.26  under subdivision 3a, but cannot seek judicial review of an 
128.27  order issued under this section. 
128.28     Sec. 10.  Minnesota Statutes 1996, section 256.045, 
128.29  subdivision 8, is amended to read: 
128.30     Subd. 8.  [HEARING.] Any party may obtain a hearing at a 
128.31  special term of the district court by serving a written notice 
128.32  of the time and place of the hearing at least ten days prior to 
128.33  the date of the hearing.  ~~Except for appeals under subdivision~~ 
128.34  ~~3b,~~ The court may consider the matter in or out of chambers, and 
128.35  shall take no new or additional evidence unless it determines 
128.36  that such evidence is necessary for a more equitable disposition 
129.1   of the appeal. 
129.2      Sec. 11.  Minnesota Statutes 1996, section 256.82, is 
129.3   amended by adding a subdivision to read: 
129.4      Subd. 5.  [DIFFICULTY OF CARE ASSESSMENT PILOT 
129.5   PROJECT.] Notwithstanding any law to the contrary, the 
129.6   commissioner of human services shall conduct a two-year 
129.7   statewide pilot project beginning July 1, 1997, to conduct a 
129.8   difficulty of care assessment process which both assesses an 
129.9   individual child's current functioning and identifies needs in a 
129.10  variety of life situations.  The pilot project must take into 
129.11  consideration existing difficulty of care payments so that, to 
129.12  the extent possible, no child for whom a difficulty of care rate 
129.13  is currently established will be adversely affected.  The pilot 
129.14  project must include an evaluation and an interim report to the 
129.15  legislature by January 15, 1999. 
129.16     Sec. 12.  Minnesota Statutes 1996, section 256F.11, 
129.17  subdivision 2, is amended to read: 
129.18     Subd. 2.  [FUND DISTRIBUTION.] In distributing funds, the 
129.19  commissioner shall give priority consideration to agencies and 
129.20  organizations with experience in working with abused or 
129.21  neglected children and their families, and with children at high 
129.22  risk of abuse and neglect and their families, and serve 
129.23  communities which demonstrate the greatest need for these 
129.24  services.  Funds shall be distributed to crisis nurseries 
129.25  according to a formula mutually agreed upon by the commissioner 
129.26  and the Minnesota crisis nursery association.  This formula 
129.27  shall include funding for all existing crisis nursery programs 
129.28  that meet program requirements as specified in paragraph (a), 
129.29  and consideration of factors reflecting the need for services in 
129.30  each service area, including, but not limited to, the number of 
129.31  children 18 years of age and under living in the service area, 
129.32  the percent of children 18 years of age and under living in 
129.33  poverty in the service area, and factors reflecting the cost of 
129.34  providing services, including, but not limited to, the number of 
129.35  days of service provided in the previous year.  At least 25 
129.36  percent of available funds for state fiscal year 1998 shall be 
130.1   set aside to accomplish any of the following:  establish new 
130.2   crisis nursery programs; increase statewide availability of 
130.3   crisis nursery services; and enhance or expand services at 
130.4   existing crisis nursery programs. 
130.5      (a) The crisis nurseries must:  
130.6      (1) be available 24 hours a day, seven days a week; 
130.7      (2) provide services for children up to three days at any 
130.8   one time; 
130.9      (3) make referrals for parents to counseling services and 
130.10  other community resources to help alleviate the underlying cause 
130.11  of the precipitating stress or crisis; 
130.12     (4) provide services without a fee for a maximum of 30 days 
130.13  in any year; 
130.14     (5) provide services to children from birth to 12 years of 
130.15  age; 
130.16     (6) provide an initial assessment and intake interview 
130.17  conducted by a skilled professional who will identify the 
130.18  presenting problem and make an immediate referral to an 
130.19  appropriate agency or program to prevent maltreatment and 
130.20  out-of-home placement of children; 
130.21     (7) maintain the clients' confidentiality to the extent 
130.22  required by law, and also comply with statutory reporting 
130.23  requirements which may mandate a report to child protective 
130.24  services; 
130.25     (8) contain a volunteer component; 
130.26     (9) provide preservice training and ongoing training to 
130.27  providers and volunteers; 
130.28     (10) evaluate the services provided by documenting use of 
130.29  services, the result of family referrals made to community 
130.30  resources, and how the services reduced the risk of 
130.31  maltreatment; 
130.32     (11) provide age appropriate programming; 
130.33     (12) provide developmental assessments; 
130.34     (13) provide medical assessments as determined by using a 
130.35  risk screening tool; 
130.36     (14) meet United States Department of Agriculture 
131.1   regulations concerning meals and provide three meals a day and 
131.2   three snacks during a 24-hour period; and 
131.3      (15) provide appropriate sleep and nap arrangements for 
131.4   children.  
131.5      (b) The crisis nurseries are encouraged to provide:  
131.6      (1) on-site support groups for facility model programs, or 
131.7   agency sponsored parent support groups for volunteer family 
131.8   model programs; 
131.9      (2) parent education classes or programs that include 
131.10  parent-child interaction; and 
131.11     (3) opportunities for parents to volunteer, if appropriate, 
131.12  to assist with child care in a supervised setting in order to 
131.13  enhance their parenting skills and self-esteem, in addition to 
131.14  providing them the opportunity to give something back to the 
131.15  program.  
131.16     (c) Parents shall retain custody of their children during 
131.17  placement in a crisis facility.  
131.18     The crisis nurseries are encouraged to include one or more 
131.19  parents who have used the crisis nursery services on the 
131.20  program's multidisciplinary advisory board. 
131.21     Sec. 13.  [257.85] [RELATIVE CUSTODY ASSISTANCE.] 
131.22     Subdivision 1.  [CITATION.] This section may be cited as 
131.23  the "Relative Custody Assistance Act." 
131.24     Subd. 2.  [SCOPE.] The provisions of this section apply to 
131.25  those situations in which the legal and physical custody of a 
131.26  child is established with a relative according to section 
131.27  260.191, subdivision 3b, by a court order issued on or after 
131.28  July 1, 1997.  
131.29     Subd. 3.  [DEFINITIONS.] For purposes of this section, the 
131.30  terms defined in this subdivision shall have the meanings given 
131.31  them. 
131.32     (a) "AFDC or MFIP standard" means the monthly standard of 
131.33  need used to calculate assistance under the AFDC program, the 
131.34  transitional standard used to calculate assistance under the 
131.35  MFIP-S program, or, if neither of those is applicable, the 
131.36  analogous standard used to calculate assistance under the MFIP 
132.1   or MFIP-R programs. 
132.2      (b) "Local agency" means the local social service agency 
132.3   with legal custody of a child prior to the transfer of permanent 
132.4   legal and physical custody to a relative. 
132.5      (c) "Permanent legal and physical custody" means permanent 
132.6   legal and physical custody ordered by a Minnesota juvenile court 
132.7   under section 260.191, subdivision 3b. 
132.8      (d) "Relative" means an individual, other than a parent, 
132.9   who is related to a child by blood, marriage, or adoption. 
132.10     (e) "Relative custodian" means a relative of a child for 
132.11  whom the relative has permanent legal and physical custody. 
132.12     (f) "Relative custody assistance agreement" means an 
132.13  agreement entered into between a local agency and the relative 
132.14  of a child who has been or will be awarded permanent legal and 
132.15  physical custody of the child. 
132.16     (g) "Relative custody assistance payment" means a monthly 
132.17  cash grant made to a relative custodian pursuant to a relative 
132.18  custody assistance agreement and in an amount calculated under 
132.19  subdivision 8. 
132.20     (h) "Remains in the physical custody of the relative 
132.21  custodian" means that the relative custodian is providing 
132.22  day-to-day care for the child and that the child lives with the 
132.23  relative custodian; absence from the relative custodian's home 
132.24  for a period of more than 120 days raises a presumption that the 
132.25  child no longer remains in the physical custody of the relative 
132.26  custodian. 
132.27     Subd. 4.  [DUTIES OF LOCAL AGENCY.] When a local agency 
132.28  seeks a court order under section 260.191, subdivision 3b, to 
132.29  establish permanent legal and physical custody of a child with a 
132.30  relative, or if such an order is issued by the court, the local 
132.31  agency shall perform the duties specified in this subdivision. 
132.32     (a) As soon as possible after the local agency determines 
132.33  that it will seek to establish permanent legal and physical 
132.34  custody of the child with a relative or, if the agency did not 
132.35  seek to establish custody, as soon as possible after the 
132.36  issuance of the court order establishing custody, the local 
133.1   agency shall inform the relative about the relative custody 
133.2   assistance program, including eligibility criteria and payment 
133.3   levels.  Anytime prior to, but not later than seven days after, 
133.4   the date the court issues the order establishing permanent legal 
133.5   and physical custody of the child with a relative, the local 
133.6   agency shall determine whether the eligibility criteria in 
133.7   subdivision 7 are met to allow the relative to receive relative 
133.8   custody assistance.  Not later than seven days after determining 
133.9   whether the eligibility criteria are met, the local agency shall 
133.10  inform the relative custodian of its determination and of the 
133.11  process for appealing that determination under subdivision 10. 
133.12     (b) If the local agency determines that the relative 
133.13  custodian is eligible to receive relative custody assistance, 
133.14  the local agency shall prepare the relative custody assistance 
133.15  agreement and assure that it meets the requirements of 
133.16  subdivision 5. 
133.17     (c) The local agency shall make monthly payments to the 
133.18  relative as specified in the relative custody assistance 
133.19  agreement.  On a quarterly basis and on a form to be provided by 
133.20  the commissioner, the local agency shall make claims for 
133.21  reimbursement from the commissioner for relative custody 
133.22  assistance payments made. 
133.23     (d) For a relative custody assistance agreement that is in 
133.24  place for longer than one year, and as long as the agreement 
133.25  remains in effect, the local agency shall send an annual 
133.26  affidavit form to the relative custodian of the eligible child 
133.27  within the month before the anniversary date of the agreement.  
133.28  The local agency shall monitor whether the annual affidavit is 
133.29  returned by the relative custodian within 30 days following the 
133.30  anniversary date of the agreement.  The local agency shall 
133.31  review the affidavit and any other information in its possession 
133.32  to assure continuing eligibility for relative custody assistance 
133.33  and that the amount of payment made pursuant to the agreement is 
133.34  correct. 
133.35     (e) When the local agency determines that a relative 
133.36  custody assistance agreement should be terminated or modified, 
134.1   it shall provide notice of the proposed termination or 
134.2   modification to the relative custodian at least ten days before 
134.3   the proposed action along with information about the process for 
134.4   appealing the proposed action. 
134.5      Subd. 5.  [RELATIVE CUSTODY ASSISTANCE AGREEMENT.] (a) A 
134.6   relative custody assistance agreement will not be effective, 
134.7   unless it is signed by the local agency and the relative 
134.8   custodian no later than 30 days after the date of the order 
134.9   establishing permanent legal and physical custody with the 
134.10  relative, except that a local agency may enter into a relative 
134.11  custody assistance agreement with a relative custodian more than 
134.12  30 days after the date of the order if it certifies that the 
134.13  delay in entering the agreement was through no fault of the 
134.14  relative custodian.  There must be a separate agreement for each 
134.15  child for whom the relative custodian is receiving relative 
134.16  custody assistance. 
134.17     (b) Regardless of when the relative custody assistance 
134.18  agreement is signed by the local agency and relative custodian, 
134.19  the effective date of the agreement shall be the first day of 
134.20  the month following the date of the order establishing permanent 
134.21  legal and physical custody or the date that the last party signs 
134.22  the agreement, whichever occurs later. 
134.23     (c) If MFIP-S is not the applicable program for a child at 
134.24  the time that a relative custody assistance agreement is entered 
134.25  on behalf of the child, at such time as MFIP-S becomes the 
134.26  applicable program, if the relative custodian had been receiving 
134.27  custody assistance payments calculated based upon a different 
134.28  program, the amount of relative custody assistance payment under 
134.29  subdivision 8 shall be recalculated under the MFIP-S program. 
134.30     (d) The relative custody assistance agreement shall be in a 
134.31  form specified by the commissioner and shall include provisions 
134.32  relating to the following: 
134.33     (1) the responsibilities of all parties to the agreement; 
134.34     (2) the payment terms, including the financial 
134.35  circumstances of the relative custodian, the needs of the child, 
134.36  the amount and calculation of the relative custody assistance 
135.1   payments and that the amount of the payments shall be 
135.2   reevaluated annually; 
135.3      (3) the effective date of the agreement, which shall also 
135.4   be the anniversary date for the purpose of submitting the annual 
135.5   affidavit under subdivision 8; 
135.6      (4) that failure to submit the affidavit as required by 
135.7   subdivision 8 will be grounds for terminating the agreement; 
135.8      (5) the agreement's expected duration, which shall in no 
135.9   case extend beyond the child's 18th birthday; 
135.10     (6) any specific known circumstances that could cause the 
135.11  agreement or payments to be modified, reduced, or terminated and 
135.12  the relative custodian's appeal rights under subdivision 9; 
135.13     (7) that the relative custodian must notify the local 
135.14  agency within 30 days of any of the following: 
135.15     (i) a change in the child's status; 
135.16     (ii) a change in the relationship between the relative 
135.17  custodian and the child; 
135.18     (iii) a change in composition or level of income of the 
135.19  relative custodian's family; 
135.20     (iv) a change in eligibility or receipt of benefits under 
135.21  AFDC, MFIP-S, or other assistance program; and 
135.22     (v) any other change that could effect eligibility for or 
135.23  amount of relative custody assistance; 
135.24     (8) that failure to provide notice of a change as required 
135.25  by clause (7) will be grounds for terminating the agreement; 
135.26     (9) that the amount of relative custody assistance is 
135.27  subject to the availability of state funds to reimburse the 
135.28  local agency making the payments; 
135.29     (10) that the relative custodian may choose to temporarily 
135.30  stop receiving payments under the agreement at any time by 
135.31  providing 30 days notice to the local agency and may choose to 
135.32  begin receiving payments again by providing the same notice, but 
135.33  that any payments the relative custodian chooses not to receive 
135.34  are forfeit; and 
135.35     (11) that the local agency will continue to be responsible 
135.36  for making relative custody assistance payments under the 
136.1   agreement regardless of the relative custodian's place of 
136.2   residence. 
136.3      Subd. 6.  [ELIGIBILITY CRITERIA.] A local agency shall 
136.4   enter into a relative custody assistance agreement under 
136.5   subdivision 5 if it certifies that the following criteria are 
136.6   met: 
136.7      (1) the juvenile court has determined or is expected to 
136.8   determine that the child, under the former or current custody of 
136.9   the local agency, cannot return to the home of the child's 
136.10  parents; 
136.11     (2) the court, upon determining that it is in the child's 
136.12  best interests, has issued or is expected to issue an order 
136.13  transferring permanent legal and physical custody of the child 
136.14  to the relative; and 
136.15     (3) the child either: 
136.16     (i) is a member of a sibling group to be placed together; 
136.17  or 
136.18     (ii) has a physical, mental, emotional, or behavioral 
136.19  disability that will require financial support. 
136.20     When the local agency bases its certification that the 
136.21  criteria in clause (1) or (2) are met upon the expectation that 
136.22  the juvenile court will take a certain action, the relative 
136.23  custody assistance agreement does not become effective until and 
136.24  unless the court acts as expected. 
136.25     Subd. 7.  [AMOUNT OF RELATIVE CUSTODY ASSISTANCE 
136.26  PAYMENTS.] (a) The amount of a monthly relative custody 
136.27  assistance payment shall be determined according to the 
136.28  provisions of this paragraph. 
136.29     (1) The total maximum assistance rate is equal to the base 
136.30  assistance rate plus, if applicable, the supplemental assistance 
136.31  rate. 
136.32     (i)  The base assistance rate is equal to the maximum 
136.33  amount that could be received as basic maintenance for a child 
136.34  of the same age under the adoption assistance program. 
136.35     (ii) The local agency shall determine whether the child has 
136.36  physical, mental, emotional, or behavioral disabilities that 
137.1   require care, supervision, or structure beyond that ordinarily 
137.2   provided in a family setting to children of the same age such 
137.3   that the child would be eligible for supplemental maintenance 
137.4   payments under the adoption assistance program if an adoption 
137.5   assistance agreement were entered on the child's behalf.  If the 
137.6   local agency determines that the child has such a disability, 
137.7   the supplemental assistance rate shall be the maximum amount of 
137.8   monthly supplemental maintenance payment that could be received 
137.9   on behalf of a child of the same age, disabilities, and 
137.10  circumstances under the adoption assistance program. 
137.11     (2) The net maximum assistance rate is equal to the total 
137.12  maximum assistance rate from clause (1) less the following 
137.13  offsets: 
137.14     (i) if the child is or will be part of an assistance unit 
137.15  receiving an AFDC, MFIP-S, or other MFIP grant, the portion of 
137.16  the AFDC or MFIP standard relating to the child; 
137.17     (ii) Supplemental Security Income payments received by or 
137.18  on behalf of the child; 
137.19     (iii) veteran's benefits received by or on behalf of the 
137.20  child; and 
137.21     (iv) any other income of the child. 
137.22     (3) The relative custody assistance payment to be made to 
137.23  the relative custodian shall be a percentage of the net maximum 
137.24  assistance rate calculated in clause (2) based upon the gross 
137.25  income of the relative custodian's family, including the child 
137.26  for whom the relative has permanent legal and physical custody.  
137.27  In no case shall the amount of the relative custody assistance 
137.28  payment exceed that which the child could qualify for under the 
137.29  adoption assistance program if an adoption assistance agreement 
137.30  were entered on the child's behalf.  The relative custody 
137.31  assistance payment shall be calculated as follows: 
137.32     (i) if the relative custodian's gross family income is less 
137.33  than or equal to 200 percent of federal poverty guidelines, the 
137.34  relative custody assistance payment shall be the full amount of 
137.35  the net maximum assistance rate; 
137.36     (ii) if the relative custodian's gross family income is 
138.1   greater than 200 percent and less than or equal to 225 percent 
138.2   of federal poverty guidelines, the relative custody assistance 
138.3   payment shall be 80 percent of the next maximum assistance rate; 
138.4      (iii) if the relative custodian's gross family income is 
138.5   greater than 225 percent and less than or equal to 250 percent 
138.6   of federal poverty guidelines, the relative custody assistance 
138.7   payment shall be 60 percent of the next maximum assistance rate; 
138.8      (iv) if the relative custodian's gross family income is 
138.9   greater than 250 percent and less than or equal to 275 percent 
138.10  of federal poverty guidelines, the relative custody assistance 
138.11  payment shall be 40 percent of the net maximum assistance rate; 
138.12     (v) if the relative custodian's gross family income is 
138.13  greater than 275 percent and less than or equal to 300 percent 
138.14  of federal poverty guidelines, the relative custody assistance 
138.15  payment shall be 20 percent of the net maximum assistance rate; 
138.16  or 
138.17     (vi) if the relative custodian's gross family income is 
138.18  greater than 300 percent of federal poverty guidelines, no 
138.19  relative custody assistance payment shall be made. 
138.20     (b) This paragraph sets forth the provisions pertaining to 
138.21  the relationship between relative custody assistance and AFDC, 
138.22  MFIP-S, or other MFIP programs: 
138.23     (1) the relative custodian of a child for whom the relative 
138.24  is receiving relative custody assistance is expected to seek 
138.25  whatever assistance is available for the child through the AFDC, 
138.26  MFIP-S, or other MFIP programs.  If a relative custodian fails 
138.27  to apply for assistance through AFDC, MFIP-S, or other MFIP 
138.28  program for which the child is eligible, the child's portion of 
138.29  the AFDC or MFIP standard will be calculated as if application 
138.30  had been made and assistance received; 
138.31     (2) the portion of the AFDC or MFIP standard relating to 
138.32  each child for whom relative custody assistance is being 
138.33  received shall be calculated as follows: 
138.34     (i) determine the total AFDC or MFIP standard for the 
138.35  assistance unit; 
138.36     (ii) determine the amount that the AFDC or MFIP standard 
139.1   would have been if the assistance unit had not included the 
139.2   children for whom relative custody assistance is being received; 
139.3      (iii) subtract the amount determined in item (ii) from the 
139.4   amount determined in item (i); and 
139.5      (iv) divide the result in item (iii) by the number of 
139.6   children for whom relative custody assistance is being received 
139.7   that are part of the assistance unit; or 
139.8      (3) if a child for whom relative custody assistance is 
139.9   being received is not eligible for assistance through the AFDC, 
139.10  MFIP-S, or other MFIP programs, the portion of AFDC or MFIP 
139.11  standard relating to that child shall be equal to zero. 
139.12     Subd. 8.  [ANNUAL AFFIDAVIT.] When a relative custody 
139.13  assistance agreement remains in effect for more than one year, 
139.14  the local agency shall require the relative custodian to 
139.15  annually submit an affidavit in a form to be specified by the 
139.16  commissioner.  The affidavit must be submitted to the local 
139.17  agency each year no later than 30 days after the relative 
139.18  custody assistance agreement's anniversary date.  The affidavit 
139.19  shall document the following: 
139.20     (1) that the child remains in the physical custody of the 
139.21  relative custodian; 
139.22     (2) that there is a continuing need for the relative 
139.23  custody assistance payments due to the child's physical, mental, 
139.24  emotional, or behavioral needs; and 
139.25     (3) the current gross income of the relative custodian's 
139.26  family. 
139.27     The relative custody assistance agreement may be modified 
139.28  based on information or documentation presented to the local 
139.29  agency under this requirement and as required by annual 
139.30  adjustments to the federal poverty guidelines. 
139.31     Subd. 9.  [RIGHT OF APPEAL.] A relative custodian who 
139.32  enters into a relative custody assistance agreement with a local 
139.33  agency has the right to appeal to the commissioner according to 
139.34  section 256.045 when the local agency establishes, denies, 
139.35  terminates, or modifies the agreement.  Upon appeal, the 
139.36  commissioner may review only: 
140.1      (1) whether the local agency has met the legal requirements 
140.2   imposed by this chapter for establishing, denying, terminating, 
140.3   or modifying the agreement; 
140.4      (2) whether the amount of the relative custody assistance 
140.5   payment was correctly calculated under the method set forth in 
140.6   subdivision 7; 
140.7      (3) whether the local agency paid for correct time periods 
140.8   under the relative custody assistance agreement; 
140.9      (4) whether the child remains in the physical custody of 
140.10  the relative custodian; 
140.11     (5) whether the local agency correctly calculated the 
140.12  amount of the supplemental assistance rate based on a change in 
140.13  the child's physical, mental, emotional, or behavioral needs, 
140.14  the relative custodian's failure to document the continuing need 
140.15  for the supplemental assistance rate after the local agency has 
140.16  requested such documentation; and 
140.17     (6) whether the local agency correctly calculated or 
140.18  terminated the amount of relative custody assistance based on 
140.19  the relative custodian's failure to provide documentation of the 
140.20  gross income of the relative custodian's family after the local 
140.21  agency has requested such documentation. 
140.22     Subd. 10.  [CHILD'S COUNTY OF RESIDENCE.] For the purposes 
140.23  of the unitary residency act, time spent by a child in the 
140.24  custody of a relative custodian receiving payments under this 
140.25  section is not excluded time.  A child is a resident of the 
140.26  county where the relative custodian is a resident. 
140.27     Subd. 11.  [FINANCIAL CONSIDERATIONS.] (a) Payment of 
140.28  relative custody assistance pursuant to a relative custody 
140.29  assistance agreement is subject to the availability of state 
140.30  funds and payments may be reduced or suspended on order of the 
140.31  commissioner if insufficient funds are available. 
140.32     (b) Upon receipt from a local agency of a claim for 
140.33  reimbursement, the commissioner shall reimburse the local agency 
140.34  in an amount equal to 100 percent of the relative custody 
140.35  assistance payments provided to relative custodians.  The local 
140.36  agency may not seek and the commissioner shall not provide 
141.1   reimbursement for the administrative costs associated with 
141.2   performing the duties described in subdivision 4. 
141.3      (c) For the purposes of determining eligibility or payment 
141.4   amounts under the AFDC, MFIP-S, and other MFIP programs, 
141.5   relative custody assistance payments shall be considered 
141.6   excluded income. 
141.7      Sec. 14.  Minnesota Statutes 1996, section 393.07, 
141.8   subdivision 2, is amended to read: 
141.9      Subd. 2.  [ADMINISTRATION OF PUBLIC WELFARE.] The local 
141.10  social services agency, subject to the supervision of the 
141.11  commissioner of human services, shall administer all forms of 
141.12  public welfare, both for children and adults, responsibility for 
141.13  which now or hereafter may be imposed on the commissioner of 
141.14  human services by law, including general assistance, aid to 
141.15  dependent children, county supplementation, if any, or state aid 
141.16  to recipients of supplemental security income for aged, blind 
141.17  and disabled, child welfare services, mental health services, 
141.18  and other public assistance or public welfare services, provided 
141.19  that the local social services agency shall not employ public 
141.20  health nursing or home health service personnel other than 
141.21  homemaker-home help aides, but shall contract for or purchase 
141.22  the necessary services from existing community agencies.  The 
141.23  duties of the local social services agency shall be performed in 
141.24  accordance with the standards and rules which may be promulgated 
141.25  by the commissioner of human services to achieve the purposes 
141.26  intended by law and in order to comply with the requirements of 
141.27  the federal Social Security Act in respect to public assistance 
141.28  and child welfare services, so that the state may qualify for 
141.29  grants-in-aid available under that act.  To avoid administrative 
141.30  penalties under section 256.017, the local social services 
141.31  agency must comply with (1) policies established by state law 
141.32  and (2) instructions from the commissioner relating (i) to 
141.33  public assistance program policies consistent with federal law 
141.34  and regulation and state law and rule and (ii) to local agency 
141.35  program operations.  The commissioner may enforce local social 
141.36  services agency compliance with the instructions, and may delay, 
142.1   withhold, or deny payment of all or part of the state and 
142.2   federal share of benefits and federal administrative 
142.3   reimbursement, according to the provisions under section 
142.4   256.017.  The local social services agency shall supervise wards 
142.5   of the commissioner and, when so designated, act as agent of the 
142.6   commissioner of human services in the placement of the 
142.7   commissioner's wards in adoptive homes or in other foster care 
142.8   facilities.  The local social services agency shall cooperate as 
142.9   needed when the commissioner contracts with a licensed child 
142.10  placement agency for adoption services for a child under the 
142.11  commissioner's guardianship.  The local social services agency 
142.12  may contract with a bank or other financial institution to 
142.13  provide services associated with the processing of public 
142.14  assistance checks and pay a service fee for these services, 
142.15  provided the fee charged does not exceed the fee charged to 
142.16  other customers of the institution for similar services. 
142.17     Sec. 15.  Minnesota Statutes 1996, section 466.01, 
142.18  subdivision 1, is amended to read: 
142.19     Subdivision 1.  [MUNICIPALITY.] For the purposes of 
142.20  sections 466.01 to 466.15, "municipality" means any city, 
142.21  whether organized under home rule charter or otherwise, any 
142.22  county, town, public authority, public corporation, nonprofit 
142.23  firefighting corporation that has associated with it a relief 
142.24  association as defined in section 424A.001, subdivision 4, 
142.25  special district, school district, however organized, county 
142.26  agricultural society organized pursuant to chapter 38, joint 
142.27  powers board or organization created under section 471.59 or 
142.28  other statute, public library, regional public library system, 
142.29  multicounty multitype library system, family services 
142.30  collaborative established under section 121.8355, children's 
142.31  mental health collaboratives established under sections 245.491 
142.32  to 245.496, or a collaborative established by the merger of a 
142.33  children's mental health collaborative and a family services 
142.34  collaborative, other political subdivision, or community action 
142.35  agency. 
142.36     Sec. 16.  Minnesota Statutes 1996, section 471.59, 
143.1   subdivision 11, is amended to read: 
143.2      Subd. 11.  [JOINT POWERS BOARD.] (a) Two or more 
143.3   governmental units, through action of their governing bodies, by 
143.4   adoption of a joint powers agreement that complies with the 
143.5   provisions of subdivisions 1 to 5, may establish a joint board 
143.6   to issue bonds or obligations under any law by which any of the 
143.7   governmental units establishing the joint board may 
143.8   independently issue bonds or obligations and may use the 
143.9   proceeds of the bonds or obligations to carry out the purposes 
143.10  of the law under which the bonds or obligations are issued.  A 
143.11  joint board established under this section may issue obligations 
143.12  and other forms of indebtedness only in accordance with express 
143.13  authority granted by the action of the governing bodies of the 
143.14  governmental units that established the joint board.  Except as 
143.15  provided in paragraph (b), the joint board established under 
143.16  this subdivision must be composed solely of members of the 
143.17  governing bodies of the governmental unit that established the 
143.18  joint board.  A joint board established under this subdivision 
143.19  may not pledge the full faith and credit or taxing power of any 
143.20  of the governmental units that established the joint board.  The 
143.21  obligations or other forms of indebtedness must be obligations 
143.22  of the joint board issued on behalf of the governmental units 
143.23  creating the joint board.  The obligations or other forms of 
143.24  indebtedness must be issued in the same manner and subject to 
143.25  the same conditions and limitations that would apply if the 
143.26  obligations were issued or indebtedness incurred by one of the 
143.27  governmental units that established the joint board, provided 
143.28  that any reference to a governmental unit in the statute, law, 
143.29  or charter provision authorizing the issuance of the bonds or 
143.30  the incurring of the indebtedness is considered a reference to 
143.31  the joint board. 
143.32     (b) Notwithstanding paragraph (a), one school district, one 
143.33  county, and one public health entity, through action of their 
143.34  governing bodies, may establish a joint board to establish and 
143.35  govern a family services collaborative under section 121.8355.  
143.36  The school district, county, and public health entity may 
144.1   include other governmental entities at their discretion.  The 
144.2   membership of a board established under this paragraph, in 
144.3   addition to members of the governing bodies of the participating 
144.4   governmental units, must include the representation required by 
144.5   section 121.8355, subdivision 1, paragraph (a), selected in 
144.6   accordance with section 121.8355, subdivision 1, paragraph (c). 
144.7      (c) Notwithstanding paragraph (a), one county, one school 
144.8   district, and one mental health entity, through action of their 
144.9   governing bodies, may establish a joint board to establish and 
144.10  govern a children's mental health collaborative under sections 
144.11  245.491 to 245.496, or a collaborative established by the merger 
144.12  of a children's mental health collaborative and a family 
144.13  services collaborative under section 121.8355.  The county, 
144.14  school district, and mental health entity may include other 
144.15  entities at their discretion.  The membership of a board 
144.16  established under this paragraph, in addition to members of the 
144.17  governing bodies of the participating governmental units, must 
144.18  include the representation provided by section 245.493, 
144.19  subdivision 1. 
144.20     Sec. 17.  Minnesota Statutes 1996, section 626.556, 
144.21  subdivision 10b, is amended to read: 
144.22     Subd. 10b.  [DUTIES OF COMMISSIONER; NEGLECT OR ABUSE IN A 
144.23  FACILITY.] (a) The commissioner shall immediately investigate if 
144.24  the report alleges that: 
144.25     (1) a child who is in the care of a facility as defined in 
144.26  subdivision 2 is neglected, physically abused, or sexually 
144.27  abused by an individual in that facility, or has been so 
144.28  neglected or abused by an individual in that facility within the 
144.29  three years preceding the report; or 
144.30     (2) a child was neglected, physically abused, or sexually 
144.31  abused by an individual in a facility defined in subdivision 2, 
144.32  while in the care of that facility within the three years 
144.33  preceding the report.  
144.34     The commissioner shall arrange for the transmittal to the 
144.35  commissioner of reports received by local agencies and may 
144.36  delegate to a local welfare agency the duty to investigate 
145.1   reports.  In conducting an investigation under this section, the 
145.2   commissioner has the powers and duties specified for local 
145.3   welfare agencies under this section.  The commissioner or local 
145.4   welfare agency may interview any children who are or have been 
145.5   in the care of a facility under investigation and their parents, 
145.6   guardians, or legal custodians. 
145.7      (b) Prior to any interview, the commissioner or local 
145.8   welfare agency shall notify the parent, guardian, or legal 
145.9   custodian of a child who will be interviewed in the manner 
145.10  provided for in subdivision 10d, paragraph (a).  If reasonable 
145.11  efforts to reach the parent, guardian, or legal custodian of a 
145.12  child in an out-of-home placement have failed, the child may be 
145.13  interviewed if there is reason to believe the interview is 
145.14  necessary to protect the child or other children in the 
145.15  facility.  The commissioner or local agency must provide the 
145.16  information required in this subdivision to the parent, 
145.17  guardian, or legal custodian of a child interviewed without 
145.18  parental notification as soon as possible after the interview.  
145.19  When the investigation is completed, any parent, guardian, or 
145.20  legal custodian notified under this subdivision shall receive 
145.21  the written memorandum provided for in subdivision 10d, 
145.22  paragraph (c). 
145.23     (c) In conducting investigations under this subdivision the 
145.24  commissioner or local welfare agency shall obtain access to 
145.25  information consistent with subdivision 10, paragraphs (h), (i), 
145.26  and (j). 
145.27     (d) Except for foster care and family child care, the 
145.28  commissioner has the primary responsibility for the 
145.29  investigations and notifications required under subdivisions 10d 
145.30  and 10f for reports that allege maltreatment related to the care 
145.31  provided by or in facilities licensed by the commissioner.  The 
145.32  commissioner may request assistance from the local social 
145.33  service agency. 
145.34     Sec. 18.  Minnesota Statutes 1996, section 626.556, 
145.35  subdivision 10d, is amended to read: 
145.36     Subd. 10d.  [NOTIFICATION OF NEGLECT OR ABUSE IN A 
146.1   FACILITY.] (a) When a report is received that alleges neglect, 
146.2   physical abuse, or sexual abuse of a child while in the care of 
146.3   a facility required to be licensed pursuant to ~~sections 245A.01~~ 
146.4   ~~to 245A.16~~ chapter 245A, the commissioner or local welfare 
146.5   agency investigating the report shall provide the following 
146.6   information to the parent, guardian, or legal custodian of a 
146.7   child alleged to have been neglected, physically abused, or 
146.8   sexually abused:  the name of the facility; the fact that a 
146.9   report alleging neglect, physical abuse, or sexual abuse of a 
146.10  child in the facility has been received; the nature of the 
146.11  alleged neglect, physical abuse, or sexual abuse; that the 
146.12  agency is conducting an investigation; any protective or 
146.13  corrective measures being taken pending the outcome of the 
146.14  investigation; and that a written memorandum will be provided 
146.15  when the investigation is completed. 
146.16     (b) The commissioner or local welfare agency may also 
146.17  provide the information in paragraph (a) to the parent, 
146.18  guardian, or legal custodian of any other child in the facility 
146.19  if the investigative agency knows or has reason to believe the 
146.20  alleged neglect, physical abuse, or sexual abuse has occurred. 
146.21  In determining whether to exercise this authority, the 
146.22  commissioner or local welfare agency shall consider the 
146.23  seriousness of the alleged neglect, physical abuse, or sexual 
146.24  abuse; the number of children allegedly neglected, physically 
146.25  abused, or sexually abused; the number of alleged perpetrators; 
146.26  and the length of the investigation.  The facility shall be 
146.27  notified whenever this discretion is exercised. 
146.28     (c) When the commissioner or local welfare agency has 
146.29  completed its investigation, every parent, guardian, or legal 
146.30  custodian notified of the investigation by the commissioner or 
146.31  local welfare agency shall be provided with the following 
146.32  information in a written memorandum:  the name of the facility 
146.33  investigated; the nature of the alleged neglect, physical abuse, 
146.34  or sexual abuse; the investigator's name; a summary of the 
146.35  investigation findings; a statement whether maltreatment was 
146.36  found; and the protective or corrective measures that are being 
147.1   or will be taken.  The memorandum shall be written in a manner 
147.2   that protects the identity of the reporter and the child and 
147.3   shall not contain the name, or to the extent possible, reveal 
147.4   the identity of the alleged perpetrator or of those interviewed 
147.5   during the investigation.  The commissioner or local welfare 
147.6   agency shall also provide the written memorandum to the parent, 
147.7   guardian, or legal custodian of each child in the facility if 
147.8   maltreatment is determined to exist. 
147.9      Sec. 19.  Minnesota Statutes 1996, section 626.556, 
147.10  subdivision 10e, is amended to read: 
147.11     Subd. 10e.  [DETERMINATIONS.] Upon the conclusion of every 
147.12  assessment or investigation it conducts, the local welfare 
147.13  agency shall make two determinations:  first, whether 
147.14  maltreatment has occurred; and second, whether child protective 
147.15  services are needed.  When maltreatment is determined in an 
147.16  investigation involving a facility, the investigating agency 
147.17  shall also determine whether the facility or individual was 
147.18  responsible for the maltreatment using the mitigating factors in 
147.19  paragraph (d).  Determinations under this subdivision must be 
147.20  made based on a preponderance of the evidence. 
147.21     (a) For the purposes of this subdivision, "maltreatment" 
147.22  means any of the following acts or omissions committed by a 
147.23  person responsible for the child's care: 
147.24     (1) physical abuse as defined in subdivision 2, paragraph 
147.25  (d); 
147.26     (2) neglect as defined in subdivision 2, paragraph (c); 
147.27     (3) sexual abuse as defined in subdivision 2, paragraph 
147.28  (a); or 
147.29     (4) mental injury as defined in subdivision 2, paragraph 
147.30  (k). 
147.31     (b) For the purposes of this subdivision, a determination 
147.32  that child protective services are needed means that the local 
147.33  welfare agency has documented conditions during the assessment 
147.34  or investigation sufficient to cause a child protection worker, 
147.35  as defined in section 626.559, subdivision 1, to conclude that a 
147.36  child is at significant risk of maltreatment if protective 
148.1   intervention is not provided and that the individuals 
148.2   responsible for the child's care have not taken or are not 
148.3   likely to take actions to protect the child from maltreatment or 
148.4   risk of maltreatment. 
148.5      (c) This subdivision does not mean that maltreatment has 
148.6   occurred solely because the child's parent, guardian, or other 
148.7   person responsible for the child's care in good faith selects 
148.8   and depends upon spiritual means or prayer for treatment or care 
148.9   of disease or remedial care of the child, in lieu of medical 
148.10  care.  However, if lack of medical care may result in serious 
148.11  danger to the child's health, the local welfare agency may 
148.12  ensure that necessary medical services are provided to the child.
148.13     (d) When determining whether the facility or individual is 
148.14  the responsible party for determined maltreatment in a facility, 
148.15  the investigating agency shall consider at least the following 
148.16  mitigating factors: 
148.17     (1) whether the actions of the facility or the individual 
148.18  caregivers were according to, and followed the terms of, an 
148.19  erroneous physician order, prescription, individual care plan, 
148.20  or directive; this is not a mitigating factor when the facility 
148.21  or caregiver was responsible for the issuance of the erroneous 
148.22  order, prescription, plan, or directive or knew or should have 
148.23  known of the errors and took no reasonable measures to correct 
148.24  the defect before administering care; 
148.25     (2) the comparative responsibility between the facility, 
148.26  other caregivers, and requirements placed upon an employee, 
148.27  including the facility's compliance with related regulatory 
148.28  standards; the adequacy of facility policies and procedures, 
148.29  facility training, an individual's participation in the 
148.30  training, caregiver supervision, and facility staffing levels; 
148.31  and the scope of the individual employee's authority and 
148.32  discretion; and 
148.33     (3) whether the facility or individual followed 
148.34  professional standards in exercising professional judgment. 
148.35     Sec. 20.  Minnesota Statutes 1996, section 626.556, 
148.36  subdivision 10f, is amended to read: 
149.1      Subd. 10f.  [NOTICE OF DETERMINATIONS.] Within ten working 
149.2   days of the conclusion of an assessment, the local welfare 
149.3   agency shall notify the parent or guardian of the child, the 
149.4   person determined to be maltreating the child, and if 
149.5   applicable, the director of the facility, of the determination 
149.6   and a summary of the specific reasons for the determination.  
149.7   The notice must also include a certification that the 
149.8   information collection procedures under subdivision 10, 
149.9   paragraphs (h), (i), and (j), were followed and a notice of the 
149.10  right of a data subject to obtain access to other private data 
149.11  on the subject collected, created, or maintained under this 
149.12  section.  In addition, the notice shall include the length of 
149.13  time that the records will be kept under subdivision 11c.  When 
149.14  there is no determination of either maltreatment or a need for 
149.15  services, the notice shall also include the alleged 
149.16  perpetrator's right to have the records destroyed.  The 
149.17  investigating agency shall notify the designee of the child who 
149.18  is the subject of the report, and any person or facility 
149.19  determined to have maltreated a child, of their appeal rights 
149.20  under this section. 
149.21     Sec. 21.  Minnesota Statutes 1996, section 626.556, is 
149.22  amended by adding a subdivision to read: 
149.23     Subd. 10i.  [ADMINISTRATIVE RECONSIDERATION OF THE FINAL 
149.24  DETERMINATION OF MALTREATMENT.] (a) An individual or facility 
149.25  that the commissioner or a local social service agency 
149.26  determines has maltreated a child, or the child's designee, 
149.27  regardless of the determination, who contests the investigating 
149.28  agency's final determination regarding maltreatment, may request 
149.29  the investigating agency to reconsider its final determination 
149.30  regarding maltreatment.  The request for reconsideration must be 
149.31  submitted in writing to the investigating agency within 15 
149.32  calendar days after receipt of notice of the final determination 
149.33  regarding maltreatment. 
149.34     (b) If the investigating agency denies the request or fails 
149.35  to act upon the request within 15 calendar days after receiving 
149.36  the request for reconsideration, the person or facility entitled 
150.1   to a fair hearing under section 256.045, may submit to the 
150.2   commissioner of human services a written request for a hearing 
150.3   under that statute. 
150.4      (c) If, as a result of the reconsideration, the 
150.5   investigating agency changes the final determination of 
150.6   maltreatment, it shall notify the parties specified in 
150.7   subdivisions 10b, 10d, and 10f. 
150.8      Sec. 22.  Minnesota Statutes 1996, section 626.556, 
150.9   subdivision 11c, is amended to read: 
150.10     Subd. 11c.  [WELFARE, COURT SERVICES AGENCY, AND SCHOOL 
150.11  RECORDS MAINTAINED.] Notwithstanding sections 138.163 and 
150.12  138.17, records maintained or records derived from reports of 
150.13  abuse by local welfare agencies, court services agencies, or 
150.14  schools under this section shall be destroyed as provided in 
150.15  paragraphs (a) to (d) by the responsible authority. 
150.16     (a) If upon assessment or investigation there is no 
150.17  determination of maltreatment or the need for child protective 
150.18  services, the records may be maintained for a period of four 
150.19  years.  After the individual alleged to have maltreated a child 
150.20  is notified under subdivision 10f of the determinations at the 
150.21  conclusion of the assessment or investigation, upon that 
150.22  individual's request, records shall be destroyed within 30 
150.23  days or after the appeal rights under subdivision 10i have been 
150.24  concluded, whichever is later. 
150.25     (b) All records relating to reports which, upon assessment 
150.26  or investigation, indicate either maltreatment or a need for 
150.27  child protective services shall be maintained for at least ten 
150.28  years after the date of the final entry in the case record. 
150.29     (c) All records regarding a report of maltreatment, 
150.30  including any notification of intent to interview which was 
150.31  received by a school under subdivision 10, paragraph (d), shall 
150.32  be destroyed by the school when ordered to do so by the agency 
150.33  conducting the assessment or investigation.  The agency shall 
150.34  order the destruction of the notification when other records 
150.35  relating to the report under investigation or assessment are 
150.36  destroyed under this subdivision. 
151.1      (d) Private or confidential data released to a court 
151.2   services agency under subdivision 10h must be destroyed by the 
151.3   court services agency when ordered to do so by the local welfare 
151.4   agency that released the data.  The local welfare agency shall 
151.5   order destruction of the data when other records relating to the 
151.6   assessment or investigation are destroyed under this subdivision.
151.7      Sec. 23.  Minnesota Statutes 1996, section 626.558, 
151.8   subdivision 1, is amended to read: 
151.9      Subdivision 1.  [ESTABLISHMENT OF THE TEAM.] A county shall 
151.10  establish a multidisciplinary child protection team that may 
151.11  include, but not be limited to, the director of the local 
151.12  welfare agency or designees, the county attorney or designees, 
151.13  the county sheriff or designees, representatives of health and 
151.14  education, representatives of mental health or other appropriate 
151.15  human service or community-based agencies, and parent groups.  
151.16  As used in this section, a "community-based agency" may include, 
151.17  but is not limited to, schools, social service agencies, family 
151.18  service and mental health collaboratives, early childhood and 
151.19  family education programs, Head Start, or other agencies serving 
151.20  children and families. 
151.21     Sec. 24.  Minnesota Statutes 1996, section 626.558, 
151.22  subdivision 2, is amended to read: 
151.23     Subd. 2.  [DUTIES OF TEAM.] A multidisciplinary child 
151.24  protection team may provide public and professional education, 
151.25  develop resources for prevention, intervention, and treatment, 
151.26  and provide case consultation to the local welfare agency ~~to~~ 
151.27  ~~better enable the agency to carry out its child protection~~ 
151.28  ~~functions under section 626.556 and the community social~~ 
151.29  ~~services act.~~ or other interested community-based agencies.  The 
151.30  community-based agencies may request case consultation from the 
151.31  multidisciplinary child protection team regarding a child or 
151.32  family for whom the community-based agency is providing 
151.33  services.  As used in this section, "case consultation" means a 
151.34  case review process in which recommendations are made concerning 
151.35  services to be provided to the identified children and family.  
151.36  Case consultation may be performed by a committee or 
152.1   subcommittee of members representing human services, including 
152.2   mental health and chemical dependency; law enforcement, 
152.3   including probation and parole; the county attorney; health 
152.4   care; education; community-based agencies and other necessary 
152.5   agencies; and persons directly involved in an individual case as 
152.6   designated by other members performing case consultation. 
152.7      Sec. 25.  Minnesota Statutes 1996, section 626.559, 
152.8   subdivision 5, is amended to read: 
152.9      Subd. 5.  [~~TRAINING~~ REVENUE.] The commissioner of human 
152.10  services shall add the following funds to the funds appropriated 
152.11  under section 626.5591, subdivision 2, to develop and support 
152.12  training: 
152.13     (a) The commissioner of human services shall submit claims 
152.14  for federal reimbursement earned through the activities and 
152.15  services supported through department of human services child 
152.16  protection or child welfare training funds.  Federal revenue 
152.17  earned must be used to improve and expand training services by 
152.18  the department.  The department expenditures eligible for 
152.19  federal reimbursement under this section must not be made from 
152.20  federal funds or funds used to match other federal funds. 
152.21     (b) Each year, the commissioner of human services shall 
152.22  withhold from funds distributed to each county under Minnesota 
152.23  Rules, parts 9550.0300 to 9550.0370, an amount equivalent to 1.5 
152.24  percent of each county's annual Title XX allocation under 
152.25  section 256E.07.  The commissioner must use these funds to 
152.26  ensure decentralization of training. 
152.27     (c) The federal revenue ~~earned~~ under this subdivision is 
152.28  available for these purposes until the funds are expended. 
152.29     Sec. 26.  [MALTREATMENT OF MINORS ADVISORY COMMITTEE.] 
152.30     The commissioner of human services, with the cooperation of 
152.31  the commissioners of health, children, families, and learning, 
152.32  and the attorney general, shall establish an advisory committee 
152.33  to review the Maltreatment of Minors Act, Minnesota Statutes, 
152.34  section 626.556, to determine whether existing state policy and 
152.35  procedures for protecting children who are at risk of 
152.36  maltreatment in the home, school, or community are effective. 
153.1      The committee shall include consumers, advocacy and 
153.2   provider organizations, county practitioners and administrators, 
153.3   school districts, law enforcement agencies, communities of 
153.4   color, professional associations, labor organizations, office of 
153.5   the ombudsman for mental health and mental retardation, and the 
153.6   commissioners of health, human services, and children, families, 
153.7   and learning. 
153.8      In making recommendations, the advisory committee shall 
153.9   review all services and protections available under existing 
153.10  state and federal laws with the focus on eliminating duplication 
153.11  of effort among various local, state, and federal agencies and 
153.12  minimizing possible conflicts of interest by establishing a 
153.13  statewide process of coordination of responsibilities.  The 
153.14  advisory committee shall submit a report to the legislature by 
153.15  February 15, 1998, that includes a detailed plan with specific 
153.16  law, rule, or administrative procedure changes to implement the 
153.17  recommendations.  
153.18     Sec. 27.  [UNIFORM CONTRIBUTION SCHEDULE FOR OUT-OF-HOME 
153.19  PLACEMENT; REPORT.] 
153.20     The commissioner of human services shall prepare 
153.21  recommendations and report to the 1998 legislature regarding a 
153.22  uniform relative contribution schedule to reimburse costs 
153.23  associated with out-of-home placement.  The commissioner shall 
153.24  use the child support guidelines in Minnesota Statutes, chapter 
153.25  518, as the basis for the uniform contribution schedule.  The 
153.26  recommendations and report are due December 1, 1997. 
153.27     Sec. 28.  [EVALUATION REPORT REQUIRED.] 
153.28     The commissioner shall report the results of the evaluation 
153.29  required under section 5 to the chairs of the house of 
153.30  representatives and senate health and human services policy 
153.31  committees by January 15, 1999. 
153.32                             ARTICLE 6
153.33                    ACCELERATING STATE PAYMENTS 
153.34     Section 1.  Minnesota Statutes 1996, section 256.025, 
153.35  subdivision 2, is amended to read: 
153.36     Subd. 2.  [COVERED PROGRAMS AND SERVICES.] The procedures 
154.1   in this section govern payment of county agency expenditures for 
154.2   benefits and services distributed under the following programs: 
154.3      (1) aid to families with dependent children in effect until 
154.4   June 30, 1997, under sections 256.82, subdivision 1, and 
154.5   256.935, subdivision 1, for assistance costs incurred prior to 
154.6   July 1, 1997; 
154.7      (2) medical assistance under sections 256B.041, subdivision 
154.8   5, and 256B.19, subdivision 1, for assistance costs incurred 
154.9   prior to July 1, 1997; 
154.10     (3) general assistance medical care under section 256D.03, 
154.11  subdivision 6, for assistance costs incurred prior to July 1, 
154.12  1997; 
154.13     (4) general assistance under section 256D.03, subdivision 
154.14  2, for assistance costs incurred prior to July 1, 1997; 
154.15     (5) work readiness under section 256D.03, subdivision 2, 
154.16  for assistance costs incurred prior to July 1, 1995; 
154.17     (6) emergency assistance under section 256.871, subdivision 
154.18  6, for assistance costs incurred prior to July 1, 1997; 
154.19     (7) Minnesota supplemental aid under section 256D.36, 
154.20  subdivision 1, for assistance costs incurred prior to July 1, 
154.21  1997; 
154.22     (8) preadmission screening and alternative care grants for 
154.23  assistance costs incurred prior to July 1, 1997; 
154.24     (9) work readiness services under section 256D.051 for 
154.25  employment and training services costs incurred prior to July 1, 
154.26  1995; 
154.27     (10) case management services under section 256.736, 
154.28  subdivision 13, for case management service costs incurred prior 
154.29  to July 1, 1995; 
154.30     (11) general assistance claims processing, medical 
154.31  transportation and related costs for assistance costs incurred 
154.32  prior to July 1, 1997; 
154.33     (12) medical assistance, medical transportation and related 
154.34  costs for assistance costs incurred prior to July 1, 1997; and 
154.35     (13) group residential housing under section 256I.05, 
154.36  subdivision 8, for assistance costs incurred prior to July 1, 
155.1   1997, transferred from programs in clauses (4) and (7). 
155.2      Sec. 2.  Minnesota Statutes 1996, section 256.025, 
155.3   subdivision 4, is amended to read: 
155.4      Subd. 4.  [PAYMENT SCHEDULE.] Except as provided for in 
155.5   subdivision 3, beginning July 1, 1991, the state will reimburse 
155.6   counties, according to the following payment schedule, for the 
155.7   county share of county agency expenditures for the programs 
155.8   specified in subdivision 2. 
155.9      (a) Beginning July 1, 1991, the state will reimburse or pay 
155.10  the county share of county agency expenditures according to the 
155.11  reporting cycle as established by the commissioner, for the 
155.12  programs identified in subdivision 2.  Payments for the period 
155.13  of January 1 through July 31, for calendar years 1991, 1992, 
155.14  1993, 1994, and 1995 shall be made on or before July 10 in each 
155.15  of those years.  Payments for the period August through December 
155.16  for calendar years 1991, 1992, 1993, 1994, and 1995 shall be 
155.17  made on or before the third of each month thereafter through 
155.18  December 31 in each of those years. 
155.19     (b) Payment for 1/24 of the base amount and the January 
155.20  1996 county share of county agency expenditures growth amount 
155.21  for the programs identified in subdivision 2 shall be made on or 
155.22  before January 3, 1996.  For the period of February 1, 1996 
155.23  through July 31, 1996, payment of the base amount shall be made 
155.24  on or before July 10, 1996, and payment of the growth amount 
155.25  over the base amount shall be made on or before July 10, 1996.  
155.26  Payments for the period August 1996 through December 1996 shall 
155.27  be made on or before the third of each month thereafter through 
155.28  December 31, 1996. 
155.29     (c) Payment for the county share of county agency 
155.30  expenditures during January 1997 shall be made on or before 
155.31  January 3, 1997.  Payment for 1/24 of the base amount and the 
155.32  February 1997 county share of county agency expenditures growth 
155.33  amount for the programs identified in subdivision 2 shall be 
155.34  made on or before February 3, 1997.  For the period of March 1, 
155.35  1997 through ~~July 31~~ June 30, 1997, payment of the base amount 
155.36  shall be made on or before July 10, 1997, and payment of the 
156.1   growth amount over the base amount shall be made on or before 
156.2   July 10, 1997.  ~~Payments for the period August 1997 through~~ 
156.3   ~~December 1997 shall be made on or before the third of each month~~ 
156.4   ~~thereafter through December 31, 1997.~~ 
156.5      ~~(d) Monthly payments for the county share of county agency~~ 
156.6   ~~expenditures from January 1998 through February 1998 shall be~~ 
156.7   ~~made on or before the third of each month through February~~ 
156.8   ~~1998.  Payment for 1/24 of the base amount and the March 1998~~ 
156.9   ~~county share of county agency expenditures growth amount for the~~ 
156.10  ~~programs identified in subdivision 2 shall be made on or before~~ 
156.11  ~~March 1998.  For the period of April 1, 1998 through July 31,~~ 
156.12  ~~1998, payment of the base amount shall be made on or before July~~ 
156.13  ~~10, 1998, and payment of the growth amount over the base amount~~ 
156.14  ~~shall be made on or before July 10, 1998.  Payments for the~~ 
156.15  ~~period August 1998 through December 1998 shall be made on or~~ 
156.16  ~~before the third of each month thereafter through December 31,~~ 
156.17  ~~1998.~~ 
156.18     ~~(e) Monthly payments for the county share of county agency~~ 
156.19  ~~expenditures from January 1999 through March 1999 shall be made~~ 
156.20  ~~on or before the third of each month through March 1999.~~  
156.21  ~~Payment for 1/24 of the base amount and the April 1999 county~~ 
156.22  ~~share of county agency expenditures growth amount for the~~ 
156.23  ~~programs identified in subdivision 2 shall be made on or before~~ 
156.24  ~~April 3, 1999.  For the period of May 1, 1999 through July 31,~~ 
156.25  ~~1999, payment of the base amount shall be made on or before July~~ 
156.26  ~~10, 1999, and payment of the growth amount over the base amount~~ 
156.27  ~~shall be made on or before July 10, 1999.  Payments for the~~ 
156.28  ~~period August 1999 through December 1999 shall be made on or~~ 
156.29  ~~before the third of each month thereafter through December 31,~~ 
156.30  ~~1999.~~  
156.31     ~~(f) Monthly payments for the county share of county agency~~ 
156.32  ~~expenditures from January 2000 through April 2000 shall be made~~ 
156.33  ~~on or before the third of each month through April 2000.~~  
156.34  ~~Payment for 1/24 of the base amount and the May 2000 county~~ 
156.35  ~~share of county agency expenditures growth amount for the~~ 
156.36  ~~programs identified in subdivision 2 shall be made on or before~~ 
157.1   ~~May 3, 2000.  For the period of June 1, 2000 through July 31,~~ 
157.2   ~~2000, payment of the base amount shall be made on or before July~~ 
157.3   ~~10, 2000, and payment of the growth amount over the base amount~~ 
157.4   ~~shall be made on or before July 10, 2000.  Payments for the~~ 
157.5   ~~period August 2000 through December 2000 shall be made on or~~ 
157.6   ~~before the third of each month thereafter through December 31,~~ 
157.7   ~~2000.~~  
157.8      ~~(g) Monthly payments for the county share of county agency~~ 
157.9   ~~expenditures from January 2001 through May 2001 shall be made on~~ 
157.10  ~~or before the third of each month through May 2001.  Payment for~~ 
157.11  ~~1/24 of the base amount and the June 2001 county share of county~~ 
157.12  ~~agency expenditures growth amount for the programs identified in~~ 
157.13  ~~subdivision 2 shall be made on or before June 3, 2001.  Payments~~ 
157.14  ~~for the period July 2001 through December 2001 shall be made on~~ 
157.15  ~~or before the third of each month thereafter through December~~ 
157.16  ~~31, 2001.~~ 
157.17     ~~(h) Effective January 1, 2002, monthly payments for the~~ 
157.18  ~~county share of county agency expenditures shall be made~~ 
157.19  ~~subsequent to the first of each month.~~ 
157.20     ~~Payments under this subdivision are subject to the~~ 
157.21  ~~provisions of section 256.017.~~  
157.22     Sec. 3.  Minnesota Statutes 1996, section 256.82, 
157.23  subdivision 1, is amended to read: 
157.24     Subdivision 1.  [DIVISION OF COSTS AND PAYMENTS.] Based 
157.25  upon estimates submitted by the county agency to the state 
157.26  agency, which shall state the estimated required expenditures 
157.27  for the succeeding month, upon the direction of the state 
157.28  agency, payment shall be made monthly in advance by the state to 
157.29  the counties of all federal funds available for that purpose for 
157.30  such succeeding month.  The state share of the nonfederal 
157.31  portion of county agency expenditures shall be ~~85~~ 100 percent.  
157.32  ~~and the county share shall be 15 percent.  Benefits shall be~~ 
157.33  ~~issued to recipients by the state or county and funded according~~ 
157.34  ~~to section 256.025, subdivision 3, subject to provisions of~~ 
157.35  ~~section 256.017.  Beginning July 1, 1991, the state will~~ 
157.36  ~~reimburse counties according to the payment schedule in section~~ 
158.1   ~~256.025 for the county share of county agency expenditures under~~ 
158.2   ~~this subdivision from January 1, 1991, on.~~  Payment to counties 
158.3   under this subdivision is subject to the provisions of section 
158.4   256.017.  Adjustment of any overestimate or underestimate made 
158.5   by any county shall be paid upon the direction of the state 
158.6   agency in any succeeding month.  
158.7      Sec. 4.  Minnesota Statutes 1996, section 256.871, 
158.8   subdivision 6, is amended to read: 
158.9      Subd. 6.  [REPORTS OF ESTIMATED EXPENDITURES; PAYMENTS.] 
158.10  The county agency shall submit to the state agency reports 
158.11  required under section 256.01, subdivision 2, paragraph (17).  
158.12  Fiscal reports shall estimate expenditures for each succeeding 
158.13  month in such form as required by the state agency.  The state 
158.14  share of the nonfederal portion of eligible expenditures shall 
158.15  be ~~ten~~ 100 percent ~~and the county share shall be 90 percent~~.  
158.16  ~~Benefits shall be issued to recipients by the state or county~~ 
158.17  ~~and funded according to section 256.025, subdivision 3, subject~~ 
158.18  ~~to provisions of section 256.017.  Beginning July 1, 1991, the~~ 
158.19  ~~state will reimburse counties according to the payment schedule~~ 
158.20  ~~set forth in section 256.025 for the county share of county~~ 
158.21  ~~agency expenditures made under this subdivision from January 1,~~ 
158.22  ~~1991, on.  Payment under this subdivision is subject to the~~ 
158.23  ~~provisions of section 256.017.~~  Adjustment of any overestimate 
158.24  or underestimate made by any county shall be paid upon the 
158.25  direction of the state agency in any succeeding month. 
158.26     Sec. 5.  Minnesota Statutes 1996, section 256.935, is 
158.27  amended to read: 
158.28     256.935 [FUNERAL EXPENSES, PAYMENT BY COUNTY AGENCY.] 
158.29     Subdivision 1.  On the death of any person receiving public 
158.30  assistance through aid to dependent children, the county agency 
158.31  shall pay an amount for funeral expenses not exceeding the 
158.32  amount paid for comparable services under section 261.035 plus 
158.33  actual cemetery charges.  No funeral expenses shall be paid if 
158.34  the estate of the deceased is sufficient to pay such expenses or 
158.35  if the spouse, who was legally responsible for the support of 
158.36  the deceased while living, is able to pay such expenses; 
159.1   provided, that the additional payment or donation of the cost of 
159.2   cemetery lot, interment, religious service, or for the 
159.3   transportation of the body into or out of the community in which 
159.4   the deceased resided, shall not limit payment by the county 
159.5   agency as herein authorized.  Freedom of choice in the selection 
159.6   of a funeral director shall be granted to persons lawfully 
159.7   authorized to make arrangements for the burial of any such 
159.8   deceased recipient.  In determining the sufficiency of such 
159.9   estate, due regard shall be had for the nature and marketability 
159.10  of the assets of the estate.  The county agency may grant 
159.11  funeral expenses where the sale would cause undue loss to the 
159.12  estate.  Any amount paid for funeral expenses shall be a prior 
159.13  claim against the estate, as provided in section 524.3-805, and 
159.14  any amount recovered shall be reimbursed to the agency which 
159.15  paid the expenses.  The commissioner shall specify requirements 
159.16  for reports, including fiscal reports, according to section 
159.17  256.01, subdivision 2, paragraph (17).  The state share shall 
159.18  pay the entire amount of county agency expenditures ~~shall be 50~~ 
159.19  ~~percent and the county share shall be 50 percent~~.  Benefits 
159.20  shall be issued to recipients by the state or county ~~and funded~~ 
159.21  ~~according to section 256.025, subdivision 3,~~ subject to 
159.22  provisions of section 256.017. 
159.23     ~~Beginning July 1, 1991, the state will reimburse counties~~ 
159.24  ~~according to the payment schedule set forth in section 256.025~~ 
159.25  ~~for the county share of county agency expenditures made under~~ 
159.26  ~~this subdivision from January 1, 1991, on.  Payment under this~~ 
159.27  ~~subdivision is subject to the provisions of section 256.017.~~ 
159.28     Sec. 6.  Minnesota Statutes 1996, section 256B.0913, 
159.29  subdivision 14, is amended to read: 
159.30     Subd. 14.  [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a) 
159.31  Reimbursement for expenditures for the alternative care services 
159.32  as approved by the client's case manager shall be through the 
159.33  invoice processing procedures of the department's Medicaid 
159.34  Management Information System (MMIS).  To receive reimbursement, 
159.35  the county or vendor must submit invoices within 12 months 
159.36  following the date of service.  The county agency and its 
160.1   vendors under contract shall not be reimbursed for services 
160.2   which exceed the county allocation. 
160.3      (b) If a county collects less than 50 percent of the client 
160.4   premiums due under subdivision 12, the commissioner may withhold 
160.5   up to three percent of the county's final alternative care 
160.6   program allocation determined under subdivisions 10 and 11. 
160.7      ~~(c) Beginning July 1, 1991, the state will reimburse~~ 
160.8   ~~counties, up to the limits of state appropriations, according to~~ 
160.9   ~~the payment schedule in section 256.025 for the county share of~~ 
160.10  ~~costs incurred under this subdivision on or after January 1,~~ 
160.11  ~~1991, for individuals who would be eligible for medical~~ 
160.12  ~~assistance within 180 days of admission to a nursing home.~~ 
160.13     ~~(d)~~ (c) For fiscal years beginning on or after July 1, 
160.14  1993, the commissioner of human services shall not provide 
160.15  automatic annual inflation adjustments for alternative care 
160.16  services.  The commissioner of finance shall include as a budget 
160.17  change request in each biennial detailed expenditure budget 
160.18  submitted to the legislature under section 16A.11 annual 
160.19  adjustments in reimbursement rates for alternative care services 
160.20  based on the forecasted percentage change in the Home Health 
160.21  Agency Market Basket of Operating Costs, for the fiscal year 
160.22  beginning July 1, compared to the previous fiscal year, unless 
160.23  otherwise adjusted by statute.  The Home Health Agency Market 
160.24  Basket of Operating Costs is published by Data Resources, Inc.  
160.25  The forecast to be used is the one published for the calendar 
160.26  quarter beginning January 1, six months prior to the beginning 
160.27  of the fiscal year for which rates are set. 
160.28     ~~(e)~~ (d) The county shall negotiate individual rates with 
160.29  vendors and may be reimbursed for actual costs up to the greater 
160.30  of the county's current approved rate or 60 percent of the 
160.31  maximum rate in fiscal year 1994 and 65 percent of the maximum 
160.32  rate in fiscal year 1995 for each alternative care service.  
160.33  Notwithstanding any other rule or statutory provision to the 
160.34  contrary, the commissioner shall not be authorized to increase 
160.35  rates by an annual inflation factor, unless so authorized by the 
160.36  legislature. 
161.1      ~~(f)~~ (e) On July 1, 1993, the commissioner shall increase 
161.2   the maximum rate for home delivered meals to $4.50 per meal. 
161.3      Sec. 7.  Minnesota Statutes 1996, section 256B.19, 
161.4   subdivision 1, is amended to read: 
161.5      Subdivision 1.  [DIVISION OF COST.] (a) The state and 
161.6   county share of medical assistance costs not paid by federal 
161.7   funds ~~shall be as follows:~~  
161.8      ~~(1) ninety percent state funds and ten percent county~~ 
161.9   ~~funds, unless otherwise provided below;~~ 
161.10     ~~(2)~~ beginning January 1, 1992, shall be 50 percent state 
161.11  funds and 50 percent county funds for the cost of placement of 
161.12  severely emotionally disturbed children in regional treatment 
161.13  centers.  
161.14     ~~For counties that participate in a Medicaid demonstration~~ 
161.15  ~~project under sections 256B.69 and 256B.71, the division of the~~ 
161.16  ~~nonfederal share of medical assistance expenses for payments~~ 
161.17  ~~made to prepaid health plans or for payments made to health~~ 
161.18  ~~maintenance organizations in the form of prepaid capitation~~ 
161.19  ~~payments, this division of medical assistance expenses shall be~~ 
161.20  ~~95 percent by the state and five percent by the county of~~ 
161.21  ~~financial responsibility.~~  
161.22     (b) In counties where prepaid health plans are under 
161.23  contract to the commissioner to provide services to medical 
161.24  assistance recipients, the cost of court ordered treatment 
161.25  ordered without consulting the prepaid health plan that does not 
161.26  include diagnostic evaluation, recommendation, and referral for 
161.27  treatment by the prepaid health plan is the responsibility of 
161.28  the county of financial responsibility.  
161.29     Sec. 8.  Minnesota Statutes 1996, section 256B.19, 
161.30  subdivision 2a, is amended to read: 
161.31     Subd. 2a.  [DIVISION OF COSTS.] ~~Beginning July 1, 1991, the~~ 
161.32  ~~state shall reimburse counties according to the payment schedule~~ 
161.33  ~~in section 256.025 for the nonfederal share of costs incurred~~ 
161.34  ~~for medical assistance common carrier transportation and related~~ 
161.35  ~~travel expenses provided for medical purposes to medical~~ 
161.36  ~~assistance recipients from January 1, 1991, on.  For purposes of~~ 
162.1   ~~this subdivision, transportation shall have the meaning given it~~ 
162.2   ~~in Code of Federal Regulations, title 42, section 440.170(a), as~~ 
162.3   ~~amended through October 1, 1987, and travel expenses shall have~~ 
162.4   ~~the meaning given in Code of Federal Regulations, title 42,~~ 
162.5   ~~section 440.170(a)(3), as amended through October 1, 1987.~~ 
162.6      The county shall ensure that only the least costly, most 
162.7   appropriate transportation and travel expenses are used.  The 
162.8   state may enter into volume purchase contracts, or use a 
162.9   competitive bidding process, whenever feasible, to minimize the 
162.10  costs of transportation services.  If the state has entered into 
162.11  a volume purchase contract or used the competitive bidding 
162.12  procedures of chapter 16B to arrange for transportation 
162.13  services, the county may be required to use such arrangements ~~to~~ 
162.14  ~~be eligible for state reimbursement of the 50 percent county~~ 
162.15  ~~share of medical assistance common carrier transportation and~~ 
162.16  ~~related travel expenses provided for medical purposes~~. 
162.17     Sec. 9.  Minnesota Statutes 1996, section 256B.19, 
162.18  subdivision 2b, is amended to read: 
162.19     Subd. 2b.  [PILOT PROJECT REIMBURSEMENT.] In counties where 
162.20  a pilot or demonstration project is operated under the medical 
162.21  assistance program, the state may pay 100 percent of the 
162.22  administrative costs for the pilot or demonstration project 
162.23  after June 30, 1990.  ~~Reimbursement for these costs is subject~~ 
162.24  ~~to section 256.025.~~ 
162.25     Sec. 10.  Minnesota Statutes 1996, section 256D.03, 
162.26  subdivision 2, is amended to read: 
162.27     Subd. 2.  ~~After December 31, 1980,~~ State aid shall be paid 
162.28  for ~~75 percent of~~ all general assistance and grants up to the 
162.29  standards of section 256D.01, subdivision 1a, and according to 
162.30  procedures established by the commissioner, except as provided 
162.31  for under section 256.017.  ~~Benefits shall be issued to~~ 
162.32  ~~recipients by the state or county and funded according to~~ 
162.33  ~~section 256.025, subdivision 3.~~  
162.34     ~~Beginning July 1, 1991, the state will reimburse counties~~ 
162.35  ~~according to the payment schedule in section 256.025 for the~~ 
162.36  ~~county share of county agency expenditures made under this~~ 
163.1   ~~subdivision from January 1, 1991, on.  Payment to counties under~~ 
163.2   ~~this subdivision is subject to the provisions of section 256.017.~~
163.3      Sec. 11.  Minnesota Statutes 1996, section 256D.03, 
163.4   subdivision 2a, is amended to read: 
163.5      Subd. 2a.  [COUNTY AGENCY OPTIONS.] Any county agency may, 
163.6   from its own resources, make payments of general assistance: (a) 
163.7   at a standard higher than that established by the commissioner 
163.8   without reference to the standards of section 256D.01, 
163.9   subdivision 1; or (b) to persons not meeting the eligibility 
163.10  standards set forth in section 256D.05, subdivision 1, but for 
163.11  whom the aid would further the purposes established in the 
163.12  general assistance program ~~in accordance with~~ according to rules 
163.13  adopted by the commissioner ~~pursuant~~ according to the 
163.14  administrative procedure act.  The Minnesota department of human 
163.15  services may maintain client records and issue these payments, 
163.16  providing the cost of benefits is paid by the counties to the 
163.17  department of human services ~~in accordance with~~ 
163.18  ~~sections~~ according to section 256.01 ~~and 256.025, subdivision 3~~. 
163.19     Sec. 12.  Minnesota Statutes 1996, section 256D.03, 
163.20  subdivision 6, is amended to read: 
163.21     Subd. 6.  [DIVISION OF COSTS.] The state share of county 
163.22  agency expenditures for general assistance medical care shall be 
163.23  ~~90~~ 100 percent ~~and the county share shall be ten percent~~.  
163.24  Payments made under this subdivision shall be made ~~in accordance~~ 
163.25  ~~with~~ according to sections 256B.041, subdivision 5 and 256B.19, 
163.26  subdivision 1.  In counties where a pilot or demonstration 
163.27  project is operated for general assistance medical care 
163.28  services, the state may pay 100 percent of the costs of 
163.29  administering the pilot or demonstration project.  ~~Reimbursement~~ 
163.30  ~~for these costs is subject to section 256.025.~~ 
163.31     ~~Beginning July 1, 1991, the state will reimburse counties~~ 
163.32  ~~according to the payment schedule in section 256.025 for the~~ 
163.33  ~~county share of costs incurred under this subdivision from~~ 
163.34  ~~January 1, 1991, on.  Payment to counties under this subdivision~~ 
163.35  ~~is subject to the provisions of section 256.017.~~ 
163.36     Notwithstanding any provision to the contrary, beginning 
164.1   July 1, 1991, the state shall pay 100 percent of the costs for 
164.2   centralized claims processing by the department of 
164.3   administration relative to claims beginning January 1, 1991, and 
164.4   submitted on behalf of general assistance medical care 
164.5   recipients by vendors in the general assistance medical care 
164.6   program. 
164.7      Beginning July 1, 1991, the state shall reimburse counties 
164.8   up to the limit of state appropriations for general assistance 
164.9   medical care common carrier transportation and related travel 
164.10  expenses provided for medical purposes after December 31, 1990.  
164.11  ~~Reimbursement shall be provided according to the payment~~ 
164.12  ~~schedule set forth in section 256.025.~~  For purposes of this 
164.13  subdivision, transportation shall have the meaning given it in 
164.14  Code of Federal Regulations, title 42, section 440.170(a), as 
164.15  amended through October 1, 1987, and travel expenses shall have 
164.16  the meaning given in Code of Federal Regulations, title 42, 
164.17  section 440.170(a)(3), as amended through October 1, 1987. 
164.18     The county shall ensure that only the least costly most 
164.19  appropriate transportation and travel expenses are used.  The 
164.20  state may enter into volume purchase contracts, or use a 
164.21  competitive bidding process, whenever feasible, to minimize the 
164.22  costs of transportation services.  If the state has entered into 
164.23  a volume purchase contract or used the competitive bidding 
164.24  procedures of chapter 16B to arrange for transportation 
164.25  services, the county may be required to use such arrangements to 
164.26  be eligible for state reimbursement for general assistance 
164.27  medical care common carrier transportation and related travel 
164.28  expenses provided for medical purposes. 
164.29     In counties where prepaid health plans are under contract 
164.30  to the commissioner to provide services to general assistance 
164.31  medical care recipients, the cost of court ordered treatment 
164.32  that does not include diagnostic evaluation, recommendation, or 
164.33  referral for treatment by the prepaid health plan is the 
164.34  responsibility of the county of financial responsibility. 
164.35     Sec. 13.  Minnesota Statutes 1996, section 256D.36, is 
164.36  amended to read: 
165.1      256D.36 [STATE PARTICIPATION.] 
165.2      Subdivision 1.  [STATE PARTICIPATION.] The state share of 
165.3   aid paid shall be ~~85~~ 100 percent. ~~and the county share shall be~~ 
165.4   ~~15 percent.  Benefits shall be issued to recipients by the state~~ 
165.5   ~~or county and funded according to section 256.025, subdivision~~ 
165.6   ~~3, subject to provisions of section 256.017.~~ 
165.7      ~~Beginning July 1, 1991, the state will reimburse counties~~ 
165.8   ~~according to the payment schedule in section 256.025 for the~~ 
165.9   ~~county share of county agency expenditures for financial~~ 
165.10  ~~benefits to individuals under this subdivision from January 1,~~ 
165.11  ~~1991, on.  Payment to counties under this subdivision is subject~~ 
165.12  ~~to the provisions of section 256.017.~~ 
165.13     Sec. 14.  [REPEALER.] 
165.14     Minnesota Statutes 1996, sections 256.026; 256.82, 
165.15  subdivision 1; 256B.041, subdivision 5; and 256B.19, subdivision 
165.16  1a, are repealed. 
165.17                             ARTICLE 7
165.18                    LIFE SKILLS SELF-SUFFICIENCY
165.19     Section 1.  [256B.095] [THREE-YEAR QUALITY ASSURANCE PILOT 
165.20  PROJECT ESTABLISHED.] 
165.21     Effective July 1, 1998, an alternative quality assurance 
165.22  licensing system pilot project for programs for persons with 
165.23  developmental disabilities is established in Dodge, Fillmore, 
165.24  Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 
165.25  Wabasha, and Winona counties for the purpose of improving the 
165.26  quality of services provided to persons with developmental 
165.27  disabilities.  A county, at its option, may choose to have all 
165.28  programs for persons with developmental disabilities located 
165.29  within the county licensed under chapter 245A using standards 
165.30  determined under the alternative quality assurance licensing 
165.31  system pilot project or may continue regulation of these 
165.32  programs under the licensing system operated by the 
165.33  commissioner.  The pilot project expires on June 30, 2001. 
165.34     Sec. 2.  [256B.0951] [QUALITY ASSURANCE COMMISSION.] 
165.35     Subdivision 1.  [MEMBERSHIP.] The region 10 quality 
165.36  assurance commission is established.  The commission consists of 
166.1   at least 13 but not more than 20 members as follows:  at least 
166.2   three but not more than five members representing advocacy 
166.3   organizations; at least three but not more than five members 
166.4   representing consumers, families, and their legal 
166.5   representatives; at least three but not more than five members 
166.6   representing service providers; and at least three but not more 
166.7   than five members representing counties.  Initial membership of 
166.8   the commission shall be recruited and approved by the region 10 
166.9   stakeholders group.  Prior to approving the commission's 
166.10  membership, the stakeholders group shall provide to the 
166.11  commissioner a list of the membership in the stakeholders group, 
166.12  as of February 1, 1997, a brief summary of meetings held by the 
166.13  group since July 1, 1996, and copies of any materials prepared 
166.14  by the group for public distribution.  The first commission 
166.15  shall establish membership guidelines for the transition and 
166.16  recruitment of membership for the commission's ongoing 
166.17  existence.  Members of the commission who do not receive a 
166.18  salary or wages from an employer for time spent on commission 
166.19  duties may receive a per diem payment when performing commission 
166.20  duties and functions.  All members may be reimbursed for 
166.21  expenses related to commission activities.  Notwithstanding the 
166.22  provisions of section 15.059, subdivision 5, the commission 
166.23  expires on June 30, 2001. 
166.24     Subd. 2.  [AUTHORITY TO HIRE STAFF.] The commission may 
166.25  hire staff to perform the duties assigned in this section.  
166.26     Subd. 3.  [COMMISSION DUTIES.] (a) By October 1, 1997, the 
166.27  commission, in cooperation with the commissioners of human 
166.28  services and health, shall do the following:  (1) approve an 
166.29  alternative quality assurance licensing system based on the 
166.30  evaluation of outcomes; (2) approve measurable outcomes in the 
166.31  areas of health and safety, consumer evaluation, education and 
166.32  training, providers, and systems that shall be evaluated during 
166.33  the alternative licensing process; and (3) establish variable 
166.34  licensure periods not to exceed three years based on outcomes 
166.35  achieved.  For purposes of this subdivision, "outcome" means the 
166.36  behavior, action, or status of a person that can be observed or 
167.1   measured and can be reliably and validly determined. 
167.2      (b) By January 15, 1998, the commission shall approve, in 
167.3   cooperation with the commissioner of human services, a training 
167.4   program for members of the quality assurance teams established 
167.5   under section 256B.0952, subdivision 4. 
167.6      Subd. 4.  [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 
167.7   LICENSING STANDARDS.] The commission may recommend to the 
167.8   commissioners of human services and health variances from the 
167.9   standards governing licensure of programs for persons with 
167.10  developmental disabilities in order to implement an alternative 
167.11  developmental disabilities licensing system if the commission 
167.12  determines that the alternative licensing system does not affect 
167.13  the health or safety of persons being served by the licensed 
167.14  program nor compromise the qualifications of staff to provide 
167.15  services. 
167.16     Subd. 5.  [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 
167.17  safety standards, rights, or procedural protections under 
167.18  sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 
167.19  3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 
167.20  and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 
167.21  subdivisions 1b, clause (7), and 10; 626.556; 626.557, or 
167.22  procedures for the monitoring of psychotropic medications shall 
167.23  not be varied under the alternative licensing system pilot 
167.24  project.  The commission may make recommendations to the 
167.25  commissioners of human services and health or to the legislature 
167.26  regarding alternatives to or modifications of the rules 
167.27  referenced in this subdivision. 
167.28     Subd. 6.  [PROGRESS REPORT.] The commission shall submit a 
167.29  progress report to the legislature on pilot project development 
167.30  by January 15, 1998.  The report shall include recommendations 
167.31  on any legislative changes necessary to improve cooperation 
167.32  between the commission and the commissioners of human services 
167.33  and health. 
167.34     Sec. 3.  [256B.0952] [COUNTY DUTIES; QUALITY ASSURANCE 
167.35  TEAMS.] 
167.36     Subdivision 1.  [NOTIFICATION.] By January 15, 1998, each 
168.1   affected county shall notify the commission and the 
168.2   commissioners of human services and health as to whether it 
168.3   chooses to implement on July 1, 1998, the alternative licensing 
168.4   system for the pilot project.  A county that does not implement 
168.5   the alternative licensing system on July 1, 1998, may give 
168.6   notice to the commission and the commissioners by January 15, 
168.7   1999, or January 15, 2000, that it will implement the 
168.8   alternative licensing system on the following July 1.  A county 
168.9   that implements the alternative licensing system commits to 
168.10  participate until June 30, 2001.  
168.11     Subd. 2.  [APPOINTMENT OF REVIEW COUNCIL; DUTIES OF 
168.12  COUNCIL.] A county or group of counties that choose to 
168.13  participate in the alternative licensing system shall appoint a 
168.14  quality assurance review council comprised of advocates; 
168.15  consumers, families, and their legal representatives; providers; 
168.16  and county staff.  The council shall: 
168.17     (1) review summary reports from quality assurance team 
168.18  reviews and make recommendations to counties regarding program 
168.19  licensure; 
168.20     (2) make recommendations to the commission regarding the 
168.21  alternative licensing system and quality assurance process; and 
168.22     (3) resolve complaints between the quality assurance teams, 
168.23  counties, providers, and consumers, families, and their legal 
168.24  representatives. 
168.25     Subd. 3.  [NOTICE TO COMMISSIONERS.] The county, based on 
168.26  reports from quality assurance managers and recommendations from 
168.27  the quality assurance review council regarding the findings of 
168.28  quality assurance teams, shall notify the commissioners of human 
168.29  services and health regarding whether facilities, programs, or 
168.30  services have met the outcome standards for licensure and are 
168.31  eligible for payment. 
168.32     Subd. 4.  [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 
168.33  county or group of counties that choose to participate in the 
168.34  alternative licensing system shall designate a quality assurance 
168.35  manager and shall establish quality assurance teams according to 
168.36  subdivision 5.  The manager shall recruit, train, and assign 
169.1   duties to the quality assurance team members.  In assigning team 
169.2   members to conduct the quality assurance process at a facility, 
169.3   program, or service, the manager shall take into account the 
169.4   size of the service provider, the number of services to be 
169.5   reviewed, the skills necessary for team members to complete the 
169.6   process, and other relevant factors.  The manager shall ensure 
169.7   that no team member has a financial, personal, or family 
169.8   relationship with the facility, program, or service being 
169.9   reviewed or with any clients of the facility, program, or 
169.10  service. 
169.11     (b) Quality assurance teams shall report the findings of 
169.12  their quality assurance reviews to the quality assurance manager.
169.13  The quality assurance manager shall provide the report from the 
169.14  quality assurance team to the county and commissioners of human 
169.15  services and health and a summary of the report to the quality 
169.16  assurance review council.  
169.17     Subd. 5.  [QUALITY ASSURANCE TEAMS.] Quality assurance 
169.18  teams shall be comprised of county staff; providers; consumers, 
169.19  families, and their legal representatives; members of advocacy 
169.20  organizations; and other involved community members.  Team 
169.21  members must satisfactorily complete the training program 
169.22  approved by the commission and must demonstrate 
169.23  performance-based competency.  Team members are not considered 
169.24  to be county employees for purposes of workers' compensation, 
169.25  unemployment compensation, or state retirement laws solely on 
169.26  the basis of participation on a quality assurance team.  The 
169.27  county may pay a per diem to team members who do not receive a 
169.28  salary or wages from an employer for time spent on alternative 
169.29  quality assurance process matters.  All team members may be 
169.30  reimbursed for expenses related to their participation in the 
169.31  alternative process. 
169.32     Subd. 6.  [LICENSING FUNCTIONS.] Participating counties 
169.33  shall perform licensing functions and activities as delegated by 
169.34  the commissioner of human services according to section 245A.16. 
169.35     Sec. 4.  [256B.0953] [QUALITY ASSURANCE PROCESS.] 
169.36     Subdivision 1.  [PROCESS COMPONENTS.] (a) The quality 
170.1   assurance licensing process consists of an evaluation by a 
170.2   quality assurance team of the facility, program, or service 
170.3   according to outcome-based measurements.  The process must 
170.4   include an evaluation of a random sample of program consumers.  
170.5   The sample must be representative of each service provided.  The 
170.6   sample size must be at least five percent of consumers but not 
170.7   less than three consumers.  
170.8      (b) All consumers must be given the opportunity to be 
170.9   included in the quality assurance process in addition to those 
170.10  chosen for the random sample. 
170.11     Subd. 2.  [LICENSURE PERIODS.] (a) In order to be licensed 
170.12  under the alternative quality assurance process, a facility, 
170.13  program, or service must satisfy the health and safety outcomes 
170.14  approved for the pilot project. 
170.15     (b) Licensure shall be approved for periods of one to three 
170.16  years for a facility, program, or service that satisfies the 
170.17  requirements of paragraph (a) and achieves the outcome 
170.18  measurements in the categories of consumer evaluation, education 
170.19  and training, providers, and systems. 
170.20     Subd. 3.  [APPEALS PROCESS.] A facility, program, or 
170.21  service may contest a licensing decision of the quality 
170.22  assurance team as permitted under chapter 245A. 
170.23     Sec. 5.  [256B.0954] [CERTAIN PERSONS DEFINED AS MANDATED 
170.24  REPORTERS.] 
170.25     Members of the quality assurance commission established 
170.26  under section 7, members of quality assurance review councils 
170.27  established under section 8, quality assurance managers 
170.28  appointed under section 8, and members of quality assurance 
170.29  teams established under section 8 are mandated reporters as that 
170.30  term is defined in sections 626.556, subdivision 3, and 
170.31  626.5572, subdivision 16. 
170.32     Sec. 6.  [256B.0955] [DUTIES OF THE COMMISSIONER OF HUMAN 
170.33  SERVICES.] 
170.34     (a) Effective July 1, 1998, the commissioner of human 
170.35  services shall delegate authority to perform licensing functions 
170.36  and activities, according to section 245A.16, to counties 
171.1   participating in the alternative licensing system.  The 
171.2   commissioner shall not license or reimburse a facility, program, 
171.3   or service for persons with developmental disabilities in a 
171.4   county that participates in the alternative licensing system if 
171.5   the commissioner has received from the appropriate county 
171.6   notification that the facility, program, or service has been 
171.7   reviewed by a quality assurance team and has failed to qualify 
171.8   for licensure. 
171.9      (b) The commissioner may conduct random licensing 
171.10  inspections based on outcomes adopted under section 7 at 
171.11  facilities, programs, and services governed by the alternative 
171.12  licensing system.  The role of such random inspections shall be 
171.13  to verify that the alternative licensing system protects the 
171.14  safety and well-being of consumers and maintains the 
171.15  availability of high-quality services for persons with 
171.16  developmental disabilities.  
171.17     (c) The commissioner shall provide technical assistance and 
171.18  support or training to the alternative licensing system pilot 
171.19  project. 
171.20     (d) The commissioner and the commission shall establish an 
171.21  ongoing evaluation process for the alternative licensing system. 
171.22     (e) The commissioner shall contract with an independent 
171.23  entity to conduct a financial review of the alternative 
171.24  licensing system, including an evaluation of possible budgetary 
171.25  savings within the department of human services and the 
171.26  department of health as a result of implementation of the 
171.27  alternative quality assurance licensing system.  This review 
171.28  must be completed by December 15, 2000.  
171.29     (f) The commissioner and the commission shall submit a 
171.30  report to the legislature by January 15, 2001, on the results of 
171.31  the evaluation process of the alternative licensing system, a 
171.32  summary of the results of the independent financial review, and 
171.33  a recommendation on whether the pilot project should be extended 
171.34  beyond June 30, 2001. 
171.35     Sec. 7.  [REQUEST FOR WAIVER.] 
171.36     By January 1, 1998, the commissioner of human services or 
172.1   health shall request a waiver from the federal Department of 
172.2   Health and Human Services to permit the use of the alternative 
172.3   quality assurance system to license and certify intermediate 
172.4   care facilities for persons with mental retardation. 
172.5                              ARTICLE 8
172.6        COMMUNITY MENTAL HEALTH AND REGIONAL TREATMENT CENTERS
172.7      Section 1.  Minnesota Statutes 1996, section 246.02, 
172.8   subdivision 2, is amended to read: 
172.9      Subd. 2.  The commissioner of human services shall act with 
172.10  the advice of the medical policy directional committee on mental 
172.11  health in the appointment and removal of the chief executive 
172.12  officers of the following institutions:  Anoka-Metro Regional 
172.13  Treatment Center, Ah-Gwah-Ching Center, Fergus Falls Regional 
172.14  Treatment Center, St. Peter Regional Treatment Center and 
172.15  Minnesota Security Hospital, Willmar Regional Treatment Center, 
172.16  ~~Faribault Regional Center,~~ Cambridge Regional Human Services 
172.17  Center, Brainerd Regional Human Services Center, ~~and until June~~ 
172.18  ~~30, 1995, Moose Lake Regional Treatment Center, and after June~~ 
172.19  ~~30, 1995,~~ Minnesota Sexual Psychopathic Personality Treatment 
172.20  Center and until June 30, 1998, Faribault Regional Center. 
172.21     Sec. 2.  Minnesota Statutes 1996, section 252.025, 
172.22  subdivision 1, is amended to read: 
172.23     Subdivision 1.  [REGIONAL TREATMENT CENTERS.] State 
172.24  hospitals for persons with mental retardation shall be 
172.25  established and maintained at Faribault until June 30, 1998, 
172.26  Cambridge and Brainerd, and notwithstanding any provision to the 
172.27  contrary they shall be respectively known as the Faribault 
172.28  regional center, the Cambridge regional human services center, 
172.29  and the Brainerd regional human services center.  Each of the 
172.30  foregoing state hospitals shall also be known by the name of 
172.31  regional center at the discretion of the commissioner of human 
172.32  services.  The terms "human services" or "treatment" may be 
172.33  included in the designation. 
172.34     Sec. 3.  Minnesota Statutes 1996, section 252.025, 
172.35  subdivision 4, is amended to read: 
172.36     Subd. 4.  [STATE-PROVIDED SERVICES.] (a) It is the policy 
173.1   of the state to capitalize and recapitalize the regional 
173.2   treatment centers as necessary to prevent depreciation and 
173.3   obsolescence of physical facilities and to ensure they retain 
173.4   the physical capability to provide residential programs.  
173.5   Consistent with that policy and with section 252.50, and within 
173.6   the limits of appropriations made available for this purpose, 
173.7   the commissioner may establish, by June 30, 1991, the following 
173.8   state-operated, community-based programs for the least 
173.9   vulnerable regional treatment center residents:  at Brainerd 
173.10  regional services center, two residential programs and two day 
173.11  programs; at Cambridge regional treatment center, four 
173.12  residential programs and two day programs; at Faribault regional 
173.13  treatment center, ten residential programs and six day programs; 
173.14  at Fergus Falls regional treatment center, two residential 
173.15  programs and one day program; at Moose Lake regional treatment 
173.16  center, four residential programs and two day programs; and at 
173.17  Willmar regional treatment center, two residential programs and 
173.18  one day program. 
173.19     (b) By January 15, 1991, the commissioner shall report to 
173.20  the legislature a plan to provide continued regional treatment 
173.21  center capacity and state-operated, community-based residential 
173.22  and day programs for persons with developmental disabilities at 
173.23  Brainerd, Cambridge, ~~Faribault,~~ Fergus Falls, St. Peter, and 
173.24  Willmar, as follows: 
173.25     (1) by July 1, 1998, continued regional treatment center 
173.26  capacity to serve 350 persons with developmental disabilities as 
173.27  follows:  at Brainerd, 80 persons; at Cambridge, 12 persons; ~~at~~ 
173.28  ~~Faribault, 110 persons;~~ at Fergus Falls, 60 persons; at St. 
173.29  Peter, 35 persons; at Willmar, 25 persons; and up to 16 crisis 
173.30  beds in the Twin Cities metropolitan area; and 
173.31     (2) by July 1, 1999, continued regional treatment center 
173.32  capacity to serve 254 persons with developmental disabilities as 
173.33  follows:  at Brainerd, 57 persons; at Cambridge, 12 persons; ~~at~~ 
173.34  ~~Faribault, 80 persons;~~ at Fergus Falls, 35 persons; at St. 
173.35  Peter, 30 persons; at Willmar, 12 persons, and up to 16 crisis 
173.36  beds in the Twin Cities metropolitan area.  In addition, the 
174.1   plan shall provide for the capacity to provide residential 
174.2   services to 570 persons with developmental disabilities in 95 
174.3   state-operated, community-based residential programs. 
174.4      The commissioner is subject to a mandamus action under 
174.5   chapter 586 for any failure to comply with the provisions of 
174.6   this subdivision. 
174.7      Sec. 4.  Minnesota Statutes 1996, section 254B.02, 
174.8   subdivision 1, is amended to read: 
174.9      Subdivision 1.  [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.] 
174.10  The chemical dependency funds appropriated for allocation shall 
174.11  be placed in a special revenue account.  ~~For the fiscal year~~ 
174.12  ~~beginning July 1, 1987, funds shall be transferred to operate~~ 
174.13  ~~the vendor payment, invoice processing, and collections system~~ 
174.14  ~~for one year.~~  The commissioner shall annually transfer funds 
174.15  from the chemical dependency fund to pay for operation of the 
174.16  drug and alcohol abuse normative evaluation system and to pay 
174.17  for all costs incurred by adding two positions for licensing of 
174.18  chemical dependency treatment and rehabilitation programs 
174.19  located in hospitals for which funds are not otherwise 
174.20  appropriated.  For each year of the biennium ending June 30, 
174.21  1999, the commissioner shall allocate funds to the American 
174.22  Indian chemical dependency tribal account for treatment of 
174.23  American Indians by eligible vendors under section 254B.05, 
174.24  equal to the amount allocated in fiscal year 1997.  The 
174.25  commissioner shall annually divide the money available in the 
174.26  chemical dependency fund that is not held in reserve by counties 
174.27  from a previous allocation, or allocated to the American Indian 
174.28  chemical dependency tribal account.  ~~Twelve~~ Six percent of the 
174.29  remaining money must be reserved for the nonreservation American 
174.30  Indian chemical dependency allocation for treatment of American 
174.31  Indians by eligible vendors under section 254B.05, subdivision 
174.32  1.  The remainder of the money must be allocated among the 
174.33  counties according to the following formula, using state 
174.34  demographer data and other data sources determined by the 
174.35  commissioner: 
174.36     (a) For purposes of this formula, American Indians and 
175.1   children under age 14 are subtracted from the population of each 
175.2   county to determine the restricted population. 
175.3      (b) The amount of chemical dependency fund expenditures for 
175.4   entitled persons for services not covered by prepaid plans 
175.5   governed by section 256B.69 in the previous year is divided by 
175.6   the amount of chemical dependency fund expenditures for entitled 
175.7   persons for all services to determine the proportion of exempt 
175.8   service expenditures for each county. 
175.9      (c) The prepaid plan months of eligibility is multiplied by 
175.10  the proportion of exempt service expenditures to determine the 
175.11  adjusted prepaid plan months of eligibility for each county. 
175.12     (d) The adjusted prepaid plan months of eligibility is 
175.13  added to the number of restricted population fee for service 
175.14  months of eligibility for aid to families with dependent 
175.15  children, general assistance, and medical assistance and divided 
175.16  by the county restricted population to determine county per 
175.17  capita months of covered service eligibility. 
175.18     (e) The number of adjusted prepaid plan months of 
175.19  eligibility for the state is added to the number of fee for 
175.20  service months of eligibility for aid to families with dependent 
175.21  children, general assistance, and medical assistance for the 
175.22  state restricted population and divided by the state restricted 
175.23  population to determine state per capita months of covered 
175.24  service eligibility. 
175.25     (f) The county per capita months of covered service 
175.26  eligibility is divided by the state per capita months of covered 
175.27  service eligibility to determine the county welfare caseload 
175.28  factor. 
175.29     (g) The median married couple income for the most recent 
175.30  three-year period available for the state is divided by the 
175.31  median married couple income for the same period for each county 
175.32  to determine the income factor for each county. 
175.33     (h) The county restricted population is multiplied by the 
175.34  sum of the county welfare caseload factor and the county income 
175.35  factor to determine the adjusted population. 
175.36     (i) $15,000 shall be allocated to each county.  
176.1      (j) The remaining funds shall be allocated proportional to 
176.2   the county adjusted population. 
176.3      Sec. 5.  Minnesota Statutes 1996, section 254B.09, 
176.4   subdivision 4, is amended to read: 
176.5      Subd. 4.  [TRIBAL ALLOCATION.] ~~Forty-two and one-half~~ 
176.6   Eighty-five percent of the American Indian chemical dependency 
176.7   tribal account must be allocated to the federally recognized 
176.8   American Indian tribal governing bodies that have entered into 
176.9   an agreement under subdivision 2 as follows:  $10,000 must be 
176.10  allocated to each governing body and the remainder must be 
176.11  allocated in direct proportion to the population of the 
176.12  reservation according to the most recently available estimates 
176.13  from the federal Bureau of Indian Affairs.  When a tribal 
176.14  governing body has not entered into an agreement with the 
176.15  commissioner under subdivision 2, the county may use funds 
176.16  allocated to the reservation to pay for chemical dependency 
176.17  services for a current resident of the county and of the 
176.18  reservation. 
176.19     Sec. 6.  Minnesota Statutes 1996, section 254B.09, 
176.20  subdivision 5, is amended to read: 
176.21     Subd. 5.  [TRIBAL RESERVE ACCOUNT.] The commissioner shall 
176.22  reserve ~~7.5~~ 15 percent of the American Indian chemical 
176.23  dependency tribal account.  The reserve must be allocated to 
176.24  those tribal units that have used all money allocated under 
176.25  subdivision 4 according to agreements made under subdivision 2 
176.26  and to counties submitting invoices for American Indians under 
176.27  subdivision 1 when all money allocated under subdivision 4 has 
176.28  been used.  An American Indian tribal governing body or a county 
176.29  submitting invoices under subdivision 1 may receive not more 
176.30  than 30 percent of the reserve account in a year.  The 
176.31  commissioner may refuse to make reserve payments for persons not 
176.32  eligible under section 254B.04, subdivision 1, if the tribal 
176.33  governing body responsible for treatment placement has exhausted 
176.34  its allocation.  Money must be allocated as invoices are 
176.35  received. 
176.36     Sec. 7.  Minnesota Statutes 1996, section 254B.09, 
177.1   subdivision 7, is amended to read: 
177.2      Subd. 7.  [NONRESERVATION INDIAN ACCOUNT.] ~~Fifty percent of~~ 
177.3   The nonreservation American Indian chemical dependency 
177.4   allocation must be held in reserve by the commissioner in an 
177.5   account for treatment of Indians not residing on lands of a 
177.6   reservation receiving money under subdivision 4.  This money 
177.7   must be used to pay for services certified by county invoice to 
177.8   have been provided to an American Indian eligible recipient.  
177.9   Money allocated under this subdivision may be used for payments 
177.10  on behalf of American Indian county residents only if, in 
177.11  addition to other placement standards, the county certifies that 
177.12  the placement was appropriate to the cultural orientation of the 
177.13  client.  Any funds for treatment of nonreservation Indians 
177.14  remaining at the end of a fiscal year shall be reallocated under 
177.15  section 254B.02. 
177.16     Sec. 8.  Laws 1995, chapter 207, article 8, section 41, 
177.17  subdivision 2, is amended to read: 
177.18     Subd. 2.  [PROGRAM DESIGN AND IMPLEMENTATION.] (a) The 
177.19  pilot projects shall be established to design, plan, and improve 
177.20  the mental health service delivery system for adults with 
177.21  serious and persistent mental illness that would: 
177.22     (1) provide an expanded array of services from which 
177.23  clients can choose services appropriate to their needs; 
177.24     (2) be based on purchasing strategies that improve access 
177.25  and coordinate services without cost shifting; 
177.26     (3) incorporate existing state facilities and resources 
177.27  into the community mental health infrastructure through creative 
177.28  partnerships with local vendors; and 
177.29     (4) utilize existing categorical funding streams and 
177.30  reimbursement sources in combined and creative ways, except 
177.31  appropriations to regional treatment centers and all funds that 
177.32  are attributable to the operation of state-operated services are 
177.33  excluded unless appropriated specifically by the legislature for 
177.34  a purpose consistent with this section. 
177.35     (b) All projects funded by January 1, 1997, must complete 
177.36  ~~their~~ the planning phase and be operational by June 30, 1997; 
178.1   all projects funded by January 1, 1998, must be operational by 
178.2   June 30, 1998. 
178.3                              ARTICLE 9
178.4             HUMAN SERVICES TECHNICAL AND POLICY CHANGES
178.5      Section 1.  Minnesota Statutes 1996, section 16A.124, 
178.6   subdivision 4b, is amended to read: 
178.7      Subd. 4b.  [HEALTH CARE PAYMENTS.] The commissioner of 
178.8   human services must pay or deny a valid vendor obligation for 
178.9   health services under the medical assistance, general assistance 
178.10  medical care, or MinnesotaCare program within 30 days after 
178.11  receipt.  A "valid vendor obligation" means a clean claim 
178.12  submitted directly to the commissioner by an eligible health 
178.13  care provider for health services provided to an eligible 
178.14  recipient.  A "clean claim" means an original paper or 
178.15  electronic claim with correct data elements, prepared in 
178.16  accordance with the commissioner's published specifications for 
178.17  claim preparation, that does not require an attachment or text 
178.18  information to pay or deny the claim.  Adjustment claims, claims 
178.19  with attachments and text information, and claims submitted to 
178.20  the commissioner as the secondary or tertiary payer, that have 
178.21  been prepared in accordance with the commissioner's published 
178.22  specifications, must be adjudicated within 90 days after 
178.23  receipt.  For purposes of this subdivision, paragraphs (a) to (c)
178.24  shall apply. 
178.25     (a) The rate of interest paid by the agency shall be the 
178.26  rate set by the treasury department for Medicare intermediaries 
178.27  paying interest on Medicare claims failing the prompt payment 
178.28  requirements established by the health care financing 
178.29  administration. 
178.30     (b) The agency is not required to make an interest penalty 
178.31  payment of less than $2. 
178.32     (c) The agency is not required to make an interest penalty 
178.33  payment on claims for which payment has been delayed for 
178.34  purposes of review by the attorney general of potentially 
178.35  fraudulent or abusive billing practices.  Interest must be paid 
178.36  for claims that are delayed with no eventual finding of fraud or 
179.1   abuse. 
179.2      Sec. 2.  Minnesota Statutes 1996, section 62D.04, 
179.3   subdivision 5, is amended to read: 
179.4      Subd. 5.  [PARTICIPATION; GOVERNMENT PROGRAMS.] Health 
179.5   maintenance organizations shall, as a condition of receiving and 
179.6   retaining a certificate of authority, participate in the medical 
179.7   assistance, general assistance medical care, and MinnesotaCare 
179.8   programs.  A health maintenance organization is required to 
179.9   submit proposals in good faith that meet the requirements of the 
179.10  request for proposal provided that the requirements can be 
179.11  reasonably met by a health maintenance organization to serve 
179.12  individuals eligible for the above programs in a geographic 
179.13  region of the state if, at the time of publication of a request 
179.14  for proposal, the percentage of recipients in the public 
179.15  programs in the region who are enrolled in the health 
179.16  maintenance organization is less than the health maintenance 
179.17  organization's percentage of the total number of individuals 
179.18  enrolled in health maintenance organizations in the same 
179.19  region.  Geographic regions shall be defined by the commissioner 
179.20  of human services in the request for proposals. 
179.21     Sec. 3.  Minnesota Statutes 1996, section 144.0721, 
179.22  subdivision 3, is amended to read: 
179.23     Subd. 3.  [LEVEL OF CARE CRITERIA; MODIFICATIONS.] The 
179.24  commissioner shall seek appropriate federal waivers to implement 
179.25  this subdivision.  Notwithstanding any laws or rules to the 
179.26  contrary, effective July 1, ~~1996~~ 1998, Minnesota's level of care 
179.27  criteria for admission of any person to a nursing facility 
179.28  licensed under chapter 144A, or a boarding care home licensed 
179.29  under sections 144.50 to 144.56, are modified as follows: 
179.30     (1) the resident reimbursement classifications and 
179.31  terminology established by rule under sections 256B.41 to 
179.32  256B.48 are the basis for applying the level of care criteria 
179.33  changes; 
179.34     (2) an applicant to a certified nursing facility or 
179.35  certified boarding care home who is dependent in zero, one, or 
179.36  two case mix activities of daily living, is classified as a case 
180.1   mix A, and is independent in orientation and self-preservation, 
180.2   is reclassified as a high function class A person and is not 
180.3   eligible for admission to Minnesota certified nursing facilities 
180.4   or certified boarding care homes; 
180.5      (3) applicants in clause (2) who are dependent in one or 
180.6   two case mix activities of daily living, who are eligible for 
180.7   assistance as determined under sections 256B.055 and 256B.056 or 
180.8   meet eligibility criteria for section 256B.0913 are eligible for 
180.9   a service allowance under section 256B.0913, subdivision 15, and 
180.10  are not eligible for services under sections 256B.0913, 
180.11  subdivisions 1 to 14, and 256B.0915.  ~~Applicants in clause (2)~~ 
180.12  ~~shall have the option of receiving personal care assistant and~~ 
180.13  ~~home health aide services under section 256B.0625, if otherwise~~ 
180.14  ~~eligible, or of receiving the service allowance option, but not~~ 
180.15  ~~both.~~  Applicants in clause (2) shall have the option of 
180.16  residing in community settings under sections 256I.01 to 
180.17  256I.06, if otherwise eligible, or receiving the services 
180.18  allowance option under section 256B.0913, subdivision 15, but 
180.19  not both; 
180.20     (4) residents of a certified nursing facility or certified 
180.21  boarding care home who were admitted before July 1, ~~1996~~ 1997, 
180.22  or individuals receiving services under section 256B.0913, 
180.23  subdivisions 1 to 14, or 256B.0915, before July 1, ~~1996~~ 1997, 
180.24  are not subject to the new level of care criteria unless the 
180.25  resident is discharged home or to another service setting other 
180.26  than a certified nursing facility or certified boarding care 
180.27  home and applies for admission to a certified nursing facility 
180.28  or certified boarding care home after June 30, ~~1996~~ 1997; 
180.29     (5) the local screening teams under section 256B.0911 ~~shall~~ 
180.30  ~~make preliminary determinations concerning~~ may determine the 
180.31  existence of extraordinary circumstances which render 
180.32  nonadmission to a certified nursing or certified boarding care 
180.33  home a serious threat to the health and safety of applicants in 
180.34  clause (2) and may authorize ~~an~~ admission ~~for a short-term stay~~ 
180.35  ~~at~~ to a certified nursing facility or certified boarding care 
180.36  home in accordance with a treatment and discharge plan ~~for up to~~ 
181.1   ~~30 days per year~~; and 
181.2      (6) an individual deemed ineligible for admission to 
181.3   Minnesota certified nursing facilities is entitled to an appeal 
181.4   under section 256.045, subdivision 3. 
181.5      If the commissioner determines upon appeal that an 
181.6   applicant in clause (2) presents extraordinary circumstances 
181.7   including but not limited to the absence or inaccessibility of 
181.8   suitable alternatives, contravening family circumstances, ~~and~~ or 
181.9   protective service issues, the applicant may be eligible for 
181.10  admission to Minnesota certified nursing facilities or certified 
181.11  boarding care homes. 
181.12     Sec. 4.  Minnesota Statutes 1996, section 245.03, 
181.13  subdivision 2, is amended to read: 
181.14     Subd. 2.  [MISSION; EFFICIENCY.] It is part of the 
181.15  department's mission that within the department's resources the 
181.16  commissioner shall endeavor to: 
181.17     (1) prevent the waste or unnecessary spending of public 
181.18  money; 
181.19     (2) use innovative fiscal and human resource practices to 
181.20  manage the state's resources and operate the department as 
181.21  efficiently as possible, including the authority to consolidate 
181.22  different nonentitlement grant programs, having similar 
181.23  functions or serving similar populations, as may be determined 
181.24  by the commissioner, while protecting the original purposes of 
181.25  the programs.  With approval of the commissioner, vendors who 
181.26  are eligible for funding from any of the commissioner's granting 
181.27  authority under section 256.01, subdivision 2, paragraph (1), 
181.28  clause (f), may submit a single application for a grant 
181.29  agreement including multiple awards; 
181.30     (3) coordinate the department's activities wherever 
181.31  appropriate with the activities of other governmental agencies; 
181.32     (4) use technology where appropriate to increase agency 
181.33  productivity, improve customer service, increase public access 
181.34  to information about government, and increase public 
181.35  participation in the business of government; 
181.36     (5) utilize constructive and cooperative labor-management 
182.1   practices to the extent otherwise required by chapters 43A and 
182.2   179A; 
182.3      (6) include specific objectives in the performance report 
182.4   required under section 15.91 to increase the efficiency of 
182.5   agency operations, when appropriate; and 
182.6      (7) recommend to the legislature, in the performance report 
182.7   of the department required under section 15.91, appropriate 
182.8   changes in law necessary to carry out the mission of the 
182.9   department. 
182.10     Sec. 5.  Minnesota Statutes 1996, section 245.652, 
182.11  subdivision 1, is amended to read: 
182.12     Subdivision 1.  [PURPOSE.] The regional treatment centers 
182.13  shall provide services designed to end a person's reliance on 
182.14  chemical use or a person's chemical abuse and increase effective 
182.15  and chemical-free functioning.  Clinically effective programs 
182.16  must be provided in accordance with section 246.64.  Services 
182.17  may be offered on the regional center campus or at sites 
182.18  elsewhere in the ~~catchment~~ area served by the regional treatment 
182.19  center. 
182.20     Sec. 6.  Minnesota Statutes 1996, section 245.652, 
182.21  subdivision 2, is amended to read: 
182.22     Subd. 2.  [SERVICES OFFERED.] Services provided ~~must~~ may 
182.23  include, but are not limited to, the following: 
182.24     (1) primary and extended residential care, including 
182.25  residential treatment programs of varied duration intended to 
182.26  deal with a person's chemical dependency or chemical abuse 
182.27  problems; 
182.28     (2) follow-up care to persons discharged from regional 
182.29  treatment center programs or other chemical dependency programs; 
182.30     (3) outpatient treatment programs; and 
182.31     (4) other treatment services, as appropriate and as 
182.32  provided under contract or shared service agreements. 
182.33     Sec. 7.  Minnesota Statutes 1996, section 245.98, is 
182.34  amended by adding a subdivision to read: 
182.35     Subd. 5.  [STANDARDS.] The commissioner shall create 
182.36  standards for treatment and provider qualifications for the 
183.1   treatment component of the compulsive gambling program. 
183.2      Sec. 8.  Minnesota Statutes 1996, section 252.025, is 
183.3   amended by adding a subdivision to read: 
183.4      Subd. 7.  [MINNESOTA EXTENDED TREATMENT OPTIONS.] The 
183.5   commissioner shall develop by July 1, 1997, the Minnesota 
183.6   extended treatment options to serve Minnesotans who have mental 
183.7   retardation and exhibit severe behaviors which present a risk to 
183.8   public safety.  This program will provide specialized 
183.9   residential services on the Cambridge campus and an array of 
183.10  community support services statewide. 
183.11     Sec. 9.  [252.294] [CRITERIA FOR DOWNSIZING OF FACILITIES.] 
183.12     The commissioner of human services shall develop a process 
183.13  to evaluate and rank proposals for the voluntary downsizing or 
183.14  closure of intermediate care facilities for persons with mental 
183.15  retardation or related conditions using the following guidelines:
183.16     (1) the extent to which the option matches overall policy 
183.17  direction of the department; 
183.18     (2) the extent to which the option demonstrates respect for 
183.19  individual needs and allows implementation of individual choice; 
183.20     (3) the extent to which the option addresses safety, 
183.21  privacy, and other programmatic issues; 
183.22     (4) the extent to which the option appropriately redesigns 
183.23  the overall community capacity; and 
183.24     (5) the cost of each option. 
183.25     The process shall, to the extent feasible, be modeled on 
183.26  the nursing home moratorium exception process, including 
183.27  procedures for administrative evaluation and approval of 
183.28  projects within the limit of appropriations made available by 
183.29  the legislature. 
183.30     Sec. 10.  Minnesota Statutes 1996, section 252.32, 
183.31  subdivision 1a, is amended to read: 
183.32     Subd. 1a.  [SUPPORT GRANTS.] (a) Provision of support 
183.33  grants must be limited to families who require support and whose 
183.34  dependents are under the age of 22 and who have mental 
183.35  retardation or who have a related condition and who have been 
183.36  determined by a screening team established under section 
184.1   256B.092 to be at risk of institutionalization.  Families who 
184.2   are receiving home and community-based waivered services for 
184.3   persons with mental retardation or related conditions are not 
184.4   eligible for support grants.  Families whose annual adjusted 
184.5   gross income is $60,000 or more are not eligible for support 
184.6   grants except in cases where extreme hardship is demonstrated.  
184.7   Beginning in state fiscal year 1994, the commissioner shall 
184.8   adjust the income ceiling annually to reflect the projected 
184.9   change in the average value in the United States Department of 
184.10  Labor Bureau of Labor Statistics consumer price index (all 
184.11  urban) for that year. 
184.12     (b) Support grants may be made available as monthly subsidy 
184.13  grants and lump sum grants. 
184.14     (c) Support grants may be issued in the form of cash, 
184.15  voucher, and direct county payment to a vendor.  
184.16     (d) Applications for the support grant shall be made by the 
184.17  legal guardian to the county social service agency ~~to the~~ 
184.18  ~~department of human services~~.  The application shall specify the 
184.19  needs of the families, the form of the grant requested by the 
184.20  families, and that the families have agreed to use the support 
184.21  grant for items and services within the designated reimbursable 
184.22  expense categories and recommendations of the county.  
184.23     (e) Families who were receiving subsidies on the date of 
184.24  implementation of the $60,000 income limit in paragraph (a) 
184.25  continue to be eligible for a family support grant until 
184.26  December 31, 1991, if all other eligibility criteria are met.  
184.27  After December 31, 1991, these families are eligible for a grant 
184.28  in the amount of one-half the grant they would otherwise 
184.29  receive, for as long as they remain eligible under other 
184.30  eligibility criteria. 
184.31     Sec. 11.  Minnesota Statutes 1996, section 252.32, 
184.32  subdivision 3, is amended to read: 
184.33     Subd. 3.  [AMOUNT OF SUPPORT GRANT; USE.] Support grant 
184.34  amounts shall be determined by the ~~commissioner of human~~ 
184.35  ~~services~~ county social service agency.  Each service and item 
184.36  purchased with a support grant must: 
185.1      (1) be over and above the normal costs of caring for the 
185.2   dependent if the dependent did not have a disability; 
185.3      (2) be directly attributable to the dependent's disabling 
185.4   condition; and 
185.5      (3) enable the family to delay or prevent the out-of-home 
185.6   placement of the dependent. 
185.7      The design and delivery of services and items purchased 
185.8   under this section must suit the dependent's chronological age 
185.9   and be provided in the least restrictive environment possible, 
185.10  consistent with the needs identified in the individual service 
185.11  plan. 
185.12     Items and services purchased with support grants must be 
185.13  those for which there are no other public or private funds 
185.14  available to the family.  Fees assessed to parents for health or 
185.15  human services that are funded by federal, state, or county 
185.16  dollars are not reimbursable through this program. 
185.17     The maximum monthly amount shall be $250 per eligible 
185.18  dependent, or $3,000 per eligible dependent per state fiscal 
185.19  year, within the limits of available funds.  ~~During fiscal year~~ 
185.20  ~~1992 and 1993, the maximum monthly grant awarded to families who~~ 
185.21  ~~are eligible for medical assistance shall be $200, except in~~ 
185.22  ~~cases where extreme hardship is demonstrated.~~  The ~~commissioner~~ 
185.23  county social service agency may consider the dependent's 
185.24  supplemental security income in determining the amount of the 
185.25  support grant.  ~~A variance~~ The county social service agency may 
185.26  ~~be granted by the commissioner to~~ exceed $3,000 per state fiscal 
185.27  year per eligible dependent for emergency circumstances in cases 
185.28  where exceptional resources of the family are required to meet 
185.29  the health, welfare-safety needs of the child.  The ~~commissioner~~ 
185.30  county social service agency may set aside up to five percent of 
185.31  ~~the appropriation~~ their allocation to fund emergency situations. 
185.32     Effective July 1, 1997, county social service agencies 
185.33  shall continue to provide funds to families receiving state 
185.34  grants on June 30, 1997, if eligibility criteria continue to be 
185.35  met.  Any adjustments to their monthly grant amount must be 
185.36  based on the needs of the family and funding availability. 
186.1      Sec. 12.  Minnesota Statutes 1996, section 252.32, 
186.2   subdivision 3a, is amended to read: 
186.3      Subd. 3a.  [REPORTS AND ~~REIMBURSEMENT~~ ALLOCATIONS.] (a) The 
186.4   commissioner shall specify requirements for quarterly fiscal and 
186.5   annual program reports according to section 256.01, subdivision 
186.6   2, paragraph (17).  Program reports shall include data which 
186.7   will enable the commissioner to evaluate program effectiveness 
186.8   and to audit compliance.  The commissioner shall reimburse 
186.9   county costs on a quarterly basis. 
186.10     (b) Beginning January 1, 1998, the commissioner shall 
186.11  allocate state funds made available under this section to county 
186.12  social service agencies on a calendar year basis.  The 
186.13  commissioner shall allocate to each county first in amounts 
186.14  equal to each county's guaranteed floor as described in clause 
186.15  (1), and second, any remaining funds, after the allocation of 
186.16  funds to the newly participating counties as provided for in 
186.17  clause (3), shall be allocated in proportion to each county's 
186.18  total number of families receiving a grant on July 1 of the most 
186.19  recent calendar year.  
186.20     (1) Each county's guaranteed floor shall be calculated as 
186.21  follows:  
186.22     (i) 95 percent of the county's allocation received in the 
186.23  preceding calendar year.  For the calendar year 1998 allocation, 
186.24  the preceding calendar year shall be considered to be double the 
186.25  six-month allocation as provided in clause (2); and 
186.26     (ii) when the amount of funds available for allocation is 
186.27  less than the amount available in the preceding year, each 
186.28  county's previous year allocation shall be reduced in proportion 
186.29  to the reduction in statewide funding, for the purpose of 
186.30  establishing the guaranteed floor.  
186.31     (2) For the period July 1, 1997, to December 31, 1997, the 
186.32  commissioner shall allocate to each county an amount equal to 
186.33  the actual, state approved, grants issued to the families for 
186.34  the month of January 1997, multiplied by six.  This six-month 
186.35  allocation shall be combined with the calendar year 1998 
186.36  allocation and be administered as an 18-month allocation.  
187.1      (3) At the commissioner's discretion, funds may be 
187.2   allocated to any nonparticipating county that requests an 
187.3   allocation under this section.  Allocations to newly 
187.4   participating counties are dependent upon the availability of 
187.5   funds, as determined by the actual expenditure amount of the 
187.6   participating counties for the most recently completed calendar 
187.7   year.  
187.8      (4) The commissioner shall regularly review the use of 
187.9   family support fund allocations by county.  The commissioner may 
187.10  reallocate unexpended or unencumbered money at any time to those 
187.11  counties that have a demonstrated need for additional funding.  
187.12     (c) County allocations under this section will be adjusted 
187.13  for transfers that occur pursuant to section 256.476. 
187.14     Sec. 13.  Minnesota Statutes 1996, section 252.32, 
187.15  subdivision 3c, is amended to read: 
187.16     Subd. 3c.  [COUNTY BOARD RESPONSIBILITIES.] County boards 
187.17  receiving funds under this section shall:  
187.18     (1) determine the needs of families for services in 
187.19  accordance with section 256B.092 or 256E.08 and any rules 
187.20  adopted under those sections; 
187.21     (2) determine the eligibility of all persons proposed for 
187.22  program participation; 
187.23     (3) ~~recommend for approval all~~ approve a plan for items and 
187.24  services to be reimbursed and inform families of 
187.25  the ~~commissioner's~~ county's approval decision; 
187.26     (4) issue support grants directly to, or on behalf of, 
187.27  eligible families; 
187.28     (5) inform recipients of their right to appeal under 
187.29  subdivision 3e; 
187.30     (6) submit quarterly financial reports under subdivision 3b 
187.31  and a report on the families approved and the amount of each 
187.32  grant, the families denied and the amount of the grants denied, 
187.33  and the families eligible but waiting for funding; and 
187.34     (7) coordinate services with other programs offered by the 
187.35  county. 
187.36     Sec. 14.  Minnesota Statutes 1996, section 252.32, 
188.1   subdivision 5, is amended to read: 
188.2      Subd. 5.  [COMPLIANCE.] If a county board or grantee does 
188.3   not comply with this section ~~and the rules adopted by the~~ 
188.4   ~~commissioner of human services~~, the commissioner may recover, 
188.5   suspend, or withhold payments. 
188.6      Sec. 15.  Minnesota Statutes 1996, section 254.04, is 
188.7   amended to read: 
188.8      254.04 [TREATMENT OF CHEMICALLY DEPENDENT PERSONS.] 
188.9      The commissioner of human services is hereby authorized to 
188.10  continue the treatment of chemically dependent persons at 
188.11  Ah-Gwah-Ching and Moose Lake area programs as well as at the 
188.12  regional treatment centers located at Anoka, Brainerd, Fergus 
188.13  Falls, ~~Moose Lake,~~ St. Peter, and Willmar as specified in 
188.14  section 245.652.  ~~During the year ending June 30, 1994, the~~ 
188.15  ~~commissioner shall relocate, in the catchment area served by the~~ 
188.16  ~~Moose Lake regional treatment center, two state-operated~~ 
188.17  ~~off-campus programs designed to serve patients who are relocated~~ 
188.18  ~~from the Moose Lake regional treatment center.  One program~~ 
188.19  ~~shall be a 35-bed program for women who are chemically~~ 
188.20  ~~dependent; the other shall be a 25-bed program for men who are~~ 
188.21  ~~chemically dependent.  The facility space housing the Liberalis~~ 
188.22  ~~chemical dependency program (building C-35) and the men's~~ 
188.23  ~~chemical dependency program (4th floor main) may not be vacated~~ 
188.24  ~~until suitable off-campus space for the women's chemical~~ 
188.25  ~~dependency program of 35 beds and the men's chemical dependency~~ 
188.26  ~~program of 25 beds is located and clients and staff are~~ 
188.27  ~~relocated.~~ 
188.28     Sec. 16.  Minnesota Statutes 1996, section 256.045, 
188.29  subdivision 3, is amended to read: 
188.30     Subd. 3.  [STATE AGENCY HEARINGS.] (a) State agency 
188.31  hearings are available for the following:  (1) any person 
188.32  applying for, receiving or having received public assistance or 
188.33  a program of social services granted by the state agency or a 
188.34  county agency under sections 252.32, 256.031 to 256.036, and 
188.35  256.72 to 256.879, chapters 256B, 256D, 256E, 261, or the 
188.36  federal Food Stamp Act whose application for assistance is 
189.1   denied, not acted upon with reasonable promptness, or whose 
189.2   assistance is suspended, reduced, terminated, or claimed to have 
189.3   been incorrectly paid; (2) any patient or relative aggrieved by 
189.4   an order of the commissioner under section 252.27; (3) a party 
189.5   aggrieved by a ruling of a prepaid health plan; (4) any 
189.6   individual or facility determined by a lead agency to have 
189.7   maltreated a vulnerable adult under section 626.557 after they 
189.8   have exercised their right to administrative reconsideration 
189.9   under section 626.557; (5) any person whose claim for foster 
189.10  care payment pursuant to a placement of the child resulting from 
189.11  a child protection assessment under section 626.556 is denied or 
189.12  not acted upon with reasonable promptness, regardless of funding 
189.13  source; (6) any person to whom a right of appeal pursuant to 
189.14  this section is given by other provision of law; or (7) an 
189.15  applicant aggrieved by an adverse decision to an application for 
189.16  a hardship waiver under section 256B.15.  The failure to 
189.17  exercise the right to an administrative reconsideration shall 
189.18  not be a bar to a hearing under this section if federal law 
189.19  provides an individual the right to a hearing to dispute a 
189.20  finding of maltreatment.  Individuals and organizations 
189.21  specified in this section may contest the specified action, 
189.22  decision, or final disposition before the state agency by 
189.23  submitting a written request for a hearing to the state agency 
189.24  within 30 days after receiving written notice of the action, 
189.25  decision, or final disposition, or within 90 days of such 
189.26  written notice if the applicant, recipient, patient, or relative 
189.27  shows good cause why the request was not submitted within the 
189.28  30-day time limit. 
189.29     The hearing for an individual or facility under clause (4) 
189.30  is the only administrative appeal to the final lead agency 
189.31  disposition specifically, including a challenge to the accuracy 
189.32  and completeness of data under section 13.04.  Hearings 
189.33  requested under clause (4) apply only to incidents of 
189.34  maltreatment that occur on or after October 1, 1995.  Hearings 
189.35  requested by nursing assistants in nursing homes alleged to have 
189.36  maltreated a resident prior to October 1, 1995, shall be held as 
190.1   a contested case proceeding under the provisions of chapter 14. 
190.2      For purposes of this section, bargaining unit grievance 
190.3   procedures are not an administrative appeal. 
190.4      The scope of hearings involving claims to foster care 
190.5   payments under clause (5) shall be limited to the issue of 
190.6   whether the county is legally responsible for a child's 
190.7   placement under court order or voluntary placement agreement 
190.8   and, if so, the correct amount of foster care payment to be made 
190.9   on the child's behalf and shall not include review of the 
190.10  propriety of the county's child protection determination or 
190.11  child placement decision. 
190.12     (b) ~~Except for a prepaid health plan,~~ A vendor of medical 
190.13  care as defined in section 256B.02, subdivision 7, or a vendor 
190.14  under contract with a county agency to provide social services 
190.15  under section 256E.08, subdivision 4, is not a party and may not 
190.16  request a hearing under this section, except if assisting a 
190.17  recipient as provided in subdivision 4. 
190.18     (c) An applicant or recipient is not entitled to receive 
190.19  social services beyond the services included in the amended 
190.20  community social services plan developed under section 256E.081, 
190.21  subdivision 3, if the county agency has met the requirements in 
190.22  section 256E.081. 
190.23     Sec. 17.  Minnesota Statutes 1996, section 256.045, 
190.24  subdivision 5, is amended to read: 
190.25     Subd. 5.  [ORDERS OF THE COMMISSIONER OF HUMAN SERVICES.] 
190.26  This subdivision does not apply to appeals under subdivision 
190.27  3b.  A state human services referee shall conduct a hearing on 
190.28  the appeal and shall recommend an order to the commissioner of 
190.29  human services.  The recommended order must be based on all 
190.30  relevant evidence and must not be limited to a review of the 
190.31  propriety of the state or county agency's action.  A referee may 
190.32  take official notice of adjudicative facts.  The commissioner of 
190.33  human services may accept the recommended order of a state human 
190.34  services referee and issue the order to the county agency and 
190.35  the applicant, recipient, former recipient, or prepaid health 
190.36  plan.  The commissioner on refusing to accept the recommended 
191.1   order of the state human services referee, shall notify the 
191.2   county agency and the applicant, recipient, former recipient, or 
191.3   prepaid health plan of that fact and shall state reasons 
191.4   therefor and shall allow each party ten days' time to submit 
191.5   additional written argument on the matter.  After the expiration 
191.6   of the ten-day period, the commissioner shall issue an order on 
191.7   the matter to the county agency and the applicant, recipient, 
191.8   former recipient, or prepaid health plan. 
191.9      A party aggrieved by an order of the commissioner may 
191.10  appeal under subdivision 7, or request reconsideration by the 
191.11  commissioner within 30 days after the date the commissioner 
191.12  issues the order.  The commissioner may reconsider an order upon 
191.13  request of any party or on the commissioner's own motion.  A 
191.14  request for reconsideration does not stay implementation of the 
191.15  commissioner's order.  Upon reconsideration, the commissioner 
191.16  may issue an amended order or an order affirming the original 
191.17  order. 
191.18     Any order of the commissioner issued under this subdivision 
191.19  shall be conclusive upon the parties unless appeal is taken in 
191.20  the manner provided by subdivision 7.  Any order of the 
191.21  commissioner is binding on the parties and must be implemented 
191.22  by the state agency ~~or~~, a county agency, or a prepaid health 
191.23  plan according to subdivision 3a, until the order is reversed by 
191.24  the district court, or unless the commissioner or a district 
191.25  court orders monthly assistance or aid or services paid or 
191.26  provided under subdivision 10. 
191.27     ~~Except for a prepaid health plan,~~ A vendor of medical care 
191.28  as defined in section 256B.02, subdivision 7, or a vendor under 
191.29  contract with a county agency to provide social services under 
191.30  section 256E.08, subdivision 4, is not a party and may not 
191.31  request a hearing or seek judicial review of an order issued 
191.32  under this section, unless assisting a recipient as provided in 
191.33  subdivision 4.  A prepaid health plan is a party to an appeal 
191.34  under subdivision 3a, but cannot seek judicial review of an 
191.35  order issued under this section. 
191.36     Sec. 18.  Minnesota Statutes 1996, section 256.045, 
192.1   subdivision 7, is amended to read: 
192.2      Subd. 7.  [JUDICIAL REVIEW.] Except for a prepaid health 
192.3   plan, any party who is aggrieved by an order of the commissioner 
192.4   of human services, or the commissioner of health in appeals 
192.5   within the commissioner's jurisdiction under subdivision 3b, may 
192.6   appeal the order to the district court of the county responsible 
192.7   for furnishing assistance, or, in appeals under subdivision 3b, 
192.8   the county where the maltreatment occurred, by serving a written 
192.9   copy of a notice of appeal upon the commissioner and any adverse 
192.10  party of record within 30 days after the date the commissioner 
192.11  issued the order, the amended order, or order affirming the 
192.12  original order, and by filing the original notice and proof of 
192.13  service with the court administrator of the district court.  
192.14  Service may be made personally or by mail; service by mail is 
192.15  complete upon mailing; no filing fee shall be required by the 
192.16  court administrator in appeals taken pursuant to this 
192.17  subdivision, with the exception of appeals taken under 
192.18  subdivision 3b.  The commissioner may elect to become a party to 
192.19  the proceedings in the district court.  Except for appeals under 
192.20  subdivision 3b, any party may demand that the commissioner 
192.21  furnish all parties to the proceedings with a copy of the 
192.22  decision, and a transcript of any testimony, evidence, or other 
192.23  supporting papers from the hearing held before the human 
192.24  services referee, by serving a written demand upon the 
192.25  commissioner within 30 days after service of the notice of 
192.26  appeal.  Any party aggrieved by the failure of an adverse party 
192.27  to obey an order issued by the commissioner under subdivision 5 
192.28  may compel performance according to the order in the manner 
192.29  prescribed in sections 586.01 to 586.12. 
192.30     Sec. 19.  Minnesota Statutes 1996, section 256.045, 
192.31  subdivision 10, is amended to read: 
192.32     Subd. 10.  [PAYMENTS PENDING APPEAL.] If the commissioner 
192.33  of human services or district court orders monthly assistance or 
192.34  aid or services paid or provided in any proceeding under this 
192.35  section, it shall be paid or provided pending appeal to the 
192.36  commissioner of human services, district court, court of 
193.1   appeals, or supreme court.  The human services referee may order 
193.2   the local human services agency to reduce or terminate medical 
193.3   assistance or general assistance medical care to a recipient 
193.4   before a final order is issued under this section if:  (1) the 
193.5   human services referee determines at the hearing that the sole 
193.6   issue on appeal is one of a change in state or federal law; and 
193.7   (2) the commissioner or the local agency notifies the recipient 
193.8   before the action.  The state or county agency has a claim for 
193.9   food stamps, cash payments, medical assistance, general 
193.10  assistance medical care, and MinnesotaCare program payments made 
193.11  to or on behalf of a recipient or former recipient while an 
193.12  appeal is pending if the recipient or former recipient is 
193.13  determined ineligible for the food stamps, cash payments, 
193.14  medical assistance, general assistance medical care, or 
193.15  MinnesotaCare as a result of the appeal~~, except for medical~~ 
193.16  ~~assistance and general assistance medical care made on behalf of~~ 
193.17  ~~a recipient pursuant to a court order~~.  In enforcing a claim on 
193.18  MinnesotaCare program payments, the state or county agency shall 
193.19  reduce the claim amount by the value of any premium payments 
193.20  made by a recipient or former recipient during the period for 
193.21  which the recipient or former recipient has been determined to 
193.22  be ineligible. 
193.23     Sec. 20.  Minnesota Statutes 1996, section 256.476, 
193.24  subdivision 2, is amended to read: 
193.25     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
193.26  following terms have the meanings given them: 
193.27     (a) "County board" means the county board of commissioners 
193.28  for the county of financial responsibility as defined in section 
193.29  256G.02, subdivision 4, or its designated representative.  When 
193.30  a human services board has been established under sections 
193.31  402.01 to 402.10, it shall be considered the county board for 
193.32  the purposes of this section. 
193.33     (b) "Family" means the person's birth parents, adoptive 
193.34  parents or stepparents, siblings or stepsiblings, children or 
193.35  stepchildren, grandparents, grandchildren, niece, nephew, aunt, 
193.36  uncle, or spouse.  For the purposes of this section, a family 
194.1   member is at least 18 years of age. 
194.2      (c) "Functional limitations" means the long-term inability 
194.3   to perform an activity or task in one or more areas of major 
194.4   life activity, including self-care, understanding and use of 
194.5   language, learning, mobility, self-direction, and capacity for 
194.6   independent living.  For the purpose of this section, the 
194.7   inability to perform an activity or task results from a mental, 
194.8   emotional, psychological, sensory, or physical disability, 
194.9   condition, or illness. 
194.10     (d) "Informed choice" means a voluntary decision made by 
194.11  the person or the person's legal representative, after becoming 
194.12  familiarized with the alternatives to: 
194.13     (1) select a preferred alternative from a number of 
194.14  feasible alternatives; 
194.15     (2) select an alternative which may be developed in the 
194.16  future; and 
194.17     (3) refuse any or all alternatives. 
194.18     (e) "Local agency" means the local agency authorized by the 
194.19  county board to carry out the provisions of this section. 
194.20     (f) "Person" or "persons" means a person or persons meeting 
194.21  the eligibility criteria in subdivision 3. 
194.22     (g) ~~"Responsible individual"~~ "Authorized representative" 
194.23  means an individual designated by the person or their legal 
194.24  representative to act on their behalf.  This individual may be a 
194.25  family member, guardian, representative payee, or other 
194.26  individual designated by the person or their legal 
194.27  representative, if any, to assist in purchasing and arranging 
194.28  for supports.  For the purposes of this section, ~~a responsible~~ 
194.29  ~~individual~~ an authorized representative is at least 18 years of 
194.30  age. 
194.31     (h) "Screening" means the screening of a person's service 
194.32  needs under sections 256B.0911 and 256B.092. 
194.33     (i) "Supports" means services, care, aids, home 
194.34  modifications, or assistance purchased by the person or the 
194.35  person's family.  Examples of supports include respite care, 
194.36  assistance with daily living, and adaptive aids.  For the 
195.1   purpose of this section, notwithstanding the provisions of 
195.2   section 144A.43, supports purchased under the consumer support 
195.3   program are not considered home care services. 
195.4      (j) "Program of origination" means the program the 
195.5   individual transferred from when approved for the consumer 
195.6   support grant program. 
195.7      Sec. 21.  Minnesota Statutes 1996, section 256.476, 
195.8   subdivision 3, is amended to read: 
195.9      Subd. 3.  [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 
195.10  is eligible to apply for a consumer support grant if the person 
195.11  meets all of the following criteria: 
195.12     (1) the person is eligible for and has been approved to 
195.13  receive services under medical assistance as determined under 
195.14  sections 256B.055 and 256B.056 or the person is eligible for and 
195.15  has been approved to receive services under alternative care 
195.16  services as determined under section 256B.0913 or the person has 
195.17  been approved to receive a grant under the developmental 
195.18  disability family support program under section 252.32; 
195.19     (2) the person is able to direct and purchase the person's 
195.20  own care and supports, or the person has a family member, legal 
195.21  representative, or other ~~responsible individual~~ authorized 
195.22  representative who can purchase and arrange supports on the 
195.23  person's behalf; 
195.24     (3) the person has functional limitations, requires ongoing 
195.25  supports to live in the community, and is at risk of or would 
195.26  continue institutionalization without such supports; and 
195.27     (4) the person will live in a home.  For the purpose of 
195.28  this section, "home" means the person's own home or home of a 
195.29  person's family member.  These homes are natural home settings 
195.30  and are not licensed by the department of health or human 
195.31  services. 
195.32     (b) Persons may not concurrently receive a consumer support 
195.33  grant if they are: 
195.34     (1) receiving home and community-based services under 
195.35  United States Code, title 42, section 1396h(c); personal care 
195.36  attendant and home health aide services under section 256B.0625; 
196.1   a developmental disability family support grant; or alternative 
196.2   care services under section 256B.0913; or 
196.3      (2) residing in an institutional or congregate care setting.
196.4      (c) A person or person's family receiving a consumer 
196.5   support grant shall not be charged a fee or premium by a local 
196.6   agency for participating in the program.  A person or person's 
196.7   family is not eligible for a consumer support grant if their 
196.8   income is at a level where they are required to pay a parental 
196.9   fee under sections 252.27, 256B.055, subdivision 12, and 256B.14 
196.10  and rules adopted under those sections for medical assistance 
196.11  services to a disabled child living with at least one parent.  
196.12     (d) The commissioner may limit the participation of nursing 
196.13  facility residents, residents of intermediate care facilities 
196.14  for persons with mental retardation, and the recipients of 
196.15  services from federal waiver programs in the consumer support 
196.16  grant program if the participation of these individuals will 
196.17  result in an increase in the cost to the state. 
196.18     (e) The commissioner shall establish a budgeted 
196.19  appropriation each fiscal year for the consumer support grant 
196.20  program.  The number of individuals participating in the program 
196.21  will be adjusted so the total amount allocated to counties does 
196.22  not exceed the amount of the budgeted appropriation.  The 
196.23  budgeted appropriation will be adjusted annually to accommodate 
196.24  changes in demand for the consumer support grants. 
196.25     Sec. 22.  Minnesota Statutes 1996, section 256.476, 
196.26  subdivision 4, is amended to read: 
196.27     Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 
196.28  county board may choose to participate in the consumer support 
196.29  grant program.  If a county board chooses to participate in the 
196.30  program, the local agency shall establish written procedures and 
196.31  criteria to determine the amount and use of support grants.  
196.32  These procedures must include, at least, the availability of 
196.33  respite care, assistance with daily living, and adaptive aids.  
196.34  The local agency may establish monthly or annual maximum amounts 
196.35  for grants and procedures where exceptional resources may be 
196.36  required to meet the health and safety needs of the person on a 
197.1   time-limited basis, however, the total amount awarded to each 
197.2   individual may not exceed the limits established in subdivision 
197.3   5, paragraph (f). 
197.4      (b) Support grants to a person or a person's family ~~may~~ 
197.5   will be provided through a monthly subsidy ~~or lump sum~~ payment 
197.6   ~~basis~~ and be in the form of cash, voucher, or direct county 
197.7   payment to vendor.  Support grant amounts must be determined by 
197.8   the local agency.  Each service and item purchased with a 
197.9   support grant must meet all of the following criteria:  
197.10     (1) it must be over and above the normal cost of caring for 
197.11  the person if the person did not have functional limitations; 
197.12     (2) it must be directly attributable to the person's 
197.13  functional limitations; 
197.14     (3) it must enable the person or the person's family to 
197.15  delay or prevent out-of-home placement of the person; and 
197.16     (4) it must be consistent with the needs identified in the 
197.17  service plan, when applicable. 
197.18     (c) Items and services purchased with support grants must 
197.19  be those for which there are no other public or private funds 
197.20  available to the person or the person's family.  Fees assessed 
197.21  to the person or the person's family for health and human 
197.22  services are not reimbursable through the grant. 
197.23     (d) In approving or denying applications, the local agency 
197.24  shall consider the following factors:  
197.25     (1) the extent and areas of the person's functional 
197.26  limitations; 
197.27     (2) the degree of need in the home environment for 
197.28  additional support; and 
197.29     (3) the potential effectiveness of the grant to maintain 
197.30  and support the person in the family environment or the person's 
197.31  own home. 
197.32     (e) At the time of application to the program or screening 
197.33  for other services, the person or the person's family shall be 
197.34  provided sufficient information to ensure an informed choice of 
197.35  alternatives by the person, the person's legal representative, 
197.36  if any, or the person's family.  The application shall be made 
198.1   to the local agency and shall specify the needs of the person 
198.2   and family, the form and amount of grant requested, the items 
198.3   and services to be reimbursed, and evidence of eligibility for 
198.4   medical assistance or alternative care program. 
198.5      (f) Upon approval of an application by the local agency and 
198.6   agreement on a support plan for the person or person's family, 
198.7   the local agency shall make grants to the person or the person's 
198.8   family.  The grant shall be in an amount for the direct costs of 
198.9   the services or supports outlined in the service agreement.  
198.10     (g) Reimbursable costs shall not include costs for 
198.11  resources already available, such as special education classes, 
198.12  day training and habilitation, case management, other services 
198.13  to which the person is entitled, medical costs covered by 
198.14  insurance or other health programs, or other resources usually 
198.15  available at no cost to the person or the person's family. 
198.16     (h) The state of Minnesota, the county boards participating 
198.17  in the consumer support grant program, or the agencies acting on 
198.18  behalf of the county boards in the implementation and 
198.19  administration of the consumer support grant program shall not 
198.20  be liable for damages, injuries, or liabilities sustained 
198.21  through the purchase of support by the individual, the 
198.22  individual's family, or the authorized representative under this 
198.23  section with funds received through the consumer support grant 
198.24  program.  Liabilities include but are not limited to:  workers' 
198.25  compensation liability, the Federal Insurance Contributions Act 
198.26  (FICA), or the Federal Unemployment Tax Act (FUTA).  
198.27  Notwithstanding section 268.04 for purposes of this section, 
198.28  participating county boards and county administrative entities 
198.29  acting on behalf of county boards are exempt from the provisions 
198.30  of section 268.04. 
198.31     Sec. 23.  Minnesota Statutes 1996, section 256.476, 
198.32  subdivision 5, is amended to read: 
198.33     Subd. 5.  [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 
198.34  For the purpose of transferring persons to the consumer support 
198.35  grant program from specific programs or services, such as the 
198.36  developmental disability family support program and alternative 
199.1   care program, personal care attendant, home health aide, or 
199.2   nursing facility services, the amount of funds transferred by 
199.3   the commissioner between the developmental disability family 
199.4   support program account, the alternative care account, the 
199.5   medical assistance account, or the consumer support grant 
199.6   account shall be based on each county's participation in 
199.7   transferring persons to the consumer support grant program from 
199.8   those programs and services. 
199.9      (b) At the beginning of each fiscal year, county 
199.10  allocations for consumer support grants shall be based on: 
199.11     (1) the number of persons to whom the county board expects 
199.12  to provide consumer supports grants; 
199.13     (2) their eligibility for current program and services; 
199.14     (3) the amount of nonfederal dollars expended on those 
199.15  individuals for those programs and services~~;~~ or, in situations 
199.16  where an individual is unable to obtain the support needed from 
199.17  the program of origination due to the unavailability of service 
199.18  providers at the time or the location where the supports are 
199.19  needed, the allocation will be based on the county's best 
199.20  estimate of the nonfederal dollars that would have been expended 
199.21  if the services had been available; and 
199.22     (4) projected dates when persons will start receiving 
199.23  grants.  County allocations shall be adjusted periodically by 
199.24  the commissioner based on the actual transfer of persons or 
199.25  service openings, and the nonfederal dollars associated with 
199.26  those persons or service openings, to the consumer support grant 
199.27  program. 
199.28     (c) The amount of funds transferred by the commissioner 
199.29  from the alternative care account and the medical assistance 
199.30  account for an individual may be changed if it is determined by 
199.31  the county or its agent that the individual's need for support 
199.32  has changed. 
199.33     (d) The authority to utilize funds transferred to the 
199.34  consumer support grant account for the purposes of implementing 
199.35  and administering the consumer support grant program will not be 
199.36  limited or constrained by the spending authority provided to the 
200.1   program of origination. 
200.2      (e) The commissioner shall use up to five percent of each 
200.3   county's allocation, as adjusted, for payments to that county 
200.4   for administrative expenses, to be paid as a proportionate 
200.5   addition to reported direct service expenditures. 
200.6      ~~(d)~~ (f) Except as provided in this paragraph, the county 
200.7   allocation for each individual or individual's family cannot 
200.8   exceed 80 percent of the total nonfederal dollars expended on 
200.9   the individual by the program of origination except for the 
200.10  developmental disabilities family support grant program which 
200.11  can be approved up to 100 percent of the nonfederal dollars and 
200.12  in situations as described in paragraph (b), clause (3).  In 
200.13  situations where exceptional need exists or the individual's 
200.14  need for support increases, up to 100 percent of the nonfederal 
200.15  dollars expended may be allocated to the county.  Allocations 
200.16  that exceed 80 percent of the nonfederal dollars expended on the 
200.17  individual by the program of origination must be approved by the 
200.18  commissioner.  The remainder of the amount expended on the 
200.19  individual by the program of origination will be used in the 
200.20  following proportions:  half will be made available to the 
200.21  consumer support grant program and participating counties for 
200.22  consumer training, resource development, and other costs, and 
200.23  half will be returned to the state general fund. 
200.24     (g) The commissioner may recover, suspend, or withhold 
200.25  payments if the county board, local agency, or grantee does not 
200.26  comply with the requirements of this section. 
200.27     Sec. 24.  Minnesota Statutes 1996, section 256B.037, 
200.28  subdivision 1a, is amended to read: 
200.29     Subd. 1a.  [MULTIPLE DENTAL PLAN AREAS.] After the 
200.30  department has executed contracts with dental plans to provide 
200.31  covered dental care services in a multiple dental plan area, the 
200.32  department shall:  
200.33     (1) inform applicants and recipients, in writing, of 
200.34  available dental plans, when written notice of dental plan 
200.35  selection must be submitted to the department, and when dental 
200.36  plan participation begins; 
201.1      (2) ~~randomly~~ assign to a dental plan recipients who fail to 
201.2   notify the department in writing of their dental plan choice; 
201.3   and 
201.4      (3) notify recipients, in writing, of their assigned dental 
201.5   plan before the effective date of the recipient's dental plan 
201.6   participation.  
201.7      Sec. 25.  Minnesota Statutes 1996, section 256B.056, 
201.8   subdivision 4, is amended to read: 
201.9      Subd. 4.  [INCOME.] To be eligible for medical assistance, 
201.10  a person must not have, or anticipate receiving, semiannual 
201.11  income in excess of 120 percent of the income standards by 
201.12  family size used in the aid to families with dependent children 
201.13  program, except that families and children may have an income up 
201.14  to 133-1/3 percent of the AFDC income standard.  In computing 
201.15  income to determine eligibility of persons who are not residents 
201.16  of long-term care facilities, the commissioner shall disregard 
201.17  increases in income as required by Public Law Numbers 94-566, 
201.18  section 503; 99-272; and 99-509.  Veterans aid and attendance 
201.19  benefits and Veterans Administration unusual medical expense 
201.20  payments are considered income to the recipient. 
201.21     Sec. 26.  Minnesota Statutes 1996, section 256B.056, 
201.22  subdivision 5, is amended to read: 
201.23     Subd. 5.  [EXCESS INCOME.] A person who has excess income 
201.24  is eligible for medical assistance if the person has expenses 
201.25  for medical care that are more than the amount of the person's 
201.26  excess income, computed by deducting incurred medical expenses 
201.27  from the excess income to reduce the excess to the income 
201.28  standard specified in subdivision 4.  The person shall elect to 
201.29  have the medical expenses deducted at the beginning of a 
201.30  one-month budget period or at the beginning of a six-month 
201.31  budget period.  ~~Until June 30, 1993, or the date the Medicaid~~ 
201.32  ~~Management Information System (MMIS) upgrade is implemented,~~ 
201.33  ~~whichever occurs last,~~ The commissioner shall allow persons 
201.34  eligible for assistance on a one-month spenddown basis under 
201.35  this subdivision to elect to pay the monthly spenddown amount in 
201.36  advance of the month of eligibility to the ~~local~~ state agency in 
202.1   order to maintain eligibility on a continuous basis.  If the 
202.2   recipient does not pay the spenddown amount on or before 
202.3   the ~~10th~~ 20th of the month, the recipient is ineligible for this 
202.4   option for the following month.  ~~The local agency must deposit~~ 
202.5   ~~spenddown payments into its treasury and issue a monthly payment~~ 
202.6   ~~to the state agency with the necessary individual account~~ 
202.7   ~~information.~~  The local agency shall code the ~~client eligibility~~ 
202.8   Medicaid Management Information System (MMIS) to indicate that 
202.9   the ~~spenddown obligation has been satisfied for the month~~ 
202.10  ~~paid~~ recipient has elected this option.  The state agency shall 
202.11  convey ~~this information~~ recipient eligibility information 
202.12  relative to the collection of the spenddown to providers through 
202.13  ~~eligibility cards which list no remaining spenddown obligation.~~  
202.14  ~~After the implementation of the MMIS upgrade,~~ the Electronic 
202.15  Verification System (EVS).  A recipient electing advance payment 
202.16  must pay the state agency the monthly spenddown amount on or 
202.17  before the ~~10th~~ 20th of the month in order to be eligible for 
202.18  this option in the following month.  
202.19     Sec. 27.  Minnesota Statutes 1996, section 256B.0626, is 
202.20  amended to read: 
202.21     256B.0626 [ESTIMATION OF 50TH PERCENTILE OF PREVAILING 
202.22  CHARGES.] 
202.23     (a) The 50th percentile of the prevailing charge for the 
202.24  base year identified in statute must be estimated by the 
202.25  commissioner in the following situations: 
202.26     (1) there were less than ~~ten~~ five billings in the calendar 
202.27  year specified in legislation governing maximum payment rates; 
202.28     (2) the service was not available in the calendar year 
202.29  specified in legislation governing maximum payment rates; 
202.30     (3) the payment amount is the result of a provider appeal; 
202.31     (4) the procedure code description has changed since the 
202.32  calendar year specified in legislation governing maximum payment 
202.33  rates, and, therefore, the prevailing charge information 
202.34  reflects the same code but a different procedure description; or 
202.35     (5) the 50th percentile reflects a payment which is grossly 
202.36  inequitable when compared with payment rates for procedures or 
203.1   services which are substantially similar. 
203.2      (b) When one of the situations identified in paragraph (a) 
203.3   occurs, the commissioner shall use the following methodology to 
203.4   reconstruct a rate comparable to the 50th percentile of the 
203.5   prevailing rate: 
203.6      (1) refer to information which exists for the first ~~nine~~ 
203.7   four billings in the calendar year specified in legislation 
203.8   governing maximum payment rates; or 
203.9      (2) refer to surrounding or comparable procedure codes; or 
203.10     (3) refer to the 50th percentile of years subsequent to the 
203.11  calendar year specified in legislation governing maximum payment 
203.12  rates, and reduce that amount by applying an appropriate 
203.13  Consumer Price Index formula; or 
203.14     (4) refer to relative value indexes; or 
203.15     (5) refer to reimbursement information from other third 
203.16  parties, such as Medicare. 
203.17     Sec. 28.  Minnesota Statutes 1996, section 256B.0627, 
203.18  subdivision 5, is amended to read: 
203.19     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
203.20  payments for home care services shall be limited according to 
203.21  this subdivision.  
203.22     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
203.23  recipient may receive the following home care services during a 
203.24  calendar year: 
203.25     (1) any initial assessment; ~~and~~ 
203.26     (2) up to two reassessments per year done to determine a 
203.27  recipient's need for personal care services; and 
203.28     (3) up to five skilled nurse visits.  
203.29     (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
203.30  services above the limits in paragraph (a) must receive the 
203.31  commissioner's prior authorization, except when: 
203.32     (1) the home care services were required to treat an 
203.33  emergency medical condition that if not immediately treated 
203.34  could cause a recipient serious physical or mental disability, 
203.35  continuation of severe pain, or death.  The provider must 
203.36  request retroactive authorization no later than five working 
204.1   days after giving the initial service.  The provider must be 
204.2   able to substantiate the emergency by documentation such as 
204.3   reports, notes, and admission or discharge histories; 
204.4      (2) the home care services were provided on or after the 
204.5   date on which the recipient's eligibility began, but before the 
204.6   date on which the recipient was notified that the case was 
204.7   opened.  Authorization will be considered if the request is 
204.8   submitted by the provider within 20 working days of the date the 
204.9   recipient was notified that the case was opened; 
204.10     (3) a third-party payor for home care services has denied 
204.11  or adjusted a payment.  Authorization requests must be submitted 
204.12  by the provider within 20 working days of the notice of denial 
204.13  or adjustment.  A copy of the notice must be included with the 
204.14  request; 
204.15     (4) the commissioner has determined that a county or state 
204.16  human services agency has made an error; or 
204.17     (5) the professional nurse determines an immediate need for 
204.18  up to 40 skilled nursing or home health aide visits per calendar 
204.19  year and submits a request for authorization within 20 working 
204.20  days of the initial service date, and medical assistance is 
204.21  determined to be the appropriate payer. 
204.22     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
204.23  authorization will be evaluated according to the same criteria 
204.24  applied to prior authorization requests.  
204.25     (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
204.26  section 256B.0627, subdivision 1, paragraph (a), shall be 
204.27  conducted initially, and at least annually thereafter, in person 
204.28  with the recipient and result in a completed service plan using 
204.29  forms specified by the commissioner.  Within 30 days of 
204.30  recipient or responsible party request for home care services, 
204.31  the assessment, the service plan, and other information 
204.32  necessary to determine medical necessity such as diagnostic or 
204.33  testing information, social or medical histories, and hospital 
204.34  or facility discharge summaries shall be submitted to the 
204.35  commissioner.  For personal care services: 
204.36     (1) The amount and type of service authorized based upon 
205.1   the assessment and service plan will follow the recipient if the 
205.2   recipient chooses to change providers.  
205.3      (2) If the recipient's medical need changes, the 
205.4   recipient's provider may assess the need for a change in service 
205.5   authorization and request the change from the county public 
205.6   health nurse.  Within 30 days of the request, the public health 
205.7   nurse will determine whether to request the change in services 
205.8   based upon the provider assessment, or conduct a home visit to 
205.9   assess the need and determine whether the change is appropriate. 
205.10     (3) To continue to receive personal care services when the 
205.11  recipient displays no significant change, the county public 
205.12  health nurse has the option to review with the commissioner, or 
205.13  the commissioner's designee, the service plan on record and 
205.14  receive authorization for up to an additional 12 months at a 
205.15  time for up to three years. 
205.16     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
205.17  commissioner's designee, shall review the assessment, the 
205.18  service plan, and any additional information that is submitted.  
205.19  The commissioner shall, within 30 days after receiving a 
205.20  complete request, assessment, and service plan, authorize home 
205.21  care services as follows:  
205.22     (1)  [HOME HEALTH SERVICES.] All home health services 
205.23  provided by a licensed nurse or a home health aide must be prior 
205.24  authorized by the commissioner or the commissioner's designee.  
205.25  Prior authorization must be based on medical necessity and 
205.26  cost-effectiveness when compared with other care options.  When 
205.27  home health services are used in combination with personal care 
205.28  and private duty nursing, the cost of all home care services 
205.29  shall be considered for cost-effectiveness.  The commissioner 
205.30  shall limit nurse and home health aide visits to no more than 
205.31  one visit each per day. 
205.32     (2)  [PERSONAL CARE SERVICES.] (i) All personal care 
205.33  services and registered nurse supervision must be prior 
205.34  authorized by the commissioner or the commissioner's designee 
205.35  except for the assessments established in paragraph (a).  The 
205.36  amount of personal care services authorized must be based on the 
206.1   recipient's home care rating.  A child may not be found to be 
206.2   dependent in an activity of daily living if because of the 
206.3   child's age an adult would either perform the activity for the 
206.4   child or assist the child with the activity and the amount of 
206.5   assistance needed is similar to the assistance appropriate for a 
206.6   typical child of the same age.  Based on medical necessity, the 
206.7   commissioner may authorize: 
206.8      (A) up to two times the average number of direct care hours 
206.9   provided in nursing facilities for the recipient's comparable 
206.10  case mix level; or 
206.11     (B) up to three times the average number of direct care 
206.12  hours provided in nursing facilities for recipients who have 
206.13  complex medical needs or are dependent in at least seven 
206.14  activities of daily living and need physical assistance with 
206.15  eating or have a neurological diagnosis; or 
206.16     (C) up to 60 percent of the average reimbursement rate, as 
206.17  of July 1, 1991, for care provided in a regional treatment 
206.18  center for recipients who have Level I behavior, plus any 
206.19  inflation adjustment as provided by the legislature for personal 
206.20  care service; or 
206.21     (D) up to the amount the commissioner would pay, as of July 
206.22  1, 1991, plus any inflation adjustment provided for home care 
206.23  services, for care provided in a regional treatment center for 
206.24  recipients referred to the commissioner by a regional treatment 
206.25  center preadmission evaluation team.  For purposes of this 
206.26  clause, home care services means all services provided in the 
206.27  home or community that would be included in the payment to a 
206.28  regional treatment center; or 
206.29     (E) up to the amount medical assistance would reimburse for 
206.30  facility care for recipients referred to the commissioner by a 
206.31  preadmission screening team established under section 256B.0911 
206.32  or 256B.092; and 
206.33     (F) a reasonable amount of time for the provision of 
206.34  nursing supervision of personal care services.  
206.35     (ii) The number of direct care hours shall be determined 
206.36  according to the annual cost report submitted to the department 
207.1   by nursing facilities.  The average number of direct care hours, 
207.2   as established by May 1, 1992, shall be calculated and 
207.3   incorporated into the home care limits on July 1, 1992.  These 
207.4   limits shall be calculated to the nearest quarter hour. 
207.5      (iii) The home care rating shall be determined by the 
207.6   commissioner or the commissioner's designee based on information 
207.7   submitted to the commissioner by the county public health nurse 
207.8   on forms specified by the commissioner.  The home care rating 
207.9   shall be a combination of current assessment tools developed 
207.10  under sections 256B.0911 and 256B.501 with an addition for 
207.11  seizure activity that will assess the frequency and severity of 
207.12  seizure activity and with adjustments, additions, and 
207.13  clarifications that are necessary to reflect the needs and 
207.14  conditions of recipients who need home care including children 
207.15  and adults under 65 years of age.  The commissioner shall 
207.16  establish these forms and protocols under this section and shall 
207.17  use an advisory group, including representatives of recipients, 
207.18  providers, and counties, for consultation in establishing and 
207.19  revising the forms and protocols. 
207.20     (iv) A recipient shall qualify as having complex medical 
207.21  needs if the care required is difficult to perform and because 
207.22  of recipient's medical condition requires more time than 
207.23  community-based standards allow or requires more skill than 
207.24  would ordinarily be required and the recipient needs or has one 
207.25  or more of the following: 
207.26     (A) daily tube feedings; 
207.27     (B) daily parenteral therapy; 
207.28     (C) wound or decubiti care; 
207.29     (D) postural drainage, percussion, nebulizer treatments, 
207.30  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
207.31     (E) catheterization; 
207.32     (F) ostomy care; 
207.33     (G) quadriplegia; or 
207.34     (H) other comparable medical conditions or treatments the 
207.35  commissioner determines would otherwise require institutional 
207.36  care.  
208.1      (v) A recipient shall qualify as having Level I behavior if 
208.2   there is reasonable supporting evidence that the recipient 
208.3   exhibits, or that without supervision, observation, or 
208.4   redirection would exhibit, one or more of the following 
208.5   behaviors that cause, or have the potential to cause: 
208.6      (A) injury to the recipient's own body; 
208.7      (B) physical injury to other people; or 
208.8      (C) destruction of property. 
208.9      (vi) Time authorized for personal care relating to Level I 
208.10  behavior in subclause (v), items (A) to (C), shall be based on 
208.11  the predictability, frequency, and amount of intervention 
208.12  required. 
208.13     (vii) A recipient shall qualify as having Level II behavior 
208.14  if the recipient exhibits on a daily basis one or more of the 
208.15  following behaviors that interfere with the completion of 
208.16  personal care services under subdivision 4, paragraph (a): 
208.17     (A) unusual or repetitive habits; 
208.18     (B) withdrawn behavior; or 
208.19     (C) offensive behavior. 
208.20     (viii) A recipient with a home care rating of Level II 
208.21  behavior in subclause (vii), items (A) to (C), shall be rated as 
208.22  comparable to a recipient with complex medical needs under 
208.23  subclause (iv).  If a recipient has both complex medical needs 
208.24  and Level II behavior, the home care rating shall be the next 
208.25  complex category up to the maximum rating under subclause (i), 
208.26  item (B). 
208.27     (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
208.28  nursing services shall be prior authorized by the commissioner 
208.29  or the commissioner's designee.  Prior authorization for private 
208.30  duty nursing services shall be based on medical necessity and 
208.31  cost-effectiveness when compared with alternative care options.  
208.32  The commissioner may authorize medically necessary private duty 
208.33  nursing services in quarter-hour units when: 
208.34     (i) the recipient requires more individual and continuous 
208.35  care than can be provided during a nurse visit; or 
208.36     (ii) the cares are outside of the scope of services that 
209.1   can be provided by a home health aide or personal care assistant.
209.2      The commissioner may authorize: 
209.3      (A) up to two times the average amount of direct care hours 
209.4   provided in nursing facilities statewide for case mix 
209.5   classification "K" as established by the annual cost report 
209.6   submitted to the department by nursing facilities in May 1992; 
209.7      (B) private duty nursing in combination with other home 
209.8   care services up to the total cost allowed under clause (2); 
209.9      (C) up to 16 hours per day if the recipient requires more 
209.10  nursing than the maximum number of direct care hours as 
209.11  established in item (A) and the recipient meets the hospital 
209.12  admission criteria established under Minnesota Rules, parts 
209.13  9505.0500 to 9505.0540.  
209.14     The commissioner may authorize up to 16 hours per day of 
209.15  medically necessary private duty nursing services or up to 24 
209.16  hours per day of medically necessary private duty nursing 
209.17  services until such time as the commissioner is able to make a 
209.18  determination of eligibility for recipients who are 
209.19  cooperatively applying for home care services under the 
209.20  community alternative care program developed under section 
209.21  256B.49, or until it is determined by the appropriate regulatory 
209.22  agency that a health benefit plan is or is not required to pay 
209.23  for appropriate medically necessary health care services.  
209.24  Recipients or their representatives must cooperatively assist 
209.25  the commissioner in obtaining this determination.  Recipients 
209.26  who are eligible for the community alternative care program may 
209.27  not receive more hours of nursing under this section than would 
209.28  otherwise be authorized under section 256B.49. 
209.29     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
209.30  ventilator-dependent, the monthly medical assistance 
209.31  authorization for home care services shall not exceed what the 
209.32  commissioner would pay for care at the highest cost hospital 
209.33  designated as a long-term hospital under the Medicare program.  
209.34  For purposes of this clause, home care services means all 
209.35  services provided in the home that would be included in the 
209.36  payment for care at the long-term hospital.  
210.1   "Ventilator-dependent" means an individual who receives 
210.2   mechanical ventilation for life support at least six hours per 
210.3   day and is expected to be or has been dependent for at least 30 
210.4   consecutive days.  
210.5      (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
210.6   or the commissioner's designee shall determine the time period 
210.7   for which a prior authorization shall be effective.  If the 
210.8   recipient continues to require home care services beyond the 
210.9   duration of the prior authorization, the home care provider must 
210.10  request a new prior authorization.  Under no circumstances, 
210.11  other than the exceptions in paragraph (b), shall a prior 
210.12  authorization be valid prior to the date the commissioner 
210.13  receives the request or for more than 12 months.  A recipient 
210.14  who appeals a reduction in previously authorized home care 
210.15  services may continue previously authorized services, other than 
210.16  temporary services under paragraph (h), pending an appeal under 
210.17  section 256.045.  The commissioner must provide a detailed 
210.18  explanation of why the authorized services are reduced in amount 
210.19  from those requested by the home care provider.  
210.20     (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
210.21  the commissioner's designee shall determine the medical 
210.22  necessity of home care services, the level of caregiver 
210.23  according to subdivision 2, and the institutional comparison 
210.24  according to this subdivision, the cost-effectiveness of 
210.25  services, and the amount, scope, and duration of home care 
210.26  services reimbursable by medical assistance, based on the 
210.27  assessment, primary payer coverage determination information as 
210.28  required, the service plan, the recipient's age, the cost of 
210.29  services, the recipient's medical condition, and diagnosis or 
210.30  disability.  The commissioner may publish additional criteria 
210.31  for determining medical necessity according to section 256B.04. 
210.32     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
210.33  The agency nurse, the independently enrolled private duty nurse, 
210.34  or county public health nurse may request a temporary 
210.35  authorization for home care services by telephone.  The 
210.36  commissioner may approve a temporary level of home care services 
211.1   based on the assessment, and service or care plan information, 
211.2   and primary payer coverage determination information as required.
211.3   Authorization for a temporary level of home care services 
211.4   including nurse supervision is limited to the time specified by 
211.5   the commissioner, but shall not exceed 45 days, unless extended 
211.6   because the county public health nurse has not completed the 
211.7   required assessment and service plan, or the commissioner's 
211.8   determination has not been made.  The level of services 
211.9   authorized under this provision shall have no bearing on a 
211.10  future prior authorization. 
211.11     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
211.12  Home care services provided in an adult or child foster care 
211.13  setting must receive prior authorization by the department 
211.14  according to the limits established in paragraph (a). 
211.15     The commissioner may not authorize: 
211.16     (1) home care services that are the responsibility of the 
211.17  foster care provider under the terms of the foster care 
211.18  placement agreement and administrative rules.  Requests for home 
211.19  care services for recipients residing in a foster care setting 
211.20  must include the foster care placement agreement and 
211.21  determination of difficulty of care; 
211.22     (2) personal care services when the foster care license 
211.23  holder is also the personal care provider or personal care 
211.24  assistant unless the recipient can direct the recipient's own 
211.25  care, or case management is provided as required in section 
211.26  256B.0625, subdivision 19a; 
211.27     (3) personal care services when the responsible party is an 
211.28  employee of, or under contract with, or has any direct or 
211.29  indirect financial relationship with the personal care provider 
211.30  or personal care assistant, unless case management is provided 
211.31  as required in section 256B.0625, subdivision 19a; 
211.32     (4) home care services when the number of foster care 
211.33  residents is greater than four unless the county responsible for 
211.34  the recipient's foster placement made the placement prior to 
211.35  April 1, 1992, requests that home care services be provided, and 
211.36  case management is provided as required in section 256B.0625, 
212.1   subdivision 19a; or 
212.2      (5) home care services when combined with foster care 
212.3   payments, other than room and board payments that exceed the 
212.4   total amount that public funds would pay for the recipient's 
212.5   care in a medical institution. 
212.6      Sec. 29.  Minnesota Statutes 1996, section 256B.064, 
212.7   subdivision 1a, is amended to read: 
212.8      Subd. 1a.  [GROUNDS FOR MONETARY RECOVERY AND SANCTIONS 
212.9   AGAINST VENDORS.] The commissioner may seek monetary recovery 
212.10  and impose sanctions against vendors of medical care for any of 
212.11  the following:  fraud, theft, or abuse in connection with the 
212.12  provision of medical care to recipients of public assistance; a 
212.13  pattern of presentment of false or duplicate claims or claims 
212.14  for services not medically necessary; a pattern of making false 
212.15  statements of material facts for the purpose of obtaining 
212.16  greater compensation than that to which the vendor is legally 
212.17  entitled; suspension or termination as a Medicare vendor; ~~and~~ 
212.18  refusal to grant the state agency access during regular business 
212.19  hours to examine all records necessary to disclose the extent of 
212.20  services provided to program recipients; and any reason for 
212.21  which a vendor could be excluded from participation in the 
212.22  Medicare program under section 1128, 1128A, or 1866(b)(2) of the 
212.23  Social Security Act.  The determination of services not 
212.24  medically necessary may be made by the commissioner in 
212.25  consultation with a peer advisory task force appointed by the 
212.26  commissioner on the recommendation of appropriate professional 
212.27  organizations.  The task force expires as provided in section 
212.28  15.059, subdivision 5. 
212.29     Sec. 30.  Minnesota Statutes 1996, section 256B.064, 
212.30  subdivision 1c, is amended to read: 
212.31     Subd. 1c.  [METHODS OF MONETARY RECOVERY.] The commissioner 
212.32  may obtain monetary recovery ~~for the conduct described in~~ 
212.33  ~~subdivision 1a by the following~~ from a vendor who has been 
212.34  improperly paid either as a result of conduct described in 
212.35  subdivision 1a or as a result of an error, regardless of the 
212.36  party responsible for the error and regardless of whether the 
213.1   error was intentional.  The commissioner may obtain monetary 
213.2   recovery using methods, including but not limited to the 
213.3   following:  assessing and recovering money ~~erroneously~~ 
213.4   improperly paid and debiting from future payments any 
213.5   money ~~erroneously~~ improperly paid~~, except that~~.  Patterns need 
213.6   not be proven as a precondition to monetary recovery ~~for~~ of 
213.7   erroneous or false claims, duplicate claims, claims for services 
213.8   not medically necessary, or claims based on false statements.  
213.9   The commissioner ~~may~~ shall charge interest on money to be 
213.10  recovered if the recovery is to be made by installment payments 
213.11  or debits.  The interest charged shall be the rate established 
213.12  by the commissioner of revenue under section 270.75. 
213.13     Sec. 31.  Minnesota Statutes 1996, section 256B.064, 
213.14  subdivision 2, is amended to read: 
213.15     Subd. 2.  [IMPOSITION OF MONETARY RECOVERY AND SANCTIONS.] 
213.16  (a) The commissioner shall determine monetary amounts to be 
213.17  recovered and the sanction to be imposed upon a vendor of 
213.18  medical care for conduct described by subdivision 1a.  Except ~~in~~ 
213.19  ~~the case of a conviction for conduct described in subdivision 1a~~ 
213.20  as provided in paragraph (b), neither a monetary recovery nor a 
213.21  sanction will be ~~sought~~ imposed by the commissioner without 
213.22  prior notice and an opportunity for a hearing, ~~pursuant~~ 
213.23  according to chapter 14, on the commissioner's proposed action, 
213.24  provided that the commissioner may suspend or reduce payment to 
213.25  a vendor of medical care, except a nursing home or convalescent 
213.26  care facility, after notice and prior to the hearing if in the 
213.27  commissioner's opinion that action is necessary to protect the 
213.28  public welfare and the interests of the program. 
213.29     (b) Except for a nursing home or convalescent care 
213.30  facility, the commissioner may withhold or reduce payments to a 
213.31  vendor of medical care without providing advance notice of such 
213.32  withholding or reduction if either of the following occurs: 
213.33     (1) the vendor is convicted of a crime involving the 
213.34  conduct described in subdivision 1a; or 
213.35     (2) the commissioner receives reliable evidence of fraud or 
213.36  willful misrepresentation by the vendor. 
214.1      (c) The commissioner must send notice of the withholding or 
214.2   reduction of payments under paragraph (b) within five days of 
214.3   taking such action.  The notice must: 
214.4      (1) state that payments are being withheld according to 
214.5   paragraph (b); 
214.6      (2) except in the case of a conviction for conduct 
214.7   described in subdivision 1a, state that the withholding is for a 
214.8   temporary period and cite the circumstances under which 
214.9   withholding will be terminated; 
214.10     (3) identify the types of claims to which the withholding 
214.11  applies; and 
214.12     (4) inform the vendor of the right to submit written 
214.13  evidence for consideration by the commissioner. 
214.14     The withholding or reduction of payments will not continue 
214.15  after the commissioner determines there is insufficient evidence 
214.16  of fraud or willful misrepresentation by the vendor, or after 
214.17  legal proceedings relating to the alleged fraud or willful 
214.18  misrepresentation are completed, unless the commissioner has 
214.19  sent notice of intention to impose monetary recovery or 
214.20  sanctions under paragraph (a). 
214.21     (d) Upon receipt of a notice under paragraph (a) that a 
214.22  monetary recovery or sanction is to be imposed, a vendor may 
214.23  request a contested case, as defined in section 14.02, 
214.24  subdivision 3, by filing with the commissioner a written request 
214.25  of appeal.  The appeal request must be received by the 
214.26  commissioner no later than 30 days after the date the 
214.27  notification of monetary recovery or sanction was mailed to the 
214.28  vendor.  The appeal request must specify: 
214.29     (1) each disputed item, the reason for the dispute, and an 
214.30  estimate of the dollar amount involved for each disputed item; 
214.31     (2) the computation that the vendor believes is correct; 
214.32     (3) the authority in statute or rule upon which the vendor 
214.33  relies for each disputed item; 
214.34     (4) the name and address of the person or entity with whom 
214.35  contacts may be made regarding the appeal; and 
214.36     (5) other information required by the commissioner. 
215.1      Sec. 32.  Minnesota Statutes 1996, section 256B.0911, 
215.2   subdivision 2, is amended to read: 
215.3      Subd. 2.  [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.] 
215.4   All applicants to Medicaid certified nursing facilities must be 
215.5   screened prior to admission, regardless of income, assets, or 
215.6   funding sources, except the following: 
215.7      (1) patients who, having entered acute care facilities from 
215.8   certified nursing facilities, are returning to a certified 
215.9   nursing facility; 
215.10     (2) residents transferred from other certified nursing 
215.11  facilities located within the state of Minnesota; 
215.12     (3) individuals who have a contractual right to have their 
215.13  nursing facility care paid for indefinitely by the veteran's 
215.14  administration; 
215.15     (4) individuals who are enrolled in the Ebenezer/Group 
215.16  Health social health maintenance organization project, or 
215.17  enrolled in a demonstration project under section 256B.69, 
215.18  subdivision 18, at the time of application to a nursing home; ~~or~~ 
215.19     (5) individuals previously screened and currently being 
215.20  served under the alternative care program or under a home and 
215.21  community-based services waiver authorized under section 1915(c) 
215.22  of the Social Security Act; or 
215.23     (6) individuals who are admitted to a certified nursing 
215.24  facility for a short-term stay, which, based upon a physician's 
215.25  certification, is expected to be 14 days or less in duration, 
215.26  and who have been screened and approved for nursing facility 
215.27  admission within the previous six months.  This exemption 
215.28  applies only if the screener determines at the time of the 
215.29  initial screening of the six-month period that it is appropriate 
215.30  to use the nursing facility for short-term stays and that there 
215.31  is an adequate plan of care for return to the home or 
215.32  community-based setting.  If a stay exceeds 14 days, the 
215.33  individual must be referred no later than the first county 
215.34  working day following the 14th resident day for a screening, 
215.35  which must be completed within five working days of the 
215.36  referral.  Payment limitations in subdivision 7 will apply to an 
216.1   individual found at screening to meet the level of care criteria 
216.2   for admission to a certified nursing facility. 
216.3      Regardless of the exemptions in clauses (2) to ~~(4)~~ (6), 
216.4   persons who have a diagnosis or possible diagnosis of mental 
216.5   illness, mental retardation, or a related condition must ~~be~~ 
216.6   ~~screened~~ receive a preadmission screening before admission 
216.7   unless the admission prior to screening is authorized by the 
216.8   local mental health authority or the local developmental 
216.9   disabilities case manager, or unless authorized by the county 
216.10  agency according to Public Law Number 101-508. 
216.11     Before admission to a Medicaid certified nursing home or 
216.12  boarding care home, all persons must be screened and approved 
216.13  for admission through an assessment process.  The nursing 
216.14  facility is authorized to conduct case mix assessments which are 
216.15  not conducted by the county public health nurse under Minnesota 
216.16  Rules, part 9549.0059.  The designated county agency is 
216.17  responsible for distributing the quality assurance and review 
216.18  form for all new applicants to nursing homes. 
216.19     Other persons who are not applicants to nursing facilities 
216.20  must be screened if a request is made for a screening. 
216.21     Sec. 33.  Minnesota Statutes 1996, section 256B.0911, 
216.22  subdivision 7, is amended to read: 
216.23     Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
216.24  (a) Medical assistance reimbursement for nursing facilities 
216.25  shall be authorized for a medical assistance recipient only if a 
216.26  preadmission screening has been conducted prior to admission or 
216.27  the local county agency has authorized an exemption.  Medical 
216.28  assistance reimbursement for nursing facilities shall not be 
216.29  provided for any recipient who the local screener has determined 
216.30  does not meet the level of care criteria for nursing facility 
216.31  placement or, if indicated, has not had a level II PASARR 
216.32  evaluation completed unless an admission for a recipient with 
216.33  mental illness is approved by the local mental health authority 
216.34  or an admission for a recipient with mental retardation or 
216.35  related condition is approved by the state mental retardation 
216.36  authority.  The county preadmission screening team may deny 
217.1   certified nursing facility admission using the level of care 
217.2   criteria established under section 144.0721 and deny medical 
217.3   assistance reimbursement for certified nursing facility care.  
217.4   Persons receiving care in a certified nursing facility or 
217.5   certified boarding care home who are reassessed by the 
217.6   commissioner of health according to section 144.0722 and 
217.7   determined to no longer meet the level of care criteria for a 
217.8   certified nursing facility or certified boarding care home may 
217.9   no longer remain a resident in the certified nursing facility or 
217.10  certified boarding care home and must be relocated to the 
217.11  community under paragraphs (b), (c), and (d) if the persons were 
217.12  admitted on or after July 1, ~~1996~~ 1997.  
217.13     (b) A resident who, upon reassessment, is determined to no 
217.14  longer meet the level of care criteria for a certified nursing 
217.15  facility or certified boarding care home is deemed to not need 
217.16  the services provided by a nursing facility.  Such a resident 
217.17  may not receive medical assistance payment for nursing facility 
217.18  or boarding care services and must be discharged under this 
217.19  subdivision.  A resident who is determined to no longer need 
217.20  nursing facility services may ask for a reconsideration of the 
217.21  resident's case mix and level of care assessment under section 
217.22  144.0722.  If reconsideration is not requested, the resident may 
217.23  not appeal the assessment.  If the resident is determined to not 
217.24  meet the level of care criteria for treatment in a nursing 
217.25  facility, the commissioner shall notify the nursing facility 
217.26  that the resident's health has improved sufficiently so the 
217.27  resident no longer needs the services provided by a nursing 
217.28  facility and that the resident must be discharged within 60 days 
217.29  after the facility receives notice, regardless of the source of 
217.30  payment for the resident's care.  The ground for discharge shall 
217.31  be that the resident's health has improved sufficiently so that 
217.32  the resident no longer needs the services of the nursing 
217.33  facility.  The nursing facility shall discharge the resident 
217.34  according to federal regulations that govern discharge of 
217.35  residents of certified nursing facilities.  If the resident's 
217.36  care is paid for by medical assistance, the commissioner must 
218.1   also notify the resident that medical assistance payment for the 
218.2   resident's nursing facility services will terminate 60 days 
218.3   after the resident receives the notice. 
218.4      (c) The resident may request, within 14 days of receiving a 
218.5   notice of discharge or of termination of medical assistance 
218.6   payments, an assessment from the local screening team defined 
218.7   under section 256B.0911 to determine whether extraordinary 
218.8   circumstances as defined in section 144.0721, subdivision 3, 
218.9   exist.  The screening team must issue a written decision within 
218.10  ten days of the resident's request.  If the screening team finds 
218.11  that extraordinary circumstances exist, the resident need not be 
218.12  discharged and medical assistance payments shall not be 
218.13  discontinued on the resident's behalf. 
218.14     (d) A resident notified of discharge of or discontinuance 
218.15  of medical assistance payment under this section may appeal 
218.16  under section 256.045 within 30 days of receiving a notice of 
218.17  discharge or of termination of medical assistance payments, or 
218.18  within 30 days of the screening team's decision that 
218.19  extraordinary circumstances do not exist, whichever is later.  
218.20  Medical assistance payments shall continue and the resident 
218.21  shall not be discharged until the commissioner issues a decision 
218.22  on the appeal.  The nursing facility may participate in the 
218.23  hearing for the limited purpose of proving that the resident 
218.24  meets the level of care criteria.  If, after a hearing, the 
218.25  commissioner of human services determines either that the 
218.26  resident meets the level of care criteria for nursing facility 
218.27  services or that extraordinary circumstances as defined in 
218.28  section 144.0721, subdivision 3, exist, medical assistance shall 
218.29  not be terminated and the resident shall not be discharged.  The 
218.30  burden is on the resident to demonstrate that the resident needs 
218.31  the services provided by a nursing facility or that 
218.32  extraordinary circumstances exist.  The commissioner shall give 
218.33  no deference to the screening team's determination.  A 
218.34  resident's appeal of discharge under this section may be 
218.35  appealed only under section 256.045 and not section 144.135. 
218.36     (e) Persons receiving services under section 256B.0913, 
219.1   subdivisions 1 to 14, or 256B.0915 who are reassessed and found 
219.2   to not meet the level of care criteria for admission to a 
219.3   certified nursing facility or certified boarding care home may 
219.4   no longer receive these services if persons were admitted to the 
219.5   program on or after July 1, ~~1996~~ 1997.  Reassessed individuals 
219.6   ineligible for services under section 256B.0913, subdivisions 1 
219.7   to 14, or 256B.0915, are entitled to an appeal under section 
219.8   256.045, subdivision 3.  The commissioner shall make a request 
219.9   to the health care financing administration for a waiver 
219.10  allowing screening team approval of Medicaid payments for 
219.11  certified nursing facility care.  An individual has a choice and 
219.12  makes the final decision between nursing facility placement and 
219.13  community placement after the screening team's recommendation, 
219.14  except as provided in paragraphs (b) and (c).  
219.15     ~~(b)~~ (f) The local county mental health authority or the 
219.16  state mental retardation authority under Public Law Numbers 
219.17  100-203 and 101-508 may prohibit admission to a nursing 
219.18  facility, if the individual does not meet the nursing facility 
219.19  level of care criteria or needs specialized services as defined 
219.20  in Public Law Numbers 100-203 and 101-508.  For purposes of this 
219.21  section, "specialized services" for a person with mental 
219.22  retardation or a related condition means "active treatment" as 
219.23  that term is defined in Code of Federal Regulations, title 42, 
219.24  section 483.440(a)(1). 
219.25     ~~(c)~~ (g) Upon the receipt by the commissioner of approval by 
219.26  the Secretary of Health and Human Services of the waiver 
219.27  requested under paragraph (a), the local screener shall deny 
219.28  medical assistance reimbursement for nursing facility care for 
219.29  an individual whose long-term care needs can be met in a 
219.30  community-based setting and whose cost of community-based home 
219.31  care services is less than 75 percent of the average payment for 
219.32  nursing facility care for that individual's case mix 
219.33  classification, and who is either: 
219.34     (i) a current medical assistance recipient being screened 
219.35  for admission to a nursing facility; or 
219.36     (ii) an individual who would be eligible for medical 
220.1   assistance within 180 days of entering a nursing facility and 
220.2   who meets a nursing facility level of care. 
220.3      ~~(d)~~ (h) Appeals from the screening team's recommendation or 
220.4   the county agency's final decision shall be made according to 
220.5   section 256.045, subdivision 3. 
220.6      Sec. 34.  Minnesota Statutes 1996, section 256B.0913, 
220.7   subdivision 10, is amended to read: 
220.8      Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
220.9   appropriation for fiscal years 1992 and beyond shall cover only 
220.10  180-day eligible clients. 
220.11     (b) Prior to July 1 of each year, the commissioner shall 
220.12  allocate to county agencies the state funds available for 
220.13  alternative care for persons eligible under subdivision 2.  The 
220.14  allocation for fiscal year 1992 shall be calculated using a base 
220.15  that is adjusted to exclude the medical assistance share of 
220.16  alternative care expenditures.  The adjusted base is calculated 
220.17  by multiplying each county's allocation for fiscal year 1991 by 
220.18  the percentage of county alternative care expenditures for 
220.19  180-day eligible clients.  The percentage is determined based on 
220.20  expenditures for services rendered in fiscal year 1989 or 
220.21  calendar year 1989, whichever is greater. 
220.22     (c) If the county expenditures for 180-day eligible clients 
220.23  are 95 percent or more of its adjusted base allocation, the 
220.24  allocation for the next fiscal year is 100 percent of the 
220.25  adjusted base, plus inflation to the extent that inflation is 
220.26  included in the state budget. 
220.27     (d) If the county expenditures for 180-day eligible clients 
220.28  are less than 95 percent of its adjusted base allocation, the 
220.29  allocation for the next fiscal year is the adjusted base 
220.30  allocation less the amount of unspent funds below the 95 percent 
220.31  level. 
220.32     (e) For fiscal year 1992 only, a county may receive an 
220.33  increased allocation if annualized service costs for the month 
220.34  of May 1991 for 180-day eligible clients are greater than the 
220.35  allocation otherwise determined.  A county may apply for this 
220.36  increase by reporting projected expenditures for May to the 
221.1   commissioner by June 1, 1991.  The amount of the allocation may 
221.2   exceed the amount calculated in paragraph (b).  The projected 
221.3   expenditures for May must be based on actual 180-day eligible 
221.4   client caseload and the individual cost of clients' care plans.  
221.5   If a county does not report its expenditures for May, the amount 
221.6   in paragraph (c) or (d) shall be used. 
221.7      (f) Calculations for paragraphs (c) and (d) are to be made 
221.8   as follows:  for each county, the determination of expenditures 
221.9   shall be based on payments for services rendered from April 1 
221.10  through March 31 in the base year, to the extent that claims 
221.11  have been submitted by June 1 of that year.  Calculations for 
221.12  paragraphs (c) and (d) will also include the funds transferred 
221.13  to the consumer support grant program for clients who have 
221.14  transferred to that program from April 1 through March 31 in the 
221.15  base year. 
221.16     Sec. 35.  Minnesota Statutes 1996, section 256B.0913, 
221.17  subdivision 15, is amended to read: 
221.18     Subd. 15.  [SERVICE ALLOWANCE FUND AVAILABILITY.] (a) 
221.19  Effective July 1, ~~1996~~ 1997, the commissioner may use 
221.20  alternative care funds for services to high function class A 
221.21  persons as defined in section 144.0721, subdivision 3, clause 
221.22  (2).  The county alternative care grant allocation will be 
221.23  supplemented with a special allocation amount ~~based on the~~ 
221.24  ~~projected number of eligible high function class A's and~~ 
221.25  ~~computed on the basis of $240 per month per projected eligible~~ 
221.26  ~~person.  Individual monthly expenditures under the service~~ 
221.27  ~~allowance option are permitted to be either greater or less than~~ 
221.28  ~~the amount of $240 per month based on individual need.  County~~ 
221.29  ~~allocations shall be adjusted periodically based on the actual~~ 
221.30  ~~provision of services to high function class A persons~~.  The 
221.31  allocation will be distributed by a population based formula and 
221.32  shall not exceed the proportion of projected savings made 
221.33  available under section 144.0721, subdivision 3. 
221.34     (b) Counties shall have the option of providing services, 
221.35  cash service allowances, vouchers, or a combination of these 
221.36  options to high function class A persons defined in section 
222.1   144.0721, subdivision 3, clause (2).  High function class A 
222.2   persons may choose services from among the categories of 
222.3   services listed under subdivision 5, except for case management 
222.4   services. 
222.5      (c) If the special allocation under this section to a 
222.6   county is not sufficient to serve all persons who qualify 
222.7   for ~~alternative care services~~ the service allowance, the county 
222.8   is not required to provide any ~~alternative care~~ services to a 
222.9   high function class A person but shall establish a waiting list 
222.10  to provide services as special allocation funding becomes 
222.11  available. 
222.12     Sec. 36.  Minnesota Statutes 1996, section 256B.421, 
222.13  subdivision 1, is amended to read: 
222.14     Subdivision 1.  [SCOPE.] For the purposes of this section 
222.15  and sections 256B.41, 256B.411, 256B.431, 256B.432, 
222.16  256B.433, 256B.434, 256B.435, 256B.47, 256B.48, 256B.50, and 
222.17  256B.502, the following terms and phrases shall have the meaning 
222.18  given to them. 
222.19     Sec. 37.  Minnesota Statutes 1996, section 256B.434, 
222.20  subdivision 2, is amended to read: 
222.21     Subd. 2.  [REQUESTS FOR PROPOSALS.] (a) ~~No later than~~ 
222.22  ~~August 1, 1995,~~ At least twice annually the commissioner shall 
222.23  publish in the State Register a request for proposals to provide 
222.24  nursing facility services according to this section.  ~~The~~ 
222.25  ~~commissioner shall issue two additional requests for proposals~~ 
222.26  ~~prior to July 1, 1997, based upon a timetable established by the~~ 
222.27  ~~commissioner.~~  The commissioner must respond to all proposals in 
222.28  a timely manner. 
222.29     (b) The commissioner may reject any proposal if, in the 
222.30  judgment of the commissioner, a contract with a particular 
222.31  facility is not in the best interests of the residents of the 
222.32  facility or the state of Minnesota.  The commissioner may accept 
222.33  up to the number of proposals that can be adequately supported 
222.34  with available state resources, as determined by the 
222.35  commissioner~~, except that the commissioner shall not contract~~ 
222.36  ~~with more than 40 nursing facilities as part of any request for~~ 
223.1   ~~proposals~~.  The commissioner may accept proposals from a single 
223.2   nursing facility or from a group of facilities through a 
223.3   managing entity.  The commissioner shall seek to ensure that 
223.4   nursing facilities under contract are located in all geographic 
223.5   areas of the state.  ~~The commissioner shall present~~ 
223.6   ~~recommendations to the legislature by February 1, 1996, on the~~ 
223.7   ~~number of nursing facility contracts that may be entered into by~~ 
223.8   ~~the commissioner as a result of a request for proposals.~~ 
223.9      (c) In issuing the request for proposals, the commissioner 
223.10  may develop reasonable requirements which, in the judgment of 
223.11  the commissioner, are necessary to protect residents or ensure 
223.12  that the contractual alternative payment demonstration project 
223.13  furthers the interest of the state of Minnesota.  The request 
223.14  for proposals may include, but need not be limited to, the 
223.15  following: 
223.16     (1) a requirement that a nursing facility make reasonable 
223.17  efforts to maximize Medicare payments on behalf of eligible 
223.18  residents; 
223.19     (2) requirements designed to prevent inappropriate or 
223.20  illegal discrimination against residents enrolled in the medical 
223.21  assistance program as compared to private paying residents; 
223.22     (3) requirements designed to ensure that admissions to a 
223.23  nursing facility are appropriate and that reasonable efforts are 
223.24  made to place residents in home and community-based settings 
223.25  when appropriate; 
223.26     (4) a requirement to agree to participate in a project to 
223.27  develop data collection systems and outcome-based standards ~~for~~ 
223.28  ~~managed care contracting for long-term care services~~.  Among 
223.29  other requirements specified by the commissioner, each facility 
223.30  entering into a contract may be required to pay an annual fee ~~in~~ 
223.31  ~~an amount determined by the commissioner not to exceed $50 per~~ 
223.32  ~~bed~~.  Revenue generated from the fees is appropriated to the 
223.33  commissioner and must be used to contract with a qualified 
223.34  consultant or contractor to develop data collection systems and 
223.35  outcome-based contracting standards; 
223.36     (5) a requirement that contractors agree to maintain 
224.1   Medicare cost reports and to submit them to the commissioner 
224.2   upon request or at times specified by the commissioner; 
224.3      (6) a requirement for demonstrated willingness and ability 
224.4   to develop and maintain data collection and retrieval systems to 
224.5   be used in measuring outcomes; and 
224.6      (7) a requirement to provide all information and assurances 
224.7   required by the terms and conditions of the federal waiver or 
224.8   federal approval. 
224.9      (d) In addition to the information and assurances contained 
224.10  in the submitted proposals, the commissioner may consider the 
224.11  following in determining whether to accept or deny a proposal: 
224.12     (1) the facility's history of compliance with federal and 
224.13  state laws and rules~~;~~, except that a facility deemed to be in 
224.14  substantial compliance with federal and state laws and rules is 
224.15  eligible to respond to a request for proposal.  A facility's 
224.16  compliance history shall not be the sole determining factor in 
224.17  situations where the facility has been sold and the new owners 
224.18  have submitted a proposal; 
224.19     (2) whether the facility has a record of excessive 
224.20  licensure fines or sanctions or fraudulent cost reports; 
224.21     (3) financial history and solvency; and 
224.22     (4) other factors identified by the commissioner that the 
224.23  commissioner deems relevant to a determination that a contract 
224.24  with a particular facility is not in the best interests of the 
224.25  residents of the facility or the state of Minnesota. 
224.26     (e) If the commissioner rejects the proposal of a nursing 
224.27  facility, the commissioner shall provide written notice to the 
224.28  facility of the reason for the rejection, including the factors 
224.29  and evidence upon which the rejection was based. 
224.30     Sec. 38.  Minnesota Statutes 1996, section 256B.434, 
224.31  subdivision 3, is amended to read: 
224.32     Subd. 3.  [DURATION AND TERMINATION OF CONTRACTS.] (a) 
224.33  Subject to available resources, the commissioner may begin to 
224.34  execute contracts with nursing facilities November 1, 1995. 
224.35     (b) All contracts entered into under this section are for a 
224.36  term of ~~four years~~ one year.  Either party may terminate a 
225.1   contract ~~effective July 1 of any year by providing written~~ 
225.2   ~~notice to the other party no later than April 1 of that year~~ at 
225.3   any time without cause by providing 30 calendar days advance 
225.4   written notice to the other party.  The decision to terminate a 
225.5   contract is not appealable.  If neither party provides written 
225.6   notice of termination ~~by April 1, the contract is automatically~~ 
225.7   ~~renewed for the next rate year~~, the contract shall be 
225.8   renegotiated for additional one-year terms, for up to a total of 
225.9   four consecutive one-year terms.  The provisions of the contract 
225.10  shall be renegotiated annually by the parties prior to the 
225.11  expiration date of the contract.  The parties may voluntarily 
225.12  renegotiate the terms of the contract at any time by mutual 
225.13  agreement. 
225.14     (c) If a nursing facility fails to comply with the terms of 
225.15  a contract, the commissioner shall provide reasonable notice 
225.16  regarding the breach of contract and a reasonable opportunity 
225.17  for the facility to come into compliance.  If the facility fails 
225.18  to come into compliance or to remain in compliance, the 
225.19  commissioner may terminate the contract.  If a contract is 
225.20  terminated, the contract payment remains in effect for the 
225.21  remainder of the rate year in which the contract was terminated, 
225.22  but in all other respects the provisions of this section do not 
225.23  apply to that facility effective the date the contract is 
225.24  terminated.  The contract shall contain a provision governing 
225.25  the transition back to the cost-based reimbursement system 
225.26  established under section 256B.431, subdivision 25, and 
225.27  Minnesota Rules, parts 9549.0010 to 9549.0080.  A contract 
225.28  entered into under this section may be amended by mutual 
225.29  agreement of the parties. 
225.30     Sec. 39.  Minnesota Statutes 1996, section 256B.434, 
225.31  subdivision 4, is amended to read: 
225.32     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
225.33  nursing facilities which have their payment rates determined 
225.34  under this section rather than section 256B.431, subdivision 25, 
225.35  the commissioner shall establish a rate under this subdivision.  
225.36  The nursing facility must enter into a written contract with the 
226.1   commissioner. 
226.2      (b) A nursing facility's case mix payment rate for the 
226.3   first rate year of a facility's contract under this section is 
226.4   the payment rate the facility would have received under section 
226.5   256B.431, subdivision 25. 
226.6      (c) A nursing facility's case mix payment rates for the 
226.7   second and subsequent years of a facility's contract under this 
226.8   section are the previous rate year's contract payment rates plus 
226.9   an inflation adjustment.  The index for the inflation adjustment 
226.10  must be based on the change in the Consumer Price Index-All 
226.11  Items (United States City average) (CPI-U) forecasted by Data 
226.12  Resources, Inc., as forecasted in the fourth quarter of the 
226.13  calendar year preceding the rate year.  The inflation adjustment 
226.14  must be based on the 12-month period from the midpoint of the 
226.15  previous rate year to the midpoint of the rate year for which 
226.16  the rate is being determined. 
226.17     (d) The commissioner ~~may~~ shall develop additional 
226.18  incentive-based payments of up to five percent above the 
226.19  standard contract rate for achieving outcomes specified in each 
226.20  contract.  ~~The incentive system may be implemented for contract~~ 
226.21  ~~rate years beginning on or after July 1, 1996.~~  The specified 
226.22  facility-specific outcomes must be measurable ~~and must be based~~ 
226.23  ~~on criteria to be developed~~ and approved by the commissioner.  
226.24  The commissioner may establish, for each contract, various 
226.25  levels of achievement within an outcome.  After the outcomes 
226.26  have been specified the commissioner shall assign various levels 
226.27  of payment associated with achieving the outcome.  Any 
226.28  incentive-based payment cancels if there is a termination of the 
226.29  contract.  In establishing the specified outcomes and related 
226.30  criteria the commissioner shall consider the following state 
226.31  policy objectives: 
226.32     (1) improved cost effectiveness and quality of life as 
226.33  measured by improved clinical outcomes; 
226.34     (2) successful diversion or discharge to community 
226.35  alternatives; 
226.36     (3) decreased acute care costs; 
227.1      (4) improved consumer satisfaction; 
227.2      (5) the achievement of quality; or 
227.3      (6) any additional outcomes proposed by a nursing facility 
227.4   that the commissioner finds desirable. 
227.5      Sec. 40.  Minnesota Statutes 1996, section 256B.48, 
227.6   subdivision 6, is amended to read: 
227.7      Subd. 6.  [MEDICARE CERTIFICATION.] (a)  [DEFINITION.] For 
227.8   purposes of this subdivision, "nursing facility" means a nursing 
227.9   facility that is certified as a skilled nursing facility or, 
227.10  after September 30, 1990, a nursing facility licensed under 
227.11  chapter 144A that is certified as a nursing facility.  
227.12     (b)  [MEDICARE PARTICIPATION REQUIRED.] All nursing 
227.13  facilities shall participate in Medicare part A and part B 
227.14  unless, after submitting an application, Medicare certification 
227.15  is denied by the federal health care financing administration.  
227.16  Medicare review shall be conducted at the time of the annual 
227.17  medical assistance review.  Charges for Medicare-covered 
227.18  services provided to residents who are simultaneously eligible 
227.19  for medical assistance and Medicare must be billed to Medicare 
227.20  part A or part B before billing medical assistance.  Medical 
227.21  assistance may be billed only for charges not reimbursed by 
227.22  Medicare.  
227.23     (c)  [UNTIL SEPTEMBER 30, 1990.] Until September 30, 1990, 
227.24  a nursing facility satisfies the requirements of paragraph (b) 
227.25  if:  (1) at least 50 percent of the facility's beds that are 
227.26  licensed under section 144A and certified as skilled nursing 
227.27  beds under the medical assistance program are Medicare 
227.28  certified; or (2) if a nursing facility's beds are licensed 
227.29  under section 144A, and some are medical assistance certified as 
227.30  skilled nursing beds and others are medical assistance certified 
227.31  as intermediate care facility I beds, at least 50 percent of the 
227.32  facility's total skilled nursing beds and intermediate care 
227.33  facility I beds or 100 percent of its skilled nursing beds, 
227.34  whichever is less, are Medicare certified. 
227.35     (d)  [AFTER ~~SEPTEMBER 30, 1990~~ JULY 1, 1997.] 
227.36  After ~~September 30, 1990~~ July 1, 1997, a nursing facility 
228.1   satisfies the requirements of paragraph (b) if at least 50 
228.2   percent of the facility's beds certified as nursing facility 
228.3   beds under the medical assistance program are Medicare certified.
228.4      (e)  [CONFLICT WITH MEDICARE DISTINCT PART REQUIREMENTS.] 
228.5   At the request of a facility, the commissioner of human services 
228.6   may reduce the 50 percent Medicare participation requirement in 
228.7   paragraphs (c) and (d) ~~to no less than 20 percent if the~~ 
228.8   ~~commissioner of health determines that, due to the facility's~~ 
228.9   ~~physical plant configuration, the facility cannot satisfy~~ 
228.10  ~~Medicare distinct part requirements at the 50 percent~~ 
228.11  ~~certification level~~.  To receive a reduction in the 
228.12  participation requirement, a facility must demonstrate that the 
228.13  reduction will not adversely affect access of Medicare-eligible 
228.14  residents to Medicare-certified beds. 
228.15     (f)  [INSTITUTIONS FOR MENTAL DISEASE.] The commissioner 
228.16  may grant exceptions to the requirements of paragraph (b) for 
228.17  nursing facilities that are designated as institutions for 
228.18  mental disease. 
228.19     (g)  [NOTICE OF RIGHTS.] The commissioner shall inform 
228.20  recipients of their rights under this subdivision and section 
228.21  144.651, subdivision 29. 
228.22     Sec. 41.  Minnesota Statutes 1996, section 256B.49, 
228.23  subdivision 1, is amended to read: 
228.24     Subdivision 1.  [STUDY; WAIVER APPLICATION.] The 
228.25  commissioner shall authorize a study to assess the need for home 
228.26  and community-based waivers for chronically ill children who 
228.27  have been and will continue to be hospitalized without a waiver, 
228.28  and for disabled individuals under the age of 65 who are likely 
228.29  to reside in an acute care or nursing home facility in the 
228.30  absence of a waiver.  If a need for these waivers can be 
228.31  demonstrated, the commissioner shall apply for federal waivers 
228.32  necessary to secure, to the extent allowed by law, federal 
228.33  participation under United States Code, title 42, sections 
228.34  1396-1396p, as amended through December 31, 1982, for the 
228.35  provision of home and community-based services to chronically 
228.36  ill children who, in the absence of such a waiver, would remain 
229.1   in an acute care setting, and to disabled individuals under the 
229.2   age of 65 who, in the absence of a waiver, would reside in an 
229.3   acute care or nursing home setting.  If the need is 
229.4   demonstrated, the commissioner shall request a waiver under 
229.5   United States Code, title 42, sections 1396-1396p, to allow 
229.6   medicaid eligibility for blind or disabled children with 
229.7   ineligible parents where income deemed from the parents would 
229.8   cause the applicant to be ineligible for supplemental security 
229.9   income if the family shared a household and to furnish necessary 
229.10  services in the home or community to disabled individuals under 
229.11  the age of 65 who would be eligible for medicaid if 
229.12  institutionalized in an acute care or nursing home setting. 
229.13  These waivers are requested to furnish necessary services in the 
229.14  home and community setting to children or disabled adults under 
229.15  age 65 who are medicaid eligible when institutionalized in an 
229.16  acute care or nursing home setting.  The commissioner shall 
229.17  assure that the cost of home and community-based care will not 
229.18  be more than the cost of care if the eligible child or disabled 
229.19  adult under age 65 were to remain institutionalized.  The 
229.20  average monthly limit for the cost of home and community-based 
229.21  services to a community alternative care waiver client, 
229.22  determined on a 12-month basis, shall not exceed the statewide 
229.23  average medical assistance adjusted base year operating cost for 
229.24  nursing and accommodation services under sections 256.9685 to 
229.25  256.969 for the diagnostic category to which the waiver client 
229.26  would be assigned except the admission and outlier rates shall 
229.27  be converted to an overall per diem.  The average monthly limit 
229.28  for the cost of services to a traumatic brain injury 
229.29  neurobehavioral hospital waiver client, determined on a 12-month 
229.30  basis, shall not exceed the statewide average medical assistance 
229.31  adjusted base-year operating cost for nursing and accommodation 
229.32  services of neurobehavioral rehabilitation programs in Medicare 
229.33  designated long-term hospitals under sections 256.9685 to 
229.34  256.969.  The following costs must be included in determining 
229.35  the total average monthly costs for a waiver client:  
229.36     (1) cost of all waivered services; and 
230.1      (2) cost of skilled nursing, private duty nursing, home 
230.2   health aide, and personal care services reimbursable by medical 
230.3   assistance.  
230.4      The commissioner of human services shall seek federal 
230.5   waivers as necessary to implement the average monthly limit.  
230.6   The commissioner shall seek to amend the federal waivers 
230.7   obtained under this section to apply criteria to protect against 
230.8   spousal impoverishment as authorized under United States Code, 
230.9   title 42, section 1396r-5, and as implemented in sections 
230.10  256B.0575, 256B.058, and 256B.059, except that the amendment 
230.11  shall seek to add to the personal needs allowance permitted in 
230.12  section 256B.0575, an amount equivalent to the group residential 
230.13  housing rate as set by section 256I.03, subdivision 5. 
230.14     Sec. 42.  [256B.693] [STATE-OPERATED SERVICES; MANAGED 
230.15  CARE.] 
230.16     Subdivision 1.  [PROPOSALS FOR MANAGED CARE; ROLE OF STATE 
230.17  OPERATED SERVICES.] Any proposal integrating state-operated 
230.18  services with managed care systems for persons with disabilities 
230.19  shall identify the specific role to be assumed by state-operated 
230.20  services and the funding arrangement in which state-operated 
230.21  services shall effectively operate within the managed care 
230.22  initiative.  The commissioner shall not approve or implement the 
230.23  initiative that consolidates funding appropriated for 
230.24  state-operated services with funding for managed care 
230.25  initiatives for persons with disabilities. 
230.26     Subd. 2.  [STUDY BY THE COMMISSIONER.] To help identify 
230.27  appropriate state-operated services for managed care systems, 
230.28  the commissioner of human services shall study the integration 
230.29  of state-operated services into public managed care systems and 
230.30  make recommendations to the legislature.  The commissioner's 
230.31  study and recommendations shall include, but shall not be 
230.32  limited to, the following: 
230.33     (1) identification of persons with disabilities on waiting 
230.34  lists for services, which could be provided by state-operated 
230.35  services; 
230.36     (2) availability of crisis services to persons with 
231.1   disabilities; 
231.2      (3) unmet service needs, which could be met by 
231.3   state-operated services; and 
231.4      (4) deficiencies in managed care contracts and services, 
231.5   which hinder the placement and maintenance of persons with 
231.6   disabilities in community settings. 
231.7      In conducting this study, the commissioner shall survey 
231.8   counties concerning their interest in and need for services that 
231.9   could be provided by state-operated services.  The commissioner 
231.10  shall also consult with the appropriate exclusive bargaining 
231.11  unit representatives.  The commissioner shall report findings to 
231.12  the legislature by February 1, 1998. 
231.13     Sec. 43.  Minnesota Statutes 1996, section 256G.02, 
231.14  subdivision 6, is amended to read: 
231.15     Subd. 6.  [EXCLUDED TIME.] "Excluded time" means: 
231.16     (a) any period an applicant spends in a hospital, 
231.17  sanitarium, nursing home, shelter other than an emergency 
231.18  shelter, halfway house, foster home, semi-independent living 
231.19  domicile or services program, residential facility offering 
231.20  care, board and lodging facility or other institution for the 
231.21  hospitalization or care of human beings, as defined in section 
231.22  144.50, 144A.01, or 245A.02, subdivision 14; maternity home, 
231.23  battered women's shelter, or correctional facility; or any 
231.24  facility based on an emergency hold under sections 253B.05, 
231.25  subdivisions 1 and 2, and 253B.07, subdivision 6; 
231.26     (b) any period an applicant spends on a placement basis in 
231.27  a training and habilitation program, including a rehabilitation 
231.28  facility or work or employment program as defined in section 
231.29  268A.01; or receiving personal care assistant services pursuant 
231.30  to section 256B.0627, subdivision 4; semi-independent living 
231.31  services provided under section 252.275, and Minnesota Rules, 
231.32  parts 9525.0500 to 9525.0660; day training and habilitation 
231.33  programs~~, and community-based services~~ and assisted living 
231.34  services; and 
231.35     (c) any placement for a person with an indeterminate 
231.36  commitment, including independent living. 
232.1      Sec. 44.  Minnesota Statutes 1996, section 469.155, 
232.2   subdivision 4, is amended to read: 
232.3      Subd. 4.  [REFINANCING HEALTH FACILITIES.] It may issue 
232.4   revenue bonds to pay, purchase, or discharge all or any part of 
232.5   the outstanding indebtedness of a contracting party engaged 
232.6   primarily in the operation of one or more nonprofit hospitals or 
232.7   nursing homes previously incurred in the acquisition or 
232.8   betterment of its existing hospital or nursing home facilities 
232.9   to the extent deemed necessary by the governing body of the 
232.10  municipality or redevelopment agency; this may include any 
232.11  unpaid interest on the indebtedness accrued or to accrue to the 
232.12  date on which the indebtedness is finally paid, and any premium 
232.13  the governing body of the municipality or redevelopment agency 
232.14  determines to be necessary to be paid to pay, purchase, or 
232.15  defease the outstanding indebtedness.  If revenue bonds are 
232.16  issued for this purpose, the refinancing and the existing 
232.17  properties of the contracting party shall be deemed to 
232.18  constitute a project under section 469.153, subdivision 2, 
232.19  clause (d).  ~~Revenue bonds may not be issued pursuant to this~~ 
232.20  ~~subdivision unless the application for approval of the project~~ 
232.21  ~~pursuant to section 469.154 shows that a reduction in debt~~ 
232.22  ~~service charges is estimated to result and will be reflected in~~ 
232.23  ~~charges to patients and third-party payors.  Proceeds of revenue~~ 
232.24  ~~bonds issued pursuant to this subdivision may not be used for~~ 
232.25  ~~any purpose inconsistent with the provisions of chapter 256B.~~  
232.26  ~~Nothing in this subdivision prohibits the use of revenue bond~~ 
232.27  ~~proceeds to pay outstanding indebtedness of a contracting party~~ 
232.28  ~~to the extent permitted by law on March 28, 1978.~~  
232.29     Sec. 45.  [TRANSITION FOR THE COMPULSIVE GAMBLING TREATMENT 
232.30  PROGRAM.] 
232.31     The commissioner of human services shall conduct a 
232.32  transition of treatment programs for compulsive gambling from 
232.33  the treatment center model to a model in which reimbursement for 
232.34  treatment of an individual compulsive gambler from an approved 
232.35  provider is on a fee-for-service basis on the following schedule:
232.36     (1) one-third of compulsive gamblers treated through the 
233.1   program must receive services paid for from the individual 
233.2   treatment reimbursement model beginning July 1, 1997; 
233.3      (2) two-thirds of compulsive gamblers treated through the 
233.4   program must receive services paid for from the individual 
233.5   treatment reimbursement model beginning July 1, 1998; and 
233.6      (3) 100 percent of compulsive gamblers treated through the 
233.7   program must receive treatment paid for from the individual 
233.8   treatment reimbursement model beginning July 1, 1999. 
233.9      Sec. 46.  [STUDY ON THE REGULATION OF HEALTH OCCUPATIONS.] 
233.10     Subdivision 1.  [COMMISSIONER OF HEALTH.] The commissioner 
233.11  of health shall study the current credentialing system for 
233.12  health occupations found in Minnesota Statutes, chapter 214, and 
233.13  make recommendations on the developing policies and criteria for 
233.14  the following:  (1) credentialing a health occupation; (2) 
233.15  changing the scope of practice or elements of existing 
233.16  regulatory systems; (3) the appropriate level or type of 
233.17  credentialing; and (4) the administrative agency placement of a 
233.18  credentialing activity.  The commissioner shall include 
233.19  recommendations for funding this evaluation process.  The study 
233.20  shall be completed by January 15, 1998.  
233.21     Subd. 2.  [LEGISLATIVE AUDITOR.] The legislative audit 
233.22  commission is requested to direct the legislative auditor to do 
233.23  the following:  (1) study the regulatory effectiveness and 
233.24  efficiency of the current health-related boards and advisory 
233.25  councils; (2) make recommendations for uniform and ongoing 
233.26  performance measures to evaluate the efficacy of regulatory 
233.27  activities; (3) make recommendations on how to improve the 
233.28  efficiency and effectiveness of current health-related boards 
233.29  and advisory councils; (4) weigh the merits of creating a 
233.30  centralized regulatory authority for violations by regulated 
233.31  health professionals of statutes and rules relating to business 
233.32  practices and personal conduct; (5) make recommendations of the 
233.33  merits of creating an interdisciplinary board to coordinate some 
233.34  or all of the health-related boards; and (6) report its findings 
233.35  and recommendations to the commissioner of health by January 15, 
233.36  1998. 
234.1      Subd. 3.  [COMMITTEE OF HEALTH-RELATED BOARDS.] A 
234.2   health-related board and advisory council committee is 
234.3   established to study the overlapping scopes of practice among 
234.4   regulated and unregulated health occupations and make 
234.5   recommendations on how to resolve this issue.  The committee 
234.6   shall also study and make recommendations on whether a 
234.7   consistent process for investigation of misconduct by health 
234.8   care professionals should be established for all health 
234.9   occupations and, if recommended, how to establish and implement 
234.10  the process.  The committee shall also make recommendations on 
234.11  policies and methods for recovering the costs of the legal, 
234.12  investigatory, and enforcement services conducted by the boards 
234.13  and the attorney general's office.  The committee shall consist 
234.14  of 20 members.  The committee must include two members appointed 
234.15  by the commissioner of health, two members appointed by the 
234.16  attorney general's office, one member appointed by the board of 
234.17  medical practice, one member appointed by the board of nursing, 
234.18  one member appointed from the health licensing board's 
234.19  administration offices, five members appointed by the council of 
234.20  executive directors to represent the other health-related boards 
234.21  and advisory councils, and eight members appointed by the 
234.22  commissioner of health who are licensed, credentialed, or 
234.23  registered by a health-related board or by the commissioner.  
234.24  The committee shall report to the commissioner of health its 
234.25  findings and recommendations by January 15, 1998.  The committee 
234.26  expires upon submission of its report.  
234.27     Subd. 4.  [REPORT.] The commissioner of health shall submit 
234.28  a report on the results of the commissioner's study and 
234.29  recommendations and the recommendations of the legislative 
234.30  auditor, the committee of health-related boards and advisory 
234.31  councils to the members of the senate health and family security 
234.32  committee and the house of representatives health and human 
234.33  services committee by February 15, 1998. 
234.34     Sec. 47.  [AUTISM ADVISORY TASK FORCE.] 
234.35     Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
234.36  services and the commissioner of children, families, and 
235.1   learning shall establish a task force to study the treatment of 
235.2   autism.  The task force shall consist of providers, advocates, 
235.3   and consumers of services to children affected by autism.  The 
235.4   terms and compensation of the members shall be as described 
235.5   under Minnesota Statutes, section 15.059, subdivision 6.  
235.6      Subd. 2.  [DUTIES.] The advisory task force shall meet on a 
235.7   regular basis to study the following: 
235.8      (1) the spectrum of autistic disorders; 
235.9      (2) treatment options for autism, including behavioral 
235.10  therapy, and outcome data on these treatment options; 
235.11     (3) the role of the schools, appropriate state agencies, 
235.12  and counties in providing services to children with autism; 
235.13     (4) funding flexibility options for services to children 
235.14  with autism, including the use of state funds to provide 
235.15  behavioral therapy; and 
235.16     (5) the use of behavioral therapy day treatment programs 
235.17  and the use of school and medical assistance funds for these 
235.18  programs. 
235.19     Subd. 3.  [REPORT.] The task force shall provide the 
235.20  commissioner of human services with the findings of the study by 
235.21  December 15, 1998.  The commissioner of human services shall 
235.22  submit a preliminary report to the legislature by January 15, 
235.23  1998, on the progress of the task force study.  The commissioner 
235.24  shall submit a final report to the legislature by January 15, 
235.25  1999, on recommendations to improve the treatment options 
235.26  available to children with autism within the current available 
235.27  funding.  The final report must include recommendations on how 
235.28  to inform and educate families with autistic children on 
235.29  available expertise and resources on the treatment of autism.  
235.30  The task force expires upon submission of its report. 
235.31     Sec. 48.  [REPEALER.] 
235.32     Minnesota Statutes 1996, section 469.154, subdivision 6, is 
235.33  repealed. 
235.34     Sec. 49.  [EFFECTIVE DATE.] 
235.35     Sections 20 to 23 and 34 are effective the day following 
235.36  final enactment. 
236.1                              ARTICLE 10
236.2                            WELFARE REFORM
236.3      Section 1.  Minnesota Statutes 1996, section 256J.50, is 
236.4   amended by adding a subdivision to read: 
236.5      Subd. 5.  [PARTICIPATION REQUIREMENTS FOR SINGLE-PARENT AND 
236.6   TWO-PARENT CASES.] For single parent cases, mandatory 
236.7   participation is required within six months of the eligibility 
236.8   determination for cash assistance.  For two-parent cases, 
236.9   participation is required concurrent with the receipt of MFIP-S 
236.10  cash assistance.